Appeals, the North Carolina Industrial Commission,
and How We May Be Able to Help
When an injured worker is denied compensation, he or she has the option of filing a claim with the North Carolina Industrial Commission (NCIC). This filing functions like an appeal of the denial decision. The filing of the claim must take place within two years of the date of the injury. The law as written enables workers to pursue these claims on their own, but it can be a lot trickier than it might seem.
If you’d like a more general view of the workers’ comp process, you can check our blog. For frequently asked questions, look at our workers’ compensation page. Here, we will focus on the NCIC, the “appeal” process, and how it all works.
Facts About the North Carolina Industrial Commission
When Was the NCIC Created?
The North Carolina Industrial Commission (NCIC) was created by the North Carolina General Assembly in 1929 to administer and enforce the North Carolina Workers’ Compensation Act.
What Does the NCIC Do?
The NCIC processes workers’ compensation claims for the State of North Carolina. This includes administrative and evidentiary hearings, mediated settlement conferences, processing motions, handling appeals, and other such work in administering claims under the North Carolina Workers’ Compensation Act. Hearings are held before personnel who function as judges, including the Executive Secretary, Special Deputy Commissioners, Deputy Commissioners, and Full Commissioners.
How Is the NCIC Appointed?
Six commissioners are appointed by the governor, and must be approved by the North Carolina General Assembly. The governor appoints one of these commissioners to serve as chairperson, to govern the NCIC. Half of the commissioners, through their background and work history, are classified as having employer backgrounds and the other half are classified as having backgrounds representing employees.
Commissioners serve six year terms, and none can serve more than two such terms. The chairperson has the authority to appoint the Deputy Commissioners that resolve workers’ compensation disputes across North Carolina. Currently, there are 20 Deputy Commissioners who hear cases in specific regions of the state.
Why NC Workers’ Compensation Claims Get Denied
An injured worker who is denied benefits or wishes to contest a decision about their case can file a claim with the NCIC. There are many reasons that a worker’s request may be denied, including:
- Failure to follow proper procedures
- Missing filing deadlines (by the worker or insurer)
- Errors on claim forms (from the worker or the employer/insurer)
- Failing to follow treatment instructions from the physician
- Disputes about the nature or circumstances of the injury, or whether it was work-related
Whatever the reason, if a worker’s claim is denied, they have the right to file a claim and have the dispute resolved by the NCIC.
Four Steps to Pursuing a Denied North Carolina Workers’ Compensation Claim
There are several steps and appropriate forms and deadlines involved in an appeal to the NCIC, and each has its own forms, rules, deadlines, and instructions. Mistakes or delays at any point in the process could harm your case, so it is highly advisable to consult with an attorney with experience working in the North Carolina workers’ compensation system.
1) File a Claim With the NCIC (Form 18)
The first step after being denied a workers’ compensation claim is to file a claim with the North Carolina Industrial Commission. There is a specific form (Form 18) for this purpose, and it should be completed and submitted. This form must be filed within two years of the date of your injury, or you may lose your right to pursue the claim. The employer and/or insurance carrier has up to thirty days to respond to this claim without being subject to a penalty.
Typically, an adjuster for the insurance company will contact you and ask to take a recorded statement. They will make this request for the express purpose of determining whether your claim should be covered by the Workers’ Compensation Act.
- If you do not provide this recorded statement, then the insurance adjuster will likely deny your claim.
- If you participate in this recorded statement without an attorney, you run the risk of making statements that could be detrimental to your claim. North Carolina has a unique law in terms of how it defines an injury by accident. So, without the guidance of an attorney, you may present your information in a way that could preclude you from receiving benefits.
2) File a Request of Hearing with the NCIC (Form 33)
If your claim is denied, you may request a hearing (Form 33) in order to have a Deputy Commissioner resolve the dispute.
If you have counsel, the NCIC will require you and your attorney to meet with representatives of your employer and the insurance company and their legal counsel to attempt to resolve the dispute without going to a hearing. This meeting typically takes place at your attorney’s office.
Both sides agree to a mediator who then attempts to help both parties resolve the dispute and reach an agreement without having to go to a hearing. Typically, a resolution at a mediation involves accepting a lump sum of money to resolve your claim. If you determine that your employer or the insurance company are unwilling to pay what you consider a fair amount for your claim, then you can decline to enter an agreement and move forward to a hearing before a Deputy Commissioner.
3) Hearing Before a Deputy Commissioner
Deputy Commissioners function like judges. They have contempt power and the ability to determine what, if any, rights you have in regards to benefits for the injury you have sustained. The worker will be sworn in, testimony will be given, and questioning and cross-examination will occur. Both sides will be provided the opportunity to present witness testimony that the judge will consider in rendering a decision. However, the judge will not likely make a decision on the day of the hearing because, in almost all workers’ compensation cases, you will have to present expert testimony from a doctor that has treated you.
Doctors are not required to attend these live hearings. Following the taking of testimony from lay witnesses, the judge will issue an order typically giving both sides 60 days to conduct depositions of medical experts. A transcribed copy of their testimony will be sent to the Deputy Commissioner to be considered when determining the outcome of your case.
After both sides have completed their depositions, the judge will give each side’s attorney an additional 30 days to prepare written arguments as to why each side believes the judge should rule in their favor. Most Deputy Commissioners take at least three months to render a decision. Some take the full six months allowed by law.
The Deputy Commissioner will issue a written opinion and award, making findings of fact and conclusions of law as to why you should or should not be awarded the benefits you are seeking.
4) Appealing to the Full Commission
It’s important to understand that when a decision is rendered by the Deputy Commissioner against your employer and/or the insurance company, they have a right to appeal that decision, as do you if the hearing does not turn out in your favor. The appeal goes to a panel of three Full Commissioners who will review your case on the cold record (without hearing any live testimony).
If two of the Full Commissioners disagree with the Deputy Commissioner’s decision, they can reverse it. That means a win by you could still result in a loss, or vice versa. The Full Commission will give you and/or your attorney 20 minutes to argue in their presence as to why the Deputy Commissioner’s decision should be upheld or reversed.
Decisions by the Full Commission have no specific time limit. Typically, the appeal process takes six months, but it can take more than a year to render a decision. There are two more levels of appeal, but only a small number of cases ever proceed past this point without resolution.
The Experienced Team at the Law Offices of James Scott Farrin
Two of our attorneys previously worked at the North Carolina Industrial Commission (NCIC). Doug Berger served as a Deputy Commissioner and heard full evidentiary hearings resulting in his ruling on the law and facts of a case. He also supervised the North Carolina Industrial Commission’s Workers’ Compensation Fraud Unit, and later managed its Claims Administration Department. Matthew Harbin served as a Special Deputy Commissioner dealing with such issues as settlement approvals, weekly benefit termination, and disputed medical treatment. The point is that they know how the system and the Commission work from the inside out.
Several of our attorneys are also North Carolina State Bar Board Certified Specialists in Workers’ Compensation Law. Several of our Workers’ Compensation attorneys have also worked as defense lawyers for the insurance industry at earlier times of their careers. These attorneys have seen Workers’ Compensation cases from both sides.
In addition, several of our Workers’ Compensation attorneys have more than 10 years of Workers’ Compensation and/or civil litigation experience. Many of our paralegals also have more than 10 years of experience in Workers’ Compensation, and several of the firm’s staff members are bilingual in both Spanish and English.
Don’t Get Lost in the Workers’ Compensation System
An experienced workers’ compensation attorney could be the key to the benefits and compensation you believe you’re entitled to receive. Knowledge of the complex laws surrounding workers’ compensation and experience working with the system help us try to ensure processes are correct, forms are error-free, and deadlines are met. Call us at 1-866-900-7078 or contact us online for a free case evaluation right away.