If you were injured on the job and your North Carolina workers’ compensation claim was denied, you’re not alone, and it doesn’t mean your case is over.
Every year, valid claims are denied by insurance companies looking to minimize costs or delay payment. Fortunately, you have the right to challenge that decision, and the law provides a process to protect injured workers, if you know how to use it.
Here’s what you need to know if your workers’ comp claim has been denied and how the team at Shankle Law Firm can help you fight for the benefits you deserve.
Why Was Your Workers’ Comp Claim Denied?
There are several reasons a claim might be denied in North Carolina, including:
- Missed Deadlines: Failing to report the injury promptly to your employer or to file Form 18 with the North Carolina Industrial Commission (NCIC).
- Accident Description is Not a Covered Injury: The law generally requires that you describe something “unusual” or “unlooked toward” other than the injury itself. Examples are a slip, trip, or fall, but these are not the only unusual factors that are covered.
- Manner in Disputed Cause of Injury: Your employer or their insurer may argue your injury didn’t occur at work or isn’t related to your job duties.
- Pre-Existing Conditions: Claims involving an aggravated or pre-existing condition may be disputed.
- Insufficient Medical Evidence: If documentation is lacking or incomplete, your injury may be questioned.
- Failure to Follow Procedures: Delays in seeking treatment or not seeing an approved physician may result in denial.
Even if your claim was denied for one of these reasons, that doesn’t mean your case is closed. You have a legal right to pursue the benefits you’re entitled to under the North Carolina Workers’ Compensation Act.
Step One: Understand the Denial Notice
In North Carolina, claim denials are typically issued using Form 61, which outlines the insurer’s reason for denying the claim. Review this form carefully, it often includes technical or vague reasons that can be challenged with the right evidence.
Don’t ignore this form. It signals that you must take further action if you want to pursue your claim.
Step Two: File a Request for Hearing (Form 33)
If you believe your claim was wrongly denied, the next step is to file Form 33 – Request that Claim be Assigned for Hearing with the NC Industrial Commission.
This form initiates the formal hearing process. After it’s filed:
- You may be scheduled for mediation, where both sides attempt to reach a resolution.
- If no resolution is reached, your case will move to a hearing before a Deputy Commissioner of the NCIC, who will make a decision.
Filing Form 33 can be complex, especially when dealing with insurance company attorneys. This is a critical stage where legal representation can make a major difference in the outcome of your case.
What Happens at a Workers’ Comp Hearing?
A hearing is a formal legal proceeding, much like a trial. Both sides present evidence, including medical records, witness testimony, and expert opinions. The Deputy Commissioner will evaluate:
- Whether your injury is covered under North Carolina workers’ comp law
- Whether it occurred “by accident” as defined by statute
- Whether timely notice and appropriate medical care were given
After the hearing, the Commissioner will issue a written decision. Either party can appeal to the Full Commission if they disagree with the outcome.
Don’t Face a Denial Alone, Here’s Why Legal Help Matters
Insurance companies have legal teams on their side. If your claim has been denied, you need someone advocating for you who understands the system, the process, and your rights.
At Shankle Law Firm, we’re experienced in handling denied claims at every stage, from gathering evidence and filing forms to negotiating settlements and representing clients in hearings before the NCIC.
We help clients:
- Meet strict filing deadlines
- Request second medical opinions where appropriate
- Work with specialists to document work-related injuries
- Build strong legal arguments backed by medical and workplace evidence
You May Still Qualify for Benefits, But Time Matters
In North Carolina, strict deadlines apply to both initial filings and appeals. If your claim was denied, don’t delay. Acting quickly gives you the best chance of reversing the denial and receiving benefits for:
- Medical expenses
- Wage replacement
- Vocational rehabilitation
- Permanent disability
Talk to Shankle Law Firm, We’re Here to Help
If your North Carolina workers’ compensation claim has been denied, don’t give up. At Shankle Law Firm, we’ve helped countless injured workers fight back and win the benefits they were rightfully owed.
Call today or contact us online to schedule your free consultation with Maggie Shankle, a Board-Certified Workers’ Compensation Specialist.
We’ll review your denial, explain your legal options, and help you take the next step toward getting the care and compensation you need.
*Please Note - The content on this website is for informational purposes only and does not constitute legal advice. Viewing this site, using information from it, or communicating with Shankle Law Firm, PA through this site does not create an attorney-client relationship. For legal advice tailored to your situation, please contact us directly at (704) 370-1212.