Workers’ Comp Claim Denied, Now What?

What do you do if your workers’ comp claim is denied? This is a valid question, and it’s probably not the only question you have about the workers’ comp claim process. You may also be wondering: Did I complete the claim form correctly? What happens if I have new information to add to my claim? Is there anything else I can do at this point?

All of these are reasonable and important questions. Fortunately, there is a process for injured workers with denied claims to request a hearing in front of a judge of the organization that administers the workers’ compensation program in North Carolina, the North Carolina Industrial Commission (NCIC). You don’t have to just sit back and accept the denial.

At this stage in the process, one of the most important questions to answer is: Who can help me after my workers’ comp claim is denied? I urge injured workers with denied claims to seek the guidance of an experienced workers’ compensation attorney to help them. Contesting a denied workers’ comp claim requires knowledge of the NC appeals process and a grasp of the documentation needed to support your claim.

Below, I will describe the three main phases of contesting your workers’ comp claim denial. Within each phase, I’ll highlight how an attorney can help you along the way.

There are three phases to go through when filing a claim for workers’ comp. Don’t navigate the process alone.
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Phase 1: The Request for a Hearing

You can file a request for a hearing before a Deputy Commissioner of the NCIC via a Form 33. Generally, the NCIC requires that you and your employer attend a mediation session in an attempt to negotiate a settlement before being granted a hearing.

How Can an Attorney Help Me at Phase 1?

An attorney can assist you in filling out the Form 33 accurately, ensuring that you provide the required specificity on why a hearing should be set. In the mediation, attorneys generally prepare and present the opening statements to the mediator, summarizing the facts of the case.

They can also communicate about your side of the case via the mediator and help you consider and weigh any offers from your employer. If the mediation is successful, a settlement is reached and there is no need to proceed to a hearing.

Phase 2: The Hearing

If no settlement is reached in the mediation, the next step is to inform the NCIC, which will set a date for a hearing, and then you can attend a hearing before a Deputy Commissioner. This hearing is your opportunity to present medical and employment evidence about how you were injured at work and how the injury has affected your life and ability to work.

How Can an Attorney Help Me at Phase 2?

An attorney can help you organize your claim’s documentary evidence (such as medical records, medical depositions, and employment records), present witness testimony and cross examine witnesses, and advocate for you professionally. An attorney can also help you adhere to all NCIC courtroom procedures.

Phase 3: The Appeal to the Full Commission

If you disagree with the Deputy Commissioner’s decision, you can appeal to a panel of three Full Commissioners of the NCIC.

How Can an Attorney Help Me at Phase 3?

At this step, the Full Commission panel reviews your case without hearing live testimony. However, if two of the Full Commissioners agree with you, you (or your attorney) are given the opportunity to present oral arguments about why you disagree with the Deputy Commissioner’s decision. An attorney with experience arguing before a court may be able to tip the scales in your favor at this point.

Note: After this phase, you can still contest the NCIC’s decision and appeal to the North Carolina Court of Appeals and after that, the North Carolina Supreme Court. These types of appeals happen rarely.

What to Do if Workers’ Comp Is Denied: Get an Attorney

The Law Offices of James Scott Farrin has several attorneys who are North Carolina State Bar Board Certified Specialists in Workers’ Compensation Law, a specialization that less than 1% of the attorneys licensed to practice in North Carolina can claim.³ We even have attorneys on our team who have worked as NCIC Commissioners. It’s important to ask the right questions, but it’s also important to ask them of the right people.

³ Figure provided by the N.C. State Bar as of 1/22.