If you have the misfortune to be injured while at work or even get an occupational disease in North Carolina, you should be able to file a claim for workers' compensation to help to ease the financial burden of being unable to work. Filing a claim might seem simple but insurers aren’t necessarily eager to part with the money and will find even the smallest mistake on your application in order to refuse to pay. This is why you should talk to an experienced North Carolina workers’ comp. attorney first to ensure your eligibility is clear. A denial of a claim can be appealed with the attorney’s help. WC Law in North Carolina In North Carolina, any employer who has at least 3 employees is required to take out workers’ comp. insurance. This provides benefits for work-related illness or injury. The North Carolina Industrial Commission (NCIC) is responsible for administering the workers’ compensation laws for the state. The workers’ comp. laws in North Carolina offer adequate coverage for all illnesses and injuries and illnesses caused at work. When you are injured and are receiving treatment you should give your employer’s details and tell the medical center the injury or sickness occurred at work. The bills for medical treatment will be then sent direct to your employer. You must inform your employer as soon as you can after the injury and you have a maximum of 30 days to do this following the injury. You will need to complete a Notice of Accident to Employer and form 18, Claim of Employee. Your employer will need to fill in Form 19. Both these forms will be sent in by your employer. Once you have been awarded workers’ comp. you will receive benefits for loss of earnings plus medical treatment. Your employer may require you use medical services that it chooses on your behalf. Why a WC Claim is Denied in North Carolina It all seems so simple especially if you know the injury was caused at work or your sickness was a result of the environment in your workplace. Insurers see it differently and try to find simple mistakes on your workers’ comp. application that results in your workers’ comp. application being delayed or denied. These include: overestimation of medical costs; excessive wage calculations; evidence that your sickness or injury is not work-related; simple administrative error on the application form; the application was filed after the deadline. If you are unhappy with the insurer’s decision you may file a workers’ comp. denial appeal. Appealing a WC Claim in North Carolina If you receive a notice that your workers’ comp claim has been denied, you will be given the reason and you will be able to generate an appeal on Form 33 “Request for Hearing” within 2 years of the injury date. Before a formal hearing is set you may be required to attend mediation which typically resolves 70 percent of disputes. The mediator will be chosen by you and your other party from a list approved by the NCIC. In order to reach a quick resolution it’s important you bring with you to the meeting documents such as your doctor’s report and testimonials from witnesses such as work colleagues. If a compromise is not reached at this stage a hearing will take place with the NCIC. At this level both parties will present their case in front of the deputy commissioner who will have the final say. >If the decision does not work in your favor, your case can be heard in front of the Full Commission. This consists of a panel of 3 workers’ comp judges. They will listen to the arguments presented to them and reach a decision. If the Full Commission’s decision is not what you hoped for you have the right to appeal to the North Carolina Court of Appeals, and even onto the North Carolina Supreme Court. Why Do I Need an Attorney for a WC Appeal? As you can see this is a long process requiring knowledge in the way the legal system works in relation to workers’ comp. claims. It will be far easier and less stressful talking to an experienced workers’ comp. attorney who will work on your behalf to reach a satisfactory conclusion to your workers’ comp. appeal.
