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How does the appeal process work for workers’ comp?

On Behalf of | Jun 21, 2024 | Workers' Compensation |

The appeal process for workers’ compensation claims in North Carolina is a critical mechanism for employees who have had their claims denied. Understanding the steps involved in this process can help workers effectively pursue the compensation they deserve.

Initial claim and denial

When an employee in North Carolina sustains a work-related injury or illness, they must file a workers’ compensation claim with their employer’s insurance carrier. If the insurance denies the claim or if the employee disagrees with the benefits provided, the next step is to file an appeal.

Filing a request for a hearing

The first formal step in appealing a workers’ compensation decision is to file Form 33, “Request that Claim be Assigned for Hearing,” with the North Carolina Industrial Commission (NCIC). Submit this form within two years of the date of injury. 

Mediation

Before the hearing, the NCIC typically requires mediation. Mediation is an informal process where both parties attempt to settle with the help of a neutral mediator. If mediation is successful, the mediator drafts a settlement agreement and submits it to the NCIC for approval. 

Formal hearing

During the formal hearing, both parties present evidence and testimony before a Deputy Commissioner. This may include medical records, witness statements, and expert testimony. 

Appeal to the full commission

If either side is not satisfied with the Deputy Commissioner’s judgment, they may appeal to the Full Commission. This involves submitting a Form 44, “Application for Review,” within 15 days of receiving the decision. 

Navigating the workers’ compensation appeal process in North Carolina requires careful adherence to procedures and deadlines. By understanding each step, injured workers can better advocate for their rights and seek the compensation they deserve.

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