Many of our workers’ compensation clients call us after they receive a letter telling them their workers’ comp claim has been denied. If your claim has been denied, don’t just take the insurance company’s word for it. News flash – insurance companies love to say “no” when it comes to paying benefits. Our law firm has recovered hundreds of thousands of dollars for injured workers whose claims were denied before they hired us.
Initial claim denials are not at all unusual. Filing a request for a hearing before a South Carolina Workers’ Compensation Commission commissioner is typically the next action step when we feel a claim has been wrongfully denied. The hearing gives us an opportunity to present supportive medical evidence and other testimony to prove your entitlement to benefits. Often times, the insurance company agrees to accept a previously denied claim due to the pressure of an approaching hearing.
With over 125 years of combined experience representing injured workers, our workers’ compensation lawyers are well-qualified to help you develop a compelling case for benefits.
Why You Should Request a Workers’ Comp Claim Hearing
If you receive a denial letter from the workers’ compensation insurance company, it may explain why your workers’ comp claim has been denied. Three of the most common reasons claims are denied include:
- Whether you were injured while on the job
- The severity of your injury
- Issues with your claim application itself
Each of these defenses can be overcome with proper preparation for a hearing.
To assert a claim for benefits, you will need to request a hearing, which is done by filing a Form 50 with the Workers’ Compensation Commission. The form requires you to summarize your accident, injuries, lost time from work, wages, medical needs and more. It also asks you to state an estimated time needed for a hearing.
As your workers’ comp attorneys, Joye Law Firm can file a Form 50 hearing request on your behalf and prepare for the hearing.
Opening Positions at a Workers Comp Claim Hearing
A hearing in front of a South Carolina workers’ compensation commissioner essentially works like a quick, informal trial. Ultimately, your claim will only be successful if you can persuade the commissioner that the initial denial of benefits was made in error. This usually requires presenting supplemental evidence. For example, you might need a second medical opinion to provide additional evidence.
Before the hearing, your employer’s workers’ compensation insurer’s lawyer will usually take a deposition of you. This is a sworn statement about your case. It gives the defense an idea of what you intend to claim at the hearing. We will prepare you for the deposition and be present when it takes place.
A couple of weeks before the hearing, we will submit several documents to the commissioner about the case we intend to present. This includes the Form 58 Pre-Hearing Brief, a list of witnesses and other evidence we plan to present, and the actual exhibits (such as medical records) we intend to submit.
Before the hearing starts, lawyers for both sides and the hearing commissioner will meet privately to quickly review the issues in question. The hearing will begin with your lawyer presenting an very brief opening statement as to why you deserve benefits, followed by the other side stating why they believe your claim should be turned down.
The commissioner will then review the facts that both sides agree to so each lawyer can state their agreement for the record.
The Crux of Your Workers’ Comp Claim: Documented Evidence
Once opening statements have been completed at a workers’ comp hearing, each side will present its evidence to the commissioner.
Most evidence for a workers’ compensation claim is documented – accident reports, employment records and medical records. In almost every case, the medical evidence is the most important evidence. Therefore, evidence packets must be compiled and presented by both sides to the commissioner. They are known as “APAs” for the state law governing workers’ comp procedures, the Administrative Procedures Act (A.P.A.).
To demonstrate your eligibility for benefits, the contents of your evidence packet must establish that you were injured while performing an activity related to your job. Further, it needs to show that you needed medical care for your injury and whether your injuries have prevented you from working.
You will be called to testify about your injuries and how they occurred. In many cases, the injured worker is the only witness who testifies at a hearing. However, in denied cases, both sides may have other witnesses who will testify about the facts of your work accident. Your doctors rarely testify at a workers’ comp hearing as the A.P.A. allows their records to come into evidence. In some cases, depositions of doctors are submitted as evidence.
As your lawyers, we will prepare you to testify. We cannot tell you what to say, but we will lead you through the questions we intend to ask, and explain the important facts that it is crucial that you talk about in your testimony. Essentially, we will ask you to tell your story:
- What your job is
- What you were doing when you were hurt
- How you were injured
- The initial medical care and diagnosis you received, including orders to not return to work
- That you notified your employer that you had been injured and you were advised to stay out of work
- Medical care you have received in the time since your injury
- Physical limitations you are experiencing due to your injury
- How your injury has adversely affected your ability to perform your job, as well as other activities in your life.
After you testify, the defense lawyer can cross-examine you. We will have prepared you for the defense’s likely questions. He or she will most likely attempt to get you to contradict your testimony or other evidence you have submitted. If your testimony at the hearing is inconsistent with your prior deposition testimony, the defense lawyer will almost always focus on that. (This is why it is crucial that you are properly prepared prior to your deposition.)
If the defense has witnesses, they present them after your side rests its case. Your lawyers will be able to cross-examine them.
Once all testimony has been provided, the commissioner will then review all of the evidence and render a decision in writing. Commissioners rarely make a decision from the bench. This makes sense as there is no way the commissioner can review all of the medical evidence while listening to the witnesses’ testimony. Most commissioners advise the parties of their decision within a few weeks of the hearing but in some cases, it could be a number of months before you are advised of the outcome. (This can vary widely from commissioner to commissioner. Based on our ample experience handling South Carolina work injury claims, we can give you some idea of what to expect in terms of how long it will take your assigned commissioner to make a decision).
How Has COVID-19 Affected Workers’ Comp Hearings?
Due to coronavirus concerns, the S.C. Workers’ Compensation Commission has adopted COVID-19 protocols for hearings, which include requiring face masks, using hand sanitizer and maintaining a social distance of 6 feet between participants. We have been very impressed with the commission’s efforts to keep the workers’ compensation system functioning as fully as possible given the concerns about the coronavirus. Ken Harrell, our law firm’s managing partner, has been one of four South Carolina lawyers who has met (via Zoom) with the chairman of the Workers’ Compensation Commission on a bi-weekly basis since the pandemic started in the U.S. to discuss best procedures for the commission and all parties to these claims.
If you prefer not to have an in-person hearing, you may request an electronic hearing using Court Call. The request must be agreed upon by all parties and approved by the jurisdictional commissioner.
Anyone who has experienced symptoms associated with COVID-19 or who has been in close contact with someone who has a confirmed COVID-19 infection within 14 days of the hearing should immediately notify their attorney or the jurisdictional commissioner so safety precautions can be implemented.
We would ask that you please contact Joye Law with any COVID-19 concerns regarding a workers’ comp hearing and let us assist you.
Contact Our South Carolina Workers’ Compensation Attorneys
As you can see, careful preparation is absolutely essential to a successful workers’ comp hearing in South Carolina. Knowing what to expect is just one part of preparation; the other is having an experienced team of lawyers on your side. You have the legal right to fight a denied workers’ compensation claim, but it requires know-how and preparation to actually win these cases. Our workers’ compensation lawyers have fought for injured workers in South Carolina for over 50 years.
To learn more about what our workers’ comp attorneys at Joye Law Firm can do for you, please call us at 888-324-3100 or fill out this online case evaluation form to schedule your free initial case evaluation. Our firm has offices in Charleston, Myrtle Beach, Columbia and Clinton, and we represent injured workers throughout the state of South Carolina.