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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. Can my employer fire me while I am on workers’ compensation?

A. No. The Retaliatory Employment Discrimination Act (REDA) specifically prevents employers from firing you because you filed a WC claim against them. REDA protects you from any firing, demotion, punishment, or other retaliatory action the employer may try to take against you. You may be able to sue for monetary damages for a REDA violation. REDA also covers co-workers who testify in WC hearings on behalf of an injured worker. For guidance in filing a REDA claim, you should contact the NC Department of Labor at (919) 807-2796 or 1-800-NCLABOR.

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. How much $ will I get from WC due to an on-the-job injury?

A. NC law permits an injured worker to receive 66%of his or her pre injury gross wages for each week they are unable to work. This salary continuation or temporary total disability (TTD) payment continues until the worker returns to work at the same job or a “suitable” position making similar wages. If the worker cannot return to a job making similar wages, they are entitled to additional benefits depending on the extent of loss of earning capacity. Each year, the maximum TTD is increased. In 2005, the maximum TTD was $704.

Q. I was involved in a car accident while working. Can I make a claim against the car insurance in addition to the workers’ compensation insurance company?

A. Yes. You will likely have a workers’ compensation claim regardless of how the car accident occurred. If the wreck was caused by someone else’s negligence, you will also have a personal injury claim against the responsible party. You should consult a lawyer familiar with both personal injury and workers’ compensation law to make sure these claims are brought in proper legal procedure. Failure to coordinate both claims could result in enforceable liens of one or both of the insurance payouts.

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.

How do I pay my lawyer?

All charges for legal services must be approved by the IC. Generally, lawyers charge a 25% flat fee for their services on WC cases. This fee is payable only if: Your claim is successful; and The IC approves the fee. Most lawyers also charge for copies, medical records received from medical providers, long distance calls and other expenses of handling your claim. These costs are usually owed whether or not your claim is successful.

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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David Gantt and his staff handled my disability claim and they were excellent. I highly recommend him, he is the best in Western North Carolina. Mrs. Kelly Reaves 5.0 stars November 5, 2019

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2019 Google Review

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Very nice and friendly service. They always answered any of my questions. Had a great experience working with them on my disability case. I highly recommend there services! After trying for 6 years and 2 unfavorable decisions, David and his team did a great job representing my case and won. I appreciate there time and…

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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2019 Google Review

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2019 Google Review

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