Raleigh Workers’ Compensation Attorneys

Handling First-Time Claims & Workers’ Comp Appeals

Under the North Carolina Workers’ Compensation Act, all businesses within the private sector with at least three employees (with very few exceptions) must carry workers’ compensation insurance. If you work for an employer with three or more employees, and you were injured on the job or suffered an occupational disease, you are likely entitled to workers’ compensation benefits. 

Filing a workers’ compensation claim can be difficult, as there are various deadlines to meet, paperwork to fill out, and documents to submit. Even when you do everything correctly, your claim may still be denied. At Hyland, Padilla & Fowler, PLLC, we help injured workers with all aspects of workers’ compensation, from filing initial claims to appealing denied claims or early termination of benefits. If you need help with your claim, do not hesitate to reach out to our team today.

Call (919) 891-8361 or contact us online for a free consultation. Hablamos español.

Types of Injuries That Qualify for Workers’ Compensation 

Workers’ compensation covers nearly all work-related injuries, illnesses, and medical conditions. As long as you can prove that your injury or condition is somehow related to your work, you should be able to file a claim and receive compensation. 

Some of the most common types of work-related injuries, illnesses, and medical conditions include: 

• Back injuries 
• Slip and fall injuries 
• Repetitive strain injuries 
• Neck and head injuries 
• Traumatic brain injuries 
• Spinal cord injuries 
• Shoulder injuries 
• Sprains and strains 
• Soft tissue injuries 
• Nerve damage 
• Broken bones/fractures 
• Burn injuries 
• Asbestos-related illnesses
• Mesothelioma 
• Toxic exposure 
• Cancer 
• Respiratory diseases
• Joint inflammation 
• Heat stroke
• Heart attacks 
• Certain mental health conditions, such as post-traumatic stress disorder (PTSD)

If your injury happened while you were at work or carrying out any work-related activities or duties that benefitted your employer, you are likely entitled to workers’ compensation benefits. The same is true if you were diagnosed with an occupational disease or work-related mental health condition. 

What Compensation Can You Receive for a Work-Related Injury? 

North Carolina’s no-fault workers’ compensation system provides certain benefits to qualifying claimants, regardless of fault. In exchange, you cannot sue your employer for damages related to your occupational injury, illness, or medical condition.

Depending on the specific details of your situation, you could be entitled to the following workers’ compensation benefits: 

• Medical Expenses: Workers’ compensation covers the cost of all medical treatments related to your qualifying injury or illness. This includes emergency transportation costs, hospital fees, treatment costs, medications, physical therapy, rehabilitation, and even transportation to and from medical appointments. 
• Temporary Disability: You may qualify for temporary partial disability (TPD) or temporary total disability (TTD) benefits, depending on whether your qualifying injury or illness allows you to return to work in a partial capacity or not at all. TTD benefits are paid at a rate of two-thirds your average weekly wage up to certain maximums and for a set period of time. 
• Permanent Disability: If your qualifying injury or illness permanently impacts your ability to return to work or engage in any gainful employment, you could qualify for permanent partial disability (PPD) or permanent total disability (PTD) benefits. The type of permanent disability and the amount you can recover depends on your impairment rating, among other factors. 
• Vocational Rehabilitation: In some cases, injured workers may qualify for vocational rehabilitation benefits under North Carolina’s workers’ compensation system. These benefits are intended to help injured workers reenter the workforce and may cover certain costs associated with job retraining, education, etc. 
• Death Benefits: North Carolina workers’ compensation provides death benefits to eligible surviving family members when a covered worker dies due to a job-related injury or illness. This benefit includes up to $10,000 in reasonable burial expenses, as well as two-thirds the deceased worker’s average weekly wage for a period of 500 weeks or until the claimant is 18 years old (if they are a minor at the time of filing). 

Our Raleigh workers’ compensation attorneys can help you understand the types of benefits you may be entitled to receive, as well as the amount in compensation you could be eligible for. Reach out to us today to request a free initial consultation with a member of our team. 

Filing a Workers' Compensation Claim in North Carolina

Filing a workers' compensation claim in North Carolina after a work injury involves several steps. Here's a general guide:

1. Report the Injury: Notify your employer about the injury as soon as possible. North Carolina law requires you to report work-related injuries within 30 days of the incident. Failure to report within this timeframe might jeopardize your ability to receive benefits.
2. Seek Medical Attention: Get medical treatment for your injury. Your employer might have a list of approved healthcare providers for you to see. If it's an emergency, seek care immediately. Ensure that you keep records of all medical treatments, prescriptions, and related expenses.
3. File a Claim Form: Obtain a workers' compensation claim form from your employer, HR department, or the North Carolina Industrial Commission (NCIC) website. Fill out the form accurately and completely. Submit the form to your employer and keep a copy for your records.
4. Employer's Responsibilities: Upon receiving the claim form, your employer is required to file a First Report of Injury (Form 19) with the NCIC and their workers' compensation insurance carrier within five days.
5. Investigation: The insurance carrier will investigate your claim to determine its validity. This may involve reviewing medical records, statements from witnesses, and other relevant evidence.
6. Decision on Benefits: After investigating your claim, the insurance carrier will decide your eligibility for benefits. If your claim is accepted, you'll start receiving benefits. If it's denied, you'll receive a written explanation.
7. Dispute Resolution: If your claim is denied or if you disagree with the benefits offered, you have the right to dispute the decision. You can request a hearing before the NCIC. It's advisable to seek legal representation at this stage to navigate the process effectively.
8. Appeal if Necessary: If you're dissatisfied with the outcome of the hearing, you can appeal the decision to the Full Commission of the NCIC. This involves filing a written appeal within a specified timeframe.
9. Receive Benefits: If your claim is approved, you'll start receiving benefits, which may include compensation for medical expenses, lost wages, vocational rehabilitation, and disability benefits.
10. Follow Up: Continue to attend medical appointments and follow your doctor's treatment plan. Keep detailed records of all medical treatments, expenses, and any changes in your condition.

Why Was My Workers' Comp Claim Denied?

Workers' compensation claims can be denied for various reasons, some of which are more common than others. Here are some common reasons why workers' compensation claims might be denied:

• Failure to Report in Time: In many states, including North Carolina, there are strict deadlines for reporting work-related injuries. If an injured worker fails to report the injury within the specified timeframe, their claim may be denied.
• Disputed Injury or Illness: If the employer or insurance carrier disputes that the injury or illness is work-related, they may deny the claim. This could happen if there's insufficient evidence to prove that the injury occurred on the job or if the employer believes the injury is not as severe as claimed.
• Pre-existing Condition: If the employer or insurer believes that the injury is related to a pre-existing condition rather than a new workplace incident, they may deny the claim. However, workers' compensation typically covers aggravation of pre-existing conditions if the work-related activities worsen them.
• Failure to Seek Timely Medical Treatment: If an injured worker delays seeking medical treatment or fails to follow the prescribed treatment plan, the insurer may question the severity of the injury or its connection to the workplace accident.
• Lack of Supporting Evidence: Insufficient documentation, such as medical records, accident reports, or witness statements, can lead to a denial of the claim. It's crucial to gather and provide as much evidence as possible to support the claim.
• Discrepancies in the Claim: Any inconsistencies or discrepancies in the details provided in the claim, medical records, or statements given to the employer or insurer can raise doubts about the validity of the claim.
• Missed Filing Deadlines: Missing deadlines for submitting claim forms, appeals, or other required documentation can result in the denial of the claim. It's essential to adhere to all deadlines set by the state's workers' compensation system.
• Employer's Dispute: In some cases, the employer may dispute the claim for reasons such as believing the injury didn't occur at work, claiming the worker was under the influence of drugs or alcohol, or alleging that the injury was intentional or self-inflicted.
• Failure to Notify Employer: If an injured worker fails to notify their employer of the injury within the specified timeframe, the claim may be denied. Prompt notification is essential to initiate the claims process.
• Jurisdictional Issues: If the injury occurred outside of the scope of employment or if the worker is not covered under the state's workers' compensation laws, the claim may be denied.

Appealing a Denied Workers’ Compensation Claim in North Carolina

Unfortunately, many workers’ compensation claims are denied in North Carolina. There are many reasons why your claim could be denied, but what’s most important is that you know that you have the right to appeal a denied claim. 

Below, we’ve provided a brief overview of the workers’ compensation appeals process in North Carolina: 

• File a claim (Form 18) with the North Carolina Industrial Commission (NCIC) to inform them of your intent to appeal a denied workers’ compensation claim.
• Submit Form 33 – Request that Claim be Assigned for Hearing with the NCIC to request a formal workers’ compensation appeals hearing.
• Participate in mandatory mediation with your employer (if applicable) to attempt to resolve the issue before proceeding.
• Receive a recommendation from the mediator on whether the issue will be forwarded to the NCIC for a hearing. 
• Prepare for your workers’ compensation appeals hearing by gathering pertinent evidence and preparing your case.
• Attend the hearing and wait for the decision from the NCIC Deputy Commissioner assigned to your case. 

If you disagree with the NCIC Deputy Commissioner’s decision, you have 15 days to request an appeal with the Full Commission, comprising three judges who will hear and decide on your case. 

We strongly recommend that you reach out to a workers’ compensation lawyer right away if your initial claim is denied. An attorney will be able to recommend the next steps and guide you through the process of appealing your denied claim. 

When to Hire a Workers’ Compensation Attorney 

It is a good idea to hire a workers’ compensation attorney from the very beginning. When you trust your workers’ compensation claim to the team at Hyland, Padilla & Fowler, PLLC, you can focus on recovering from your injury or occupational illness while we handle the various details involved in your case. We can make sure that you do not miss any important deadlines and can help you correctly fill out all necessary paperwork to reduce the risk of your claim being denied. If your claim is denied, however, we can immediately take action to initiate the appeals process. 

As your legal team, we will be there to answer your questions and provide the personalized, one-on-one guidance you need throughout the entire process. Our Raleigh workers’ compensation lawyers understand the challenges you are facing, and they are prepared to help you seek the full benefits you are owed. We have successfully represented numerous clients in all types of workers’ compensation matters, including initial claims filing processes, denied claim appeals, and more. 

Schedule a complimentary consultation with our team today; call (919) 891-8361 or contact us online today to get started.