Why Was My Workers’ Compensation Claim Denied?

2-1Why Was My Workers’ Compensation Claim Denied?

In North Carolina, as elsewhere, when an employee gets hurt while on the job, they are entitled to file a workers’ compensation claim. An employee may file a claim to obtain benefits if they suffer an on-the-job injury. The North Carolina Industrial Commission (NCIC) administers workers’ compensation. Once you file a claim, the insurance company and the employer review it to make a determination. Sometimes, a workers’ compensation claim is denied. When that happens, you could be left with large medical bills and unpaid time off from work.


Reasons Why a Claim Might Be Denied

There are several common reasons why your workers’ comp claim might be denied. An employer or insurance company may deny a claim. If they do, you need to understand the reason so you can take further action. A knowledgeable attorney will help you.


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Is Your Injury a Pre-Existing Condition?

If your injury seems to be something that was present before you filed a claim, the insurance company may deem it a pre-existing condition. Remember that the insurance company may be trying to find a reason not to approve a claim, so they will review the injury to see if you already had the same health issues in the past. If they say the condition was pre-existing, you may not have provided complete documentation to show exactly when and how the injury happened. If you reinjured a condition that was originally caused on the job, you will need to prove the cause of the injury.


Did You Wait Too Long to File a Claim?

It is important to report an on-the-job injury immediately after it happens. North Carolina requires you to file a claim within 30 days of the incident. You should tell your employer about the injury right away. Your employer may require you to see the company physician or to visit a doctor approved by the company’s insurance. If you do not visit the doctor immediately following the injury, it can be more difficult to prove that the injury happened at work.


Was Your Injury Work Related?men-on-roof-workers-compensation-Attorneys-Charlotte-Monroe-Mooresville

You may find that your workers’ comp claim was denied because they feel that your injury is not work-related. This may be because you did not provide enough supporting documentation to prove the injury happened at work. Your employer may not believe that you were hurt at work, even though you were. Report the injury to your employer as soon as possible. Fill out an internal accident report if your company offers it. Make sure you document the time and place of the incident as well as exactly how it occurred and who else witnessed the accident.



Did You Fail to Visit a Doctor?

If you did not go to the doctor as you should have, or if you failed to follow instructions from your physician, your claim might be denied. You must seek medical treatment and care for your injury exactly as your doctor orders. If you do not tell the doctor how the injury occurred, they will not put that information on the report, and the claim could be denied. If the company requires you to visit a specific doctor, make sure you follow the rules.


What to Do if Your Claim Was Denied

If you receive a letter that denies your workers’ compensation claim, you have the right to appeal the decision. The letter states the reason your claim was denied, and this is helpful information. You will need to gather evidence to prove that they wrongfully denied your claim and proof that your injury should be covered by workers’ compensation. File a request for a hearing through the NCIC. There are various steps involved, which will require discovery and possibly mediation. A skilled attorney will help you through the process.


If your workers’ compensation claim was wrongfully denied, take action. Contact our attorneys at Arnold & Smith, PLLC, to schedule a case review. Call (704) 370-2828 to receive a video or phone consultation with our lawyers to explore your legal options or fill out our contact form. Now taking cases throughout North Carolina with offices in Uptown Charlotte, Mooresville and Monroe.






The skilled personal injury attorneys at Arnold & Smith, PLLC are dedicated to maximizing the financial recovery and obtaining justice for every personal injury client injured by another party’s negligence. The issues our personal injury clients may be facing include, but are not limited to, slip and fall injuries, wrongful death, product liability, catastrophic injuries, dog bite claims, car and truck accident injuries, motorcycle injuries, traumatic brain injury (TBI), nursing home negligence, spinal cord injury, boating accidents, and defective medical device injury. Our personal injury attorneys understand the devastating impact such an injury can have on a person’s life, and that the effects so often go beyond physical pain and suffering. The personal injury attorneys at Arnold & Smith, PLLC are dedicated to helping clients determine the strength of their claims, and to aggressively pursuing the means necessary to achieve the best possible end result for each client’s particular situation.



N.C. Industrial Commission Home Page (nc.gov)

What Is a Pre-existing Condition? (webmd.com)


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