How To Appeal a Denied Workers’ Comp Claim in NC

A guide to help workers navigate
the appeals process after a denied
workers’ comp claim in Charlotte

The denial of a workers’ compensation claim can be a devastating blow, especially when you’re dealing with the physical and financial burdens of a workplace injury. However, it’s important to remember that a denial isn’t the end of the road. North Carolina law provides injured workers with the right to appeal these decisions, offering a second chance to secure the benefits they deserve.

This article will guide you through the essential steps of appealing a denied workers’ compensation claim in North Carolina. We’ll break down the process, timelines, and key considerations, empowering you to navigate the system with confidence and advocate for your rightful compensation.

If you find yourself overwhelmed or uncertain at any point during the process, remember that the experienced Charlotte workers’ compensation attorneys at Wilder Pantazis Law Group are available to assist you every step of the way.

How do I appeal a denied workers’ comp claim in North Carolina?

Anyone dealing with a rejected claim after a work injury understands how frustrating the experience can be, but fortunately, you still have the option to appeal. Below are the steps you should take if you believe your employer or their workers’ compensation insurer has wrongly denied your claim in North Carolina.

Step 1: Review the denial letter

The first crucial step after receiving a denial is to thoroughly review the insurance company’s letter. This document will outline the specific reasons for the denial, which could range from insufficient medical evidence to disputes over the work-related nature of your injury. 

Understanding these reasons is essential for crafting a strong appeal, as you’ll need to address each point of contention raised by the insurer.

Step 2: Talk to an attorney

Consulting with an experienced workers’ compensation attorney is highly recommended after receiving a denial. 

At the onset of an appeal, an attorney can help by:

• Explaining the complexities involved in the appeals process
• Identifying potential weaknesses in the insurance company’s decision
• Gathering the necessary evidence to support your claim
• Ensuring all necessary paperwork is completed and filed on time.

They can also represent you during hearings and negotiations, ensuring your rights are protected throughout the appeal.

Step 3: File an appeal

After understanding the reasons for denial and consulting with an attorney, you’ll need to formally initiate the appeals process. This involves filing Form 33, “Request That Claim Be Assigned for Hearing,” with the North Carolina Industrial Commission (NCIC).

This form officially notifies the NCIC of your intention to appeal the denial and request a hearing before a Deputy Commissioner.

So, how long do I have to file a workers’ comp appeal in NC after a denied claim?

Generally, it’s a good idea to file an appeal within one year of the denial because the longer you wait, the more challenging it may become to gather the necessary evidence and witness testimonies to support your appeal, but there is no hard deadline in North Carolina.

Step 4: Mediation

In most cases, the North Carolina Industrial Commission (NCIC) will require or suggest mediation before proceeding to a hearing. Mediation is a process where a neutral third party, known as a mediator, helps the involved parties reach a settlement agreement. This process provides an opportunity to resolve the dispute without the need for a formal hearing, which can be time-consuming and stressful. 

During mediation, both parties will present their sides, and the mediator will facilitate discussions to find a mutually agreeable solution. It’s important to be well-prepared for mediation, with all relevant evidence and documentation, to strengthen your position and increase the likelihood of a favorable outcome.

Step 5: Prepare for hearing

If mediation is unsuccessful in resolving your workers’ compensation dispute, the next step is to prepare for a formal hearing before the North Carolina Industrial Commission (NCIC). It’s crucial to thoroughly prepare by organizing all relevant documents, including medical records, witness statements, and any other evidence that supports your claim. 

Working closely with your attorney during this stage is essential, as they can help you build a strong case, anticipate opposing arguments, and represent your interests effectively during the hearing.

Step 6: Attend hearing

A workers’ comp hearing is similar to a court trial, where both sides present evidence and make legal arguments to support their positions. You should come prepared with evidence to support your claim and be ready to provide clear and concise testimony regarding your injury and its impact on your ability to work.

Your attorney will help you present your case effectively, cross-examine the insurance company’s witnesses, and counter their arguments. Remember, this hearing is your opportunity to make a strong case for why you deserve workers’ compensation benefits.

Step 7: Appeal to full commission

If the decision by the Deputy Commissioner is not in your favor, you can appeal to a 3-judge Full Commission of the North Carolina Industrial Commission (NCIC) within 15 days of the ruling. This appeal is based on the record from the initial hearing, along with written arguments from both parties. 

It’s crucial to work closely with your attorney to prepare a strong written argument that highlights any errors in the Deputy Commissioner’s decision and reinforces the evidence supporting your claim. A successful appeal can overturn the initial decision and grant you the workers’ compensation benefits you deserve.

Step 8: Additional appeals

If necessary, you can appeal the Full Commission’s decision to the North Carolina Court of Appeals within 30 days. Should the Court of Appeals’ decision still not be in your favor, you may also have the option to take your case to the North Carolina Supreme Court, although this is a rare occurrence. 

Please be aware that at each stage, the appeals process becomes more complex, and the focus shifts increasingly toward legal arguments and interpretations. Working with an experienced attorney is crucial during these higher-level appeals to ensure your case is presented effectively and to navigate the intricate legal requirements.

Was your workers’ comp claim denied in Charlotte? We can help!

At Wilder Pantazis Law Group, we understand how stressful it is to receive a denied workers’ comp claim when you’re trying to deal with the physical and financial burdens of a workplace injury. That’s why we’re committed to helping North Carolina workers appeal their wrongfully denied claims so they can get the compensation they need and deserve.

With more than 85 years of combined experience, our skilled Charlotte work injury attorneys have a deep understanding of workers’ compensation law and a proven track record of securing justice for our clients. We’ll review your case, explain your options, and help you navigate the complexities of the appeals process.

Don’t let your employer get away with violating your right to compensation after a work injury. Contact Wilder Pantazis Law Group today to schedule a free consultation to learn how we can help with your claim.