In this article, you can discover:
- The timeline for a workers’ compensation claim to process
- The actions and steps required for a workers’ compensation claim to process
- How to appeal a denied workers’ compensation claim
The claims process for workers’ compensation claims in the State of North Carolina has many different steps. Most people don’t know about workers’ compensation laws, so it’s best to speak with a workers’ compensation attorney. Doing so will assist with meeting the required timeline and taking all the correct actions.
Anytime an injury happens at work, the individual or their attorney can file a claim for workers’ compensation benefits with the North Carolina Industrial Commission. The North Carolina Industrial Commission is the state agency that oversees and assists with the administration for all work-related injuries within the state.
When a claim for a benefit is filed with the Industrial Commission, the Industrial Commission’s first step is to reach out to the employer and their workers’ compensation insurance company by writing a letter. This letter will require the employer and/or their workers’ compensation insurance company to issue a response to the Industrial Commission either accepting or denying liability for the work-related injury. If you’re denied benefits, you still have options. For example, you can employ a workers’ compensation attorney and request a formal hearing in front of one of the North Carolina Industrial Commission judges.
The workers’ compensation system has two types of judges: Deputy Commissioners and Commissioners. Deputy Commissioners will preside over cases at the initial hearing phase of a claim. Commissioners will preside over cases at the appeals phase of a claim.
A hearing request is the first step in appealing a benefits denial. The next step after a hearing is requested is an Order for the parties to participate in a mediation. Once the Deputy Commissioner orders mediation, the Deputy Commissioner will allow 120 days for the parties to conduct a mediation. Mediation is a meeting where the parties can try to resolve any issues without going through the hearing process. Part of the purpose for the mediation process is to limit the number of cases that Deputy Commissioners must address for hearing. Deputy Commissioners understand that, in some cases, the parties can resolve their issues without the need for a hearing. Doing so saves the Deputy Commissioner time and effort in conducting a hearing. Even in instances where the parties cannot resolve the issues at mediation, the mediation process is still helpful by allowing the Deputy Commissioner to understand the parties have at least tried to resolve the issues prior to a hearing.
Suppose the parties cannot resolve all the issues in the claim at a mediation. In that case, the Deputy Commissioner sets a formal hearing for a date approximately two months following the mediation date.
The hearing is where the injured employee and any witnesses they have can testify. The hearing also allows the employer and workers’ compensation insurance company to offer any witnesses they wish to testify about the case. However, none of the treating physicians will offer any testimony at the hearing. The Deputy Commissioner instead will order that the parties obtain any medical testimony via deposition within sixty days following the hearing date. At a deposition, the attorneys representing each side can ask the treating physician questions. Further, a court reporter will be present and transcribe the testimony. The transcript for the deposition is then sent to the Deputy Commissioner.
Once all the evidence has been presented to the Deputy Commissioner, the Deputy Commissioner will allow 30 days for each side to write their written arguments or contentions. These written arguments enable the parties to address any testimony at the hearing, testimony from the treating physicians via deposition, and any other documents entered into evidence at the hearing. Once the Deputy Commissioner receives the written arguments or contentions, the Deputy Commissioner, at that point, then has up to 6 months to issue a decision.
For individuals denied benefits it is essential to start the hearing process with a workers’ compensation attorney as soon as possible, as the entire hearing process can take up to a year before a final decision to be made by the Deputy Commissioner. The main emphasis in starting the hearing process as soon as possible is to assure what’s already a lengthy process is not delayed further. Once the Deputy Commissioner issues a decision via a formal hearing, the decision can be appealed to the Full Commission. These appeals are heard before a panel of three Commissioners.
When an appeal is filed, the Industrial Commission will first create a transcript of all the relevant evidence. They will incorporate all the testimony provided at the hearing, any documents entered into evidence at the hearing and the doctors’ depositions into one record.
The appealing party will be given the opportunity to submit written arguments as to why the initial decision should be changed. Once that’s provided to the Full Commission, the party who prevailed at the initial hearing before the Deputy Commissioner is given the opportunity to write their written arguments as to why the initial decision should be upheld. After reviewing these written arguments, the Full Commission will schedule a date for oral arguments.
The date of oral arguments allows the attorneys to appear before a panel of three Commissioners. These oral arguments allow 20 minutes for each the attorney to explain their positions further and answer any questions the Commissioners may have about their written arguments. Once oral arguments are conducted (typically within approximately three to four months), the Full Commission will issue a decision.
The North Carolina Court of Appeals is the only court that can hear an appeal from a decision of the Full Commission. However, the Full Commission’s decision can only be changed or remanded back to the Full Commission for a new decision by the North Carolina Court of Appeals if the Full Commission’s decision was based on a misapplication of the law or if the noted facts on which the Full Commission’s decision was based were not part of the evidence presented to the Industrial Commission. For more information on Workers Compensation Claims Process In NC, an initial consultation is your next best step.