If you experience a workplace injury, you face a wide variety of challenges. Your injury may keep you away from work. Your budget may be strained by the impact of lost wages and the cost of medical care. Because of these challenges, denial of your workers’ compensation claim can be particularly stressful.
However, a denied claim may not be the final answer in your case. The appeals process offers you a way to challenge this decision and work for the benefits you need.
Why did the provider deny your claim?
When you receive a denial, you will also receive a reason why your claim was denied. Common reasons for workers’ compensation denial include:
- The employee did not report the injury or file their claim in the required amount of time.
- The plan does not cover an injury.
- There is not enough evidence—whether in the form of medical records or witness statements—to prove that the injury occurred or was work-related.
- The employee did not pursue treatment for the injury.
You may be able to appeal this decision.
While a denied claim can be disheartening, filing for an appeal will allow you to challenge this decision. Most cases enter mediation initially, and many appeals—70 percent or more of appeals filed in North Carolina—end in a settlement before the workers involved need a hearing.
If you, your employer and your workers’ compensation insurance provider cannot reach a solution through mediation, you can pursue a hearing with the Industrial Commission.
While not every appeal is successful, an appeal could allow you to receive the workers’ compensation benefits you are due.