At Waple & Houk, PLLC, our Westport workers’ compensation attorneys believe all North Carolina employees have the right to pursue benefits from their employer’s insurance coverage after suffering a work-related injury. Unfortunately, insurance companies see it differently.
Our experienced workers’ compensation lawyers in Lincoln County know that receiving a denial for your claim can be overwhelmingly stressful, but it is not the end of the discussion. If you have been hurt at work and are receiving resistance from your employer’s insurance provider, contact our skilled North Carolina workers’ compensation attorneys today for help.
What are the Most Common Reasons North Carolina Workers’ Compensation Claims are Denied?
Workers’ compensation claims in North Carolina can be denied for various reasons, and employees need to be aware of potential pitfalls in the claims process.
Here are some common reasons why they may be initially denied:
- Failure to Report the Injury Promptly
Delayed reporting of a workplace injury can be grounds for denial. In North Carolina, injured workers are generally required to report the injury to their employer within 30 days to qualify for workers’ compensation benefits.
- No Causal Connection to Work
A claim may be denied if the insurance carrier disputes the causal connection between the injury and the workplace. It is essential to provide clear evidence that the injury occurred due to work-related activities.
- Preexisting Conditions
Claims may be denied if the insurance carrier argues that the injury is related to a preexisting condition rather than a new workplace incident. Establishing a clear link between the work activities and the injury is crucial.
- Failure to Seek Medical Treatment:
If an injured worker fails to seek timely medical treatment, the insurance carrier may question the severity of the injury or whether it is work-related.
- Disputes Over Medical Treatment
Disagreements regarding the necessity or appropriateness of medical treatment can lead to claim denials. It is important to follow prescribed medical procedures and provide thorough documentation.
- Disputes Over the Course of Employment
If the injury occurred outside the scope of employment, the claim may be denied. Claims could be challenged if the injury occurred during a break or while engaging in personal activities unrelated to work.
- Employer Disputes the Claim
Sometimes, employers may dispute the validity of a workers’ compensation claim. This could be due to concerns about the legitimacy of the injury, disagreements over the cause, or other factors.
Independent Medical Examination (IME) Disputes
If the insurance carrier requires an independent medical examination and the results conflict with the treating physician’s assessment, it may lead to disputes and potential claim denial.
Can I Appeal a Denied North Carolina Workers’ Compensation Claim?
Injured workers have the right to appeal a decision denying their claim. Our skilled workers’ compensation attorneys in Westport can help you navigate the appeals process and protect your rights while challenging the denial and presenting evidence supporting your claim for benefits.
Contact Our Westport Workers’ Compensation Lawyers Today
Our legal team at Waple & Houk, PLLC PLLC will thoroughly investigate your case to build a strong North Carolina workers’ compensation claim. We can help you recover damages for your medical care, lost income, surgery costs, physical therapy costs, and lost earning capacity.