After an injury, you will need to seek compensation as soon as possible for your suffering. The debt following a work accident can be devastating, and you and your family do not need that stress. Fortunately, your South Carolina workers’ compensation should cover your medical care or permanent disability, right?
Not necessarily, as your employer might dispute your injury claims. They may say you were not injured at work, you did not file on time, or their insurance carrier says your injuries did not meet the definitions set by the state of South Carolina. They may claim you are ineligible, and if so, you will need to fight back for your compensation.
So, how are South Carolina workers’ comp disputes resolved? Luckily, you can fight back to get the workers’ compensation benefits you deserve with the right help on your side: a proven South Carolina workman’s comp attorney. HawkLaw, P.A. wants to help you get your life back on track after suffering your injury. Call our law firm today at 1-888-HAWK-LAW (429-5529) for a free consultation.*
What Are the Eligibility Requirements for Workers’ Comp in South Carolina?
Before filing a workers’ compensation claim, it is a good idea to speak with an experienced attorney who is well-versed in South Carolina employment law. Not all employees are covered by workers’ comp, but general criteria a claimant must meet include:
- Must be an employee (e.g. not an independent contractor)
- Must work for an employer that carries workers’ compensation coverage through an insurance company
- Suffers an on-the-job injury or illness
- Meets deadlines for filing a workers’ compensation claim
Section 42-1-360 of South Carolina law stipulates there are certain exemptions relating to the ability to collect compensation for a workplace injury. Exemptions include but are not limited to casual employees (as defined by Section 42-1-130), employers with four or fewer employees, or specific industries that can elect or are not required to participate.
6 Reasons Why Your Workers’ Compensation Claim Was Denied
Unfortunately, it is far too common for employers to make mistakes when reviewing workers’ compensation claims. The following are the primary reasons a workers’ compensation claim would be denied.
1. Your Employer Thinks You Missed the Deadline
Under compensation law, you are required to notify your employer within 90 days of the workplace accident occurring. If you miss this deadline, chances are you will be denied. However, some injuries do not have a clear-cut time, such as repetitive stress injuries or diseases from exposure to toxic substances (e.g., asbestos or certain chemicals) since these tend to develop over time. A skilled South Carolina workers’ compensation attorney can help you establish your case and offer sound legal advice.
1. The Personal Injury Was Not Work-Related
Claims are often denied if it appears the injury or sickness occurred outside the scope of your job. Generally, if your injury occurred off-hours (e.g., a car accident in a personal vehicle driving to work) or outside of work (e.g., exposure to asbestos at home), your claim will likely be denied.
2. Your Employment Status Was Misclassified
Only employees are covered under workers’ compensation policies. To avoid paying for benefits, some employers improperly classify their workers as independent contractors (ICs). This does not mean you are ineligible, but you will have to demonstrate your work met the legal definition of an employee rather than an IC.
3. You Were Injured Due to Carelessness
Employers may try to claim injured or ill workers did something wrong to cause their condition and, as a result, deny their workers’ compensation claim. It is unusual for an employee to cause their own injury, although there are a few exceptions that will disqualify a worker from monetary compensation for their injury; these include drinking, using illicit substances, and horseplay.
4. You Had a Pre-Existing Condition
Sometimes employers will pursue a denial based on the claim a pre-existing condition caused your injury. Workers are often able to dispute these claims if they have a condition that was aggravated or worsened due to work-related tasks or being in the workplace (e.g., a breathing condition and poor air quality).
5. You Lack Proof of Injury
Employers might try to skirt responsibility by making claims that an injured worker is exaggerating their condition and having a physical examination done by one of their doctors. If this happens to you, know you have the absolute right to get a separate, independent doctor to provide a medical examination and a second option to prove your work-related injury.
Working with a good workers’ compensation lawyer can help you determine if you were unfairly denied. If it appears your employer is trying to get out of paying for benefits, you can fight back to receive the compensation you deserve to help pay for your medical bills, lost wages, and other injury-related expenses.
How To Resolve a Workers’ Compensation Dispute
You do not have to automatically accept a denial for workers’ compensation benefits, you can take specific steps to resolve your dispute.
Step One: Set an Informal Meeting
After your denial, look over your denial letter for the reason you were denied. The reason should be listed on your letter, and your lawyer can help you determine how to address your denial. For example, the insurer or your employer may claim you were not injured enough, so you may need to supply further medical proof of your injury.
Once you have gathered the evidence you need, you will need to schedule an informal conference with your employer and their workers’ compensation insurance provider. This initial meeting will be an informal discussion of your condition and your denial. You will talk to your employer about their denial and present the evidence you have to support yourself and your injury.
You can also answer any questions the insurer or employers have about your claim, as well. You will have a chance to discuss what you are owed, what benefits you should be receiving, and what benefits you can expect moving forward.
Many South Carolina residents are able to reach a dispute resolution agreement with their employer informally; however, some employers may still deny your workers’ comp claim. When you are unable to come to an agreement informally, you can take your claim to the South Carolina workers’ compensation commission.
Step Two: Seek Legal Counsel
As soon as possible after you are injured, it is a good idea to seek legal representation for your workers’ comp case because an attorney can help you gather and present evidence, file any required forms before the deadline, and provide sound legal advice about your case. They can also help you pursue more coverage if what is offered is not adequate to address treatment for your injury, occupational disease, or to pay for your medical expenses and other losses.
Step Three: Schedule a Hearing With the Commissioner
When your employer refuses to settle, and you still believe that you are owed compensation, you are not out of options. Instead of accepting your expenses, you can schedule a hearing with the workers’ compensation commissioner and your attorney.
To start the process, you and your lawyer will file form 50, which provides the commissioner with a snapshot of your claim, along with a request for a hearing. The hearing may be scheduled weeks away, but this also provides time for you and your attorney to prepare. Once your meeting day arrives, you and your lawyer will present evidence you have, showing that you were seriously injured while at work and that you need benefits. You may choose to address disputes about your claim, such as the following:
- You do not believe you received all your benefits.
- Your employer denies that your accident counts.
- Your employer did not report the accident.
In these cases, you and your lawyer will present your claim to the commissioner, and your employer will have the same opportunity. The commissioner then decides whether to approve your claim or uphold the denial.
Can You Appeal Decisions Made by the Commission?
Yes, you can go through an appeals process after a decision is made by the full commission. To file an appeal, you must:
- File within 14 days.
- Submit a Request for Commission Review.
- Pay a $150 fee.
- Wait for the commission to review your appeal.
If your claim is denied again, you do have the option to appeal to the South Carolina Court of Appeals. In your appeal, you must explain in detail why your reasoning as to why you think the decision is incorrect (it helps to apply and cite specific SC law).
You can also go another step higher, to the South Carolina Supreme Court, but this is rare, and the court has no obligation to hear your case. Your attorney can best advise you on how to proceed with your appeal to increase your chances of success.
Seek Answers For Your Workers’ Compensation Dispute
After a serious accident, you need compensation for your suffering. Unfortunately, it is not so easy to get the help you need after an on-the-job injury. There is a chance that your employer will deny your workers’ compensation case, leaving you to deal with the aftermath of your injury, including paying for medical treatment.
Fortunately, you do not have to deal with this alone. Instead, seek out a lawyer from HawkLaw, P.A. to help you take action. You will need someone who knows how South Carolina workers’ compensation disputes are resolved, and you will need someone ready to fight back for you.
If your workers’ comp claim has been denied, speak to your attorney about scheduling a hearing and getting your benefits. HawkLaw offers free consultations* in which we will discuss what we can do for you and your claim. Reach out by calling 1-888-HAWK-LAW (429-5529) or by filling out the online form below.