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THE WORK COMP BLOG

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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.

P: 828-252-2852

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FREQUENTLY ASKED WORKERS' COMPENSATION QUESTIONS

Q. What if my workers’ compensation doctor assigns a permanent partial impairment (P.I.) rating for my injury?

A. When a doctor releases you from care, a permanent disability rating may be assigned to your injured body part. A rating means that you will never again be 100% healthy in that body part. Whether you can return to work depends on the severity of your injury and how that injury affects your ability to handle the physical demands of your work. If you are able to return to making the same wages as before your work injury, this rating may be your only compensation. However, if you are not able to earn the same pre-injury wages, your rating will not represent your only compensation. Your impairment rating is only one factor the Industrial Commission and NC Law will consider in determining what damages the work injury caused you. NC Law permits you to select the most favorable method or compensating you for the injuries and loss of earning...

Q. When is my first WC disability check due?

A. WC law requires the insurance company to pay you 66% of your pre injury gross wage for each week you are unable to work. The first check is due on the 14th day after the injury. No compensation is due for the first seven (7) days of lost time unless you are out of work over twenty-one (21) days. If you miss more than twenty-one (21) days of work, a check for the first week of missed work becomes due.

Q. What if my work injury causes or exacerbates my depression or other mental illness?

A. Work injury related depression and other mental impairments may be compensable under NC Law. Our appellate courts are regularly expanding the consideration of mental and physical ailments that result from your employment and/or inability to work after a physical injury. If you believe your work injury caused or deepened any mental difficulty you might have possessed before or after the actual injury, you should fully discuss your thoughts with your mental counsellor. The Industrial commission is increasingly aware of and open to the concept that mental ailments can be as significant as physical ones.

Q. Do I have to allow my Rehabilitation Provider in the examining room while I am being examined by my doctor for a workers’ compensation claim?

A. No. Workers have an absolute right to a private examination by their doctors. The NC Industrial Commission does encourage the worker to allow the provider to meet with both the worker and the doctor immediately following the examination when the doctor discusses his/her findings and makes his/her recommendations for treatment. This will allow everyone to be aware of and understand treatment plans and expectations.

What benefits can I receive under WC?

The employer is normally responsible for any medical expense your doctor feels will make you better. This normally includes prescriptions, medical supplies, TENS units, crutches, braces, physical therapy and any other expenses you would not have incurred but for your injury. These expenses are payable by the employer until the case is settled. While you have a general right to choose your own doctor for treatment, the insurance company retains certain rights to pre-authorize medical treatment. You should never go to a doctor without obtaining insurance pre-authorization. You should also never let an insurance company force their doctors on you without your approval. A rehabilitation nurse assigned by the insurance company does NOT have the right to be in your exam room with the doctor. Lost Wages In N.C., the employer is responsible for paying you only 66 2/3% of your gross average wages, up to a maximum that changes each year....

Q. When am I eligible to receive Workers’ Compensation benefits?

A. Regardless of whether you miss any time from work, you are entitled to have your medical expenses paid by the Workers’ Compensation insurance carrier. When your work injury causes you to miss more than one (1) week of work, you are entitled to receive 2/3 of your gross average wages until you are able to return to work. Once you have missed one (1) month of work, you will also be paid for that first week.

Our Video Library is not closed-captioned.  Instead of embedding our videos, we have created posts for them, where full transcripts of can be found.
Click on the links below to view the video and its transcript.

Workers’ Compensation Overview on Vimeo

Workers Compensation Overview

Workers’ Compensation Injuries and the Complex nature of the law on Vimeo

Workers’ Compensation Injuries and the Complex Nature of the Law

Waiting Periods for Workers’ Compensation Benefit Payments

Waiting Periods for Workers’ Compensation Benefits

NC Workers’ Compensation Elements of Settlement

NC Workers’ Compensation Elements of Settlement

Settlements of Workers’ Compensation Claims on Vimeo

Settlement of Workers’ Compensation Claims in North Carolina

Pre Existing Conditions and Work Comp in North Carolina

Pre-existing Conditions and Workers’ Compensation Claims

NC Workers’ Comp Covers Many Different Kinds of Injuries

NC Workers’ Comp Covers Many Different Kinds of Injuries

Reopening Workers’ Compensation Cases

Reopening Workers’ Compensation Cases

Can’t Return To Work After an Injury

Workers’ Compensation Benefits When You Cannot Return to Work

Specific Traumatic Injuries

Specific Traumatic Injuries Under Workers’ Compensation

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2019 Google Review

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2019 Google Review

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2019 Google Review

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2019 Google Review

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