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Handling a workers’ comp denial in North Carolina

by | Feb 21, 2017 | Workers' Compensation

As a law enforcement officer, you know that your job comes with inherent risks. Getting injured while on the job is fairly high probability. Perhaps you recently injured your back while trying to handcuff a suspect that was resisting. While you only required a bit of rest and relaxation after the strain, what happens if you suffer a catastrophic injury? You know that you are entitled to workers’ compensation if you suffer an injury while on duty, but what do you do if the insurance company denies your claim?

Workers’ compensation denials happen more often than you might think. Fortunately, you do have rights and options when it comes to receiving compensation for a work-related accident. A local North Carolina attorney with personal injury experience can help you if the insurance company denies your workers’ compensation claim. Read further for the next steps you should take after a denial of benefits.

Reasons for denials

If you file a workers’ compensation claim and it gets denied, the first thing you should do is find out why. There are a number of reasons why insurance providers deny claims. Usually, they will send the claimant a letter explaining the reason. For example, the company may deny you for not meeting eligibility requirements. Other common denial reasons include not reporting the injury within the specified timeframe or not filing the actual claim on time. You could also receive a denial if your employer disputes the claim or if your injury is not compensable.

Injuries that the fall into the non-compensable category often include stress-related injuries. This is because they are generally hard to prove.

Appealing the denial

Your letter of denial should include a deadline for filing an appeal. However, you do have the option of meeting with your employer or the insurance provider to discuss the reasons for the denial and to determine if you can easily resolve the dispute. It is possible that the denial was a simple clerical error or misunderstanding.

If you choose to move forward with the appeal process, be prepared for a complicated legal experience. You will probably have to go before a judge for a hearing with the labor department or state workers’ compensation board. You may have to go through several levels of appeals in order to resolve your case. You attorney can help you gather evidence, such as incident reports and medical documentation, to present to the appeal board.

Due to the complexity of handling a denial for workers’ compensation benefits, it is important that you choose the right legal representation. Furthermore, you should understand your rights and options during the appeals process.


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