When your North Carolina workers' compensation claim gets denied

You've worked reliably for your employer for years. You have paid into both workers' compensation and health insurance pools. You show up for work, try your hardest and then come back to do it again the next day. Hopefully, you've felt like your employer appreciated your efforts. 

Then, one day, you have an accident at work. Maybe a machine malfunctions or you slip and then fall, hurting yourself. You report the accident to your employer, seek medical care and file a workers' compensation claim. 

Much to your frustration, however, you receive notice while you are still in recovery from your injuries that your employer denied your claim: Workers’ compensation is not covering your medical care and lost wages. You don't know when you will return to work, but you feel insulted, like your employer has intentionally diminished the years of work you've done. What are your options and how do you protect yourself and your family in this situation? 

How the denial process works 

In order to qualify for workers' compensation, you must have an injury or illness obtained as a direct result of your employment. As soon as possible, you should report the injury or illness to your employer, ideally before you seek treatment. If your employer has on-site medical assistance, you should visit that facility before going to an outside medical provider. Once your injury or illness gets confirmed, you should file a basic claim with workers' compensation. 

Your employer has the option, at that point, to submit Form 61, which is a formal, in-depth denial of your claim. You have the right to know the details of why your claim has gotten denied. Perhaps your employer doesn't believe that the injury happened at your work. In some cases, to keep workers' compensation premiums as low as possible, employers may even lie in an attempt to deny their workers earned benefits for injuries at work. Thankfully, you have the right to push back. 

You can file an appeal 

The good news is that North Carolina law provides recourse for workers whose employers are trying to unfairly deny them workers' compensation benefits. The bad news is that it can be a lengthy process, so instead of immediate medical coverage and wage replacement after a week, you won't have any workers' compensation benefits until the appeal process is finished. 

You will submit a Form 33, called a Request for Hearing form. You are allowed to hire an attorney to help you present your case during the appeal. At your appeal hearing, you can present evidence, ranging from medical and personal records to testimony from those who witnessed the accident.

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