Health Care

When Are Workers’ Compensation Injuries Not Compensable

Workers' Injury Compensation Claims

When Are Workers’ Compensation Injuries Not Compensable

Suffering a workplace injury does not mean there will be a compensable claim. In fact, many Workers’ Compensation claims are denied by employers’ insurance carriers. These claims are denied for various reasons. It is important to keep in mind that insurance companies do not have the final say over the compensability of claims. Ultimately, it is the North Carolina Industrial Commission that determines whether claims brought by injured workers are compensable.

Finding an experienced Workers’ Comp attorney early in a claim can make the difference between claims being denied or being found compensable. How claims are reported to the employer, insurance company, and medical providers may go a long way in determining whether a claim will be accepted or denied. Attorneys can help with filing all the necessary forms in addition to supporting the injured worker during the claim’s investigation and early medical treatment. If the claim is denied, a strong advocate before the Industrial Commission is an injured worker’s best bet to convince the Industrial Commission that the claim should be compensable.

What are the Common Causes of Non-Compensable Claims?

Some common reasons claims are found not compensable include:

  • The injured worker fails to file a claim within two years. Injured workers are required to file a notice of their injury to the Industrial Commission within two years from the date of injury. Failing to do so will prevent any benefits.
  • The injured worker is unable to prove that their injury was caused by the workplace accident. If the injured worker alleges a back injury, they must show their need for additional treatment is related to their workplace injury. Insurance companies and employers will argue that the medical treatment the injured worker needs were caused by a previous medical condition in some instances. For example, if the insurance company and employer can show that the injured worker was already in pain management for back pain, then they can argue that any treatment recommendations were related to the preexisting condition. The injured worker is required to show that the need for additional medical treatment is related to his or her workplace injury.
  • The injured worker did not suffer an injury by accident. In addition to back claims, the injured worker must show that their injury was the result of an injury by accident. An accident is often defined as an unlooked-for event. Claims are not compensable if they are part of the injured worker’s normal work routine. There does not need to be an accident for back claims, but there must still be a specific traumatic incident.
  • The injured worker is not credible. If the Industrial Commission finds that the injured worker is not credible, the regulatory body has the right to deny the claim. The credibility of injured workers are damaged when they are inconsistent while reporting the events surrounding their accidents to their employers, medical providers, and to the North Carolina Industrial Commission.

Experienced Attorneys at Cardinal Law Partners Can Help

If you have questions about your Workers’ Compensation claim, call Cardinal Law Partners. We have handled workers’ compensation claims similar to yours before. We work hard to get our clients the benefits they deserve as quickly as possible. Call us at 833-444-4257.