How to Dispute a Workers Compensation Claim: A Step-by-Step Guide

Introduction

Many denied workers' compensation claims are valid work injuries. If your workers' compensation claim has been denied, you are not alone. In this article we will outline the steps to dispute a workers' compensation claim denial.

We will outline the steps and information needed to communicate with your employer and the insurance company and explain what evidence is needed to proceed step by step. You don’t have to fight alone for the benefits you need.

Understand Compensable Work Injuries

To help you understand what makes a work incident compensable and how to argue a denied workers’ compensation claim, we’ve set out below what is needed to establish that an incident is a compensable work-related incident.

1. Nature of the Harm - This is the type of injury that has occurred as a result of your work. It could be physical, psychological or even an occupation related disease such as a slip at work or Repetitive Strain Injury (RSI) or a work related illness.
2. Evaluating the Incident: Determine whether the incident(s) occurred while claimant was on duty and suffered illness or injury while at work. If a claimant suffered an injury off hours or off company premises he or she will not be considered for compensation.
3. Consult Legal Definitions: Consult legal definitions and look to relevant laws on workers’ benefits that apply in your state. Such information as to benefits afforded under workers’ compensation can usually be found on the website of your state labor department.
4. Document Everything - Make sure to write down as many details surrounding your work place injury as possible. Document the date and time the injury occurred. Keep track of any medical treatment you receive as well as any other relevant facts pertaining to your claim. You should also obtain contact information for any witnesses that saw you get hurt. These individuals may be called to testify on your behalf in a workers compensation hearing.

By knowing what makes up a compensable work-related incident, you can be best prepared to process a disputed workers’ compensation claim to recoup sufficient lost-time benefits to assist in your return to work and full recovery from your on-the-job injury. For the incidents in 2022-2023 in North Carolina for which there was lost-time workers’ benefits, the average was $47,316 per incident. Caught incidents averaged $47,749 per claim and slips/falls averaged $54,499 per claim.

Initiate Communication with Employers and Insurers

The process to collect benefits from workers’ compensation is complex, however, with the aid of a workers compensation attorney, you will collect the benefits that you are entitled to receive. An injured employee must first establish that their condition is compensable. In addition, the injured employee must notify their employer of their injury and allow the employer or the employer’s insurance company to file a workers compensation claim on their behalf. Although workers compensation is a no-fault system of recovery, an employee can still collect for work-related injuries even if the employee’s actions caused the injury.

1. Document All Correspondence: The claimant should retain records of all written and verbal communication with the workers compensation carrier and adjuster. This includes keeping a record of all telephone conversations with the claims adjuster and copies of all letters sent to him/her.
2. Contact Your Employer: Set up a meeting with your supervisor or human resources representative and discuss your work injury. Inform them of your projected return to work date and of any special needs your workplace can provide to aid in your recovery.
3. Engage with the Insurer: Establish communication with your claims adjuster. Provide the adjuster with any information you believe to be relevant to your workers compensation claim. Ask the adjuster any questions you have regarding your workers compensation claim.
4. Follow Up: Be sure to follow up in a timely fashion with your employer and the workers compensation insurance company’s adjuster to assure that proper action is being taken in a prompt manner to resolve your claim. Most cases are closed quickly when all parties are notified and following up with each of them to complete the process.
5. Keep Records of Communications with Attorney: It is in your best interest to keep a copy of all letters, correspondence and notes from phone conversations with your attorney handling your workers compensation case.

Maintaining clear lines of communication is one of the most critical components in achieving the best possible outcome in your workers’ compensation benefits. The attorneys at Vasquez Law Firm have years of experience in handling workers compensation claims for our clients. Vasquez Law Firm is a bilingual law firm and offers free initial consultations to discuss the specific needs of our clients. We operate on a no-win, no-fee basis which means that there is no risk in seeking the compensation that you are entitled to. We can assist you in reclaiming your rights and getting you back to where you need to be.

Follow Formal Dispute Procedures

Fight Your Workers Compensation Claim Denial by Following These Steps for Help in the Claims Process After a Denied Workers Compensation Claim.

1. Understand the Denial: The denial letter explains why the workers compensation claim was denied. There are many reasons why a claim is denied, but if you address the reason(s) for the denial of your workers compensation claim, you can re-write the claim and re-submit it.
2. File a Formal Dispute - A Claim Petition or an Application for an Informal Hearing must be filed with the appropriate Workers’ Benefits Board, depending on your state’s specific laws. All forms, and the steps required to file a dispute, are found on your state’s website.
3. Attend Hearings: A hearing will be held by a Judge or Arbiter and you need to attend this to present your evidence to fight your workers' compensation denial.
4. Seek Legal Assistance: There are many workers compensation attorneys who are familiar with the claims process and can assist in preparing your case to present your situation to a Judge or Arbiter.
5. Follow Deadlines: Make sure that you meet all of the required time limits for your claims and your appeals. If you miss even one key deadline then your dispute could be ruined.

By going through the disputed workers compensation claim steps, you will regain control of your situation.

Gather and Preserve Supporting Evidence

This is the final installment in a series of posts addressing how to deal with a dispute over a workers compensation claim after it has been denied.

1. Gather Medical Records: Collect copies of all medical treatment that you received for your work place injury including records of all doctor visits and treatments (including X-rays and prescriptions) and keep them organized in a file for future reference.
2. Document the Incident: To make sure you can recall all of the details surrounding your workplace injury, document everything that happened from the time of the injury to the time you reported it to your employer. Make sure to include the date and time of the incident, where it happened, and any other facts and circumstances leading up to the incident. It is also wise to write down as much as the other people who witnessed your workplace injury can recall.
3. Gather Witness Statements: Statements from coworkers, your manager, and other co-workers that were on the scene when you were hurt on the job are needed to prove what actually happened when you were injured at work and to support your claim for compensation for your on the job injury.
4. Physical Evidence: Be sure to save any physical pieces of evidence from your accident or injury. Such items can include broken or damaged equipment as well as photographs of the accident scene. These items of physical evidence are crucial in helping to prove your dispute workers compensation case.
5. Organize Evidence: Evidence can be gathered and be put into a file or on a computer file. This makes it easy to pull information that is needed for hearings and negotiations with insurance companies.
6. File Form 18: The clock starts on this important step the moment your workplace injury occurred. You must file the Form 18 within two years of the date of the accident to ensure you are able to receive all of the benefits to which you are entitled as a result of your workplace injury.
7. Notify Your Employer of Your Injury: In North Carolina, you are required by statute to give your employer written notice of a work place injury within 30 days of the date of the incident. This written notice helps the employer and the NC Workers Compensation Commission to understand that your injury occurred as a result of your work and therefore you are entitled to receive benefits to aid in your recovery from your workplace activities.
8. Show How Pre-Existing Injuries Were Affected by Workplace Activities: Make sure to clearly state the nature and extent of current illness or injury and how your pre-existing medical problems were affected by your workplace activities.

As a general rule, preserving evidence of a work-related injury will help your case greatly. In North Carolina for example, there were nearly 68,600 nonfatal work injuries reported in 2023. At Vasquez Law Firm, we have years of experience helping individuals and their families dispute workers compensation denials. We can assist with your workers compensation claim in English and Spanish and will work tirelessly to protect your rights throughout the process. Most importantly, it is in your best interest to immediately treat any work-related injuries. They not only promote your health but will also serve your legal interests.

Conclusion

When a work injury claim is denied, it can be a frustrating and overwhelming event for the injured worker. The following is intended to provide clarification of a work injury and the best way to communicate with your employer and their insurance company in order to process a claim and dispute a claim that has been denied by an insurance company.

These are a few of the main topics we discussed including ways to collect and protect evidence for your work injury claim, keeping open communication with the party responsible for paying your claim, and listing out the formal ways to dispute a denied workers’ compensation claim. We strongly believe that it is very important to understand your options and to have the proper legal assistance to fight for your rights and seek justice for a denied work injury claim. The entire bilingual team at Vasquez Law Firm stands ready to assist you in seeking all of the compensation that you deserve.

We all know that we need to recover our lost wages after a work injury but seeking justice and enforcing our rights is just as important. If you have suffered a work injury, you should seek the assistance of an attorney who can guide you through the process of recovering compensation for your injuries. Most attorneys, including the bilingual attorneys at Vasquez Law Firm, offer free initial consultations. We can assist you in recovering the compensation you deserve and work with you to develop a payment plan that is flexible and affordable to assist you in reaching your goal of asserting your rights and rebuilding your life after a work injury. Seek help today.

Frequently Asked Questions

What is a compensable work injury?

A compensable work injury is an incident that results in harm, such as physical or psychological injury, or an occupational disease, that occurs as a direct result of work-related activities.

How can I determine if my work incident is compensable?

To determine if your work incident is compensable, evaluate whether the incident occurred while you were on duty and if the injury or illness happened at work. Injuries that occur off hours or off company premises are typically not eligible for compensation.

What legal resources should I consult regarding workers' compensation?

You should consult legal definitions and relevant laws on workers' benefits that apply in your state. This information can usually be found on your state labor department's website.

Why is documentation important for a workers' compensation claim?

Documentation is crucial because it provides detailed evidence of the incident, including the date and time of the injury, medical treatment received, and contact information for witnesses. This information can support your claim during a workers' compensation hearing.

What types of injuries are commonly reported in workers' compensation claims?

Common injuries reported in workers' compensation claims include slips and falls, repetitive strain injuries (RSI), and other work-related illnesses.

What are the average lost-time benefits for work-related incidents in North Carolina?

For incidents in 2022-2023 in North Carolina, the average lost-time workers' benefits were $47,316 per incident. Specifically, caught incidents averaged $47,749 per claim, while slips and falls averaged $54,499 per claim.

List of Sources

1. Understand Compensable Work Injuries
   • Workplace Injury Statistics 2026 | Type of Injuries & States (https://sokolovelaw.com/personal-injury/workplace/statistics)
   • How NC Workers Compensation Reforms Affect You in 2026 | Vasquez Law Firm (https://vasquezlawnc.com/blog/nc-workers-compensation-reforms)
   • Workers’ Compensation Costs - Injury Facts (https://injuryfacts.nsc.org/work/costs/workers-compensation-costs)
   • North Carolina Workers' Comp Defense Blog | CSH Law (https://cshworkerscomp.com/resources/blog)
   • North Carolina Workers' Comp Update - Hedrick Gardner (https://hedrickgardner.com/blog/north-carolina-workers-comp-update)
2. Initiate Communication with Employers and Insurers
   • Court Dismisses Worker's Civil Claims for Heat-Related Injuries| Workers Compensation News | WorkCompCentral (https://workcompcentral.com/news/article/id/0aeef9f65ecbea930035d74d4debe680914dee12)
   • Seven People Charged in $100M Workers' Compensation Fraud Operation in Florida (https://insurancejournal.com/news/southeast/2026/08/14/881604.htm)
   • 7 charged in alleged $100 million Florida workers’ comp fraud scheme (https://abcnews4.com/news/nation-world/5-local-people-among-7-charged-in-alleged-100m-florida-workers-comp-fraud-scheme)
   • Insurer sanctioned for forcing workers' comp case after claim dismissed (https://insurancebusinessmag.com/us/news/risk-compliance-legal/insurer-sanctioned-for-forcing-workers-comp-case-after-claim-dismissed-541374.aspx)
   • 5 local people among 7 charged in alleged $100M Florida workers' comp fraud scheme (https://cbs12.com/news/local/florida-attorney-general-uthmeier-charges-7-in-nearly-100m-workers-compensation-money-service-fraud-scheme-including-5-from-palm-beach-county-treasure-coast-west-palm-beach-lake-worth-port-st-lucie)
3. Follow Formal Dispute Procedures
   • Denied a Workers' Comp Claim in NC? What to Do Next (https://farrin.com/blog/what-to-do-if-your-workers-comp-claim-is-denied-in-nc)
   • What Happens When Workers' Comp Claims Are Denied in NC? | Vasquez Law Firm (https://vasquezlawnc.com/blog/workers-comp-claims-denied-nc)
   • What You Need to Know About Workers Compensation Law... | Vasquez Law Firm (https://vasquezlawnc.com/blog/navigating-new-workers-comp-laws-insights-for-nc-residents)
   • Rising Workplace Injury Claims in North Carolina Raise Questions About Access to Benefits - Legal Reader (https://legalreader.com/rising-workplace-injury-claims-in-north-carolina-raise-questions-about-access-to-benefits)
   • North Carolina Workers' Compensation News (https://dodgejones.com/blog)
4. Gather and Preserve Supporting Evidence
   • What to Know About Your NC Workers’ Comp Case | Farrin (https://farrin.com/blog/things-you-should-know-about-your-workers-compensation-case)
   • North Carolina Workers' Compensation News (https://dodgejones.com/blog)
   • How To File a Workers' Compensation Claim In North Carolina? 2026 (https://sumwaltgrouplaw.com/blog/how-to-file-workers-compensation-claim-in-north-carolina)
   • Why Your Workers’ Comp Claim Was Denied in North Carolina And How to Fix It (https://roane-law.com/why-your-workers-comp-claim-was-denied-in-north-carolina)
   • Fully or Partially Responsible for an Injury at Work? (https://deutermanlaw.com/fully-or-partially-responsible-for-an-injury-at-work)