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15 Things People Want to Know When Appealing a Denied Workers’ Comp Claim

Law6_07032014So the workers' compensation insurance company denied your claim for benefits for a work related injury.

The only way an insurance company can be made to pay benefits to an injured worker is to secure an order from the Industrial Commission requiring payments be made to you.

 

  1. How can I get the Industrial Commission to make my insurance company pay?

Your attorney will need to request a hearing by filing a Form 33. Your attorney will then have to prove you should receive benefits at a hearing before the Industrial Commission.

If the Industrial Commission agrees with your position, then it will issue an order requiring the insurance company to pay you benefits.

 

  1. Do I have to hire an attorney in order to obtain a hearing before the Industrial Commission?

No, you do not necessarily have to hire an attorney. However, your employer and the insurance company will likely be represented by a highly-skilled attorney who will fight to prevent you from receiving benefits.

 

  1. How long will it take to have my claim set for hearing?

Before a hearing is set for your case, the Industrial Commission will require you and your attorney to meet with representatives of the insurance company and their attorney in order to see if you and the insurance company can agree to settle this matter - usually for a lump sum cash settlement.

This meeting or mediation takes place usually within 60 to 90 days after you have hired an attorney. If a settlement can't be reached between you and the insurance company, then the Industrial Commission will set up a hearing/trial within two months of the mediation date.

 

  1. Will my claim be heard by a judge or a jury?

Your claim will be heard and decided by 1 of 20 judges who hear cases across the state of North Carolina. There is no jury trial like you see on "Matlock" or "The Good Wife."

The judge will swear you in as a witness and your attorney will ask you questions about the circumstances that resulted in your injury, or any other matters that you have in dispute with regard to your claim. Your employer's attorney will be able to cross-examine you at this hearing. Both you and your employer can present witnesses to support each side's position in the case.

 

  1. Where will my hearing take place?

Your hearing will be set at one of five locations closest to where you and/or your employer is located. The hearing location could require up to a two hour drive for you and your witnesses to attend.

 

  1. How long does a hearing last?

A hearing typically lasts less than 4 hours. If the hearing is estimated to last more than 4 hours, the Industrial Commission will specially set it before one of three judges designated to hear lengthy cases.

 

  1. How long does it take the judge hearing my case to decide whether I win or lose?

Unlike "Judge Judy", the judge who hears your case will not render a decision on the day you testify. It will usually be months before a decision is made by the judge.

Usually you and your employer will want doctors who have examined you or reviewed your medical records to testify. To try to build a strong case, you will need a doctor who treated you to give an opinion that the injury was likely caused by the work-related accident or incident you reported. You may also need to have a doctor testify about your ability to return to work for your employer as well as what treatment you need.

Doctors are not required to attend a hearing and neither are any other witnesses. The judge hearing your case will typically issue an order giving you and your employer 60 days after the hearing to go to each doctor's office and record the doctor's testimony. Both your attorney and your employer's attorney will likely ask questions of the doctor who treated you. The doctor's testimony is then transcribed and a copy is sent to the judge who will read the testimony of each doctor.

 

  1. Who pays to have the testimony of each doctor recorded and transcribed?

The employer will be required to pay for the cost of recording and transcribing of up to two doctors solely selected by you. If you have seen multiple doctors, then you may be required to pay the costs of additional doctors you want to testify. The taking of the testimony of a doctor is called a deposition. Depositions can cost in excess of $1000.

 

  1. How soon does the judge decide whether I win or lose after he or she receives copies of the doctors' depositions?

The judge will issue an order giving your attorney and your employer's attorney 30 days to send the judge a written copy of each side's argument as to why the judge should rule for or against you.

 

  1. So it will take 2-3 months to try to settle the case. Then another 2 months to have my case set for hearing (if I don't settle). Then 2 months to get the testimony of the doctors and 1 month for the attorneys to send the judge written arguments. I've waited a long time - how soon will the judge decide whether I win or lose after receiving the written arguments?

The judge has up to 3 months to decide the case after receiving the written arguments. The judge will write an Opinion and Award and will mail copies to your attorney and your employer's attorney.

 

  1. If I win, how soon can I expect to receive monetary benefits the judge ordered the insurance company to pay?

Typically, the insurance company will not pay the amount ordered by the judge if it loses the case. They will then appeal the judge's decision to the Full Commission.

 

  1. If I lose, do I have a right to appeal the decision?

Yes.

 

  1. What is the Full Commission?

They are six appellate judges appointed by the Governor. They sit in groups of three judges hearing the appeal of the cases that were heard by the 20 trial judges. If two of the judges disagree with the decision made by the judge that heard your case, then the decision is overturned.

 

  1. Will I be able to testify before the three Full Commission judges who will decide whether the trial judge's decision in my case should be upheld or overturned?

No. When you and other witnesses testify before the trial judge, a recording is made of the testimony. If your case is appealed, a written copy of that recorded testimony is made and sent to the Full Commission. The Full Commission judges read the testimony and decide whether you win or lose.

Even if the judge who saw you face to face believes you, the Full Commission judges can reverse that judge's decision because they don't believe you based upon the written testimony they have read. Your attorney and the insurance company's attorney will be given 20 minutes to argue in front of the 3 judges at the Full Commission as to whether the decision by the trial judge who heard your case should be upheld or overturned. This hearing takes place in Raleigh at the Industrial Commission.

 

  1. How long afterwards will I know whether I have won or lost my case after it is appealed to the Full Commission?

It takes 2-3 months for the Full Commission to set the 40 minute hearing for your attorney and the insurance company's attorney to attend. Both sides are given time to submit written arguments on their positions as to how the judges should decide the outcome of the case. The Full Commission takes between 3 and 6 months to render their decision after the 40 minute hearing.

 

Read this if you've been denied benefits:

If you've been denied benefits, you could be in for a long ride, and we highly recommend you do not try to present your case in front of the Industrial Commission on your own.

Most workers' compensation attorneys work on a contingency fee basis - meaning they will only take an attorney's fee out of your final settlement, so you have no upfront costs.

At our firm, we have several NC Board Certified Workers' Compensation Specialists and two former Industrial Commissioners.  Click here to tell us about your case and get a free case evaluation. Or call us at 1-866-900-7078.

 

Contact Information

Raleigh Law Office

4325 Lake Boone Trail, Suite 100
Raleigh, NC 27607
Phone: 919-834-1184
Toll Free: 1-866-900-7078

Durham Law Office

280 South Mangum Street, Suite 400
Durham, NC 27701
Phone: 919-688-4991
Fax: 800-716-7881

Fayetteville Law Office

517 Owen Drive
Fayetteville, NC 28304
Phone: 910-488-0611
Toll Free: 1-866-900-7078

Charlotte Law Office

1001 Morehead Square Drive, Suite 350
Charlotte, NC 28203
Phone: 704-599-1078
Toll Free: 1-866-900-7078

New Bern Law Office

1505 South Glenburnie Rd, Unit P
New Bern, NC 28562
Phone: 252-634-9010
Toll Free: 1-866-780-3422

Greenville Law Office

702 G Cromwell Dr.
Greenville, NC 27858
Phone: 252-355-5205
Toll Free: 1-866-780-3227

Greensboro Law Office

300 N. Greene Street, Suite 850
Greensboro, North Carolina 27401
Phone: 336-665-7072
Toll Free: 1-866-900-7078

Goldsboro Law Office

214 South William Street, Suite 3
Goldsboro, NC 27530
Phone: (919)-731-2581
Toll Free: 1-866-900-7078

Henderson Law Office

514 Dabney Drive, Suite 200
Henderson, NC 27536
Phone: 252-492-4600
Toll Free: 1-866-900-7078

Roanoke Rapids Law Office

709 Julian R. Allsbrook Highway
Roanoke Rapids, NC 27870
Phone: 252-537-9670
Toll Free: 1-866-900-7078

Rocky Mount Law Office

3202 Sunset Avenue, Suite B
Rocky Mount, NC 27804
Phone: 252-937-4730
Toll Free: 1-866-900-7078

Sanford Law Office

703-B South Horner Boulevard
Sanford, NC 27330
Phone: 919-775-1564
Toll Free: 1-866-900-7078

Wilson Law Office

2315 Airport Blvd Suite A
Wilson, North Carolina 27896
Phone: 252-246-9090
Toll Free: 1-866-900-7078

Winston-Salem Law Office

301 N. Main Street, Suite 2409-C
Winston-Salem, NC 27101
Toll Free: 1-866-900-7078