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Why was my workers’ compensation claim denied?

May 04, 2020

Were you injured at work? Did your work-related injury or illness keep you from your job for a few weeks? A lack of income for that amount of time can be scary, especially nowadays.

North Carolina workers’ compensation laws require employers to carry work comp insurance if they have three or more employees. If you sustain injuries on the job, workers’ compensation insurance is supposed to help cover your lost wages and medical treatment. However, not all claims are approved. Keep reading for common reasons why your workers’ compensation claim might be denied.

When can a claim become ineligible for compensation?

There are several situations that may set your claim up for denial:

  • You did not report your injury. Typically, you must report your injury to your employer as soon as you can after it happens. Waiting too long may cause a denial of your claim.
  • Your claim was not filed soon enough. North Carolina allows 30 days from the date of the injury to file a workers’ compensation claim.
  • You did not seek or receive medical treatment. To qualify for workers’ compensation benefits, you must receive medical treatment for your injury.
  • Your employer fights your worker’s compensation claim. You claim may see denial if your employer claims that the injury was not work-related.

While there are many other reasons you may not receive benefits, this list is an example of some common issues. Oftentimes, claims are denied because of a misunderstanding or a mistake. A clerical error or a missing medical record can make a big difference.

What can you do if you receive a denial letter?

If your claim was denied, you should appeal that decision. When you receive the notice of denial, it will have a section explaining your rights for filing an appeal. Don’t put it off, however. The time you have to file an appeal is short.

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