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It is an unfortunate fact that many workers’ compensation claims in Wilmington and around North Carolina are denied. This can be for any number of reasons ranging from an incomplete application or a late filing to a lack of medical evidence. This denial can place many people in a difficult economic position as their injury leaves them unable to work, but the denial of coverage prevents them from collecting essential income.

In any situation where a person has a claim denied by a workers’ compensation insurance company, they have the right to file an appeal. North Carolina law strictly limits the methods through which people can file this appeal and people must exhaust this process before they can take a case to court.

The process for appealing a workers’ compensation decision in Wilmington can be complex and lengthy. However, it is essential that people follow this process to give themselves the best chance at a successful outcome. An experienced attorney could help people to understand the law and to stand by their side during all hearings.

Why Might an Insurance Company Deny a Claim?

Insurance companies make their profits by collecting premiums paid by employers and finding any excuse possible to avoid paying claims. This can include refusing to pay for administrative reasons. Under North Carolina law, employees who are injured on the job must notify their employer within 30 days of the incident, both in person and in writing. Additionally, that worker must submit Form 18a to the North Carolina Industrial Commission. If a person fails to take either of these steps, the insurance company can deny the claim.

Companies may also deny claims for medical reasons. To qualify for workers’ compensation, an employee must be able to prove that the injury or illness happened while at work. Insurance companies will often dispute if an injury took place at work, especially if they suspect horseplay. No matter the reason that an insurance company denies a claim, a worker has the right to file an appeal.

How Can an Employee File a Workers’ Compensation Appeal in Wilmington?

All denials must be accompanied by a written notice that outlines the reasons for the denial. Insurance companies must make a decision on all workers’ compensation claims within 14 days of the receipt of the claim form. Once a person receives this notice, they have a time limit of two years for appealing a workers’ compensation decision in Wilmington.

Unfortunately, North Carolina law does not allow people who are seeking enforcement of a workers’ compensation policy to take their case directly to court. Instead, employees must submit to a state organized mediation session by filing Form 33. These mediation sessions give both sides a chance to argue their version of the facts and why they feel that their decision is correct.

Only if this mediation session fails to produce a satisfactory result can an injured worker take their case to a state court. These trials are in essence contract cases where an injured employee argues that the insurance company breached their contract with the employee to provide compensation in case of a workplace injury.

Appealing a Workers’ Compensation Decision Can be a Complex Process

North Carolina laws prevent people from taking their workers’ compensation cases directly to court. Instead, people must attend state-run mediation sessions that are designed to produce a satisfactory result with as little pain as possible. Only after these sessions fail can a person file a lawsuit in court seeking payment of benefits.

An attorney could help people who are appealing a workers’ compensation decision in Wilmington. They work to help people to understand workers’ compensation laws, to file the proper paperwork, and represent their interests in both mediation sessions and in the courtroom. Contact an attorney today to discuss your case.