Asheville Workers Compensation Appeals Lawyer

We Can Appeal Your Benefit Denial

Workers’ compensation insurance provides an invaluable financial safety net for anyone who suffers an injury on the job in North Carolina. Unfortunately, many injured workers encounter unexpected challenges when it comes to collecting the benefits they need to recover. Some claims are denied unfairly and must be appealed. If you have experienced any such issues after a workplace injury, an Asheville workers’ compensation appeals lawyer can assist you.

Helping Injured Workers With Claim Appeals in Asheville, NC

If you have been injured on the job, you may have thought that your employer’s workers’ compensation insurance would take care of you. And it should. However, insurance companies are businesses, and their goal is profits not paying out on every claim. If your claim for workers’ comp benefits has been denied, you do not have to take that as the final word on the matter.

At Ganly & Ramer, P.L.L.C., our Asheville workers’ compensation appeal attorneys have decades of experience helping area workers who are injured, to secure the benefits that they deserve. Our firm has the only Asheville workers’ compensation attorney who is AV Preeminent* peer-review rated through Martindale-Hubbell.

Filing Your Workers’ Compensation Claim in Asheville

Workers’ compensation insurance works similarly to most other types of insurance, but a claimant’s employer will be involved in the process. Once you suffer any type of injury at work, you should report it to your employer immediately and request the materials you will need to file your claim. If your employer refuses to provide these materials or retaliates against you in any way, you need to consult a lawyer right away.

Most North Carolina employers will handle these claims in good faith, providing their injured workers with the forms they need to file their claims for benefits. As part of the claim filing process, you should expect to undergo a medical evaluation from a workers’ compensation doctor approved by your employer’s insurance carrier. This doctor will assign a disability rating that reflects the severity of your condition.

After completing these procedural requirements, you will be ready to file your claim. At this point, the insurance company will review all relevant documentation and the medical report from the workers’ compensation physician to determine your eligibility for benefits. They may contact you and/or your employer for more information as to how your injury happened. If they approve your claim, you should receive your first benefits check within a few weeks.

Benefits You Could Receive Through Workers’ Compensation Insurance

Workers’ compensation insurance serves two important purposes. First, it protects employers from civil liability for their injured workers’ damages, meaning you cannot sue a covered employer for an injury you suffered on the job. Second, it provides valuable financial assistance to an injured worker in the form of medical expense coverage and disability benefits during the time they are unable to work because of their injury.

The exact amount of benefits you could receive from a successful workers’ compensation claim will depend on your usual earning rate and the severity of your injury. Workers’ compensation benefits may continue for up to 500 weeks or until the claimant is able to return to work. However, severely injured claimants may qualify for extensions beyond the usual time limit or qualify for permanent disability benefits.

Ensuring Success With Your Workers’ Compensation Claim

The workers’ compensation claim process can be more complex than it initially appears, and there are a few things you can do to greatly increase your chances of success with the claim. The first is to hire an experienced attorney to help you navigate the claim filing process. You should report the injury to your supervisor immediately and obtain the forms you will need to file your claim. Your attorney can help you complete these forms and submit the claim in a timely manner.

Part of your claim filing process will be a medical evaluation, and you may not agree with the workers’ compensation doctor’s assessment of your injury. Your attorney can help you arrange for a second opinion if possible, and once you have fulfilled all the procedural requirements for your claim, you can submit it to the insurance carrier.

Having the right attorney on your side will not only make the claim filing process easier and more likely to yield a positive outcome but you will also be prepared to face an unexpected denial from the insurance company and/or unethical actions from your employer pertaining to your claim. The team at Ganly & Ramer, P.L.L.C., is prepared to help you address and overcome any such eventualities with your work injury case in Asheville.

Workers’ Compensation Claim Denials in Asheville

It’s possible for a workers’ compensation insurance carrier to deny a claim for several reasons. Some of the most commonly cited reasons for claim denials in the Asheville area include:

• Missing or incomplete claims forms. These errors can be easily corrected in most cases by providing the insurance company with the necessary information and/or corrections.
• Employment status disputes. Your employer could deny you access to the claim forms you need by claiming that your employment status does not qualify you for benefits. Some employers intentionally misclassify their employees to avoid paying for workers’ compensation insurance coverage for them, and your attorney can help you address any such disputes with your employer.
• Eligibility disputes. An insurance company may claim that you are ineligible for benefits due to causing your own injury, but they will only allege this if there is evidence showing you were under the influence of drugs or alcohol at the time your accident happened or that you intentionally failed to follow applicable workplace safety regulations.
• Insufficient harm. The insurance company may allege that your injury is not serious enough to impact your ability to work. They may also claim that you have a preexisting condition that is not covered by your employer’s policy. Your attorney can help you counter this with supporting documentation and medical reports.
• Scope of employment disputes. The insurance company may attempt to argue that the injury in question happened outside of the scope of your employment. For example, you cannot file a workers’ compensation claim for an injury you suffered on the way to or from work, but you would have grounds for a claim if you were injured while traveling for work.

Whatever reason the insurance company cites for denying your claim, you have a limited time in which to respond. It is crucial to connect with an experienced Asheville workers’ compensation appeals lawyer to have the greatest chance of success in navigating the complex appeals process.

Effective Representation In The Workers’ Compensation Appeals Process

A great number of workers’ comp claims that are denied, are denied for reasons that can be overcome at appeal. There may be sufficient medical evidence to support your claim. It may not have been presented properly in your initial application for benefits. We will investigate the medical evidence that is part of your case and create the most persuasive presentation of the facts possible.

We will present your appeal to the North Carolina Industrial Commission (NCIC) and, if necessary, to the North Carolina Court of Appeals and North Carolina Supreme Court. We are dedicated to securing results for our clients.

If you intend to appeal a denied workers’ compensation claim in Asheville, you must respond to the denial swiftly or you could lose your right to appeal the decision. Working with an experienced Asheville workers’ compensation appeals lawyer will help to ensure you meet the deadline. Once you submit your notice to appeal, the NCIC will schedule a mediation session between you, your employer, the insurance company, and a neutral mediator.

During mediation, you will have the opportunity to present your case and explain why you believe your claim was unfairly denied. The mediator will consider arguments, evidence, and testimony from all parties before delivering their recommendation to the NCIC.

The mediator may recommend that the NCIC reverses the claim denial. If so, this process is usually resolved relatively quickly. If they do not decide in your favor, you would then have the right to request a hearing with the NCIC appeals board. Your Asheville workers’ compensation appeals lawyer can help you prepare for this hearing and present the strongest possible arguments for overturning the claim denial.

This hearing will take place before three administrative law judges who will consider all arguments before decided to uphold or overturn the original denial. Your Asheville workers’ compensation appeals lawyer will be your most valuable asset when it comes to presenting the strongest case possible when appealing your denied claim.

Addressing Employer Retaliation in a Workers’ Compensation Case

While the appeals process applies when a workers’ compensation claim is denied by an insurance carrier, it is also possible for an employer to interfere with their injured employee’s claim filing process. Employers may worry about increased rates if too many employees file injury claims. When they retaliate against employees or fail to uphold their legal duties after injuries they can face severe penalties.

Your employer may attempt to claim that you are ineligible for workers’ compensation benefits due to the status of your employment or the nature of your injury. They may also claim that you caused your injury yourself and are therefore ineligible or that your injury resulted from a preexisting condition and therefore does not qualify for benefits. It is important to consult an experienced attorney immediately after any injury at work to help you resolve such issues.

What to Expect From Your Asheville Workers’ Compensation Appeals Lawyer

The workers’ compensation claim filing process may seem straightforward at first, but it is possible to encounter all types of issues that you will not know how to address on your own. The right attorney on your side means you can approach your claim filing process with confidence and that you will be prepared to address any unexpected challenges you encounter as you seek the benefits you deserve for your injury.

Ganly & Ramer, P.L.L.C. has successfully resolved many work injury cases for clients in Asheville and the surrounding communities of North Carolina. When you choose our firm to represent you in a workers’ compensation case, you can rest assured that we will be fully prepared to assist you in the event your claim is unfairly denied for any reason. We can help you resolve disputes with your employer and/or their insurance company and guide you through the appeals process.

Our goal in every workers’ compensation case we accept is to help our client maximize their recovery as quickly as possible after they have been injured in the workplace. You have a limited time in which to pursue your benefits, and if your claim is denied for any reason you must respond with your intent to appeal the decision as soon as possible. Whatever your case demands, you can trust our firm to guide you to a favorable outcome.

FAQs

Q: What Benefits Can I Receive From Workers’ Compensation Insurance?

A: The benefits you could receive from workers’ compensation insurance are likely to include medical expense coverage and disability benefits, the latter of which will vary based on the severity of your injury and the scope of long-term or permanent harm you have suffered. The exact value of your claim will vary based on multiple factors, and your attorney can help you maximize the total benefits you receive from a successful claim.

Q: Can I Be Fired While on Workers’ Compensation in Asheville?

A: Yes, you could be fired while on workers’ compensation in Asheville, but your injury cannot be the reason you are fired. Employers have broad flexibility to fire employees under at-will employment law, but they cannot fire employees for illegal reasons to retaliate against legally protected actions. If you believe a firing was wrongful in any way it is important to consult an attorney you can trust as soon as possible.

Q: Will Workers’ Compensation Cover Pain and Suffering?

A: No, workers’ compensation does not cover pain and suffering, even if you suffered an extremely painful and debilitating injury while performing your job duties. You can receive medical expense coverage and disability benefits to make up for your lost income, but you can only claim pain and suffering compensation through a personal injury suit if a third party outside of your work caused your injury.

Q: Do I Need a Lawyer to Appeal a Denied Workers’ Compensation Claim?

A: Having a lawyer assist you will make appealing a denied workers’ compensation claim much easier. Your attorney will help you navigate the complex appeals process and address all of the procedural requirements you may need to fulfill with the NCIC. Appealing any type of denied workers’ compensation claim may require extensive review of the initial claim and rebuttal of any disputes raised against you, and an attorney can make these processes much easier.

Q: Will I Get More Benefits if I Hire a Workers’ Compensation Lawyer

A: You are more likely to maximize your benefits if you hire a workers’ compensation lawyer to represent you. The right attorney can make the entire claim filing process easier and assist you with resolving any unexpected disputes you may not know how to address on your own. They can review your determination of benefits to ensure it is fair and help you explore any other available avenues of legal recourse you may have overlooked on your own.

Contact Us Today To Get Started

When you have been injured on the job, do not hesitate to secure the representation of a firm that has dedicated itself for decades to the goal of helping injured workers. At Ganly & Ramer, P.L.L.C., we are here for you. Call 828-844-5274 or simply contact us online to schedule your free initial consultation with our experienced workers’ compensation lawyer.