Understanding North Carolina’s Workers’ Compensation Appeals Process

The North Carolina Industrial Commission (NCIC) is responsible for processing workers’ compensation claims and providing benefits to injured workers.

Unfortunately, it is not uncommon for legitimate workers’ compensation claims to be wrongfully denied. 

If you have had your North Carolina workers’ compensation claim denied, you must understand your rights and the appeals process to challenge the decision and protect your right to benefits. Here are the steps to navigate the appeals process if your claim is denied.

Why Was Your Workers’ Compensation Claim Denied?

Insurance companies in North Carolina often unfairly deny valid workers’ compensation claims, leaving injured workers without needed compensation and support. These denials can be based on a variety of reasons, including:

• Disputing the cause of your injury as not being due to a workplace accident 
• Alleging that you failed to give notice of the accident to your employer within the prescribed time frame 
• Claiming that you did not adhere to the treatment plan prescribed by your doctor 
• Asserting that you were under the influence of an intoxicating substance at the time of the accident 
• Querying or challenging your injuries and whether they are related to the incident or pre-existing conditions 
• Arguing that you are an independent contractor rather than an employee

The Appeals Process

If your claim is rejected, it can be an upsetting experience. However, you have the right to appeal the decision and challenge rejecting your claim. 

Understanding the process and filing an appeal can be complex and time-consuming; it is important to be aware of all the steps involved to make informed decisions throughout the process.

Notify the Industrial Commission

When you receive a denial from the Industrial Commission, it is important to act quickly. You must provide written notification of your intent to appeal the decision within 14 days. This can be done by delivering a letter of appeal to the Commission or submitting an online form on its website. You must provide all the necessary information and clear justification for your case to ensure your appeal is successful. 

Include supporting documents such as medical records or witness statements demonstrating why the initial ruling should be overturned. 

Find an Attorney to Represent You

Having an attorney represent you at a worker’s compensation appeal conference that will be scheduled after the NCIC receives your notification can be incredibly beneficial. Worker’s compensation lawyers at Whitley Law are familiar with the laws and regulations and the appeals process and procedures that must be followed. 

They also have a comprehensive understanding of the medical evidence and know how to properly present it in order to ensure that your rights and interests are being fully represented. 

Attend Your Mediation Conference

At the mediation conference, both parties involved in the dispute will have an opportunity to explain their situation and reach a resolution. The mediator at the conference is neutral and unbiased and will facilitate the conversation between both parties to reach a solution. 

Mediation conferences are voluntary and confidential, meaning that all information shared during the conference remains private and cannot be used as evidence in court. Depending on the nature of the dispute, it may take several sessions to resolve it. 

Once both parties have reached an agreement, it can be put into writing and signed into effect. 

In Case of Disagreement With the Mediator   

If you find yourself in disagreement with the mediator’s recommendation, you may file a request to have a hearing before an administrative judge. This is done through filing Form HA-501, which requests a hearing before an administrative law judge. 

At a hearing in front of an administrative judge, both sides are given the opportunity to present testimony from witnesses and evidence related to their case. The judge then reviews this information and makes a decision based on it. If you disagree with the decision, you can appeal it by requesting a hearing before a panel of three administrative judges. 

Should you still disagree with the Industrial Commission’s ruling, you can pursue further legal recourse through North Carolina’s Court of Appeals and, potentially, the Supreme Court. Regardless of the outcome, it is important that you understand your rights throughout this process and present your case as best as possible to achieve a favorable result.

Feeling Confident to Appeal Your Workers Compensation Denial?

Having the right attorney by your side is the best way to give yourself a fighting chance when appealing a workers’ compensation claim that has been denied. An experienced lawyer can help you understand the legal process involved in filing an appeal and present evidence and arguments to support your case so you can receive compensation for your workplace injuries. 

Ultimately, having an advocate knowledgeable about workers’ compensation matters can make all the difference in achieving a successful outcome.

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