What to Do If Your Workers’ Comp Claim Is Denied in North Carolina

Getting a denial letter after a workplace injury feels like a punch to the gut. You have done your part, worked hard for your employer, and now that you are sidelined by an injury, the insurance company is saying “no.” In our experience serving the Sandhills and Randolph County, we see this happen to good, hardworking people every day.

If you are wondering what to do if your workers’ comp claim is denied in North Carolina, the most important thing to know is that a denial is not the end of the road. It is often just the beginning of a formal legal process designed to protect your rights.

Our team at Rowland & Yauger grew up right here in Moore County. Before we ever stepped foot in a law school classroom, we were working blue-collar jobs just like yours. We know how much is on the line when your paycheck stops, but the bills don’t.

Understanding the Form 61 Denial.

In North Carolina, when an insurance carrier or employer denies your claim, they must file a specific document called Form 61 (Denial of Workers’ Compensation Claim). Under N.C. Gen. Stat. § 97-18(c), the employer or carrier must provide a detailed statement of the grounds for denying your claim.

Common reasons we see for denials in Carthage and Asheboro include:

• The injury did not occur by “accident” as defined by state law.
• The injury did not “arise out of and in the course of” your employment.
• You failed to provide written notice to your employer within 30 days.
• The insurance company claims your condition is pre-existing rather than work-related.

The First Step: Filing Form 33 for a Hearing.

If you receive a Form 61 and disagree with the reasons provided, you have the right to challenge that decision. To start the formal appeal process, you must file Form 33 (Request That Claim Be Assigned for Hearing) with the North Carolina Industrial Commission.

According to N.C. Gen. Stat. § 97-24, the right to compensation is barred unless a claim is filed with the Commission within two years from the date of the accident. If you miss this window, you could lose your right to benefits forever. Filing Form 33 moves your case out of the insurance company’s hands and puts it in front of the Industrial Commission for a neutral review.

Mandatory Mediation in North Carolina.

Before you ever see a judge, North Carolina law typically requires you to attend a mediated settlement conference. This is a meeting where both sides meet with a neutral third party, a mediator. The goal is to see if the case can be resolved without a formal hearing.

Under N.C. Gen. Stat. § 97-80(c), the Commission may order parties to participate in mediation. This is often a good opportunity to settle your claim, but we never recommend going into these meetings without a clear understanding of what your case is worth.

At Rowland & Yauger, we have spent decades sitting at these tables, making sure our neighbors are treated fairly by big insurance companies.

The Formal Hearing Before a Deputy Commissioner.

If mediation does not result in an agreement, your case will proceed to a formal hearing. This is like a trial, but it is held before a Deputy Commissioner rather than a jury.

During this hearing, we present evidence to prove your claim is compensable. This often includes:

1. Your Testimony: You will explain how the injury happened and how it affects your life.
2. Medical Evidence: Records and testimony from your doctors are vital. Under N.C. Gen. Stat. § 97-84, the Deputy Commissioner will make findings of fact and rulings of law based on the evidence presented.
3. Witness Statements: Co-workers or supervisors who saw the accident may also be called to testify.

If the Deputy Commissioner rules against you, you are still not out of options. You can appeal against the decision to the Full Commission, which is a three-judge panel that reviews the record of your case. Under N.C. Gen. Stat. § 97-85: An application for review must be made to the Commission within 15 days from the date on which notice of the award was given. If necessary, cases can even be appealed further to the North Carolina Court of Appeals.

Why Local Connection Matters in Your Claim.

We aren’t just lawyers who handle cases in Moore and Randolph Counties; we are your neighbors. We grew up here, and we understand the types of jobs that keep our local economy moving, from manufacturing and construction to agriculture and healthcare. When we talk about your “job site,” there is a good chance we have been there or worked a job just like it.

We have helped over 60,000 clients over the last 25 years. With more than 650 five-star reviews across our Carthage and Asheboro offices, we take pride in being a firm that people can talk to plainly. We don’t use fancy “legalese” to confuse you; we use the law to protect you.

Contact Rowland & Yauger, Attorneys & Counselors at Law.

No matter what kind of legal matter you or your family may be facing, trying to get through it on your own is a dangerous decision. Even minor issues can have significant consequences for years to come.

We are trial-tested attorneys who spend a great deal of time in courts throughout central North Carolina. With offices in Carthage and Asheboro, we serve residents throughout the Sandhills, including Pinehurst, Aberdeen, and Southern Pines.

We regularly appear on behalf of clients in courts in Moore and Randolph Counties, as well as many surrounding counties. Whenever possible, we negotiate agreements in personal injury and workers’ comp cases without going to court. Still, we never cut corners and will not settle for agreements that are not in our clients’ best interests.

If your workers’ comp claim was denied, call us today at 910-621-2991 (Carthage) or 336-537-5547 (Asheboro) for a consultation.