If your workers’ compensation claim was denied, you have the option to appeal. While it may feel like a significant setback, a denied claim is often the starting point on the path to getting the benefits you deserve.
Why was my claim denied?
Many claims are denied initially. The insurance adjuster, employer or third party administrator is required to tell you exactly why they denied your claim. Understanding why your claim was denied will help you decide what details to highlight when you request a hearing.
Claims are often denied because:
- The claim was submitted incorrectly
- The injury was not supported with the appropriate medical records or with enough proof that it was work-related
- There were preexisting injuries and conditions
Too often, a valid claim is denied due to one of these circumstances. You have a right to appeal if the insurance company is unwilling to offer a fair settlement.
How can I support my case?
It is in the best interest of an insurance company to find an excuse to avoid paying out for workers’ compensation benefits. An attorney for the insurance company will try to prove your claim isn’t valid, so it’s important to avoid giving a recorded statement before you discuss your case with a qualified workers’ compensation lawyer.
For an appeal, clearly explain your injury or illness, what benefits you are claiming and why you disagree with the denial of your claim. You can prepare for the appeal process by gathering the documents to support your case, including:
- Any paperwork from your employer, insurance company and the North Carolina Industrial Commission (NCIC)
- Work notes from your doctors
- Pay stubs from before and after the injury as well as your most recent W-2
You can appeal to a notice of denial within two years of the injury or when the doctor told you of your job-related illness. It is important to meet this and other deadlines throughout the process. An experienced lawyer can help you thoroughly investigate your work-related accident and guide you through the appeal process.