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How Can I Appeal a Denied WC Claim?

You were clearly injured at work. You file a workers’ compensation claim with your employer’s workers’ comp insurance carrier.

You’re denied.

Now what?

How Can You Be Denied Workers’ Comp If You Were Clearly Injured at Work?

There’s no shortage of reasons behind this often-asked question. Sometimes claims are denied because the employer alleges the injury was not an accident or because it occurred as a result of a normal work routine. Sometimes not reporting the injury right away could result in denial. Sometimes the employer might simply lie and say you weren’t injured on the job.

Bottom line is this, I’ve seen some of the very entities that are supposed to protect my clients in the event of injury try to protect their bottom line instead. And if that means doing everything in their power to deny benefits, then the injured worker could be up the creek without a paddle.

That’s because the insurance companies, third-party administrators, and even employers have all sorts of “legal” loopholes they can pull to try and avoid paying. The workers’ comp system in North Carolina has become more and more obscure and can sometimes take even our best talent and legal resources (and we have many!) to sort through their entangled rules, guidelines, and processes.

What You Should Do After You’re Injured on the Job

First, seek medical assistance. Then provide written notice to your employer immediately after the injury. This can be in the form of a text, email, letter – just make sure it is in writing so they cannot come back and say they were never notified.  Notice should also be filed with the Industrial Commission (the workers’ comp “court”) within 30 days on a Form 18.

Yet what happens when you’ve followed those steps, but you’re still being denied benefits?

What Should You Do If You’re Denied Workers’ Comp?

If you’ve been denied workers’ compensation benefits, you’re going to need the NC Industrial Commission to force the insurance company’s hand.

If your employer and/or insurance company denies your claim, you can file a request for hearing on a Form 33.

But be careful. How you present your case during this hearing will have a huge effect on how much (if any) workers’ comp benefits you’re able to collect. You really have two options. You can present your case without an attorney or with an attorney.

Denial Hearings – Without an Attorney

When you file Form 33 without an attorney, a hearing will be scheduled before a judge – the Deputy Commissioner. The role of North Carolina Deputy Commissioner is something I am very familiar with. I held that position for 10 years. I can tell you from experience that it is very difficult for an injured employee to win without legal representation.

For example, here is what your hearing might look like when representing yourself:

Your hearing will usually be scheduled within 90 days after you file Form 33.  At your hearing, you and any witnesses you present will be allowed to testify.

Typically you will need an expert medical witness in order to prove your case. These witnesses typically do not come cheap. Physicians are not required to appear at the hearing. So you may not be able to get one to testify (they are very busy and expensive to boot).

What many people do not realize is that if you represent yourself, the judge is more limited in how he or she can receive the testimony of any physicians involved, and this can cause delay with the decision on your case.

Denial Hearings – With an Attorney

We advise that you secure an attorney before you file Form 33. If an attorney is involved, the North Carolina Industrial Commission will allow physicians to testify by deposition and will, in most cases, require your employer and/or the insurance company to pay for the costs of up to two physician depositions who can testify on your behalf.

Furthermore, if you secure an attorney, the Commission will order your employer and/or the insurance company to meet with you and your attorney to discuss settling your case.

If you have a strong case, the employer and/or insurance company may be willing to settle for a reasonable amount at this meeting.

But let me emphasize an important point:
We will not take your case unless we believe we can get a better result for you than you could get for yourself.1

Get a FREE Evaluation From NC Workers’ Comp Lawyers

When you contact us for a free case evaluation, we’ll tell you point blank if we think we can help you more than you could help yourself.1 And if we can’t, click here for our booklet which outlines information you can use to attempt to go through this process on your own.

If you decide to choose us to represent your rights, you’ll have the collective experience and knowledge of several experienced workers’ comp attorneys (some of whom previously represented the “other side”), as well as paralegals and others who have previous experience working for the insurance companies. Seven of our attorneys are NC Board Certified Specialists in workers’ compensation law. (This is the highest level of specialization available in NC, and only a small percentage of NC attorneys can make that claim. Very small.)3 And in 2017 our firm received the highest ranking possible by U.S. News – Best Lawyers® “Best Law Firms” for workers’ compensation law in the greater Raleigh area.4

Click here for a free case evaluation or call us today at 1-866-900-7078.


3Based on figures provided by the N.C. State Bar as of December 31, 2015.

4Visit www.usnews.com for more information about criteria for inclusion.