Would You Know if Your NC Workers’ Comp Injury Was Incorrectly Denied?

You’re injured on the job, and you’re in dire need of workers’ compensation benefits to help you out while you recover. Unfortunately, your claim was denied. Why? Was the denial correct? How can you fight back? Let’s discuss the three types of workers’ comp claims and potential reasons for denials.

Learn More: How to File for Workers’ Comp in North Carolina

Types of Workers’ Comp Injuries

In North Carolina, there are three basic types of workers’ compensation claims. Each has its own rules and special circumstances that you need to prove to the workers’ comp insurance company in order to try and receive benefits.

Tip: Workers’ compensation is not typically concerned with fault, but a worker who injured themselves intentionally or because they were under the influence of drugs or alcohol is not generally eligible.

Injury Type #1: Injury by Accident

Perhaps you tripped and fell or a coworker dropped a computer on your foot. Were you injured while driving a company truck? North Carolina law says that injuries caused by accidents like these are generally compensable. However, we have seen instances where injured workers were denied compensation. The help of an attorney can make a significant difference.

Injury Type #2: Specific Traumatic Incident

From a workers’ compensation standpoint, specific traumatic incidents only apply to spine injuries. In order to be deemed compensable, back injuries must occur as the result of a “specific traumatic incident.” For example, if you sustain a herniated disc while lifting a box at work, even though you may have been performing a routine part of your job in the normal manner, you may very well have a compensable workers’ compensation claim.

Back Injuries

Back injuries can happen very suddenly and take a long time to heal. Unfortunately, back injuries are also very common at work. If you’ve strained muscles, sprained ligaments, or ruptured a disc in your back, you may be eligible for compensation.

Hernias

Hernia injuries may also be compensable if they are the direct result of a specific traumatic incident of the work assigned. However, a stricter application of the rule applies to hernia injuries compared to back injuries. For a hernia injury to possibly be compensable, it must appear suddenly following the injury and it must be a new hernia and not one that had developed prior to the accident.

Injury Type #3: Occupational Disease

This refers to a condition that develops over time as a result of your job duties and/or your work environment. Most people are familiar with examples of exposure to mold, asbestos, or hazardous chemicals. It is up to you to show that your job elevated your risk of injury. These claims can be very tricky to prove.

Carpal Tunnel Syndrome

While certain medical conditions are expressly identified as an occupational disease in North Carolina, many are not. Repetitive motion injuries such as carpal tunnel syndrome are a very gray area and may or may not be a compensable occupational disease.

Tip: It is against the law for your employer to fire you in retaliation for filing a workers’ compensation claim.

Was Your Workers’ Comp Claim in NC Denied? Some Possible Reasons

When will it end? First, you suffer an injury at work that causes you pain and keeps you from earning a living. Now, the insurance company – almost always a for-profit entity – is saying they won’t provide the benefits that can help you survive.

Why is this happening? What are some reasons your workers’ comp claim might have been denied?

You may be denied benefits if you:

  • Didn’t notify your employer promptly of your injury; or
  • Didn’t submit timely paperwork to the North Carolina Industrial Commission; or
  • Got medical treatment on your own

Aside from these, there are other potential issues that may prevent you from getting benefits. You could be denied workers’ comp benefits if your employer claims that you:

  • Were an independent contractor rather than an employee; or
  • You were not on the job when you were injured
Tip: Employee can mean a wide variety of things under workers’ compensation law. Don’t just accept your employer’s designation.

Your Medical Records

If your claim is strong but you haven’t provided the proper medical records and documentation, your claim will probably be denied. The workers’ compensation insurance adjuster will want to see that the condition you’re experiencing is directly attributable to the injury you suffered on the job and is impacting your ability to work.

Appealing a Workers’ Compensation Claim Denial

You’ve submitted your paperwork and medical records in a timely and thorough manner and you believe you were injured as an employee on the job. Yet you receive notice that your benefits have been denied. To appeal a denial, you’ll have to request a hearing with the North Carolina Industrial Commission (NCIC). That’s the agency responsible for administering workers’ comp benefits in the state.

Before a hearing, the NCIC may send you and your employer to mediation. You have to have an attorney to participate in a mediation. If mediation is unsuccessful or if you do not have an attorney, an appeal hearing is set. The appeal is your opportunity to try to show the Commission that your denial was improper through testimony and evidence. If the Commission rules against you, more appeals may be available to you.

A free case evaluation is the first step in fighting for the compensation you may deserve.

Should You Appeal? Were You Unfairly Denied Workers’ Comp Benefits?

Any legal claim needs to be established with convincing evidence. If you’re still in the early stages, try to avoid an appeal altogether. If you contact a workers’ compensation lawyer as soon as possible after your injury, they can help you try to secure evidence and any potential witnesses before it’s too late.

If you’ve already applied and been denied, don’t assume that it’s definitely you who got it wrong. Your employer and their insurance company have a different agenda than yours. We’ve seen instances where an employer completely ignores an employee they were previously very friendly with and doesn’t even notify insurance of a claim.

The bottom line is this: Every case is different and the law is very complicated. The devil is always in the details. Consult an attorney for guidance on how best to proceed, wherever you are in the process.

How Our Lawyers Can Help if Your Claim Has Been Incorrectly Denied

Many of our attorneys and paralegals have previously worked for insurance companies. They know first-hand how some insurance companies may try to delay and deny your claim.

Many of our workers’ comp attorneys are NC State Bar Board Certified Specialists in Workers’ Compensation law. One is even a former North Carolina state senator who helped write some of North Carolina’s workers’ compensation laws.

If you have any questions or if you’re ready to claim your free case evaluation, call 1-866-900-7078.

About the Author

Josh D. Smith practices workers’ compensation law in North Carolina for the Law Offices of James Scott Farrin. He is among the less than 1% of attorneys licensed to practice in North Carolina who are North Carolina State Bar Board Certified Specialists in Workers’ Compensation Law.a Josh was named on the “Best Lawyers: Ones to Watch”b list for Workers’ Compensation Law – Claimants by Best Lawyers in America for 2021 and 2022. He is currently a member of the North Carolina Advocates for Justice, the North Carolina Bar Association, and the 10th Judicial District Bar Association.

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

bFor more information regarding the standards for inclusion, please visit www.bestlawyers.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.