How Do I Win a Workers’ Compensation Appeal?

Woman in a peach blouse and her arm in a cast calls Workers’ Compensation lawyer from her desk

You applied for workers’ compensation benefits, but your claim was denied. What do you do next?

You can file a hearing request with the North Carolina Industrial Commission (NCIC) to contest the denial. After this hearing, if you are still unsatisfied with the decision reached, you can appeal it by requesting a new hearing in front of a three-judge panel of the NCIC. I have helped many clients fight (and win!1) their workers’ compensation appeals, and in this article I will outline the three main steps of the appeals process. I will also provide additional advice that can hopefully help you obtain the workers’ compensation benefits you may deserve.

What Are the Steps of the Workers’ Comp Appeals Process?

When you are hurt on the job, there is a process to follow when filing your workers’ compensation claim. And if that claim is denied, there is a process for contesting that decision.

Let’s go over the three steps to follow when contesting a workers’ compensation claim denial.

Step 1 – File a Hearing Request With the NCIC.

If your workers’ comp claim was denied, you can file a Form 33, which is a request for a hearing before a Deputy Commissioner of the NCIC to review the case. Typically, you will be required to attend a mediation prior to hearing, which provides an opportunity for the parties to resolve disputed issues. If both parties agree to settle the case at mediation, there will be no need for a hearing.

Step 2 – Attend a Hearing Before a Deputy Commissioner.

If the parties are unable to settle the case (or resolve the disputed issues), the parties will then inform the NCIC that a resolution has not been reached and request a hearing date before a Deputy Commissioner. At the hearing, both parties can present evidence and testimony in support of their positions. Typically, the parties will receive a decision from the Deputy Commissioner within the next 6-12 months.

Step 3 – Appeal to the Full Commission.

If you disagree with the Deputy Commissioner’s decision, you can file an appeal and request a new hearing before a panel of three NCIC Commissioners. If the NCIC grants your request, each party will typically have 20 minutes to explain its position. The Full Commission will subsequently render a new decision.

Note: in North Carolina, there are additional levels of appeals after the Full Commission hearing, but most cases never reach those levels.

What Can You Do to Improve Your Chances of Winning Your Appeal?

Woman with crutches presents her Workers’ Compensation denial letter to a lawyer in a gray suitIf your workers’ compensation claim is denied, my top piece of advice to you is to seek the counsel of an experienced workers’ comp lawyer. Disputing a workers’ comp denial can take a long time and may seem overwhelming at times. I encourage my clients to let me worry about the details so that they can focus on their recovery.

In addition to ensuring that your forms are filed and deadlines are met, an attorney can help you:

  • Navigate the NCIC
  • Investigate why the insurance company denied your claim
  • Negotiate with the insurance company at the mediation
  • Prepare you for giving testimony at hearings with the NCIC
  • Examine you at the hearing so that key facts and evidence are part of the record
  • Gather information from your treating physicians in depositions
  • Prepare a detailed report (including case law) of the hearing before the Deputy Commissioner to support your claim
  • Present an oral argument to the Full Commission detailing your position on the Deputy Commissioner’s decision

People have various reasons for not hiring a workers’ compensation attorney, but I hope the preceding list demonstrates how an attorney can help you fight a denied workers’ compensation claim.

I urge you to seek an attorney who knows how the system works and is familiar with NCIC procedures. At my firm, we have attorneys on staff who worked at the NCIC – one served as a Deputy Commissioner and another as a Special Deputy Commissioner. For a free case evaluation, contact us online or call us at 1-866-900-7078.

Advice on How to Try to Win a Workers’ Comp Appeal: Keep Positive

  • Man with arm in sling frowns at denial letter while wife consoles him with hands on his shouldersKeep a positive attitude.
    Workers’ compensation benefits are intended to help employees hurt on the job receive medical care and pay.
  • Keep detailed records.
    Case evidence matters. Share any relevant communications and records with your attorney.
  • Keep a close eye on deadlines.
    Don’t hurt your chances for workers’ comp benefits by missing deadlines. Your attorney can make sure your case is on track.

Don’t just accept a workers’ comp claim denial.  And you do not have to contest that denial in court by yourself. If you are concerned that hiring a lawyer will be too costly, don’t be. My firm operates on a contingency fee basis, which means there won’t be an attorney’s fee unless we get you compensation.2 And there are no upfront costs or hourly fees to worry about.

Call the Law Offices of James Scott Farrin at 1-866-900-7078 or contact us online. We have many North Carolina State Bar Board Certified Specialists in Workers’ Compensation – a certification that less than 1% of attorneys licensed to practice in North Carolina can claim.*

Let us put our knowledge, experience, and resources to work to help you fight your workers’ comp claim denial. We want you to have the benefits to which you may be entitled.

 

*Figures provided by NC State Bar as of 1/22.

Ryan Bliss

About the Author

Ryan Bliss is a workers’ compensation attorney in North Carolina and co-leader of the Workers’ Compensation Department at the Law Offices of James Scott Farrin. Ryan is one of fewer than 200 North Carolina State Bar Board Certified Specialists in Workers’ Compensation Law.a He was named a “Rising Star”b by Super Lawyers Magazine in 2018 and wrote an article called “Workers’ Compensation for the Undocumented Worker” for Trial Briefs Magazine in January 2018.

aNumbers provided by NC State Bar as of 2/21.

bFor more information regarding standards of inclusion, please visit www.superlawyers.com.

five star review badge Former Workers’ Compensation Client, Online Google Review
I want to thank everybody who worked on my case at James Scott Farrin.

I want [to] thank everybody [who] worked on my case at James Scott Farrin. They did a very professional and great job. I would recommend them to anybody that was ever looking for a lawyer, and I definitely would use them again. 1

For legal reasons and client confidentiality, reviews have been slightly edited to remove identifying information and correct typos.