Workers’ compensation is a system of exchange where employees agree not to sue their employer for work-related injuries and illnesses, and in exchange, medical care and other associated costs are covered by the employer’s workers’ comp insurance. Unfortunately, it is all too common for the employer or the insurance company to deny compensation claims or reduce the benefit amount. An experienced Winston-Salem workers’ compensation lawyer can help you in many of these situations.
When Your Employer Does Not Have Workers’ Comp Insurance
North Carolina law requires that all businesses with three or more employees must either have workers’ compensation insurance or be self-insured. There are exceptions, such as domestic or household workers, some railroad employees, farm workers and some types of agricultural workers. However, many of these exceptions also have exceptions. For example, regardless of how many employees are involved, any work that involves radiation must be insured, and even if workers are classed as independent contractors, they may be considered employees as far as workers’ compensation is concerned.
If your employer claims not to have workers’ comp insurance, you should seek legal help; you may be able to prove that they are in violation of state law or claim some benefits from the state’s compensation fund.
When Your Eligibility Is in Question
Some situations and injuries are not clearly defined as work-related or not. If the injury or illness occurred during a company-sponsored event, on company property, during work-related travel or in the course of doing something that benefits your employer, you may be eligible for workers’ compensation benefits. If the illness or injury is due to a pre-existing condition, you may still be eligible if it can be proven that your work activities or environment made it worse or caused it to reoccur.
The eligibility of any given situation is rarely as clear-cut as insurance carriers and employers would like it to be, so if you are denied compensation due to ineligibility, you should seek legal advice.
When Your Claim Has Been Denied
If you have submitted a workers’ compensation claim and your claim has been denied, you may still have a case. Many claims are denied for procedural reasons such as time limits or filing errors, and others because the employer disputes the facts of the accident or injury. While not every carrier or employer will behave this way, the fact remains that there are many incentives to deny workers’ comp claims, most having to do with liability and changing insurance costs.
It can be incredibly disheartening to receive a claim denial, but North Carolina state law requires that the denial must be accompanied by, at minimum, a form outlining the insurance carrier’s reasons for denying your claim. In addition, many denials come with a letter providing further details about the reasoning. This gives you a good place to start; bring the form or letter with you, along with any other documentation relating to your case, when you go to speak with a workers’ compensation lawyer. It is likely that you can request a hearing or file an appeal.
If you have been injured on the job in Winston-Salem, if you are filing a workers’ compensation claim, if your claim has been denied or if you are considering an appeal, contact Lewis & Keller today. We can assess your case, and walk you through your options and your next steps.