Can You Be Disqualified From Receiving Workers’ Compensation in North Carolina?

Riddle & Riddle Injury Lawyers | October 15, 2025 | Workers' Compensation

In North Carolina, you can be disqualified from receiving workers’ compensation benefits under certain circumstances. Understanding your rights is important. An insurance company or your employer may deny your workers’ comp claim without cause.

This blog discusses why your workers’ compensation claim may be denied in North Carolina. However, each case is unique. It is always wise to seek legal advice from a skilled workers’ compensation lawyer.

Who Qualifies for Workers’ Compensation in North Carolina?

In North Carolina, most businesses with three or more employees must carry workers’ compensation insurance. This coverage pays for:

Medical treatment
Partial wage replacement
Vocational rehabilitation, if needed

You are generally eligible if:

You’re classified as an employee (not an independent contractor)
Your injury or illness happened while performing job duties

Even when you meet these basic criteria, certain disqualifying factors can still impact your claim.

Disqualifying Factors That Can Lead to a Denied Claim

Some denials are based on the injured worker’s conduct at the time of the accident. These are among the most common legal grounds for disqualification:

Intoxication or Drug Use

If you were under the influence of alcohol or an illegal drug when injured, your claim may be denied. To disqualify you, your employer must prove:

You were impaired
The impairment caused or contributed to your injury

A failed drug or alcohol test creates a rebuttable presumption of impairment, shifting the burden of proof to you.

Willful Misconduct or Reckless Behavior

Workers’ comp can be denied or reduced (by up to 10%) if the injury was caused by:

Intentional self-harm or violence toward others
Horseplay, roughhousing, or unsafe behavior
Violating known safety rules
Refusing to use required safety equipment

If your actions show a disregard for workplace safety, your claim could be reduced—or denied altogether.

To qualify, your injury must arise “out of and in the course of” employment. Claims are often denied when:

The injury occurs during a personal errand or lunch break
You were commuting (unless performing a work-related task)
The injury happened off-site while off-duty

If your injury didn’t occur while performing job duties, your claim may be disqualified.

Technical Reasons Claims Get Denied

Not all denials are based on behavior. Many claims are denied for procedural or coverage-related reasons, including:

Missed Deadlines

North Carolina law requires you to:

Notify your employer within 30 days of the injury
File Form 18 with the North Carolina Industrial Commission within two years

Failure to meet either deadline may result in disqualification.

Employer Doesn’t Carry Coverage

Most employers must carry workers’ comp insurance. However, some small businesses or exempt organizations may not be covered. If your employer lacks insurance illegally, you may still be able to pursue compensation through other legal avenues.

Misclassification as an Independent Contractor

Only employees qualify for workers’ comp in North Carolina. Independent contractors are excluded—but some employers misclassify workers to avoid coverage. If this happens, you may be able to challenge your classification with the help of a lawyer.

Being misclassified doesn’t automatically disqualify you—legal action can often correct the issue and restore your eligibility for benefits.

Legal Burdens and Rebuttable Presumptions

Usually, it’s the employer’s responsibility to prove that disqualifying behavior (like intoxication) occurred and caused your injury. But if a drug or alcohol test shows impairment, the burden shifts to you. You’ll need to prove that the substance didn’t contribute to the accident.

These cases often require expert testimony or medical evidence to support your position.

What To Do if Your Workers’ Compensation Claim Is Denied

If your claim has been denied—whether for misconduct, technical issues, or an insurance company’s bad faith—you still have options. Here’s what to do:

Don’t assume the denial is final: Many denials are made in error.
Request a copy of the denial explanation: This will clarify the reason.
Contact a workers’ compensation attorney: A lawyer can review your case, gather evidence, and represent you in an appeal.

Taking these steps quickly can increase your chances of reversing the denial and securing the benefits you’re entitled to.

Talk to a Fayetteville Workers’ Compensation Lawyer Today

A denied claim doesn’t mean you’re out of options. If your workers’ comp benefits have been denied or reduced, the team at Riddle & Riddle Injury Lawyers can help. We’ll investigate the reason for the denial and fight for the benefits you deserve.

For more information, contact Riddle & Riddle Injury Lawyers to schedule a free consultation with a workers’ compensation lawyer in North Carolina today. We have twelve convenient locations in North Carolina, including Greenville, Raleigh, Goldsboro, Jacksonville, Kinston, Charlotte, Greensboro, Durham, Fayetteville, Wilmington, Winston-Salem & Garner.

Riddle & Riddle Injury Lawyers – Raleigh Office
4600 Marriott Dr STE 500, Raleigh, NC 27612
(919) 876-3020

Riddle & Riddle Injury Lawyers – Durham Office
100 E Parrish St STE 200, Durham, NC 27701
(919) 728-1770

Riddle & Riddle Injury Lawyers – Goldsboro Office
601 N Spence Ave, Goldsboro, NC 27534
(919) 778-9700

Riddle & Riddle Injury Lawyers – Charlotte Office
1914 J N Pease Pl Suite 142, Charlotte, NC 28262
(704) 486-5824

Riddle & Riddle Injury Lawyers – Greenville Office
300 E Arlington Blvd Suite 2A #110, Greenville, NC 27858
(252) 397-8620

Riddle & Riddle Injury Lawyers – Fayetteville Office
2517 Raeford Rd, Fayetteville, NC 28305
(910) 387-9186

Riddle & Riddle Injury Lawyers – Greensboro Office
7B Corporate Center Ct Suite 15, Greensboro, NC 27408
(336) 516-9066

Riddle & Riddle Injury Lawyers – Jacksonville Office
3391 Henderson Dr, Jacksonville, NC 28546
(910) 455-5599

Riddle & Riddle Injury Lawyers – Garner Office
500 Benson Rd Suite 111, Garner, NC 27529
(800) 525-7111

Riddle & Riddle Injury Lawyers – Kinston Office
807 N Queen St, Kinston, NC 28501
(252) 397-8624

Riddle & Riddle Injury Lawyers – Wilmington Office
1608 Queen St Suite 12, Wilmington, NC 28401
(910) 889-4064

Riddle & Riddle Injury Lawyers – Winston-Salem Office
102 W 3rd St, Ste 1007, Winston-Salem, NC 27101
(336) 516-9042