Denied Workers’ Compensation Claim Lawyers in North Carolina

The Law Offices of James Scott Farrin handles denied workers’ compensation claims for injured workers across North Carolina. If you were hurt on the job and your employer or its insurance company denied your claim, you still have options to challenge the denial and pursue the benefits you may be entitled to under North Carolina law.

While a  denied workers’ compensation claim can leave you feeling overwhelmed, frustrated, and uncertain about what comes next, you don’t have to face that uncertainty alone. We believe every injured worker deserves to be heard and guided through the legal process with care. We can help you understand your options as you work with the North Carolina Industrial Commission (NCIC) to pursue benefits after a claim denial.

A denial can be frustrating, but knowing that you have options to challenge the decision can be an important first step towards moving your claim .

Which Workers’ Compensation Law Firms Handle Denied Claims in North Carolina?

The workers’ compensation attorneys at the Law Offices of James Scott Farrin handle denied workers’ compensation claims for injured workers across North Carolina. Workers’ compensation law firms that represent injured workers with denied claims across the state  typically assist with NCIC filings, claim disputes, mediation, hearings, and appeals.

If you have been injured at work, look for a North Carolina law firm with experience handling:

• Denied workers’ compensation claims
• North Carolina Industrial Commission filings
• Form 33 hearing requests
• Mediations
• Deputy Commissioner hearings
• Medical evidence disputes
• Insurer communications
• Appeals, where applicable

What Does It Mean When a Workers’ Comp Claim Is Denied?

A workers’ compensation denial means your employer or its insurance carrier is disputing your claim, part of your claim, or certain benefits you are seeking. However, it does not always mean you are out of options. In many circumstances, you can challenge the decision and continue pursuing the workers’ compensation benefits you may be entitled to under North Carolina law.

Common reasons many employers and insurance companies deny workers’ compensation claims include questions about:

• Whether the injury happened at work
• Whether the injury arose out of the worker’s job duties
• Whether the injury was the result of an unusual set of circumstances or whether it was the result of the performance of routine work activity
• Whether the injury is the result of intoxication
• Whether the injury was reported on time
• Whether the correct forms were filed
• Whether there is enough medical evidence
• Whether the worker followed authorized medical treatment
• Whether the insurer disputes the extent of disability or need for care

Whatever the reason for the denial, understanding why your claim was disputed can help you determine what steps you should take next.

Common Reasons Workers’ Compensation Claims Are Denied in North Carolina

Workers’ compensation claims in North Carolina may be denied for many reasons, and understanding the reason can help injured workers better understand the issues affecting their claims and what options may be available.

The Insurance Company Disputes Whether the Injury Was Work-Related

An insurance company may deny a workers’ compensation claim if it disputes whether the injury arose out of or occurred in the course of employment. For example, an insurer might question whether a back injury happened while an employee was lifting materials for work or resulted from an activity unrelated to the job.

The Injury Was Not Reported or Filed on Time

Waiting to report a workplace injury can create problems for a workers’ compensation claim. In North Carolina, injured workers generally should give their employer written notice of the accident as soon as possible and within 30 days. If there is a delay, the employer or insurance company may question when or how the injury occurred or raise the timing of the notice as an issue in the claim.

The Claim Forms Were Incomplete or Incorrect

Workers’ compensation claims involve forms and other documentation, and missing or inaccurate information can complicate the process. An incorrect date, incomplete description of the accident, or another error may lead to questions about the claim and potentially contribute to delays or disputes.

The Medical Evidence Is Disputed

Medical evidence can play an important role in establishing the nature and extent of a work-related injury. An insurer may deny a claim if it questions whether a diagnosis, recommended treatment, or period of disability is connected to the workplace accident. For example, the insurer may challenge whether ongoing treatment is necessary because of the work injury.

The Insurer Claims the Worker Did Not Follow Medical Instructions

Disputes can also arise over whether an injured worker followed authorized medical treatment or other medical instructions. Missing appointments, not following treatment recommendations, or disagreements about a worker’s ability to return to work may become issues that affect the claim or certain benefits.

The Claim Involves a Preexisting Condition

Having a preexisting medical condition does not automatically prevent an injured worker from having a workers’ compensation claim. It can, however, create additional disputes about what caused the worker’s current symptoms or need for treatment. For example, if someone with a history of back problems suffers a new back injury at work, the insurance company may question how much of the worker’s condition is related to the workplace accident.

Other Factors That Can Complicate a Denied Workers’ Comp Claim

In addition to the reasons for workers’ comp claim denials listed above, the following factors often make denied claims more complicated:

• Medical records that do not accurately reflect what the injured employee reported
• The employer lacks workers’ compensation insurance
• The injured employee does a recorded statement with the insurance adjuster without the assistance of an attorney

Whatever reason is given for a denial, it is important to understand that the insurance company’s decision may not be the final word on your workers’ compensation claim.

What to Do After a Workers’ Comp Claim Denial in NC

A denied workers’ compensation claim can leave you wondering what to do next. Taking the following organized, timely steps can help you better understand the denial, preserve important information, and determine how to move forward.

1. Review the denial reason. Read the denial carefully to understand why your employer or its insurance carrier is disputing your claim or benefits.
2. Save all forms, letters, emails, and other communications related to your claim. Keep copies of correspondence from your employer, the insurance company, the North Carolina Industrial Commission, medical providers, and others involved in your claim.
3. Gather medical records related to the injury. Keep copies of medical records, treatment recommendations, work restrictions, bills, and other documents that may help show the nature of your injury and its connection to your work.
4. Confirm whether a Form 18 has been filed with the North Carolina Industrial Commission. Form 18 is used to provide notice of the accident to the employer and file the employee’s claim with the Industrial Commission. Confirming that this step has been completed can help you identify whether additional action is needed.
5. Determine whether a Form 33 hearing request may be appropriate. Form 33 is used to request that a disputed claim be assigned for a hearing before the North Carolina Industrial Commission. Whether requesting a hearing is the appropriate next step will depend on the circumstances of your claim.
6. Avoid missing deadlines. Workers’ compensation claims are subject to filing requirements and deadlines. Acting promptly after a denial may help protect your ability to pursue your claim.
7. Speak with a North Carolina workers’ compensation attorney. An attorney can review the reason for the denial, evaluate the circumstances surrounding your claim, explain the available legal options, and help you determine what steps may be appropriate.

A denied claim can feel like a setback, but it does not necessarily mark the end of your workers’ compensation case. Understanding the reason for the denial and taking timely action can help you make informed decisions about what comes next.

How the North Carolina Industrial Commission Handles Denied Claims

When a workers’ compensation claim is denied or disputed in North Carolina, there is a process for bringing the disagreement before the North Carolina Industrial Commission (NCIC). The steps that apply can vary depending on the circumstances of the claim, but the following chart provides a general overview of how a disputed claim may move through the NCIC process.

 

How a Lawyer Can Help Challenge a Denied Workers’ Comp Claim

Challenging a denied workers’ compensation claim can involve medical evidence, filing requirements, deadlines, and proceedings before the North Carolina Industrial Commission. A workers’ compensation lawyer can help you understand why your claim was denied, help address issues that may be standing in the way, and guide you through the steps in challenging the denial.

A workers’ compensation lawyer may help by:

• Reviewing the denial reason
• Identifying missing or disputed evidence
• Filing or correcting NCIC forms
• Gathering medical records
• Communicating with the employer and insurance carrier
• Preparing for mediation
• Representing the worker at a hearing
• Working with medical providers or expert witnesses when needed
• Evaluating whether an appeal is available after an unfavorable decision

Having an attorney on your side can help you respond to the issues raised by the insurance company and pursue the workers’ compensation benefits you may be entitled to under North Carolina law.

Why Choose the Law Offices of James Scott Farrin for a Denied Workers’ Comp Claim?

The Law Offices of James Scott Farrin has a team of North Carolina workers’ compensation attorneys and legal professionals who understand the challenges injured workers can face when seeking to overturn a denied claim.

Here are some of the advantages representation by our firm can bring to your case:

• Focused workers’ compensation experience: Our team represents injured workers across North Carolina and has experience handling disputes that proceed through mediation and hearings before the North Carolina Industrial Commission.
• Board Certified Specialists on our team: Many of our workers’ compensation attorneys are rare North Carolina State Bar Board Certified Specialists in Workers’ Compensation Law, reflecting their focused knowledge and experience in this area of law.
• Experience from different sides of the workers’ compensation system: Our team includes former insurance adjusters and insurance defense firm professionals, providing insight into how insurers may evaluate and dispute claims. We also have attorneys who formerly served on the North Carolina Industrial Commission.
• A team and resources behind your claim: Our workers’ compensation attorneys are supported by legal professionals and firm resources that can help investigate disputed issues, gather evidence, communicate with insurers, and prepare a claim for mediation or a hearing when appropriate.
• A substantial history of representing injured people: Since 1997, the Law Offices of James Scott Farrin has recovered more than $2 billion in total compensation for more than 78,000 clients across the firm’s practice areas.¹
• No fee unless we recover compensation for you: We handle workers’ compensation cases on a contingency fee basis, so you do not pay a fee unless we obtain compensation for you.²

A denial can be discouraging, but you do not have to take on the insurance company by yourself. Our team can review what happened, help you understand the options that may be available, and fight for the workers’ compensation benefits you may be entitled to under North Carolina law.

What Benefits May Be at Stake After a Denial?

A workers’ compensation denial can affect access to medical care, wage replacement, and other benefits available under North Carolina law. The potential benefits at issue will depend on the worker’s injury, ability to work, and other circumstances of the claim.

An attorney can help you determine which benefits may apply – and whether they may have been improperly denied or disputed.

 

What Makes a Denied Workers’ Comp Claim More Complicated?

Questions about how an injury occurred, conflicting medical information, or disagreements over a worker’s ability to return to work can add layers of complexity to a claim. Some denied workers’ compensation claims involve the following issues that can make resolving the dispute more challenging:

• The injury was not witnessed
• Symptoms developed over time
• The worker has a prior injury or preexisting condition
• The employer disputes when or how the injury happened
• The insurer authorizes some benefits but denies others
• The worker is pressured to return before they feel medically ready
• Multiple parties may be involved
• Medical treatment is delayed or denied

When these issues arise, an attorney can help build a strong response to the denial by identifying the points of disagreement and evidence needed to address them.

Call James Scott Farrin About Your Denied Workers’ Comp Claim

Our workers’ compensation team will listen to your story, answer your questions, and provide a professional analysis of your circumstances – at no cost and with no obligation. As our client, we will put you and your needs first and guide you on how to pursue benefits after a claim denial. Call us 24/7 at 1-866-900-7078 or contact us online now.