How Workers Comp Disputes Are Settled in North Carolina

Dealing with a work injury is a pain in and of itself, but when your claim for workers compensation benefits is denied, you’ll need to do everything you can to get this denial overturned. When you choose to enlist the services of a regarded legal professional, this process can be made a little bit easier. Continue reading to learn more about how the workers comp denial and appeals process works in North Carolina.

Negotiating with the Insurance Company

Your first step prior to filing a formal appeal with the North Carolina Industrial Commission (NCIC) is for your attorney to negotiate with the insurance company. If your claim is like many others, the insurance adjuster has denied your claim due to something minor, such as an error in your application, or because they don’t believe your condition was, in fact, work-related.

Your lawyer can provide the evidence that shows how your on-the-job injury or illness came to be so that your eligibility status is no longer questioned. We can also help correct any issues in your paperwork so that the insurer can go ahead and approve your claim. Should the insurance company uphold your denial, however, we’ll move on to mediation.

Mediation Can Be Helpful

Between 70 percent and 75 percent of all denied settlements are resolved after attending a mediation session with the insurance company and/or the employer. In mediation, the insurer will present their reasoning for your claim denial, and we’ll argue our case for why you are entitled to these workers compensation benefits.

Both sides will be heard by the mediator, who will then make suggestions about how to move forward with your claim. The goal is to get the insurance company to see reason and proceed with approving your claim. In the event that we are unable to come to an agreement, we’ll request a hearing with the NCIC by filing Form 33.

Your Workers Comp Hearing with the NCIC

Once we’ve been granted a hearing with the NC workers comp commissioner, we’ll present your claim to be independently reviewed, and you’ll have the opportunity to testify in front of the North Carolina deputy industrial commissioner. Likewise, the insurer and your employer can present their own evidence and witnesses for testimony.

After each side has presented their case, the Commissioner will then issue a written ruling that details their reasons for either approving or denying your work comp claim. If your claim for benefits has been approved, you’ll begin collecting your benefits in the coming weeks. However, if your claim is denied, we have the option of bringing your claim to the appellate court.

Get in Touch with a North Carolina Work Comp Lawyer

Though it is not a requirement that you hire an attorney for the work comp process, having one by your side can help make the dispute process much easier to tackle. You can schedule your complimentary claim review with a North Carolina work comp lawyer at Ricci Law Firm, P.A. by calling our office at 252-752-7785 or by completing the online form at the bottom of this page.