Accepted Claims and Denied Claims

by Josh Levy 12. June 2011 23:06

Upon notice of a workers’ compensation claim, the insurance carrier and employer must decide whether to “accept” the claim and make it compensable, or “deny” the claim and not immediately pay benefits under the North Carolina Workers’ Compensation Act.  The choice between accepted claims and denied claims applied to injury by accident claims and occupational disease claims.

If the claim is accepted, the insurance carrier and employer have the right to direct medical treatment.  This means that you are required to go to the doctors and other medical professional chosen by the insurance company.  Generally, you are required to comply with the instructions and medical treatment of the insurance company’s doctors.

Additionally, if the claim is accepted, the insurance company is required to pay monetary benefits to you.  These benefits can be up to two-thirds (2/3) of your average weekly wage if you are out of work, or two-thirds of the time that you miss from work.  These monetary benefits do not begin until you miss seven days from work.  If you miss twenty-one or more days, the insurance company is required to retroactively pay you benefits for the first seven days of work missed.

If the claim is denied, the insurance company and employer will not pay you any monetary benefits, or pay for the cost of any medical treatment.  If you are unable to work following a denied claim, you may not receive any monetary benefits until the matter is heard by the North Carolina Industrial Commission, or the claim is resolved through a settlement.  However, you have the right to direct your own medical treatment as long as you can pay for it yourself or through insurance coverage.

Levy Law Offices represents individuals in accepted claims and denied claims.  If you have been injured on the job,  please contact Josh Levy at Levy Law Offices to schedule an appointment via telephone at (919) 846-0125 or via e-mail at josh.levy@jnl-law.com.

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