What Should I Do if I’m Denied Workers’ Compensation Benefits?

In South Carolina, most employers are required to carry workers’ compensation coverage. Workers’ comp is a no-fault system that is designed to provide benefits to employees who suffer an injury on the job, regardless of how it was caused. There are a few exceptions to this, such as self-inflicted injuries and injuries that occur because of a violation of company policy, but in general, your employer is supposed to cover you as long as the illness or injury is work-related.

Unfortunately, obtaining workers’ compensation benefits is not nearly as easy as it should be. The system is complex and confusing, and many employers make it even more difficult by throwing up unnecessary roadblocks that are designed to frustrate a worker into giving up on the benefits they deserve.

If you have been denied workers’ compensation benefits by your employer or their insurer, this does not necessarily mean it is the end of the road. Call our office for a free, no obligation consultation, so we can take an in-depth look at your case and advise you of your next steps.

Common Reasons why Workers’ Compensation Benefits are Denied

Employers and their insurers will often look for a reason to deny a workers’ comp claim, so they can save money on premiums or benefits that have to be paid out. Here are some of the most common reasons for a workers’ compensation claim denial:

Your Injury did not Happen on the Job

Workers’ compensation benefits are only available for injuries that are work-related. In some cases, this is fairly clear-cut. For example, if you slipped and fell at home and hurt yourself, you could not reasonably expect your employer to cover that. There are other instances, however, where things are not so clear. For example, if your boss asked you to go pick up lunch for you and the rest of the crew and you were injured on the way to the restaurant, this could be considered work-related, even if you were “off the clock” when it happened.

Your Injury was the Result of a Pre-Existing Condition

Closely related to the previous point, your employer could claim that your injury already existed before your workplace accident, therefore you are not covered. However, even if a workplace accident aggravated or worsened an already existing condition, you might still qualify for workers’ comp. This is another one of these complicated instances that needs to be looked at by an experienced workers’ compensation attorney.

You Did Not Receive Proper Treatment/You were not Treated by an Approved Medical Provider

in South Carolina, your employer has the right to choose your medical provider. If you saw your own provider without their permission, or you did not get medical treatment at all for your injury, they may claim that you are faking or exaggerating your injury, or that you do not have adequate proof that it happened.

You Missed the Deadline for Filing a Claim

Many workers’ compensation claims are denied because of technicalities, such as missing a filing deadline. In South Carolina, you are supposed to report a workplace injury within 90 days of it occurring. Some employers misread the law and try to impose deadlines that are sooner than 90 days, and there are other instances when the exact origin of the injury is unclear. This is common with repetitive stress injuries and others that occur over an extended period of time.

Appealing a Workers’ Compensation Claim in South Carolina

If you were denied workers’ compensation benefits in SC, you have the right to file an appeal with the South Carolina Worker’s Compensation Commission. The first step is to submit a hearing request (to the commission) along with the required fee. Once this is done, the next step will usually be an informal conference.

At the informal conference, the parties will try to reach an agreement to resolve the dispute. If the dispute cannot be resolved, a hearing can be scheduled before a workers’ compensation commissioner. If you are dissatisfied with the results of this hearing, the second level of appeal is a hearing before a panel of three commissioners. If this does not yield a successful result, you can bring your case to the South Carolina Court of Appeals.

Although you are not required to retain an attorney for the appeals process, your chances of success are greatly increased when you have experienced legal counsel in your corner. Your attorney will know the ins and outs of this process and be able to represent you through each step. They will prepare the strongest possible case on your behalf, so you are well-positioned to obtain a favorable outcome.

Contact a Skilled and Knowledgeable Spartanburg, SC Workers’ Compensation Lawyer

Whether you have just suffered a work-related illness or injury, or you have been denied workers’ compensation benefits, the Nowell Law Firm is here to help. Call our office today at (864) 469-2481 or message us online for a free consultation and case review.