Has Your Workers’ Compensation Claim Been Denied?

October 20, 2015 | By Riddle & Brantley Accident Injury Lawyers
Has Your Workers’ Compensation Claim Been Denied?

Denied Workers’ Compensation Claims

North Carolina’s workers’ compensation system was designed to provide injured workers with medical treatment and partial wage-replacement benefits quickly and without requiring claimants to show that their employer did anything wrong. Unfortunately, the process does not always work so simply.

If your workers’ comp claim has been rejected, you are not alone. Many valid claims are initially denied by employers and insurance companies that are more concerned about saving money than protecting your health and financial well-being after a workplace accident. We can help. Riddle & Brantley’s team of skilled North Carolina workers’ compensation attorneys have significant experience with successfully appealing denied claims. Let us put our experience to work for you.

Get Help from Our Board-Certified Specialists in Workers’ Comp Law

You suffered a serious injury on the job or contracted an occupational illness. You may be unable to work due to your condition, and the medical bills are piling up. Now you find out that your employer and the workers’ compensation insurance company have denied your claim for benefits. You need help from an attorney who has the qualifications required to get results.

Riddle & Brantley’s team of Raleigh & Goldsboro workers’ comp attorneys includes two lawyers who have earned certification from the North Carolina State Bar as specialists in workers’ compensation law. Chris Brantley and Adam Smith are among a select few North Carolina attorneys who have met the rigorous demands for board certification as workers’ compensation specialists.

The North Carolina State Bar’s Board of Legal Specialization recognizes lawyers who have demonstrated knowledge, experience, and achievement in workers’ compensation law. According to the board, in order to qualify, attorneys must:

  • Demonstrate substantial involvement in workers’ compensation law, averaging 500 hours per year in the practice area over a five-year period.
  • Undergo a strict peer-review process by other attorneys, judges and deputy commissioners of the North Carolina Industrial Commission.
  • Pass a rigorous exam on workers’ compensation law.
  • Participate in at least 36 hours of continuing legal education (CLE) on workers’ compensation in a three-year period.

Reasons Given for Denying Workers’ Comp Claims

Workers’ compensation is supposed to provide benefits quickly and without a drawn-out dispute over what caused the accident or who was to blame. However, there are some reasons why an injured worker may not be entitled to benefits. Unfortunately, employers and their insurance companies often try to use these exceptions as grounds to wrongfully deny a valid claim.

Your employer and insurance company may have tried to deny your workers’ comp benefits by claiming:

  • You are an independent contractor, not an employee. Independent contractors are generally ineligible for workers’ comp benefits under North Carolina law. Some employers label their workers as independent contractors in hopes of avoiding certain requirements, including providing workers’ comp benefits. However, calling someone an independent contractor does not make them one. Many workers are misclassified as independent contractors when they are actually employees who are entitled to workers’ comp benefits if they are hurt on the job. Our lawyers can investigate your situation to determine whether you have been wrongly classified as an independent contractor.
  • Your injury did not occur within the “course and scope” of your employment. In order to be covered, the N.C. Workers’ Compensation Act requires that an injury must have arisen within the “course and scope” of your employment. An employer or insurer may try to use this language to argue that you are not entitled to benefits because you were doing something unrelated to work when you got hurt. In many cases, an investigation into the circumstances will reveal that the workers’ activities were in fact within the course and scope of employment.
  • You were not actually injured or your injuries are less severe than you claim. Your employer and its insurer may accept that you were involved in a workplace accident, but they may attempt to deny your claim because they believe you did not actually suffer any injuries or your injuries are not as bad as you say. Our lawyers can work with your medical providers to provide evidence that supports your injury claim.
  • You were impaired by alcohol or drugs when you were hurt. The N.C. Workers’ Compensation Act provides that injured workers are not entitled to benefits if the injury was caused by intoxication (being drunk) or being under the influence of controlled substances (illegal drugs and certain prescription medications). Employers and their insurers frequently use this language in an attempt to deny a claim. However, they bear the burden of proving the exemption, and there are often legal reasons why it doesn’t apply. For example, just being impaired is not enough for a claim to be denied. The employer and its insurer must show that the impairment caused the accident. It must also be shown that the drug or alcohol consumption was enough to “cause the employee to lose the normal control of his or her bodily or mental faculties, or both.”
  • You intentionally hurt yourself or you were trying to hurt someone else when you were injured. The Act also bars benefits when the injury was caused by the worker’s “willful intention to injure or kill himself or another.” The burden is on the employer and its insurer to prove this was the case in order to use this exemption. Your lawyer can investigate the circumstances and bring forth evidence that your injury was not caused by an intentional act to injure or kill yourself or someone else.
  • You lied about your health when you were hired. The Act allows a claim to be denied if the employer can prove that the injured worker “knowingly and willfully made a false representation as to the employee's physical condition” – in other words, knowingly lied about your health – during the hiring process, the employer relied on the false representations, those false representations were a “substantial factor” in the hiring process, and there was a causal connection between the false representations and the injury or occupational illness. While an employer or an insurer may raise this exemption in an attempt to deny your claim, there are many requirements that may not have been met. Your lawyer can investigate your case and point out any holes in your employer’s argument.
  • You failed to report the injury. Many claims are denied, not because they are invalid, but because the employer and its insurer argue that no proper report was made. The Workers’ Compensation Act has specific requirements for reporting a workplace accident or occupational injury, including deadlines. Whether you complied with these requirements is a question of fact, and the evidence may reveal that your employer’s argument is wrong. Even if you did in fact fail to comply with the requirements, there may be certain circumstances that could override the need for technical compliance. Your lawyer can review the circumstances and make applicable arguments.

Denied Workers’ Comp Claim? Our Lawyers Can Help

If your workers’ compensation claim has been denied, do not give up. Your employer and the insurance company do not have the final word on whether you are entitled to benefits. Let a qualified Raleigh workers’ compensation attorney review the facts in your case to determine whether you may have a strong case for appealing the denial.

Insurance companies are not in the business to protect injured workers. Insurers may do anything they can in order to protect their bottom line even if it means denying benefits to those that deserve them. Don’t let them get away with it. At Riddle & Brantley, our skilled attorneys have helped many injured workers go on to get the workers’ compensation benefits they need and deserve despite a claim that was initially rejected.