Question 1

How long does it take to find out if a workers' comp claim is approved in North Carolina?

Accepted Answer

Under North Carolina law, the insurance carrier generally has 30 days from the date you file Form 18 (Notice of Accident) to accept (Form 60), deny (Form 61), or pay without prejudice while investigating (Form 63). Under a Form 63, the insurer can pay initial benefits while taking up to 90 days to make a final approval or denial decision. Note that Form 18 is filed by you (the employee), while your employer files Form 19 within 5 days of learning about the injury. You can check progress by asking your employer, contacting the insurance adjuster assigned to your claim, or calling the NCIC's Claims Administration Section.

Question 2

When do workers' comp payments start after a claim is approved in North Carolina?

Accepted Answer

Medical benefits typically begin as soon as the claim is approved or accepted. Lost wage (disability) benefits work differently: they do not kick in until after a seven-day waiting period, and you will only collect retroactively for that first week if your disability forces you out of work for 21 days or more. If the insurer uses Form 63 to investigate the claim "without prejudice," initial payments may start quickly, though a final decision will be pending.

Question 3

What happens if my workers' comp claim is denied?

Accepted Answer

If your claim is denied, you can appeal by filing Form 33 (Request that Claim be Assigned for Hearing) with the NCIC. Getting a hearing date before a Deputy Commissioner typically takes six to twelve months. Before a formal hearing occurs, the NCIC routinely orders mandatory mediation, where you (or your attorney) negotiate with the insurer's representative before a neutral mediator to attempt a settlement.

Question 4

Who do I contact to check on my workers' comp claim?

Accepted Answer

You have three main options: reach out to your employer, who can contact their insurance carrier; contact the insurance adjuster assigned to your claim directly; or call the NCIC Claims Administration Section to confirm receipt of forms or ask general administrative questions.

Question 5

How long does it take to hear back on a workers' comp claim in NC?

Accepted Answer

Under North Carolina law, the workers' compensation insurance company generally has 30 days from receiving notice of your injury (or the filing of Form 18) to respond. During this 30-day window, the insurer must formally accept the claim (Form 60), deny it (Form 61), or initiate temporary payments without admitting liability while continuing their investigation (Form 63). If the insurer uses Form 63, they have up to 90 days from the notice date to issue a final approval or denial.

Question 6

What does it mean if my claim is pending in North Carolina?

Accepted Answer

A "pending" or "under investigation" status means the insurance provider has received your claim but has not yet reached a final decision on liability. During this time, the adjuster is typically gathering medical records, reviewing accident reports, or interviewing witnesses to verify if the injury is work-related. Depending on how the insurer files Form 63, you may receive temporary wage or medical benefits while the claim is pending, but these payments can be stopped if the insurer ultimately decides to deny the claim before the 90-day investigation window closes.

Workers’ Compensation