Determining the Validity of a Workers’ Compensation Claim in Greenville

If you suffer an injury in the course of your employment, workers’ compensation should take care of your medical bills and pay a certain amount of your wages while you recuperate. In some instances, though, an employer may challenge the validity of a Greenville employee’s workers’ compensation claim.

It is important not to panic in this situation—you have rights, and those rights could protect you and your claim for compensation. If your claim is denied by either your employer or your employer’s workers’ compensation insurance company, a qualified workers’ compensation lawyer may be able to help. Let a skilled attorney guide you through the process of determining the validity of a workers’ compensation claim in Greenville.

Common Reasons for Workers’ Compensation Denials

Every workers’ compensation claim is different, but there are certain common reasons—some of which may be legitimate—why a claim may be denied. These included but may not be limited to:

• No immediate reporting – an injured worker must report their injury immediately to their employer, orally and in writing, within one month of the injury occurring
• No witnesses – an accident that occurs when no one is around is generally harder to prove in terms of connecting workplace circumstances to an injury
• Drugs or alcohol in the body – workers’ compensation does not cover injuries that occur because a person was intoxicated or under the influence of illegal drugs while on the job
• No medical treatment – it is essential that injured workers seek medical help and keep records of all treatments, as a worker claiming injury who did not seek medical treatment is likely to have their claim denied
• Employer claims a non-work injury – if an employer or insurance company alleges that the injury suffered by the employee did not occur at work or while performing work-related duties, the injured worker must provide evidence that their injury was indeed work-related

Form 33, Request for Hearing

Sometimes, despite an attorney determining the validity of a workers’ compensation claim in Greenville, an individual’s claim may still be denied. A worker whose workers’ compensation claim was denied may appeal the denial by filling out Form 33, “Request for Hearing” and filing it within two years of the injury with the North Carolina Industrial Commission (NCIC), the agency that oversees workers’ compensation in the state. The NCIC could send the appeal to mediation, where a third party would attempt to reach a settlement between the employer, insurance company, and employee.

If a settlement is not reached, a formal hearing may be necessary. At the hearing, the injured worker must present evidence showing why their claim should not have been denied. A deputy NCIC commissioner then makes a final decision on their case.

Even if the denial is upheld, the worker could submit an Application for Review to the NCIC within 15 days. Three judges then make a decision, which is based on either briefs submitted by the employee or by hearing oral arguments. If the judges still uphold the denial, the worker could finally appeal to the North Carolina Court of Appeals or the state’s Supreme Court.

How a Greenville Workers’ Compensation Lawyer Could Help

A workers’ compensation lawyer in Greenville could thoroughly investigate the circumstances surrounding your accident and the reasons given for a denial. They could collect all evidence necessary, from medical records to possible videos of the incident causing the injury, and guide you through the entire often-complicated process while working hard to obtain a reversal of the original denial.

If you or a loved one suffered an on the job injury and the employer is trying to invalidate your claim, consider seeking a dedicated attorney’s help in determining the validity of a workers’ compensation claim in Greenville. To schedule a consultation, call today.