Common Employer Tactics to Deny Workers’ Comp in North Carolina

Recent stats reveal that workers’ comp denials are on the rise. But here’s the thing: just because a claim is denied doesn’t mean it’s permanent or off the table. In fact, when challenged, many insurance companies wind up paying out claims that they initially denied.

If you’re wading through the muddy waters of a workers’ compensation claim, it’s important for you to understand why claims get denied and the kinds of tactics your employer might use to get out of paying you what you’re owed. Here’s a high-level overview of some common defense plays employers and their insurance companies might use to avoid paying out on your claim and an explanation of what you can do to counteract these questionable practices.

Workers’ compensation in North Carolina: The basics

In North Carolina, workers’ compensation serves as a sort of no-fault insurance to protect employees and employers from the negative effects of work-related accidents and injuries. Any employer with three or more employees in our state is required to obtain workers’ compensation coverage, and employers who fail to do so can face harsh legal consequences.

If you’re hurt on the job or develop a chronic condition as a direct result of your job responsibilities, you may be able to file a claim against your employer’s insurance. These claims generally serve to provide injured workers with the funds they need to pay for their medical expenses and replace a certain portion of lost wages during the recovery process.

Workers’ comp benefits are generally time-limited, and injured employees will stop receiving benefits once they return to work at their pre-accident levels (although certain benefits, like relevant medical costs, may still be available). If a work-related injury results in permanent disability, the injured employee may become eligible for additional, long-term benefits to fill in the gaps.

11 reasons claims get denied

There are a lot of strict requirements involved with workers’ compensation claims, and failing to meet any of those requirements could result in a denial. Some of these denials may be legitimate, while others less so. If you failed to meet established deadlines, sought medical care from an unauthorized provider or submitted inaccurate or incomplete paperwork, you may receive a clear-cut denial that leaves little room for negotiation.

In other cases, however, you may find yourself fighting back against unfair and even dishonest tactics from your employer or their insurance company. Even though workers’ compensation is technically no-fault insurance, it can still cost an employer a pretty penny to pay out on an injured worker’s claim.

While we certainly hope our employer will hold up their end of the bargain in the event of a work-related injury, many North Carolinians find their claims tied up and bogged down by these shifty insurance tactics. Here are a few of the ways your employer might try to circumvent paying you what you’re owed after an on-the-job injury:

1)   Claiming your accident wasn’t work-related

In order to qualify for workers’ comp benefits, you have to be able to show that your injury happened either at work or as a result of your employment. Workplace accidents tend to be a little more clear-cut in this capacity because there will be a clear line between, say, an equipment malfunction or slip-and-fall accident and your specific injury.

In cases involving repetitive strain injuries or exposure-related illnesses, it can be harder to prove causation, and employers like to take advantage of this uncertainty. They might attempt to claim that you had a pre-existing condition or sustained an injury while you were off the clock, for example. They might even argue that an injury that appeared to be the direct result of a workplace incident was actually unrelated and sustained outside of work.

Prompt and thorough reporting is your best friend when it comes to protecting the integrity of your claim. You should generally inform your employer right away if you suffer an injury on the job or begin experiencing symptoms of an injury or illness that you believe to be work-related. If any coworkers can speak to your experience, you can also include them on your report to provide another layer of credibility to your claim.

2)   Discouraging incident reports

Sometimes, employers will pressure employees into not reporting accidents or injuries. They’ll tell you that your accident wasn’t that serious or that there’s “no rush” to make a formal report while knowing full well that delayed reports can compromise your credibility. They might even take things a step further by encouraging you to seek medical care on your own insurance plan or with an unauthorized provider rather than following the proper protocols of their workers’ comp policy.

Any of these tactics can do serious damage to your claim and bar you from accessing the care you need to make a full recovery. In North Carolina, employees are required to report any workplace injuries within 30 days, so you shouldn’t let anyone pressure you to play the “wait and see” game after an accident. Report your accident or injury to your employer in writing as soon as you can, and be sure to keep a copy for your own records.

3)   Misclassifying traditional employees as independent contractors

Another sneaky way employers try to dodge responsibility for workers’ comp claims is by misclassifying workers as independent contractors when they’re legally considered employees. This distinction is important because contractors generally aren’t covered under workers’ compensation laws, while employees are. If an employer mislabels an employee as a contractor, they can skirt their responsibilities in the event of an accident and leave the worker on the hook for their own damages.

North Carolina uses a multi-factor ‘right-to-control’ test, examining whether the employer controls the manner, method, and details of the work, along with other factors such as payment method and ability to hire assistants. If you’re expected to work specific hours or are barred from working other jobs, for example, you may be legally classified as an employee and subsequently eligible for benefits. An experienced workers’ compensation lawyer can review the facts of your case and help you determine whether you may have been illegally classified as an independent contractor when you should have been treated like a traditional employee.

4)   Engaging in retaliation or intimidation

It’s illegal for an employer to intimidate an employee into not filing a claim or to retaliate against them for reporting a workplace injury, full stop. Even still, some employers will engage in nefarious practices to strong-arm employees into keeping quiet about accidents and injuries. If your employer started cutting your hours, stripping you of titles or otherwise cultivating a hostile work environment after you filed a workers’ comp claim, you may have a whole other can of worms on your hands.

Contact a workers’ compensation attorney right away if you suspect your employer has been intimidating or retaliating against you because of a potential workers’ comp claim. This is highly illegal activity and you deserve to hold them accountable to the fullest extent of the law.

5)   Rushing through low-ball settlements

Sometimes an employer or their insurer will try to slap a Band-Aid on a problem rather than following the proper channels for resolution. They might offer you a small, quick settlement right after your accident in the hope that you’ll take whatever pennies they’re offering rather than dealing with the complexities of the system. This might feel like a reasonable compromise on its face, but once a settlement is approved by the North Carolina Industrial Commission, it is generally final and limits future claims.

Before signing or even verbally agreeing to anything, you should ask your attorney to review the offer on your behalf. They can make sure you’re getting a fair deal and can push back if they think you’re being low-balled or silenced. They can also consult with economists and care planners to develop a clearer sense of the true cost of your injuries and fight for a financial arrangement that can actually meet your needs.

6)   Pointing to incomplete or inaccurate paperwork

Workers’ compensation claims involve a fair amount of documentation, and insurers are quick to scrutinize every detail. Even small errors like missing dates, incorrect names, or incomplete forms can give an employer or insurer a reason to deny a claim.

In some cases, a claim involving a legitimate workplace injury could face denial simply because it’s missing a required form or the information didn’t line up across documents. Employers and insurers may point to these technical issues when arguing that the claim is unreliable or that you didn’t file it properly.

This is why accuracy and consistency matter from day one. Keep copies of every document you submit and review paperwork carefully before you file to help prevent unnecessary denials that don’t relate to the validity of your claim.

7)   Requiring treatment from an authorized medical provider

In North Carolina, employers and their insurance carriers typically have the right to direct injured workers to an approved medical provider. If you seek treatment outside that authorized network without permission, your employer or insurer may attempt to deny or suspend your benefits.

Some workers make the mistake of seeing their primary care doctor or an emergency provider without realizing that doing so could complicate their claim. Insurers may argue that they are not required to compensate you for treatment from a provider who isn’t in their network, even if the medical attention is required.

To avoid this issue, injured employees should follow the employer’s medical treatment instructions whenever possible and document any circumstances that require immediate or alternative care. If disputes arise over medical authorization, an attorney can help protect your access to appropriate treatment.

8)   Questioning delayed medical treatment

Even when an injury is reported on time, delays in seeking medical care can raise red flags for employers and insurers. They may argue that if the injury were truly serious or work-related, you would have sought medical treatment right away.

Insurers may point to gaps in treatment as evidence that your injury happened outside of work, was caused by something else, or wasn’t that serious. This tactic is especially common when a person has soft-tissue injuries or conditions that worsen over time.

Seeking prompt medical attention not only protects your health, but also creates a clear record linking your condition to a workplace incident. If you are consistent in receiving follow-up care, this can reinforce the legitimacy of your claim.

9)   Alleging intoxication or drug or alcohol use

Another tactic employers may use is claiming that drugs or alcohol played a role in the accident. Workers’ compensation benefits can be denied if an employer argues that intoxication caused or contributed to the injury.

Following a workplace accident, employers may require drug or alcohol testing. A positive result can quickly become the centerpiece of a denial, even if the substance did not actually cause the injury.

Because these allegations carry serious consequences, it’s important to understand your rights and the limits of what employers can claim. If intoxication is raised as an issue, legal guidance is often critical to challenge unsupported or exaggerated assertions.

10)  Claiming the injury happened during horseplay or rule violations

Employers may also deny claims by arguing that the injury occurred while the employee was engaging in horseplay, violating safety rules, or acting outside the scope of their job duties.

These arguments are often used to shift blame onto the injured worker and frame the incident as a personal choice rather than a workplace accident. Insurers may point to safety policies, training materials, or witness statements to support this narrative.

Not every deviation from routine duties disqualifies a claim, however. Many injuries occur while employees are still furthering their employer’s business interests, even if circumstances weren’t ideal. These situations often require careful legal analysis to push back against oversimplified denials.

11)  Arguing that your claim lacks supporting evidence

Even when an injury is legitimate, insurers may deny a claim by asserting that there isn’t enough evidence to prove it occurred at or because of your work. This argument may come up in cases where you don’t have the necessary medical records, witness statements, incident reports, or written communication.

Because the burden of proof rests with the injured worker, gaps in documentation give insurers an opening to dispute causation or severity. This is particularly common in cases involving unwitnessed accidents, repetitive stress injuries, or occupational illnesses.

Thorough documentation from medical records to written injury reports can make a significant difference in overcoming this type of denial. When insurers challenge evidence, having legal representation can help make sure your claim gets a fair evaluation.

How to shield yourself from dishonest tactics

Here’s the deal: If you’re an employee who was injured at work, you’re likely entitled to compensation under North Carolina law. Even if your employer or their insurance provider attempts to derail your claim with one (or more) of the tactics described above, your rights are still your rights. Nevertheless, the best defense is a good offense, and there are some things you can do to protect the integrity of your claim.

Here are five of the best things you can do to strengthen your North Carolina workers’ compensation claim:

1. Report your injury immediately: Documentation is an integral part of any workers’ compensation claim. You should always report work-related accidents and injuries as soon as they occur to ensure there are no delays in your claim. Make reports in writing, and retain a copy for your own records so no one can raise questions about whether you did your part.
2. Follow medical advice: You should always see an employer-approved medical provider for treatment after an accident rather than visiting your own doctor. You should also follow any and all medical advice you receive so your employer cannot claim that your failure to adhere to a care plan exacerbated your symptoms or undercut the severity of your condition.
3. Document everything: Throughout every step of the claims process, you should keep copies of every single document you receive. Incident reports, medical records, phone records and invoices can all paint a clear picture of your losses and add veracity to your claim.
4. Stay tight-lipped: While you should always be courteous and honest while fighting for workers’ compensation benefits, it’s important not to say too much before the dust has settled. Avoid discussing your claim with your employer, their insurer or other employees, as anything you say to these people could come back to bite you later on.
5. Talk to a lawyer: No matter where you are in the claims process, an experienced workers’ compensation lawyer can help you safeguard your rights and fend off shady employer and insurance tactics. They are there to advocate for you, educate you and fight tirelessly to ensure you receive the benefits you’re entitled to under North Carolina law.

If you or someone you know was injured at work and is encountering resistance from an employer or their insurance company, don’t wait to speak with an experienced workers’ compensation attorney. The sooner you can get the ball rolling, the less opportunity your employer will have to undercut or compromise your claim.

At Price, Petho & Associates, our experienced workers’ comp lawyers understand how far employers will go to get out of paying injured workers what they deserve. That’s why we’re dedicated to helping North Carolinians fight back and access support when they need it most. Give us a call today or fill out our online contact form to schedule a free case consultation, and let’s discuss what the next move should be in your workers’ compensation claim.