Filing a workers’ compensation claim should provide benefits when you get injured at work. However, not all claims receive approval. Understanding why claims get denied can help you avoid mistakes and ensure you receive the benefits you deserve.
Missed deadlines
North Carolina law requires you to report your injury to your employer within 30 days. Failing to do so could result in a denial. You also need to file a formal claim with the North Carolina Industrial Commission within two years. Missing these deadlines makes it difficult to receive compensation.
Lack of medical evidence
Your claim needs medical documentation to support your injury. If you fail to see a doctor or do not follow the prescribed treatment, the insurance company may deny your claim. A lack of medical records or conflicting reports from different doctors can also lead to denial.
Employer disputes the claim
Your employer might argue that your injury did not happen at work or resulted from a pre-existing condition. If your employer challenges the claim, the insurance company may deny it. Having witnesses or documentation proving the injury occurred at work helps counter this issue.
Injury not covered by workers’ comp
Not all injuries qualify for workers’ compensation. If your injury happened outside work duties or resulted from horseplay, intoxication, or intentional misconduct, your claim will likely face denial. Understanding what qualifies as a work-related injury prevents misunderstandings.
Failure to follow procedures
Workers’ comp claims involve strict procedures. If you fail to seek medical treatment from an approved provider, refuse a drug test, or do not provide the necessary paperwork, your claim may face rejection. Following the correct steps ensures a smoother process.
Knowing these common reasons for claim denials helps you take the right steps when filing for workers’ compensation.