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What to do when your employer denies your workers’ comp claim

| Apr 18, 2018 | Uncategorized

Many employers will want to get out of paying an employee’s medical bills in a workers’ comp case. This matter becomes even more complicated in North Carolina where lawmakers recently shifted the burden of proof to fall more on the employee’s side than the employer’s. 

There are many reasons why an employer will deny a workers’ comp claim. Some of the most common include believing the employee did not experience a serious injury or seeing the employee not having to take time off work to recover. There are numerous other reasons why your claim received a denial, but the most important thing for you to do right away is to contact your employer’s workers’ comp insurance provider. You may also need to get in touch with an experienced attorney if the matter seems more complicated than you anticipated. 

Appeal

You need to figure out why your employer denied the claim in the first place. Your employer should submit this information in a formal letter, and this document should also contain information about the timeline for filing an appeal. Most of the time, you will have 30 days from receiving the letter to file the petition. However, you should speak with your employer first. There have been cases where an employee received a denial due to a clerical error, so sometimes it is possible to resolve the issue without getting an attorney involved. 

Go through mandatory mediation

In North Carolina, you need to submit Form 33 to both the insurer and employer. In addition to this document, you need to send a description of the injury you sustained, a list of all witnesses to the injury and the specific benefits you requested. Once the court receives everything, all parties involved will go through mandatory mediation, which involves everyone sitting down with an impartial third party. This is a time for both sides to submit evidence. If the parties cannot reach a resolution at this meeting, then they will advance to a formal hearing. 

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