Been denied workers comp by employers insurance carrior because they say I was not hurt at work. How can this be?

Asked about 1 year ago - Concord, NC

I was hurt on the job 3 months ago. Herniated 2 discs in lower back and have had sciatica the past 2 months. I have had to get all my treatment from my own insurance because of comp was denied. comp insurance says that my injury did not happen at work, BUT I have 2 letters from my employer saying I'm not working there anymore because I did get hurt at work, but didn't report it in a timely manner. How is it I can get messed over this bad? How can they have it both ways? I makes no sense. I have a mediation set for 4 weeks from now and can't understand how this could happen. Under my own insurance I had an MRI done and it showed the herniations.I just had my first epidural injection last week and feel a lot better. Hope this is all I need. Not sure what is next if claim is delayed more.

Attorney answers (8)

  1. John M. McCabe

    Pro

    Contributor Level 12

    7

    Lawyers agree

    Answered . You should immediate retain a qualified workers comp attorney. While I would need to know more about the specifics of your case, back injury cases are usually easy to establish. You need to contest the denial. Continue using your own health insurance in the meantime.

  2. Bobby L. Bollinger Jr.

    Pro

    Contributor Level 17

    7

    Lawyers agree

    Answered . Happens all the time. Hopefully you have a good workers' comp lawyer going to the mediation with you. If not, you should get one.

    This answer is intended as general information and not as specific legal advice. If you want to have a free... more
  3. Damon Terry Duncan

    Contributor Level 11

    6

    Lawyers agree

    Answered . From: Damon Duncan, Workers' Comp Attorney with offices in Charlotte, Greensboro & Winston-Salem, NC

    I agree with John. You need to hire an experienced workers' compensation attorney ASAP because they can help you with the insurance company and can work to get your claim possibly accepted.

  4. Kevin B. Bunn

    Pro

    Contributor Level 7

    5

    Lawyers agree

    Answered . It's the insurance company's intent to pay as little as possible. You need help.

  5. Martha L. Ramsay

    Pro

    Contributor Level 8

    4

    Lawyers agree

    Answered . What an unfortunate welcome to the workers’ compensation world! I have seen workers’ compensation carriers deny claims because of an alleged failure to timely report the injury. The Workers’ Compensation Act does require than an employee provide written notice of their injury within 30 days. However, the courts have held that if the employer had actual knowledge of the injury, no written notice is required. The timing of when you told your employer will be an important factor in your case.

    You say that you have a mediation coming up- that should mean that a request for a hearing has been filed. The mediation is a way to resolve the claim without a ruling from a judge. If you do not resolve your case at mediation, you have the right to ask the judge to order the Defendants to pay for your medical care, lost time from work and permanent injury. I urge you to consult with an attorney who is a Workers’ Compensation specialist- so they can advise you on how best to pursue your case and how cases like yours are valued. Good luck!

    Martha Ramsay is a North Carolina attorney. As such, her responses to posted inquiries, such as the one above,... more
  6. John M Connell

    Pro

    Contributor Level 19

    5

    Lawyers agree

    Answered . You need to get workers compensation attorney. This will go nowhere if you don't because they will never agree with you.

  7. Karen Dena Steinitz

    Contributor Level 10

    4

    Lawyers agree

    Answered . If your injury was not reported right away, it is not uncommon for the insurance to deny it. The judge will ultimately make a decision based on many factors: (1) were there witnesses (2) how long did it take to report? (3) why didn't you report it right away, did you first think it was a minor incident (4) when you did report it, who did you tell? (5) was a report taken? (6) how soon did you get medical treatment? (6) it's good if you reported to your doctors that the claim was work related. The list goes on and on.

    I agree with the others that you should find an attorney. At the hearing, the Judge will hear your side of the story. Judges often find in favor of the injured worker. They denied it this way because they agree it happened, but question if it happened while you were at work. That is what it sounds like from the 2 letters you described. In this case, the judge will make a decision. If he finds you believeable, he will reverse the denial.

    If claim was delayed, as you also indicated, the employer may still be investigating, ie talking to your managers and co workers.

  8. Richard L. Huffman Jr.

    Pro

    Contributor Level 10

    1

    Lawyer agrees

    Answered . DO NOT GO TO A MEDIATION WITHOUT AN ATTORNEY! It will not go well for you. The next step after mediation is an actual hearing on your claim. Again do not go to the hearing without an attorney. Your odds of success are greatly diminished if you do not have an attorney. Some people do not hire an attorney because they do not want to pay a percentage of their claim with an attorney. However, receiving 75% of good settlement or judgment is a whole lot better than receiving 100% of nothing.
    It is common for insurance companies to deny cases. They do not make money by paying claims. A delay in notifying your employer is a common reason for a denial. People can hurt their backs anywhere and in an infinite number of ways. The insurance company will try to argue that you did not hurt your back at work but rather hurt it off the job.
    I hope the epidural helps. My experience is that they generally provide only short term relief.
    You potentially have a serious injury. The decisions you make now could affect the rest of your life. You will not be surprised that my advice is to hire a lawyer.
    Good luck.

    I am licensed to practice law only in North Carolina. My answer provides only general information. Do not rely on... more

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