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How to appeal a denied workers’ comp claim in NC

On Behalf of | Jun 27, 2024 | Firm News

Receiving a denial for your workers’ compensation claim can be disheartening, especially when you are relying on that support to recover from a workplace injury. However, it is important to remember that a denial does not have to be the final word. In North Carolina, there are clear steps you can follow to contest the decision and stand up for your rights.

Understand the reason behind the denial

It is no secret that insurance companies will sometimes deny legitimate workers’ compensation claims. That is why it is vital to understand their reasons and take quick action to appeal the decision. Start by thoroughly reviewing the denial letter you received. Knowing the reason is essential, as it will guide your next steps.

Challenge the decision

Your journey to contest the denial starts with filing these forms with the North Carolina Industrial Commission:

  • Form 18: This document asserts your claim of an injury at work. Make sure to provide detailed information about the injury, including how the incident occurred.
  • Form 33: This form allows you to bring your case forward for a hearing. Include all relevant details about your case and attach any additional evidence that supports your claim, such as medical reports or witness statements.

Submitting these forms correctly and completely is your first critical step toward having your voice heard and your claim reconsidered.

Engage in mediation

During this part, both you and your employer will present your sides of the story. It is important to come prepared with all relevant documents and a clear idea of the resolution you seek.

Attend the hearing

Sometimes, despite everyone’s best efforts, you might not reach an agreement with your employer during mediation, or you might find the mediator’s recommendation unsuitable. If that happens, the next step is to attend a hearing. This is your opportunity to present your case directly to the Industrial Commission. Explain clearly and confidently how the injury occurred, the impact it has had on your life and why you believe the denial of your claim was incorrect.

After the hearing, the commission will deliberate and decide on your appeal. This can take some time, so patience is essential.

Remember, when it comes to navigating the workers’ compensation system, each step you take is crucial in advocating for your rights and ensuring you receive the compensation you deserve. While it is a journey that requires patience and perseverance, understanding these steps empowers you to move forward confidently.