What happens if my workers compensation claim is denied?

What to Do if Your Workers' Comp Claim is Denied in SC

When a person suffers an injury on the job in South Carolina, most employers have workers’ compensation insurance that covers the medical costs the victim incurs due to the injury, as well as a portion of lost wages. Workers’ compensation claims are handled by the South Carolina Workers’ Compensation Commission (WCC).

In order to obtain workers’ compensation benefits, an injured worker needs to file a claim. It is important to note that some claims may be denied. The reasons for denials can vary, but people are often left confused about what options they have in these situations.

Has your workers’ compensation claim been denied after a severe injury you or your loved one suffered on the job in South Carolina? Do not wait to contact Stewart Law Offices.

Reasons a Workers’ Compensation Claim May Be Denied in S.C.

The WCC has numerous reasons for denying workers’ compensation claims. Some of the most common reasons that these claims are denied include:

  • Deadlines — Failure to report an injury to your employer within 90 days can result in a loss of benefits. In addition, South Carolina generally gives people two years to file a workers’ compensation claim. However, different deadlines may apply in cases involving repetitive trauma injuries such as carpal tunnel syndrome or occupational illnesses that develop over the course of several months or years. The law gives people with these types of injuries or illnesses two years from the date that they knew or should have known about the condition.
  • Incorrect classification — If an employer classified you as an independent contractor, you would not be eligible for workers’ compensation. You should speak with a knowledgeable workers’ compensation attorney about appealing a denial based on incorrect classification.
  • Behavior — An employer could challenge your benefits award on the grounds that your own behavior was the proximate cause of your injuries. This type of claim may be involved in a case in which an employee is accused of having been under the influence of alcohol or drugs while on the job.
  • Pre-existing issues — Your employer may argue that you are seeking compensation for a pre-existing condition. You can still obtain benefits if your injury worsened or aggravated a pre-existing condition.
  • Lack of proof — The insurance company may claim that there is inadequate proof of an injury having resulted from a workplace accident. Some insurers may require independent medical examinations, and you should be sure you have a lawyer before agreeing to these exams.
  • Not injured on the job — An employer may argue that your injury was not the result of any workplace activity. You could be required to prove that your injury was related to your employment.
  • Mistakes on paperwork — Many claims are denied for simple oversights in the initial applications. You can avoid these kinds of issues that create unnecessary and lengthy delays by having an experienced attorney handle your claim from the very start.

The list above is not all-inclusive, but any reason for denial is not necessarily final. You have the right to challenge some of the conclusions that led to your denial.

How to Appeal a Denied Workers’ Compensation Claim

When your workers’ compensation claim has been denied, you should immediately contact an experienced workers’ compensation lawyer. You will have the ability to request a hearing and can often make multiple appeals, if necessary.

You can apply for a hearing by directly contacting the commissioner’s judicial department and requesting a form or using the form on the WCC website. During a hearing, a single workers’ compensation commissioner will hear the case and render a decision to approve or deny benefits.

If the single commissioner denies your benefits, you can appeal his or her decision. You can request a commission review, but the request needs to be filed within 14 days of you receiving the commissioner’s decision. There is a $150 filing fee that can be waived in some cases.

If your claim has been denied after a commission review, you can appeal through state courts. A lawsuit will have to be filed within 30 days of you receiving the commission’s decision.

An appeal of the commission’s decision will be handled by the South Carolina Court of Appeals. Any appeal of the South Carolina Court of Appeals decision will be heard by the Supreme Court of South Carolina.

How to Request a Hearing

Workers’ compensation commissioners conduct hearings to resolve disputes between employees and the representatives for employers. You can apply for a hearing if:

  • Your employer does not report your accident.
  • Your employer denies your injury by accident.
  • You believe you are not receiving all of your benefits.

The Form 50 is used to request a hearing. A $50 fee is required.

Appealing to the Full Commission

Most orders issued by single commissioners can be appealed for review by a panel of commissioners. Either party can request a review by filing a Form 30, Request for Commission Review, within 14 days of receipt of the order.

A full commission panel is typically a panel of three commissioners. As of February 2019, the South Carolina WCC has two different full commission panels.

Appeals from decisions handed down by a panel of three commissioners or by the full commission have to be filed with the Court of Appeals. There is no appeal beyond the state Supreme Court.

What to Expect After a Workplace Injury

It is important for people to take the proper steps whenever they have suffered any kind of injury on the job. Some people have a temptation to avoid medical treatment and attempt to work through injuries, but this can often make some injuries worse than they would have been had treatment been sought.

In general, any person who is involved in a workplace accident should take the following measures:

  • Report the accident — Do not wait to report an accident to your employer. Waiting too long can lead to a loss of benefits. It is even better when you put your report in writing so you can make a copy for yourself to prove that you reported your incident.
  • Get medical care — You should always go to a hospital. Insurance companies will often use any delays in treatment to argue that injuries were not as severe as claimed. Your treatment expenses should be covered by your employer if you see their chosen medical care provider, although you always have the right to see your own doctor at your own expense.
  • Collect evidence — Try to take pictures of the scene of your accident. For example, get photographs of a hazard that caused a slip and fall accident. Try to take pictures from different angles and distances. If other co-workers saw your accident, make sure you know who they are and that you have their contact information.
  • File the proper forms — Your employer has an obligation to complete certain forms and submit them to the appropriate parties. You may be required to file a WCC Form 12-A, Form 50, or Form 52.
  • Contact an attorney at Stewart Law Offices — Many people believe that they can handle their workers’ compensation claims on their own and then are shocked to encounter denials of the claims for benefits. That’s why it is important to talk to a skilled lawyer about your accident. Your attorney will be able to assist you from start to finish in applying for full workers’ compensation benefits and appealing any denials. In cases that involve lump-sum settlements, your lawyer will also work to negotiate a fair settlement. Your attorney can also investigate your accident to determine if any additional parties bear liability for your injuries.
Call at 866-783-9278 or contact us online to arrange your free and confidential case review.

Let Our Attorneys Help You Appeal a Denied Workers Comp Claim

When your claim has been denied, an experienced workers’ compensation lawyer will be able to determine why the claim was denied and how to help you move forward. The attorney will be able to handle all the legal legwork that goes into representation for any hearing and appeals that follow.

If your workers’ compensation claim was denied in South Carolina, it is important for you to retain legal counsel immediately. An experienced workplace injury attorney can help you fight for all of the benefits you are entitled to receive.

A trusted South Carolina workers’ comp lawyer from Stewart Law Offices, can visit with you in your hospital room or home if you cannot come to our office. Please call 866-783-9278 or contact us online to set up a free consultation about your workers’ compensation claim.