Workers’ Compensation Denied Claims
As soon as you suffer a work-related injury, you should report it to your employer, then you should file a claim with the South Carolina Workers’ Compensation Commission (SCWCC). Your employer may agree to accept your claim or they may deny it. If you contest the denial of benefits, the Commission may preside over certain aspects of your case, and ultimately may hold a hearing to determine whether you should have been awarded benefits. Employers and insurance companies do not always approve claims. The Commission is a state agency that serves to determine whether workers who are injured on the job receive the Workers’ Compensation benefits that they are legally entitled to.
Common Reasons Why Claims Are Denied
If you were denied benefits, you should have received a denial letter stating the reason for the denial of your claim. Common reasons why claims are denied include:
- Failure to Report Injury: If you have been injured on the job, you must immediately report your injury to your supervisor. Failing to make a timely report may result in a denial of your claim. In South Carolina, injured workers have up to 90 days to report a work-related injury. However, in some circumstances the details as to when that period begins can be complex. Speak to a qualified lawyer about your concerns to ensure that you do not forfeit your claim.
- Improper or Untimely Filing of Claim: Once you have reported your injury to your employer, the state Workers’ Compensation law requires that you file your claim within a certain specified period. The employer must also take timely action by informing the state or their insurance carrier, as appropriate.
- Employer or Insurance Company Disputed Your Claim: Sometimes, an employer will claim that your accident happened outside of work, was the result of horseplay or intentional conduct, or is related to a pre-existing injury and therefore not related to your employment. If your employer has denied your claim, you will need to gather evidence to support your claim. An experienced Workers’ Compensation lawyer can take statements from witnesses, obtain affidavits, issue subpoenas, and conduct depositions as well as gather medical records from your physician that connect your injury to your workplace. For an employer, denying your claim means keeping a low premium.
- Injury is Not Compensable: In certain states, claims for stress-related injuries, for example, are not compensable.
- You Did Not Receive Medical Treatment: You must receive medical treatment for your injury or work-related health condition to obtain benefits.
How to Appeal a Denial of Benefits in South Carolina
If you have been denied benefits and believe that the decision was in error, you can request a hearing before the SCWCC. Form 50, a special form that must be submitted to appeal the decision, should be completed before the hearing. The hearing will be held before one of seven commissioners and is much like a civil trial, but somewhat less formal. Both sides can introduce evidence which the commissioner will consider in rendering their decision.
The decision of the commissioner can be appealed to a panel of three commissioners on an appellate panel. The decision of the appellate panel can be appealed further to the South Carolina Court of Appeals and even the Supreme Court of South Carolina.
At any part in the appeals process, the parties can agree to participate in mediation, which is a less formal and often less costly method of resolving legal disputes. Most mediation take place prior to a formal trial before the South Carolina Workers’ Compensation Commission.
The South Carolina Workers’ Compensation Lawyers at Chappell, Smith & Arden Fight for the Rights of Injured Workers
The experienced South Carolina Workers’ Compensation lawyers at Chappell, Smith & Arden understand how a work-related injury can change your life. The Workers’ Compensation system is designed to provide injured workers some wage replacement, and cover their medical bills for their work place accidents. However, it can be a confusing and difficult process to navigate without the help of an experienced professional.
With six offices located throughout South Carolina, we represent clients in the counties of Lexington, Richland, Sumter, Aiken, Florence, Lancaster, York, Orangeburg, Kershaw, and Newberry, and in the communities of Columbia, Lexington, Irmo, Chapin, Rock Hill, Aiken, Sumter, Newberry, Florence, and Spartanburg. To set up a free consultation, call us today at 803-929-3600 or contact us online.