An initial denial of your workers’ compensation claim doesn’t necessarily mean the end of the road for you. — several levels of appeal are available. Maximizing you chances on appeal, however, is almost certainly going to require the services of a lawyer, because strict rules of procedure and evidence apply.
Appeal Deadline and Grounds for Denial
Once you submit your workers’ compensation claim, it will be accepted or denied within 14 days. Common reasons for denial include:
- You missed the filing deadline;
- You failed to submit sufficient documentation;
- You application contained Insufficient information about your injury or illness; and
- You failed to establish that your condition is work-related.
Deadline for Filing an Appeal
To submit your appeal, you must file Form 33, Request for Hearing before the second anniversary of the date of your injury. Don’t wait until the last minute to submit your claim — the sooner you get started working on your appeal and the sooner you submit a well-prepared case, the better.
The Mediation Requirement
You will be required to attend a mediation conference before a hearing will be scheduled. The participants will be you, the insurance company and the mediator. Although your mediator must be qualified by the state government, many qualified mediators exist, and a list will be provided if you ask for one. If you cannot agree with the insurance company on a mediator, one will be selected for you.
You are not required to reach an agreement, only to participate in the process, and you are permitted to bring a workers’ compensation lawyer with you to the hearing. If you do reach an agreement, it will become legally binding the moment it is signed by both parties. If you do not reach an agreement, you must proceed to a hearing where a deputy commissioner will decide your claim.
The Formal Hearing
The hearing will be held by the North Carolina Industrial Commission. The hearing will work a lot like a trial — both parties may attend, the proceedings are adversarial, and you can submit evidence and call witnesses.
The deputy commissioner will mail the final decision to you. If you disagree with it, you can appeal one more level up, to the Full Commission. If you are not satisfied there, you can appeal to the North Carolina Court of Appeals. It is even theoretically possible to appeal to the North Carolina Supreme Court.
Time Waits for No One
The sooner you begin pursuing your appeal, the better your chances will be for a favorable outcome — even if you would have met the filing deadline in any case. North Carolina workers’ compensation lawyer John A. Hedrick can be of great help to you in this situation.
Mr. Hedrick has been helping clients with their workers’ compensation claims for decades now, and he is state-certified in workers’ compensation law. We can be reached by phone at 919-626-3895; otherwise you can simply complete our online contact form. We serve clients throughout Raleigh and throughout the entire state of North Carolina.