What to Do When Workers’ Comp Won’t Pay

The North Carolina workers’ compensation system provides benefits for workers who suffer qualifying injuries on the job. However, it’s common for disputes to arise between injured workers, employers, and insurers.

So, let’s say you’ve been hurt at work, and by law, your injury is eligible for workers’ compensation benefits. What happens if workers’ comp doesn’t pay?

What Won’t the Insurer Pay?

Generally, there are two forms of benefits to which injured workers are entitled in accepted, compensable workers’ compensation cases: payment of related medical bills and wage loss benefits.

So, what happens when workers’ comp is not paying for authorized, related medical expenses or wage loss benefits? Here are a few scenarios.

Scenario 1: Workers’ Comp Insurer Refuses to Pay Medical Costs for a Compensable Injury

PROBLEM: You suffer one or more common workplace injuries. The insurance company accepts your case and their chosen medical care provider recommends a surgery to ensure you heal properly. However, the insurer refuses to pay for the procedure.

POSSIBLE SOLUTION: Take your dispute to the North Carolina Industrial Commission. If an injury is covered, the insurance carrier should authorize and pay for related medical expenses. If they refuse, you may want to hire a workers’ compensation attorney to represent you.

North Carolina workers’ compensation law is complicated and and there are various methods by which you may choose to seek relief. Legal missteps in your claim may put you at a disavantage and harm your ability to seek full, timely benefits. I highly recommend that injured workers hire an attorney as soon as possible, especially in this type of scenario.

Scenario 2: Workers’ Comp Insurer Refuses to Pay Wage Benefits for a Compensable Injury

PROBLEM: You suffered a severe back injury on the job. The insurance company accepts your case, their chosen medical provider takes you out of work, and there’s no dispute about how much money you should be receiving. However, the insurer refuses to send the payments.

POSSIBLE SOLUTION: You may need to take these kinds of disputes to the North Carolina Industrial Commission. Some workers’ comp insurers may fail to pay timely wage loss benefits to injured workers. In some instances, they may argue that you’re not entitled to any payments. In other cases, the argument centers around how much you should be receiving. Either way, an experienced workers’ comp attorney can develop a legal strategy and help you fight for all of your benefits.

Scenario 3: I Got Hurt on the Job and My Employer Doesn’t Have Workers’ Comp Insurance

PROBLEM: You sustain an injury at work. Even though your employer meets the requirements of being legally required to carry workers’ compensation insurance, you find out they’re uninsured.

POSSIBLE SOLUTION: This can be a nightmare scenario for an injured worker and these cases are often fraught with challenges. It is probably best to hire an attorney to try to ensure you investigate all possible legal avenues. If your uninsured employer is legally required to carry workers’ compensation insurance – and most are – they may be subject to penalties under the law.

What Can I Do if an Insurer or Employer Refuses to Pay Workers’ Compensation?

I’d suggest hiring an experienced workers’ compensation attorney to represent you and try to move your claim forward. This is probably all new to you, but we deal with these issues every day. There’s a good chance we’ve already encountered the insurance company that’s troubling you.

By retaining a workers’ comp attorney, you get more than experience and advocacy. We’re in your corner, fighting for your livelihood and your rights under the law.

Some insurance companies may use bullying tactics to pressure you. Those tactics don’t work on us.

If a workers’ compensation insurance company is giving you a hard time, don’t get mad. Get representation. Call James Scott Farrin.

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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.