Getting a denial on your workers’ comp claim can be devastating. You were hoping for benefits to help you through this difficult time while you’re out of work. Now, you’re facing an appeals process you wanted to avoid. How long do workers’ comp appeals take?
The wait time from filing your appeal to getting a decision from a judge is about 11-14 months. But there are some nuances you should be aware of.
What Is the Workers’ Comp Appeals Process?
If your claim is denied by your employer’s insurance company, you can file a hearing request with the North Carolina Industrial Commission (NCIC). The NCIC is the court system for workers’ comp appeals. There are three stages in appealing to the NCIC: mediation, a hearing before a judge, and appealing to the Full Commission.
Stage 1: Mediation
Before the NCIC will grant you a hearing, you’ll likely have to attend mediation. Mediation is a meeting between the two parties to the case under the guidance of a neutral third party.
The mediation should be completed within 120 days of when you filed your appeal and were notified to attend mediation. If a settlement can’t be reached at mediation, the next stage of your appeal is to go before an NCIC judge.
Stage 2: Hearing Before a Judge
At this hearing there will be one judge, the court reporter, both parties to the case, and potentially witnesses to testify for either side. Most NCIC hearings occur within about 60 days of an unsuccessful mediation.
You submit all documentation to the judge in advance of the hearing (medical records, bills, and other related documents). After the hearing, in which non-expert witness testimony may be given, the parties have a certain amount of time to ask the doctors to the case questions under oath. The doctors’ answers are vitally important, and it is crucial that you ask the right questions, bearing in mind specific legal standards. Then, you’ll submit a report to the judge laying out all your arguments and your evidence. The other side will do the same.
Next, the judge will decide who won the case. Most judges will take at least three months to make a ruling. Judges are allowed up to six months or more to reach their decision. Hopefully, your appeal ends here and you are awarded benefits.
Appealing to the Full Commission
If the judge rules against you, the next stage is an appeal to the Full Commission. The appeal must be made within 15 days. The hearing before the Full Commission will take place about three months after your appeal and supporting documentation are filed. For this hearing, there will be three judges instead of one. They’ll take a look at your case from scratch. They’ll review the record but won’t hear testimony.
The Full Commission is not required to make a decision by any particular deadline. Cases are often decided within six months, but it may take up to a year or more before the Commission reaches a decision on your case. Overall, the process may take about two years from when you file your appeal to resolution if you end up having to appeal to the full Commission.
Note: There are two more possible levels of appeal, but very few cases ever get past this point.
Can the Worker’s Comp Appeals Process Be Sped Up?
On one hand, no. As you can see from the timeline above, a good deal of the process is waiting for other people. You can try and schedule your mediation as quickly as possible, but your mediator may have a full schedule already. And you can’t control how long it will take for a decision at each hearing.
On the other hand, maybe. If you want to prioritize closing your case quickly over pushing for maximum compensation, you may be able to resolve your claim at mediation. About 70% of claims get resolved at that stage. If the insurance company is denying you any benefits, you may have no choice but to take your case as far as it needs to go. That of course means a longer wait time.
Controlling What You Can
There are also steps you can take to minimize delays on your end, such as making sure to show up to all doctors’ appointments and following your doctor’s orders in full. If you don’t follow your doctor’s orders, the insurance company may be motivated to push back harder on your case, delaying things further.
Missed deadlines and incomplete paperwork also cause unnecessary delays. To try and ensure nothing is missed and things move along as briskly as possible, consider hiring an attorney.
When Should I Contact an Attorney?
If you’ve applied and been denied, you may be feeling discouraged. Contact a worker’s compensation attorney as soon as you’ve been denied so you can decide on your strategy going forward. An attorney can be a source of support as you prepare yourself for the next leg in your battle for benefits. In fact, an attorney can take the entire legal burden off your plate – the sooner, the better for your peace of mind.
Have you received a denial? An attorney can help you move your appeal along and try to ensure the result at the end is worth the wait. For a free, no-obligation case evaluation from one of our attorneys, call us at 1-866-900-7078 or visit us online.Text Us
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