Workers Compensation Appeals Process

A denial of a workers compensation claim by an insurance carrier can be discouraging and frustrating, but these denials happen all the time. We are here to help injured workers get the compensation they deserve, including appealing those denials.
When working on a denial, we fill out a form for the state Industrial Commission (Form 33 — a Request That Claim Be Assigned for Hearing). We provide a statement explaining why the employee and the insurer are unable to agree, we list the doctors you’ve seen and witnesses that should testify on your behalf, along with other information.

It’s not just a denial of a claim that can be appealed. You have the right to appeal any aspect of your workers compensation claim, including,

• Denial due to technical reasons, the insurer believes the injury is not work-related or is a pre-existing condition,
• An incorrect calculation of benefits,
• A disputed permanent partial disability rating,
• Termination of benefits, and
• Return to work disputes.

The Industrial Commission requires a mediated settlement conference in most cases. If the parties cannot reach an agreement, we will get ready for your hearing (though mediation may fail, the claim could be settled at any time during the process). We will prepare the evidence, interview witnesses, prepare you to testify and put together the best case we can.
A hearing (which is like a mini-trial) is presided over and judged by a deputy commissioner. The hearings have specific rules and procedures that govern how they are run. After the hearing, both sides have a specific time limit set by the deputy commissioner to take depositions (where witnesses are interviewed, under oath, by attorneys from both sides) from medical and/or vocational experts, plus additional time to submit a written Proposed Opinion and Award. The deputy commissioner makes a decision based on the hearing testimony, depositions and the suggested resolution by each party.

A ruling that doesn’t go your way may be appealed to the North Carolina Court of Appeals.

Though the hearing process can be long and stressful, the reality is workers compensation carriers deny claims they should not have. Hearing procedures are in place to potentially right that wrong. Hearings before a deputy commissioner give you an opportunity to tell your side of the story. We make the most of that opportunity for our clients.

If your workers compensation claim has been denied, contact our office to schedule a free consultation, so we can talk about your situation and your options.