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Dealing with a work-related injury is stressful enough. Receiving a denial of your workers’ compensation claim? That adds another layer of confusion and frustration. If you’re a North Carolina worker facing this situation, you’re not alone, and you still have options. Here’s what North Carolina workers need to know about handling a denied workers’ comp claim and when it’s time to get legal help from a Charlotte workers’ compensation attorney.
Why Workers’ Compensation Claims Get Denied in North Carolina
In North Carolina, employers and their insurance companies don’t approve every claim. While this may feel personal, many denials are tied to rules or missing information.
Some of the most common reasons workers’ comp claims are denied include:
- Missed deadlines for reporting the injury or filing the claim
- Lack of clear medical documentation proving the injury
- Disputes over whether the injury occurred at work
- Employer statements claiming the injury was not work-related or was due to misconduct
Many workers’ compensation claims in North Carolina that are denied based on the initial claims are reversed or settled after further action. The denial letter (Form 61) is your starting point for understanding the denial of your workers’ comp claim.
What Is a Denial Letter in a North Carolina Workers’ Compensation Claim?
When your claim is denied in North Carolina, you’ll receive a Form 61. This is the official “Denial of Workers’ Compensation Claim” notice from the employer’s insurance.
This document includes important information like:
- The specific reason(s) your claim was denied
- Evidence (or lack of it) the insurer used to make the decision
- Deadlines for disputing the denial
Don’t ignore this form. If you plan to appeal, time is limited. You generally have up to two years from the injury date to file most claims, but appeal deadlines can be much shorter.
Appealing a Workers’ Compensation Denial in NC
You have the right to dispute a denied claim through the North Carolina Industrial Commission (NCIC). The first step in the appeal process is to request a formal hearing by submitting Form 33.
Here’s how to begin:
- Fill out NCIC Form 33 (Request for Hearing)
- Clearly explain why you believe your claim is valid
- Submit supporting documentation whenever possible
- File it with the NCIC and send a copy to your employer and their insurer
You can find Form 33 and instructions to complete the form on the NC Industrial Commission site. Timely filing is essential. If you wait too long, you risk losing your right to any benefits—even if your injury is legitimate.
Exploring Mediation Options Before a Hearing
Before a formal hearing, your case may be sent to mediation. In North Carolina, most contested workers’ compensation cases go through this step first. Mediation is a way for both sides, the injured worker and employer/insurer, to potentially reach a resolution without a hearing.
During mediation:
- A neutral third party helps guide the discussion
- You can present your case and supporting evidence
- If both sides agree to a settlement, it usually ends the dispute
If no agreement is reached, your case proceeds to a hearing before a Deputy Commissioner.
What to Expect at a Workers’ Comp Hearing
The hearing is like a mini trial. You’ll present your case to a Deputy Commissioner from the NCIC, who acts like a judge.
To prepare, you’ll need evidence such as:
- Medical records and doctor testimony
- Accident reports or on-the-job injury documentation
- Witness statements from coworkers
- Expert assessments (if needed)
The Deputy Commissioner will listen to both sides and issue a written decision sometime after the hearing. In some cases, further appeals are allowed, but only under strict timelines.
NC Workers’ Comp Denial FAQs
Thousands of North Carolina workers are injured or develop occupational illnesses each year. Injured workers have rights under state and federal laws. Common questions we often get about a workers’ compensation appeal include:
Can I keep receiving medical treatment while appealing?
Yes, but you may have to pay up front if the claim is denied. If the appeal succeeds, those costs can be reimbursed in many cases.
What if I miss my deadline to appeal the denial?
Missing a deadline can lead to losing your right to appeal. That’s why it’s critical to act quickly and speak with a lawyer for guidance.
What if my employer says it’s my fault I got injured?
Workers’ comp in NC is a no-fault system. Even if you made a mistake, you may still be eligible for benefits unless misconduct is proven.
Contact a Workers’ Comp Attorney Today
Facing a denied workers’ comp claim is frustrating, but it doesn’t have to be the end. With experienced legal help, many North Carolina workers overturn denials and receive compensation they rightfully deserve.
Bradford Law offers free consultations to review your denial and explain your next steps. We’re proud to serve injured workers throughout North Carolina and understand how to work within state employment and workers’ compensation laws.
Contact our office to schedule your consultation with a Charlotte workers’ compensation attorney. Let Bradford Law help you fight for the benefits you’ve worked hard to earn.
