• 18 Nov 2025

What to Do If Your Workers’ Compensation Claim Is Denied

Having your workers’ compensation claim denied can feel overwhelming, especially when you are recovering from a workplace injury, facing medical bills, and uncertain about how to move forward. In North Carolina you have options. This page explains the denial process, your appeal rights, your chances of winning a workers’ comp appeal, and whether you can sue your employer. At Paul Robinson Law we help clients in Raleigh, Cary, Durham, and the surrounding Triangle area navigate these challenges and protect their rights.

Why Was My Workers’ Comp Claim Denied?

Before you can respond, it is crucial to understand why your claim was denied. Common reasons include:

• Failure to report the injury promptly (under N.C. Gen. Stat. § 97‑22)
• Insufficient medical documentation linking the injury or illness to work duties
• Insurer or employer contests whether your job duties caused the injury
• Claim denied based on intoxication, horseplay, or pre‑existing condition
• Paperwork or procedural errors (such as incorrect or incomplete forms)

These reasons are frequently cited in denial letters and must be addressed in any appeal.

Immediate Steps You Should Take If Your Claim Is Denied

Review the denial letter carefully. Confirm exactly what reason the insurer or employer gave for denying your claim. It will often reference specific grounds. 

Preserve all records. Keep the denial letter, medical records, wage statements, witness statements, emails/texts about the injury, and employer safety reports.

Seek legal advice early. A workers’ comp denial case can turn into a formal hearing. Having an attorney early often improves your chances.

Consider your appeal timeline. Although the exact deadline may vary, you will need to act promptly, filing a formal hearing request (Form 33) is the first major step.

How Do You Appeal a Workers’ Compensation Denial in North Carolina?

Step One: File Form 33 - Request That Claim Be Assigned for Hearing

To make an appeal, you must file Form 33, “Request That Claim Be Assigned for Hearing” with the North Carolina Industrial Commission (NCIC). Filing the form initiates the formal appeal process, which typically begins with mediation.

Step Two: Attend Mediation

Often the next step is mediation, an informal conference between you, the employer/insurer, and a mediator to try to resolve the dispute without a full hearing.

Step Three: Prepare for and Attend the Formal Hearing

If mediation does not resolve the issue, a hearing before a Deputy Commissioner of the NCIC will take place. You’ll present evidence, doctors may testify, and you’ll have to show work‑relatedness, timely reporting, and causation.

Step Four: Further Appeals if Needed

If the hearing decision is adverse, you may appeal to:

• The Full Commission (three‑judge panel)
• The North Carolina Court of Appeals
• (In rare cases) the North Carolina Supreme Court

What Are Your Chances of Winning a Workers’ Comp Appeal?

While past outcomes never guarantee future results, you increase your odds by:

• Acting promptly
• Demonstrating clear work‑related causation
• Showing proper reporting and the correct process was followed

Insurers often deny claims at first; many valid claims succeed on appeal with strong evidence and legal representation.

What If My Employer Refuses to File a Workers’ Compensation Claim?

Under North Carolina law, most employers are required to carry workers’ compensation insurance. If your employer refuses to file a claim or tries to deny your status as an employee, you may have additional legal paths:

Report the refusal to the NCIC. You may have a separate cause of action if the employer acted willfully or breached legal obligations.

Note: You cannot usually sue your employer for negligence if the workers’ compensation system covers you, but you may pursue third‑party claims (if someone other than your employer caused your injury).

Ensuring your employer carries coverage and has properly reported your claim is crucial.

How Paul Robinson Law Can Help After a Workers’ Comp Denial

At Paul Robinson Law we bring local experience in Raleigh, Cary, Apex, Clayton and Durham to workers’ compensation denial cases. We assist by:

• Reviewing the denial reason and assessing legal options
• Filing Form 33 and managing appeals process
• Gathering evidence including medical records, job duty logs, witness statements
• Representing you at mediation and hearing
• Exploring related claims if your employer mishandled your filing or a third party is involved
• If your claim was denied, don’t give up hope. Let us review your situation and map a strategy to fight back.

FAQs: Denied Workers’ Comp Claims

What happens if workers’ comp claim is denied?

You’ll get a denial letter. You still have the right to appeal and may still obtain benefits by filing Form 33 and proceeding through NCIC mediation/hearing. 

How long do I have to appeal?

You should act immediately. While Form 33 can often be filed within 2 years of injury, waiting reduces your chance of success and evidence may fade. 

Can I sue my employer for denying workers’ comp?

In most cases the workers’ comp system is your exclusive remedy as an employee. However, if your employer intentionally failed to carry insurance or a third‑party caused your injury, other claims may exist.

What not to say to a workers’ comp adjuster?

Avoid downplaying your injury, admitting you weren’t hurt badly, failing to follow doctor’s orders, or making inconsistent statements. These can weaken your appeal.

What percentage of workers’ comp claims get denied?

Exact percentages vary. However, many valid claims are denied at first and succeed on appeal when properly handled with documentation and legal help.