Reason why workers compensation claims are denied.

Denied Workers’ Compensation Claim? Here’s How to Appeal in Greensboro

In Personal Injury by Greensboro Attorney

According to Statista, the most disabling workplace injuries in the US in 2023 by cost are (in chronological order) overexertion, falling, being struck by an object or equipment, and exposure to harmful substances. Accidents and injuries can happen at any time due to hazardous work conditions. Hence, North Carolina law protects workers by requiring employers with three or more employees to obtain workers’ compensation insurance. It protects employees when they suffer from injuries or illnesses on the job. When this happens, they become eligible to receive compensation, especially if they miss work due to an injury or illness.

Understanding how you can fight for your right to receive compensation when you suffer from an injury is essential. However, it does not help your dire situation when you’re denied a compensation claim. How can you pay your medical bills or cover your lost wages? In these cases, you need legal expertise to assist you in filing for your workers’ compensation claim to avoid being denied. 

Common Reasons for Denied Workers’ Compensation Claims

Workers’ compensation claims can be subject to denial for various reasons. If you’ve been denied, you must assess your claim to ensure that you have satisfied the requirements that qualify you for compensation. This knowledge also helps you fight for your rights, especially if you believe you have been wrongfully denied.

Procedural Error

A procedural error is the most common reason for denying a workers’ compensation claim. Procedural errors range from using the incorrect form to submitting an incomplete claim form. Therefore, you must review all the steps to process your workers’ compensation claim or file it with the aid of an attorney to guide you through the process to ensure that all the necessary steps are done correctly. 

Insurance companies thoroughly review all claims to ensure the validity of the claim, which is why you need to comply with the requirements.

Workers’ compensation claims can be subject to denial.

Processor Error

The processor is responsible for processing all claims regarding workers’ injury compensation. Since they handle multiple claims at a time, an error could hurt your chances of receiving compensation for your work injury. 

You need a qualified workers’ compensation attorney to help determine where the error came from so that corrective actions can be taken and you will receive your compensation.

Eligibility Factors

An employee must meet specific employment requirements to become eligible for a workers’ compensation claim. One example is if you’re an independent contractor of a company instead of an official employee. Under North Carolina law, independent contractors are ineligible to receive this benefit from their employer. 

However, there are some potential issues here because some companies do not hire regular employees and label them as independent contractors. It is a ruse from such employers to avoid paying their employees workers’ compensation insurance. You can consult your attorney if this was the reason for the denial of your insurance claim, especially if you performed the duties of a regular employee during the scope of your employment.

Course and Scope of Employment

Another reason a workers’ compensation claim may be denied is if the employer or insurance company argues that the injury was not sustained during the course and scope of employment. The NC Workers Compensation Act states that employees are entitled to these benefits when performing their duties. However, if the employee sustained the injury outside the work environment or during off-duty hours, this can be a reason for denial.

30 day notice required for workers compensation claims.

If your injury is work-related, you must present evidence that proves that you sustained your injury at work to avoid the hassle of denied claims. An experienced attorney can assist in finding helpful evidence to support your case.

Missed Deadline

The North Carolina law requires you to notify your employer about your workplace injury within 30 days. A written notice is essential so your employer knows your intent to pursue your benefits. If you fail to provide a written notice within 30 days, your workers’ compensation claim will be subject to denial.

Injury Due to Intoxication or Illegal Drug Use

The North Carolina law states you are not entitled to receive your compensation if the injury occurs due to intoxication or the employee was under the influence of illegal drugs during work. However, the employer bears the burden of proving drug use and intoxication as a possible cause of injury. An attorney can help the employee defend such claims, primarily if they cannot provide a link between the impairment and directly causing the accident. 

Steps to Appeal Denied Workers’ Compensation Claim

It can be disheartening for an employee to receive a notice of denial for their workers’ compensation benefits, especially if they’re facing steep medical bills and lost wages. The good news is you can appeal the denial to improve your chances of claiming those benefits.

The first step is to know the reason for the denial. The notice typically states the reason for the denial, which gives you an idea of what to correct when filing the appeal. 

The next step is to notify your employer and the insurance company that you are filing an appeal. 

It is also crucial to consult with an experienced workers’ compensation attorney about your case. They can study your claim and help suggest ways to improve your chances of the claim being approved. Your attorney will be beneficial during the workers’ compensation hearing, wherein a judge will review the evidence you present to determine if they will grant your benefits. 

How a Workers’ Compensation Lawyer in Greensboro Can Help

Filing an appeal for a workers’ compensation claim is a challenging process. The insurance company will have already evaluated your case and believes it is unworthy of granting you the benefits you deserve. Therefore, an experienced workers’ compensation attorney in Greensboro is your best tool to reverse the results when you file the appeal. Their legal expertise can advise you on the best course of action and the evidence you should collect and present during the hearing of your case. 

In addition, workers’ compensation attorneys understand the nuisances of the law, so they can help you navigate the complex process easily.