Contesting the Denial of a North Carolina Workers’ Compensation Claim

Injured workers have two years to file their claims under the North Carolina’s Workers’ Compensation Act. The claim must be filed at the Commission. It should be filed using “Form 18.” We usually prepare and file the Form 18 for our clients. That way, they do not have to worry about missing the deadline.

Upon notifying your employer of your injury, their insurance company may call you to take a “recorded statement” from you. You should get some legal advice from an experienced workers’ compensation lawyer BEFORE you speak to the insurance investigator and give a recorded statement. Many cases are denied and lost for good because the injured worker trusted the insurance investigator and gave a statement, before the person got legal advice and learned what details were the most important to provide in the statement.

Upon notifying your employer that you were hurt a work, you may be a denial from the insurance carrier. A claim denial can make any injured worker’s heart sink. Unfortunately, many employers and insurance companies prioritize profits over people, making this situation all too common. These actions can create severe hardship for workers and their families, especially if the injured worker is the primary breadwinner in the household.

However, if you get a denial notice, you should not give up the fight. In many cases, workers can successfully contest the denial and get the benefits they deserve.

How does it work?

If your employer or insurance provider denies your claim, your remedy is to request a hearing before North Carolina’s Industrial Commission. To do so, you or your lawyer will have to file a Form 33 Request for Hearing. This will cause the Commission to hold a “full evidentiary hearing” at a local courthouse before a Deputy Commissioner.

During this hearing, you will testify, and your attorney will question additional witnesses who may be able to help your claim and cross-examine the witnesses that Employer and insurance company offer to defeat your claim. After the hearing, the lawyers will take the testimony of the treating doctors by deposition. The Deputy Commissioner will eventually render a written decision as to whether your claim should be paid or denied.

The evidence admitted at the hearing and in the medical depositions will typically include:

  • Testimony from coworkers who saw your injury occur—or who claim it did not happen.
  • Records from physicians detailing your injuries and the extent of your disability.
  • Documentation showing that you were at work when the injury occurred, and documentation of your pre-injury average weekly wages, such as a paystub or work email.
  • Medical testimony about the work-related cause of your injury, and the extent to which it has prevented you from working.

Claim denials can be devastating

Injured workers who are unable to work need financial support to care for themselves and their families. When employers or insurance companies deny those claims, they are leaving injured workers with a sense of uncertainty, which can result in a great deal of anguish and financial hardship for the worker and their family. That is why the injured worker should fight the denial and contest the decision.

When you’re dealing with these claims, you’ll want a trusted legal partner who knows what they’re doing. While many lawyers say they handle workers’ compensation, many of them simply “dabble” in it. But it is attorney Bob Bollinger’s area of expertise—he has been a Certified Specialist in Workers’ Compensation since the year 2000, and has successfully handled hundreds of cases for injured workers.

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