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What Happens When Workers’ Comp Claim Is Denied

Sometimes, the workers’ compensation insurance company will refuse to provide the benefits that an injured worker is entitled to. If your workers’ comp claim is denied improperly, you need to know what happens next. A workers’ compensation lawyer can fight for you to get the benefits you should receive under North Carolina law.

You can take steps to issue an appeal, including a request for a hearing from the Industrial Commission if your workers’ compensation claim is denied.

Reasons Your Workers’ Compensation Claim May Have Been Denied

The insurance company might try to justify its denial of your workers’ compensation claim for one of these reasons:

  • You did not use a specific form to notify your employer of your injury. Failure to use a specific form is not a valid reason for the denial of a claim. You do not have to use a particular form to notify your boss of your injury. As the North Carolina Industrial Commission explains, “A simple written statement giving the date of the accident and a brief description of the injury is all that is necessary.”
  • You missed the deadline to notify your boss that you were injured on the job. While it is best to provide the written notice to your boss as soon as possible, North Carolina Law gives you up to 30 days. A text message, email, paper letter, or form can satisfy the written notice requirement.
  • Your employer was not negligent. The insurer cannot use this reason to deny your claim. You do not have to prove that your boss’s carelessness in some way caused your injury. The North Carolina Department of Insurance verifies that our state’s workers’ compensation program is a no-fault system of insurance, so negligence is not an issue.
  • You were partly at fault for your injuries. Again, since this is a no-fault system of insurance, fault is not an issue. As long as you did not intentionally injure yourself or engage in a prohibited activity, North Carolina workers’ comp programs cannot deny your claim based on your negligence.
  • You refused to take a drug test within 30 days of the injury. The insurer may deny your claim if you don’t cooperate with the program requirement of undergoing drug testing within 30 days of your accident.

You can talk to a workers’ compensation attorney at no cost to find out if the denial of your claim was proper or if you have legal options. An attorney can help you explore options like refiling, supplementing your claim with additional evidence, or filing an appeal of the denial.

What Happens if Your Boss Refuses to Do Their Part?

There are several scenarios in which your employer might fail to perform their legal obligations after you are hurt on the job. Here are a few examples:

  • Your boss might try to talk you out of filing a workers’ compensation claim by telling you that they can’t afford to pay your medical bills and 2/3 of your regular salary. This is a deceptive statement because the cost of those benefits gets paid by the insurance company, not your employer.
  • Your employer might not have workers’ compensation insurance or claim that they do not carry this insurance. Your lawyer can verify online who your employer’s insurance carrier is and if your employer is required to participate in this program. Most employers in North Carolina must carry workers’ compensation insurance. If they do not have workers’ compensation insurance, you still have options.
  • Your employer might refuse or fail to report your injury after you provide written notice of the accident. You should file a Form 18 or 18B with the Industrial Commission within two years of the accident. Lack of a Form 18 or 18B could be the reason for the denial. Our team can handle this process for you.

It Is Illegal for Your Employer to Retaliate Against You After a Work Injury

If your employer retaliated against you for filing a workers’ compensation claim by firing or demoting you, you can work with an attorney on a separate legal action for your boss’s illegal conduct. North Carolina law strictly forbids such retaliatory actions by employers.

Get Help from a Workers’ Compensation Attorney at Whitley Law Firm

Suffering a severe injury is bad enough without having to scratch and claw for the benefits that you deserve. You can get the Whitley Advantage of having a personal advocate fight your battles for you. We treat our clients like family, offering respect, care, and compassion through every stage of the process.

Whitley Law Firm offers a free consultation and handles these cases on a contingency-fee basis. That means that you do not pay upfront legal fees, and we only get paid when you win. You can call us at (919) 785-5000 to get started.