Work Comp Denial in South Carolina Guide

You do not expect that you will get injured on the job when you show up for work each day. When you suffer a workplace injury or illness, though, you want your workers’ compensation claim to be accepted. Filing a South Carolina workers’ comp claim is often a lengthy and confusing process. Insurance companies and the South Carolina Workers’ Compensation Commission often deny claims that still have a chance of succeeding with the right legal advice. You have enough to worry about with your injuries. Let the experienced workers’ compensation attorneys at HawkLaw, P.A. do the heavy lifting for you and help you get the workers’ comp benefits you deserve.

Are You Eligible to Receive Workers’ Compensation in South Carolina?

You may or may not be eligible for workers’ compensation benefits. Before you file a workers’ comp claim, you should ask yourself the following questions:

Did You Report the Injury Within 90 Days?

South Carolina workers’ compensation laws require you to notify your employer within 90 days of a ​​work-related injury or illness. Your employer may specifically designate someone who receives injury reports. If not, you must report your injury or illness to someone in a supervisor or manager position.

Did You Seek Your Employers’ Recommended Medical Professional for Evaluation?

Employers in South Carolina may choose the doctor who treats injured employees after workplace accidents. When you report your injury to your employer, you should ask to see their preferred doctor for medical treatment.

Did Your Injury Occur at Work Due to Work?

Workers’ compensation benefits are only available to injured workers for injuries directly related to their jobs. If you do not have a work-related injury or illness, you might not be eligible for benefits.

What Does Workers’ Compensation in South Carolina Cover?

You might qualify for three different kinds of workers’ comp benefits: medical, lost wages, and permanent disability. Your benefits will depend on whether your disability is partial or total, and temporary or permanent:

• Partial temporary disability: You are still able to do some limited form of work, even if it is not what you formerly did. You are also expected to recover eventually.
• Partial permanent disability: You will not get any better than your current condition, but you can still do some form of work.
• Total temporary disability: You cannot work at all, but you should eventually heal and be able to return to work at your previous job.
• Total permanent disability: You might never be able to work again.

The benefits you may receive from your employer’s workers’ compensation insurance may include reimbursement for medical expenses and coverage of ongoing medical care. It may also cover lost wages due to your inability to work at all, or your inability to work at the same level of earnings as before.

Why Was Your Workers’ Comp Claim Denied?

Insurance companies deny far more South Carolina workers’ compensation claims than they should. They may claim that they do so in order to prevent fraud and misuse of the system, but they often are simply looking for any possible excuse to deny a claim. Some common reasons may include the following:

Injury Not Covered Under Workers’ Comp Laws

Workers’ comp only covers serious work-related injuries. The insurance company may argue that your injuries are not severe enough to prevent you from working at your regular job.

Injury Not Related to Workplace Accident

An insurance company may try to claim that your injury was not work-related. For example, they may argue that an accident that occurred somewhere other than your regular workplace was not a “workplace accident,” even if you were there as part of your job duties.

Failed to Seek Treatment

If you did not seek medical care after the accident, you could be ineligible for workers’ comp benefits, or the insurance company could conclude that your injuries were not serious enough for coverage to apply.

Pre-Existing Injury

The insurance company could argue that your injury is a pre-existing condition, and therefore not the result of a workplace accident.

Employer Is Challenging Your Claim

Your employer may challenge your workers’ compensation claim. They have an incentive to do so since their insurance premiums will go up if your claim succeeds.

What Steps Should You Take If Your Workers’ Comp Claim Is Denied?

When you first file a workers’ comp claim, you may have an informal conference with representatives from the insurance company and the South Carolina Workers’ Compensation Commission. If the insurance company denies your claim, you may have to go through several levels of appeals that get increasingly formal.

First Appeal

A workers’ compensation commissioner will hear your first appeal. The Commission’s office is located in Columbia, but you may have a hearing in the jurisdiction where your injury occurred. This appeal requires you to pay a $25 filing fee. The commissioner will make a decision called an “order.”

Second Appeal

You may appeal the commissioner’s order to a panel of three commissioners. This stage of the appeals process is known as “Commission Review.” You have 14 days from the date of the order to request a hearing and pay a filing fee of $150.

The commissioners’ decision is called an “award.” They will provide you with a notification of the award, along with a legal ruling and a statement of their “findings of fact.”

Third Appeal

If you disagree with the commissioners’ award, you may appeal to the South Carolina Court of Appeals within 30 days. This level of appeal is much more formal than the previous ones since it is in the judicial system.

Fourth Appeal

The final level in the workers’ comp appeals process is in the South Carolina Supreme Court. You may request a review of the Court of Appeals’ order, but the state supreme court has the discretion to decide what cases they hear. The court has no obligation to hear your claim.

Why Do I Need a Workers’ Comp Attorney?

After suffering an injury in a work accident, securing your South Carolina workers’ comp benefits can be difficult. You must gather medical records and other medical evidence in order to support your claim. You may have thought you did everything correctly, only to receive a denial in the mail. Fortunately, you do not have to make a workers’ compensation claim without help.

The South Carolina workers’ compensation lawyers at HawkLaw, P.A. know how to take action against a workers’ comp denial. We can help you prepare your case, and we can advocate for you before the Commission or the courts.

Denied Your Benefits? See What You Can Do About It.

To request a free consultation* with an experienced personal injury lawyer, call 888-HAWKLAW or complete the online contact form to speak to the Client Engagement Team at HawkLaw today.