What Can I Do If My Workers’ Compensation Claim is Denied?
If you have suffered an injury or occupational disease while at work, you are likely hoping to be eligible for workers’ compensation benefits. But what do you do if your North Carolina workers’ compensation claim is denied? The answer will likely depend on the reason for the denial.
Common Denials for Workers’ Compensation Claim
The following are reasons why your workers’ compensation claim may be denied.
1. You are not an “employee” under the Workers’ Compensation Act.
“Employee” is a term defined under § 97-2(2). Examples of people who are not considered employees under the act include: people whose employment is casual and any person performing voluntary service.
Examples of people you might be surprised to consider are employees under the act include: minors, aliens, unlawfully employed individuals, members of the North Carolina National Guard while on State active duty under orders of the Governor and members of the North Carolina State Defense Militia while on State active duty under orders of the Governor.
2. You have not suffered an “injury by accident” as defined by the Workers’ Compensation Act.
“Injury by accident” is a term defined under § 97-2(6) and requires an “injury by accident arising out of and in the course of the employment…” Sometimes you may suffer an injury at work, but there was no accident that led to the injury.
For example, if you are lifting a 10-pound box, and this is in your normal course of employment, and your arm gives out, this may cause an injury to your arm, but there was no accident. However, there is one very specific exception to this rule: a claim for injury to a person’s back does not need to show a specific accident. Instead, you must be able to show that a specific traumatic incident arising out of the work assigned caused the injury. If we take our earlier example and just replace “arm” with “back”, it becomes a compensable claim.
Additionally, if you are engaging in some activities or duty which you are not authorized to undertake by your employment, any resulting injury would be deemed not to be caused by the course of your employment.
3. You are not suffering from a “disability.”
If you are not incapacitated because of the injury and you can still earn the same wages you were receiving at the time of the injury (at your old job or at a new one), then the insurance company may refuse to pay you for time out of work.
4. Your injury was caused by your intoxication or willful intention.
If you sustain an injury due to your willful failure to use safety equipment or by ignoring a safety rule set by your employer (of which you were aware), your claim could be denied or your compensation could be reduced.
5. You are an independent contractor, not an employee.
This can be a very contentious issue in your claim. If you are an independent contractor, you are generally not entitled to recover for an injury. However, deciding if you are an independent contractor is not so cut-and-dry.
6. You did not provide proper notice of the accident to the employer.
Written notice of an accident must come within 30 days after the accident, unless there is a reasonable excuse for not providing said notice on time (ex.: you are in the hospital) and your employer is not prejudiced. If your employer knows of your injury, though you have not provided written notice yet, it will be hard for them to argue they are prejudiced by the lack of formal notice.
It is also important to remember that your right to compensation is barred if you file a claim 2 years after the accident or after the last payment of medical compensation when no other compensation has been paid and the employer’s liability has not been
My Claim Was Denied. Now What?
If your workers’ compensation claim was denied, you do have the right to dispute the denial. Your first step is to consult with an experienced workers’ compensation attorney, who will be able to help you through the process of disputing your claim denial.
Our knowledgeable attorneys will be there for you every step of the way to getting you the compensation you deserve. If you have been injured at work and denied compensation, contact SeiferFlatow, PLLC at 704-512-0606 to schedule your free consultation.