The Workers' Compensation claim appeal process sometimes can be complicated. A Workers' Comp attorney in Dunn, NC can walk you through the process, so you know what to expect.
Overview of the Workers' Compensation Claim Appeal Process
Once the insurer or employer has denied a claim, a notice (Form 61) for the reason of denial must be sent out to all involved parties. This may include the claimant, hired legal representation, healthcare providers and the Commission.
The reasons for denying the claim must be specific. If a claimant believes the findings are wrong, a hearing can be requested. To keep the claim process moving, a lawyer can offer more manpower in terms of locating information with which to refute a denial of a claim.
Form 33 will need to be completed and submitted to the Industrial Commission, which oversees these types of claims. The good news for workers is that they cannot be billed for medical expenses until a final decision has been made as to whether or not it’s a legitimate claim.
Before the hearing, you will be required to submit all of your evidence. Similar to a personal injury trial, both sides are allowed to request depositions. Other types of investigative work may be done to prepare for the hearing.
Unlike a traditional hearing, arguments for both sides aren’t given. Instead, all of the evidence is submitted and considered. However, all parties involved will be required to provide testimony under oath.
It can take anywhere from a month to six months for a decision to be reached. If the answer isn’t favorable, either side may appeal.
The Workers' Compensation claim appeal process at this point doesn’t allow for new evidence to be submitted. Instead, written arguments will be considered.
Unfortunately, it is very difficult to appeal a hearing decision successfully. Of course, all of this could potentially be avoided by securing legal representation from the start.
Reasons a Workers' Compensation Claim Could Be Denied
It’s important to know some of the reasons that claims are denied, so that it isn’t necessary to go through the Workers' Compensation claim appeal process. Of course, one of the big factors is not having legal counsel.
But one reason a claim could be denied is failure to notify the employer of an illness or injury promptly. You have 30 days in which to submit a written notice about the illness or injury. The best thing to do is let the employer know about it as soon as possible.
Another reason for a denied claim is not being specific about the injuries. It’s important that the cause of the accident is explained, along with the diagnosis and prognosis.
Exaggerating is another possible cause for a claim to be denied. Be truthful about the nature of your injuries, and your claim won’t stalled because of unnecessary investigations into your purported stories.
It’s important you consider seeking legal help from a Workers' Comp attorney in Dunn, NC if you were injured at work. It will be even more critical if your claim is denied and you have to go through the Workers' Compensation claim appeal process.