When a workers’ compensation claim gets denied, the next step often involves filing an appeal. Unfortunately, not all appeals succeed. Understanding why an appeal might face denial and knowing the steps to take afterward can help you navigate this challenging process more effectively.
Potential reasons for the denial
Several factors can lead to denying a workers’ compensation claim appeal in North Carolina. These may include:
- Incomplete or incorrect documentation
- Lacking necessary medical records or containing errors
- Insufficient evidence to prove the injury or illness directly relates to the workplace
- Missed deadline for filing an appeal
Lastly, discrepancies in testimonies or inconsistencies in the claimant’s account can also lead to a denial, as the board requires a consistent and credible narrative.
What to do after a denied appeal
If your appeal faces denial, you must act promptly. First, review the decision notice carefully to understand the reasons for the denial. This insight can help you address the issues in any subsequent actions. Consider requesting a further appeal or judicial review if available. North Carolina law allows for additional appeals requiring a clear strategy and often more robust evidence.
Gathering new or additional evidence can strengthen your case. Also, ensure that all documentation is complete and accurate. Maintaining open communication with the insurance company can also be beneficial throughout this process, as settlements might be possible even after a denial.
Taking legal action
If you believe you have a strong case, you may want to seek help from a legal professional who can provide invaluable assistance. They can help ensure all paperwork is completed, submitted correctly, and on time. They can also guide you in gathering necessary evidence and presenting a compelling case. They can negotiate with insurance companies on your behalf, possibly leading to a more positive settlement.