What to Do If Your Workers’ Comp Claim Is Denied

By | June 19, 2017

Workers’ compensation insurance is an important part of ensuring that workers who are injured on the job are able to recover compensation for their medical expenses and part of their lost wages.

Despite the fact that workers’ compensation is a no-fault system, where workers do not have to prove negligence in order to be compensated, employers and their insurers may deny a workers’ compensation claim in order to save money. If your workers’ compensation claim is denied, you have the right to appeal the claim and fight for the compensation you are owed.

Here are some tips for navigating the workers’ compensation claims process.

Workers’ Comp Claim Denied – What’s Next?

The first thing that you should do if your workers’ compensation claim is denied is to hire an experienced workers’ compensation lawyer who can guide you through the process of appealing the denial. From there, you need to file a Form 33 – Request for Hearing.

The first step is mediation with your employer. Mediations are required. In fact, if you submit a request for hearing, you will be sent an order for a “mediated settlement conference.”

Mediation is often a successful way of resolving workers’ compensation disputes. The North Carolina Industrial Commission reports that settlement rates for mediation conferences are at or above 70-75 percent.

Preparing for Your Hearing

If mediation is unsuccessful, the next step is the hearing. A hearing is an opportunity for you to present your side of your workers’ compensation case.

During the hearing, you will provide testimony, submit medical evidence that speaks to your injuries, and you may call witnesses to testify on your behalf. At the conclusion of the hearing, a written order will be issued. If the order is not in your favor and your benefits are denied, you can once again appeal.

Appealing to the Full Commission

If a hearing is not concluded in your favor, you may file an appeal before the full commission. If you are not already working with an attorney, it is essential that you hire one at this point in the process.

As at the hearing, you will again present evidence, and must make a strong case for why your claim should be approved and why you deserve workers’ compensation benefits. If your claim is once again denied, you may file an appeal.

Throughout the entire process, it is important that you follow your doctor’s orders, and refrain from engaging in activities or behaviors that could discredit your claim (for example, if you are claiming a broken leg, don’t post a picture of yourself going for a jog on social media).

Get Help From an Experienced Workers’ Compensation Lawyer Now

If your workers’ compensation claim is denied, the smartest thing that you can do is to hire an experienced workers’ comp attorney who has handled mediations, hearings, and appeals in the past. 

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