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Workers’ Comp Denied Claims

A legitimate workers’ compensation claim can be denied for a number of reasons. It’s shocking and disappointing, but if you have had a denied workers’ compensation claim it is by no means the last word on your case.

If you receive a letter stating that your claim was denied, your next step should be to talk with an experienced workers’ compensation lawyer.

The workers’ compensation lawyers at Wilson, Reives, Silverman & Doran know your rights and are ready to help you gain the compensation you deserve.

Why was my claim denied?

Workers’ compensation insurers deny claims for several reasons. Here are some of the most common:

Your injury wasn’t reported immediately

Many employers and their insurers assume that if you didn’t report an accident or injury immediately, then you weren’t really hurt. In North Carolina, the law states that an injured worker or his/her representative “shall immediately on the occurrence of an accident or as soon thereafter as practical” give written notice of the accident. Failure to give notification without a “reasonable excuse” within 30 days could lead to a denial of compensation. While neither of these need to be in a specific format, you do need to have written documentation to your employer what happened and when. (Pro tip: keep a copy of the notice and put it in a file).

Your employer should (but rarely does) give you a blank Industrial Commission Form 18 – Notice of Accident to Employer and Claim of Employee, Representative or Dependent for Workers’ Compensation Benefits to fill out. You can now also fill out a Form 18 online.  The online process will require you to set up an account (it should take less than 5 minutes to do so).

Although this seems like a simple task, it can be complicated (what you say makes a difference) so it is highly advisable that you consult with an experienced workers’ compensation attorney before you submit anything to the North Carolina Industrial Commission.

Contact the workers’ compensation attorneys at Wilson, Reives, Silverman & Doran for a free consultation so that you can make sure your Notice of Accident will be completed and filed properly.

Your injury was not witnessed

Although you can’t change the fact that others may not have witnessed your injury, insurers can and do question this kind of workers’ compensation claim. You can protect yourself by notifying your supervisor immediately, filling out an incident report, and seeking medical care. When you go to the doctor, be sure to explain how and when the injury occurred so that it is in your records.

Your employer disputes that the injury was sustained at work

If this is the case with your workers’ compensation claim, gathering additional evidence that supports your workers’ compensation claim should be your first priority. Evidence can include witness/coworkers’ accounts that verify that the accident or exposure occurred while you were working, or a doctor’s statement that attributes your condition to a workplace situation. The best way to protect yourself is to immediately notify your supervisor of the injury when it occurs and fill out a written incident report.

Sometimes a worker may be afraid of telling a supervisor because they are worried about losing their job. Do not fall into that trap. Report the injury, seek medical attention, and talk with an experienced workers’ compensation attorney about your rights.

You refused to sign medical authorizations or give the insurance company a recorded statement

Workers’ compensation insurers will usually ask injured employees to sign medical authorization forms or give a recorded statement. However, giving a statement without a lawyer present puts you in an awkward position. Additionally, no law requires you to give one. Nor do you have an obligation to sign over authorization to your medical bills and records, especially since doing so may allow insurers to invade your privacy and even gain access to medical records that don’t pertain to your accident.

If the insurer pressures you to sign a medical authorization and you would prefer not to sign one, contact a lawyer immediately and ask that he or she handle communication with the insurer.

You filed your claim after being laid off or fired

Insurers tend to regard claims after an employee layoff or firing as “revenge claims,” but it may be the case that by the time you got around to filing a legitimate claim, you had already been replaced or let go. Time can be your enemy in workers’ compensation. Do not wait for your employer to take action. Protect yourself, notify a supervisor as soon as the injury occurs, and complete a written incident report. Delaying the reporting of the claim can only lead to problems for you. Protect your rights and make an appointment for a free consultation with an experienced workers’ compensation lawyer.

Look at the letter you received regarding your denied workers, compensation claim for the reason(s) for the denial, and talk to an attorney if you are still uncertain why your claim was denied.

How do I challenge a denied workers’ compensation claim?

If your claim is denied, you have the right to a hearing in front of a Deputy Commissioner at the North Carolina Industrial Commission. An injured worker can file a Form 33 Notice of Hearing and the case will be docketed. Many times, the case will be ordered into mediation so the parties can have a chance to settle the claim before the hearing. It’s a good idea to talk with a lawyer as soon as you receive notice of your claim denial as he or she will need time to prepare and strengthen your case.

The workers’ compensation lawyers at Wilson, Reives, Silverman & Doran are here to provide you with trusted, effective legal counsel to help you determine whether a hearing is the best course of action, and if so, to prepare your case for mediation and trial if necessary. All consultations for a denied workers’ compensation claim are given free of charge.

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