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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. How long do I have to file a workers’ compensation claim?

A. NC law requires you to file a written notice of accident with the NC Industrial Commission within thirty (30) days of your injury. You should file the claim regardless of the extent of injury since many small hurts can become major injuries over time. Since the Courts are forgiving of late filings up to two (2) years from the date of accident, you should not hesitant to file your claim even if more than thirty (30) days have passed. While reporting claims can cause some grief from employers, more heartache happens when insurance companies refuse to pay medical bills and other damages because of late filings.

Q. Are back injuries that are not “accidents” covered by Workers’ Compensation?

A. Yes. Generally, a work injury must be an “accident” to be compensable. Back injuries do not have to meet this requirement. NC law accepts back injuries that do not result from “accidents” if the worker can trace the injury to a “specific traumatic incident.” The more precise the time of the incident, the more likely the back injury claim will be compensable. ANY back injury should be prompted reported and checked out by a qualified physician. The details of the incident should be given very carefully and completely to both employer and medical providers. Many back injuries do not become symptomatic until several days later.

Q. Can I draw Workers’ Compensation weekly checks and Social Security checks at the same time?

A. Yes, but your Social Security check will be reduced or offset by the amount of your Workers’ Compensation check. Social Security law mandates an offset of disability checks when your combined income totals 80% of more of your pre injury earnings. Federal law requires that you report all income or benefits that you receive while receiving Social Security checks. The offset or reduction in Social Security benefits can be lessened or minimized by careful planning and legal wording in your Workers’ Compensation settlement. You should consult a qualified lawyer to help you maximize your payments from each source.

Q. What should I do if my employer refuses to report my work accident?

A. NC law requires you to file a written notice of accident within thirty (30) days of your injury. You should contact the NC Industrial Commission or a local lawyer to get the proper forms to file your claim in a timely manner. Your failure to properly file the claim may result in denial based on legal procedure. The NC Industrial Commission is the government agency that compiles info on work accidents and serves as the court to decide disputed claims in workers’ compensation matters.

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 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.

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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My first time meeting Mr.Gantt, he was very open and honest about what it takes to get my SSDI. He was optimistic about my case. He walked me through what he needed on my part. I was very happy with the results of my hearing. I am very pleased with Mr.Gantt and definitely recommend his…

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November 2019 AVVO Review

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November 2019 AVVO Review

November 27, 2019

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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2019 AVVO Review “Get ‘er done Gantt!”

July 10, 2019

I was very satisfied with David Gantt’s expertise and knowledge in all aspects handling my case. He dealt with all the paperwork and contacted all necessary providers to get my medical history – it was extremely hassle free! He communicated and counseled me on what to expect – being very forthcoming (he’s a straight shooter)!…

2019 Facebook review

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2019 Google Review

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2019 Google Review

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2019 Google Review

May 9, 2019

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

May 9, 2019

The whole office is very respectful. Answered all my questions. So Glad they were there cause I had no clue after fighting for 2 years. Thank you guys soo much. ~K.H.

2019 Google Review

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Avvo Review 2019

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Google Review 2019

April 10, 2019

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2019 Google Review

April 9, 2019

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Avvo Review 2019

April 8, 2019

Linda Calloway Mundy David Gantt is an outstanding Lawyer. I highly recommend him. He was beside me all the way and I would like to thank him. ~Linda 5 Stars

2019 Google Review

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2019 Google Review

February 10, 2019

When I applied for Social Security Disability I saw no reason that I would need a lawyer since my case seemed clear. It wasn’t until the second rejection that I realized that I had no idea how the system worked. A couple of local lawyers I had contacted suggested that I talked to David Gantt…

2019 Google Review

February 10, 2019

This office is fantastic. The staff is helpful and friendly. He is honest with you about the pros and cons of your case. He works hard to get a positive result. ~S.G.

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