A workers’ compensation claim can be denied for many reasons

If you suffer an on-the-job injury, you shouldn’t hesitate to receive immediate medical attention. This has nothing to do with your finances, and everything to do with the fact that you don’t want to make your situation worse.

At some point, depending on the circumstances, you may decide to file a workers’ compensation claim. It sounds simple to obtain benefits, but this isn’t always the case. Unless you had a very clear accident, such as falling off a roof in front of 10 witnesses, you should get legal advice from a workers’ compensation lawyer before talking to the insurance company representatives.  It’s possible that your case will be denied if you give a statement before you know which details are important.  Getting your claim denied really complicates your situation.

Here are some common reasons for a workers’ compensation denial:

  • You did not report the injury to your employer in a timely manner (you need to do this right away and report it IN WRITING within 30 days)
  • You did not file a claim on time (you have two years to file a claim with the NC Industrial Commission)
  • Your employer has a legitimate reason to dispute your claim, such as by saying that you were injured outside of work, or your employer is dishonest and simply makes up a reason to deny the claim–a COMMON occurrence.
  • You are dealing with a non-compensable injury– you did not suffer an “injury by accident” for instance (which is why you need legal advice before you give the recorded statement–so you know which details to talk about!)
  • You did not receive medical treatment for the injury
  • You simply do not have enough evidence to back up your claim that you suffered the injury at work–you failed to tell the doctors that you were hurt at work, and how you were hurt, or there are no witnesses

There are other reasons for a workers’ compensation claim denial, but these are most common.

If you receive a denial notice (“Form 61”) in the mail, it would be in your best interest to sit down in a quiet place, read it from start to finish, and make note of what went wrong.  You will need to hire a good lawyer to help you at that point, as you will have no other options.

You have the right to request an evidentiary hearing to challenge the denial, and if you win, you can eventually receive the compensation available under the law.   Depending on the reason for a denial, you may be able to win the case at the hearing, but not all injuries on the job are covered by workers’ compensation.  

If you get hurt at work, contact us for a free consultation before you talk to the insurance adjuster.  That free conversation may save you a lot of financial pain and two years of litigation.

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