North Carolina’s workers’ compensation system is a no-fault system, just like the workers’ comp systems of other states. However, that does not mean that if you sustain an injury at work you will automatically receive compensation. The workers’ compensation board may have several reasons for denying your claim. If you hope to appeal the decision, it is crucial that you understand the various reasons for a denial so you can successfully appeal it. FindLaw explains when an insurance company may deny workers’ comp benefits.
Before you go through the process of filing an appeal, you should first make sure that you meet the eligibility requirements for benefits. For instance, if you injured yourself while away from work or while engaging in horseplay, you are ineligible for benefits. However, if you believe that your injury is legitimately work-related and that you sustained it while engaging work-related activities, look to additional common reasons for denial.
One common reason insurance companies deny workers’ comp claims is because workers fail to report their injuries on time. If you do not report your injury within the timeframe specified by North Carolina law, you may have unwittingly forfeited your rights to benefits. The same is true if you do not file your claim on time. Most states give workers between 30 and 90 days to file their claims.
The insurance company may have denied your claim if your employer disputes it. Employers dispute claims for several reasons, but the most common cause is because an employer believes an injury was the result of horseplay or that it occurred outside of work.
If your injury is not compensable, you may not qualify for benefits. For example, many states do not compensate stress-related injuries, as they are tough to prove.
If you failed to receive medical treatment for your injury, it is unlikely you will qualify for benefits. Finally, if there is insufficient evidence that your injury took place at work, you may have difficulty recovering compensation.
You should not use this article as legal advice. It is for educational purposes only.