The North Carolina Workers’ Compensation Act was developed to assist people who are injured at work. Without this safety net, injured workers and their families might struggle to pay bills while dealing with the injury and related medical expenses.
Unfortunately, not all claims are approved and sometimes legitimate claims are denied. There are a number of reasons a workers’ compensation claim could be denied, but all workers are entitled to an appeal should he or she feel the decision is wrong.
If you’ve been injured while working for an employer, you may be entitled to wage-loss benefits and medical expenses for the work-related injury.
At the Law Offices of Michael A. DeMayo, our greatest reward is helping injured people and their families. We would be proud to represent you and your workers’ compensation claim.
What’s Covered by Workers’ Compensation?
Workers’ compensation will reimburse medical expenses (past, present, and future) as well as any related lost wages. Workers’ compensation does not pay for noneconomic damages like pain and suffering, mental anguish, etc.
When an injured person collects workers’ compensation, he or she is no longer entitled to seek compensation from his or her employer directly through a personal injury claim.
However, depending on the circumstances, an injured worker or surviving family member may be able to sue a third party whose negligence contributed directly to the injury or death. (A third party, for example, is not the immediate employer but could be an equipment manufacturer or other business associated with the employment.)
In some cases, there may be disagreements about how much money is needed to cover an injury or illness. It’s best to contact an experienced North Carolina lawyer should this circumstance arise. A workers’ compensation lawyer will work with the employer and their insurance company to ensure benefits for the worker.
What Happens If a Claim Is Denied?
There are several reasons a legitimate workers’ compensation claim could be denied or limited. The most common reason is that injured workers fail to meet the state deadlines for filing or forms aren’t properly completed.
Other reasons a claim could be denied include:
- Missing forms or documentation
- Lack of credible evidence (i.e., medical records, witness testimony, etc.)
- Disputes with the employer or insurance company
- The injury isn’t severe enough to qualify
In North Carolina, any injury or illness must be reported orally and in writing to the employer within 30 days of the event. Workers will need to formally file the claim (Form 18) with the North Carolina Industrial Commission; this form establishes a legal claim of injury on the victim’s behalf and must be filed within two years of the injury.
Decision letters are mailed approximately two weeks after the claim is filed. If you receive a letter from the Commission denying the claim, note the appeal deadline, and contact a workers’ compensation lawyer immediately.
The appeal process will start with a hearing with a judge, and it will require organization and evidence gathering to ensure a fair outcome.
Workers’ compensation laws are complicated, but you don’t have to fight for your benefits alone. With four convenient locations throughout North Carolina, the Law Offices of Michael A. DeMayo are dedicated to helping injured workers maximize their benefits.
What North Carolina Workers Need to Know
Workers’ compensation functions like insurance; however, collecting these benefits prohibits a worker from suing his or her employer for injuries.
To receive workers’ compensation, you have to be employed at the time of the injury, and the injury must be a result of the employment. In other words: injuries must be caused by whatever tasks are required by the job.
This rule also extends to illnesses sustained while working (e.g., lung cancer or mesothelioma) and cumulative trauma such as carpal tunnel syndrome. Benefits can be provided temporarily while the injury recovers or provided in perpetuity, depending on the circumstances.
Workers’ compensation claims are awarded based on strict liability: this means fault or negligence doesn’t have to be proven or assigned to a particular party in order to collect benefits.
All North Carolina employers who employ three or more workers must obtain workers’ compensation insurance or qualify as self-insured employers. If an employer fails to provide this coverage, they could face stiff financial penalties or be charged with a misdemeanor or felony and possibly imprisoned. All injured workers who qualify are entitled to workers’ compensation, and neglecting to provide these benefits is a criminal offense.
Do you have questions about a denied workers’ compensation claim? The workers compensation attorneys at The Law Offices of Michael A. DeMayo are here to help.
We have four convenient office locations throughout North Carolina. Call 888-203-9995 to get started now.