When employees in North Carolina suffer a work-related injury or illness that forces them to take time off work, it can have detrimental impacts on their finances and future. Governed by the North Carolina Industrial Commission, the workers’ compensation program provides benefits to employees who were injured on the job, but sometimes, claims are denied. By understanding the reason for the denial and the process of requesting a review of the decision, an injured worker may appeal the denied claim and pursue recovery of the benefits he or she deserves.
Why are claims denied?
Most applicants receive either an approval or denial within 14 days after filing. The most common reasons a workers’ compensation claim is denied include the following:
- The applicant missed the filing deadline.
- The applicant did not supply a sufficient amount of documentation to support the claim.
- The applicant did not establish the injury or illness was work-related.
All parties will receive a denial form (Form 61) from the insurance company that details the reasons for the denial. Since an injured worker may receive weekly payments that are two-thirds of the weekly wage, as long as it does not exceed $987, a denial of a claim can prevent the applicant from obtaining money for support when the individual is not able to work.
Request for a hearing
After receiving a denial form, the injured worker and his or her attorney may request a hearing on the matter before the Industrial Commission, and Form 33, “Request for Hearing,” must be submitted. In most cases, the applicant will have to go through mediation with the insurance company before a hearing will be scheduled, and the applicant can have an attorney present. If parties reach an agreement during mediation, the decision will become binding. If no agreement can be reached, the matter will go to a formal hearing before a deputy commissioner with the Industrial Commission.
The process of filing for and obtaining workers’ compensation benefits can be challenging. Also, many people do not know where to turn when their application is denied. From the initial filing to requesting a hearing of a denied claim, an injured worker will do well to work with an experienced workers’ compensation attorney in North Carolina throughout the process.