It’s not a secret that workers’ compensation claims get denied often. Reasons for those denials range from a poor case to a simple misfiled claim form or missed deadline. You can appeal your claim if it is denied.
The question is not necessarily, “How many times can you appeal a workers’ compensation case?” It’s not really about the number of appeals, but the increasing levels of judicial authority to which you can appeal. They are:
- Hearing With a Deputy Commissioner of the North Carolina Industrial Commission (NCIC)
- Hearing Before the Full Commission
- The North Carolina Court of Appeals
- The North Carolina Supreme Court
So what happens at each step?
Appeal #1: Deputy Commissioner of the North Carolina Industrial Commission
If your workers’ compensation claim is denied, you’ll get notification of that denial in writing, which will include a reason for the denial. If you disagree, you’ll have to submit a form (Form 33) to request a hearing with a deputy commissioner of the NCIC.
Understand that, before this hearing, you generally have to go through mediation with your employer and their insurer. A third-party mediator will work with all parties to find a resolution. If you and the other party cannot agree on a mediator, the NCIC will appoint one.
Only if the mediation fails will you proceed to a formal hearing. All sides will present evidence to support their case, including medical records and possibly witness testimony.
If the deputy commissioner rules in your favor, you can receive benefits (assuming your employer or their insurance company does not appeal the ruling). If they rule against you, you will have to press your appeal further.
Appeal #2: The Full Commission
If the deputy commissioner denies you, you must submit another form (an Application for Review) to the NCIC within 15 days. Your appeal needs to include all of your evidence and why you feel the deputy commissioner’s ruling was in error.
Three commissioners from the NCIC will hear evidence, review the prior appeal briefs, and may elect to hear oral arguments. It’s crucial that you have complete evidence to support your case. After this point, you will not generally be able to introduce new evidence.
If the commission rules in your favor, you can begin receiving benefits. Your employer or their insurance company can still appeal an unfavorable decision, as can you. However, the next level of appeal goes beyond the NCIC and into a courtroom.
Appeal #3: The North Carolina Court of Appeals
If the full commission denies you, you can escalate your case to the judicial branch. At this stage, your appeal takes place in an actual courtroom. It is very rare for a workers’ compensation claim to get this far, but when it does, a lawyer is a necessity. If you have not hired one and reached this point, you have a difficult road ahead.
Hiring a lawyer is now a must, but that lawyer must start at the beginning to fully understand your case and how to fight on your behalf. And because new evidence cannot be introduced – an appeal is generally heard based on the evidence available to the lower court only – that lawyer may find the going tough.
Your lawyer is going to be arguing points of law. You’ll need someone intimately familiar with workers’ compensation law, and even then, it’s going to be difficult if they’re “coming in cold.”
The Court of Appeals may rule in your favor, or they may remand the case back to the prior level with new guidance. If they rule against you, you’ve got one more possible chance in state court.
Appeal #4: The North Carolina Supreme Court
When all other attempts fail, you may appeal your workers’ compensation case to the North Carolina Supreme Court. To call this exceptional would, perhaps, be understating it. You should understand a few things about your case if it has gotten this far.
First, the North Carolina Supreme Court does not have to hear your appeal. It may decline to review the case, which would render the verdict of the Court of Appeals final.
Second, like the Court of Appeals, the North Carolina Supreme Court is not a trial court. It exclusively hears appeals on decisions rendered by lower courts.
The North Carolina Supreme Court’s ruling will determine whether you win or lose your appeal.
Can My Workers’ Compensation Case Go to the United States Supreme Court?
If going before the North Carolina Supreme Court is exceptionally rare, appearing before the United States Supreme Court is even more so. Many of the same rules apply, but there are a few more to note.
- Your attorney must be admitted to argue before the United States Supreme Court.
- The only way for a federal court of any kind, including the Supreme Court, to hear your workers’ comp case is if the case raises a question of federal law or jurisdiction.
In short, it’s a safe bet you won’t be headed to Washington, D.C. for your workers’ compensation case.
Closing Arguments on the Four Levels of Appeals for Workers’ Compensation Cases
The more you think about the process of a workers’ compensation case as a whole, the more it makes sense to hire representation at the outset of your case. Not only can they skillfully present your case at the initial stage, but they are experienced in negotiating and trying to reach a favorable outcome as soon as possible.
Appeals to the court system can take years to resolve. Many injured workers do not have that kind of time. One of the benefits of hiring a workers’ compensation attorney is to try to resolve your case as quickly as possible with the most favorable possible outcome.
If you’ve been hurt on the job and need help, don’t hesitate to contact us. We’ll evaluate your case for free.