Access Denied: What Happens When a Worker's Comp Claim Is Denied?

When a person is injured on the job. The employer must then put its workers compensation carrier on notice of the claim.If the carrier admits the claim, it will then take the necessary steps to begin payment of any medical or indemnity compensation to which the injured worker is entitled. However, if the carrier denies the claim, the carrier is under no obligation to begin any compensation under the Workers' Compensation Act.
There are numerous reasons why a Keenan Injured Worker  compensation carrier may deny a claim. Those reasons range from a perceived lack of credibility of the injured worker to the injured worker's failure to file the claim within the statute of limitations. Regardless of the reason for the denial, the carrier must notify the injured worker, in writing, of the denial. The denial shall include a detailed statement of the basis of the denial, including the facts as alleged by the employer concerning the injury, the specific source of the information that the employer is relying on, and why those alleged facts do not entitle the Injured at Work to compensation. N.C. Industrial Commission Rule 601. If the carrier is denying the claim, the employer must also inform the injured worker that he or she has the right to request a hearing regarding his or her denied claim. N.C. Gen. Stat. A97-18(c)
If your claim has been denied, you can request a hearing before the Industrial Commission to have a deputy commissioner decide the matter. When the Industrial Commission receives the written request for hearing, the case will immediately be ordered to mediation. The mediation is an opportunity for the parties to attempt to settle their issues prior to going to the hearing. A neutral mediator will be employed to help facilitate an attempt at resolving the issues. If the parties are unable to reach a resolution to the issues/concerns, the case will proceed forward to the hearing.
At the hearing, the deputy commissioner will listen to the evidence that each side presents. If there medical depositions to be taken, this will occur in the days following the hearing. The deputy commissioner will review the evidence and decide whether the injury is compensable under the Workers' Compensation Act and issue orders in accordance with his or her opinion. For example, if the deputy commissioner believes that the injury is compensation, he or she will order the workers' compensation carrier to pay medical compensation and indemnity benefits to which the injured worker is entitled. If either party does not agree with the opinion and award of the deputy commissioner, the party may appeal the decision to the Full Commission. Similarly, if any party does not agree with the decision of the Full Commission, that party may appeal the decision of the Full Commission to the North Carolina Court of Appeals.

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