How long do I have to appeal my workers’ comp denial?

If you received a Form 61 (denial), file Form 33 right away. You technically have up to two years from the injury date to pursue a claim, but waiting weakens your case. If a hearing was held and you lost, you have 15 days to appeal that decision.

Will I get any benefits during the appeal?

Unfortunately, not usually. If your claim was fully denied, benefits don’t start unless we win. If a specific benefit was denied (like a surgery), we may be able to push for interim relief. Either way, we push to resolve your appeal quickly.

Can I settle after my claim was denied?

Yes. In fact, many claims settle during mediation—even after a denial. The insurer may pay a lump sum rather than risk losing at hearing. We’ll negotiate and advise whether the offer is fair.

The adjuster said I can go to mediation alone. Should I?

No. They may be trying to avoid a strong case being built against them. Mediation is a negotiation—one where they have experience and you don’t. Having an attorney sends a message and protects your interests.

What does it cost to appeal a comp denial?

We work on contingency—you pay nothing up front, and we only get paid if we recover benefits or a settlement for you. Our fee is capped by law (usually 25% of back pay or settlement).

Denied Workers’ Comp Claim? Here’s How to Appeal in North Carolina

If your workers comp claim was denied in NC, you’re not alone—and you’re not out of options. Denials happen more often than they should, especially in rural counties like Halifax and Northampton. Insurance companies hope you’ll give up, but the law gives you the right to appeal. At the Law Office of Franklin L. Jones Jr., we help injured workers fight back after a denial, guiding them through the appeals process and into the hearing room with strong evidence on their side.

Why Workers’ Comp Claims Get Denied in NC

Getting a denial letter after a work injury is frustrating, especially when you’re still in pain and unable to work. Some of the most common reasons claims are denied include:

Your employer disputes that the injury happened on the job
The insurance doctor says your condition isn’t work-related
You didn’t report the injury “on time” or missed a deadline
They blame a pre-existing condition
They argue you’re not technically an “employee” (common for contractors or gig workers)

Sometimes, denials are simply unjustified. Unfortunately, insurers save money by denying legitimate claims. That’s why having a Halifax workers comp denial lawyer on your side makes all the difference.

Appealing a Workers’ Comp Denial: What to Expect

In North Carolina, the appeals process is handled through the NC Industrial Commission. Here’s how it works:

01

Filing Form 33

To request a formal hearing, you (or your lawyer) file Form 33: Request for Hearing. This is the first official step in challenging your denial.

02

Mandatory Mediation

Before the hearing, most cases go through mediation. This is an informal settlement meeting where both sides try to resolve the dispute.

03

Hearing Before a Deputy Commissioner

If mediation fails, your case goes to a formal hearing (think of it like a mini trial).

04

Decision Issued

The Deputy Commissioner will review the evidence and issue a written decision, usually a few weeks later.

05

Appeals Beyond the Hearing

If the decision is still not in your favor, we can appeal to the Full Commission (a three-judge panel) and, if needed, the NC Court of Appeals.

At every step, we handle deadlines, legal filings, and strategy so you can focus on recovery.

How We Fight Denials & Build Your Case

A denied claim doesn’t scare us—it motivates us. We prepare every case as if it’s going to trial. That means:

Gathering complete medical records
Getting written opinions from your treating doctors
Collecting statements from co-workers or witnesses
Challenging the insurer’s arguments with medical and legal evidence
Showing how your work either caused or worsened your condition (which is enough under NC law)

If the denial is due to missed notice or “timeliness,” we often prove your employer knew about the injury anyway—or that the delay didn’t hurt their investigation. If the issue is a pre-existing condition, we show how the job made it worse.

Franklin L. Jones Jr. will present your case personally at the hearing and cross-examine the insurance company’s witnesses. You won’t face the system alone.

The hearing itself is typically held in a conference room or via video—not a crowded courtroom. A Deputy Commissioner acts as the judge. You may testify about how the injury happened and how it’s affected your ability to work. The insurance company will be represented by a defense lawyer.

Medical records and depositions are usually submitted in writing—doctors don’t often appear live. After the hearing, a decision is mailed weeks later. If you win, the insurance company may have to pay back benefits and cover future medical care. If not, we move forward with an appeal.

It’s a process—but we handle every step for you.

FAQs – Appealing a Denied Workers’ Comp Claim

How long do I have to appeal my workers’ comp denial?
If you received a Form 61 (denial), file Form 33 right away. You technically have up to two years from the injury date to pursue a claim, but waiting weakens your case. If a hearing was held and you lost, you have 15 days to appeal that decision.
Will I get any benefits during the appeal?
Unfortunately, not usually. If your claim was fully denied, benefits don’t start unless we win. If a specific benefit was denied (like a surgery), we may be able to push for interim relief. Either way, we push to resolve your appeal quickly.
Can I settle after my claim was denied?
Yes. In fact, many claims settle during mediation—even after a denial. The insurer may pay a lump sum rather than risk losing at hearing. We’ll negotiate and advise whether the offer is fair.
The adjuster said I can go to mediation alone. Should I?
No. They may be trying to avoid a strong case being built against them. Mediation is a negotiation—one where they have experience and you don’t. Having an attorney sends a message and protects your interests.
What does it cost to appeal a comp denial?
We work on contingency—you pay nothing up front, and we only get paid if we recover benefits or a settlement for you. Our fee is capped by law (usually 25% of back pay or settlement).