What Are the Main Reasons a Workers’ Comp Claim is Denied?

If you have suffered a work-related injury, receiving workers’ compensation benefits can help pay your bills and medical expenses. Unfortunately, not all workers’ compensation claims are approved, even if you have a legitimate claim. Understanding why your claim was denied can help you appeal your claim and get your benefits approved.

The main reasons a workers’ compensation claim is denied include:

• The injury or illness isn’t severe enough. Insurance companies may argue that your ailment is not severe enough to warrant taking time off work. If an insurance company can say that you can continue working, they will deny your claim.
• The injury or illness is not work-related. Insurance agents may claim that your ailment did not occur while you were working or during a non-work-related activity.
• The claim missed the deadline. Workers’ compensation claims are bound by strict regulations. If you miss a filing deadline, your claim will likely be denied.
• Your employer disputes your injury or illness. If your employer disagrees with the facts of your claim, the insurance company may deny your request for benefits.
• You have a pre-existing condition. Your pre-existing medical condition can be used as a reason to deny your claim, even if it did not contribute to your injury or illness.
• You did not seek proper medical treatment. If you did not follow your prescribed medical treatment or attend doctor’s appointments, your workers’ compensation claim could be denied.

Seeking workers’ compensation benefits is a long process that can be complex. If you need assistance with your claim, contact our law office at 910-621-2991 (Carthage) or 336-537-5547 (Asheboro).

How Do You Appeal a Workers’ Compensation Claim Denial?

Although receiving a denial of workers’ compensation benefits can be frustrating, the good news is that you can appeal that denial. Your denial letter will have specific instructions and an exact reason for the denial.

When you are ready to appeal, take the following steps:

File an Intent to Appeal

You must notify the North Carolina Industrial Commission of your intent to appeal within 14 days of receiving your letter. If you have already missed this deadline, contact our office today to see how you can proceed.

Attend Mediation

The Industrial Commission will schedule a conference with a mediator, a representative from your employer’s insurance company, and your legal representative. Our team can help you get your claim approved during mediation.

Request an ALJ Hearing

If your claim is not approved during mediation, you can request a hearing before an administrative law judge (ALJ). Our team can present evidence to bolster your claim.

Request a Panel Hearing

A panel hearing happens before three ALJs. If your initial hearing does not end in your favor, you can request another hearing to present further evidence for your claim.

How Can an Attorney Help With Your Appeal?

The appeals process for workers’ compensation claims is complicated and can be hard to navigate without a legal background. The attorneys on our team will help you submit your request for appeal plus gather evidence to present. We can negotiate with your employer’s insurance company plus represent you before a judge if your claim requires a hearing.

Our team of lawyers has extensive experience helping our clients get workers’ compensation claims approved. We know what insurance agents need to see to accept your claim, and we will not stop fighting until you get the outcome you deserve.

Should You Contact a North Carolina Attorney?

When you are injured on the job, receiving workers’ compensation can mean the difference between affording your expenses and falling behind on bills. Many legitimate claims are denied each year by overzealous insurance companies looking to conserve profits. Our team of attorneys will walk you through the appeals process so you can get the benefits you need to support yourself and your family.

At Rowland & Yauger Attorneys & Counselors at Law, we understand how important it is to get your workers’ compensation claim approved. We are committed to working with you after a claim denial. For more information about how we can assist you, call 910-621-2991 (Carthage) or 336-537-5547 (Asheboro) today.