Claims and appeals for workers’ compensation in North Carolina

Workers who are injured at work will usually opt to file for workers’ compensation benefits to help them get their medical bills paid for. If they aren’t able to return to work right away, they might need the wage replacement benefits.

You would think that it would be very easy to obtain workers’ compensation benefits, but this isn’t always the case. Many workers apply for the benefits and then get a letter that either denies them benefits or states that they will get fewer benefits than what they were expecting. Here are some important points to know about the workers’ compensation system in North Carolina:

You have time limits

There are time limits at every stage in the workers’ compensation process. You have a 30-day time limit to notify your employer about the accident, but you have two years to file a workers’ compensation claim. There is an exception to this if the employer has paid for medical care. In that case, the claim must be filed within two years from the final payment date for that care. The appeals process also has time limits, which are stated in the documents you receive pertaining to your case. Make sure you read these carefully so that you are aware of what you need to do.

Common reasons for denial

Getting a notification that your claim is denied is disheartening. There are many reasons why this might occur. One is that you didn’t meet the time limits to report your injury or file the workers’ compensation claim. Others include that the injury isn’t a compensable one, you didn’t get medical care for the injury, or there isn’t evidence that the injury was related to work. There is also a chance that your employer might dispute your claim, which can result in a denial.

A few points about appeals

When you don’t agree with the decision that is rendered, you can appeal. Make sure you read the notification thoroughly so you can find out what your options are. Filing your appeal on time is crucial. Your appeal can’t contain any new information or evidence. Only facts that have already been presented can be included in the appeal. You must present your case appropriately and must be prepared to make oral arguments or meet other requirements from the appeal board.

Getting your case to move through the workers’ compensation system may be a challenge. Often, the rules, requirements and procedures are complex. You may need to seek assistance to determine your next steps.

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