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Top reasons for workers comp denials

For injured workers in North Carolina, workers' compensation can offer a way to get the benefits they need to tide them over while coping with their injuries. Many depend on these benefits to get medical care and pay bills during times when their injuries or conditions limit their ability to work.

Learning the insurance company has denied your claim can be discouraging. Avoiding the following common pitfalls can increase your chances of getting benefits sooner rather than later.

Technical mistakes

When applying for workers' comp, you must follow all technical requirements carefully. Missing a deadline or failing to submit complete paperwork can result in denial. In particular, be sure to notify your employer about your injury or diagnosis as soon as possible. Having written confirmation of your notification can help you document its timeliness.

Injury unrelated to work

To qualify for workers' compensation, your injury or condition must relate to your work. Insurers deny claims when they believe the paperwork does not show this connection. This does not mean having to prove your employer was at fault or caused your injury. However, you do need to show an injury happened in the course of your work duties. If your injury happened while you were traveling or attending a company-sponsored recreational event, your situation may present some complex legal questions. 

Injury does not necessitate benefits

Insurers may also deny a claim or allow fewer benefits when they believe your injury or condition does not need further treatment or does not limit your ability to work. Getting proper medical attention and following your treatment plan is the best way to achieve optimal recovery. Doing so is also essential to ensure proper documentation of your medical situation.

Taking the next step

A denial does not have to be the end of the road. In many cases, filing an appeal can pave the road to obtaining the right benefits. The workers' comp appeals process has several steps, each with its own deadlines and paperwork requirements.

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