If you have a pre-existing injury and get hurt at work, you may have concerns about filing for workers’ compensation.
Workers’ compensation allows you to continue having an income while you’re unable to work due to an injury. In South Carolina, workers’ compensation covers lost wages, medical bills and provides disability benefits, even if the injury was not the employer’s fault. You can also get workers’ compensation for aggravation of a pre-existing condition. Hiring a workers’ comp attorney familiar with this type of claim can help you avoid a claim denial.
Pre-Existing Injury Qualifications
Sustaining an injury at work typically entitles you to a worker’s compensation claim. You may have to prove that the accident occurred during work hours and while doing activities outlined in your job description.
If you have a pre-existing condition, there’s a higher risk of re-injury. You can receive workers’ comp benefits if an accident at work causes:
- An old injury to flare-up
- Aggravation of a previous condition
- An existing injury to worsen
- A decline in your physical health
Your claim may still be denied if you are unable to prove that there was any aggravation or worsening (meaning any pain is only from the existing condition). It may also be denied if you are unable to prove the flare-up was connected to an injury at work or from performing your job duties. An experienced South Carolina workers’ compensation worker can help you gather the evidence needed to prove your claim.
What Pre-existing Conditions are Covered?
It’s estimated that between 50 and 129 million Americans have a pre-existing condition that’s prone to aggravation. Common pre-existing ailments that may result in re-injury during a workplace accident include:
- Arthritis
- Broken bones
- Herniated disks
- Spondylosis
- Torn ligaments
- Degenerative disc disease
The most prevalent and debilitating injuries seen in the workplace are back problems. Each year, there are over 2 million reported cases of back injuries. It’s predicted that 8 out of every 10 Americans will experience a back injury in their lifetime.
How to Get Workers’ Comp for Pre-Existing Conditions
Trying to get workers’ comp for an injury can be difficult if you’re unfamiliar with the process. But trying to get coverage for a pre-existing condition can be even more challenging.
South Carolina Workers’ Compensation Law Section 42-9-5 outlines the criteria a worker must present to receive benefits. When an accident aggravates a pre-existing condition, you must prove the injury occurred during the execution of your work responsibilities. You must also show:
- The new injury affected the pre-existing or permanent ailment
- The pre-existing or permanent physical impairment exacerbated the recent injury
To get benefits started, you must notify your employer of the injury when it occurs. Then you should request a checkup from your company’s preferred doctor. You are entitled to visit your own physician for medical cases, but your company can deny coverage claims for these visits unless they have approved the health care provider.
To approve a switch to your family doctor, contact your employer or the insurer with the request. If the switch is denied, you can request a hearing with the South Carolina Workers’ Compensation Commission.
If you cannot notify your supervisor immediately, you have 90 days to do so to be eligible for a claim, as outlined in the S.C. Workers’ Compensation Act. You should start receiving benefits once your employer approves your claim.
How to Handle a Denied Claim
It’s not uncommon for a company or insurance provider to deny a workers’ compensation claim. But getting a denial letter isn’t the end of your claim process.
Common reasons for a claim denial include injuries that occur off-the-clock, missing the deadline to inform your employer of the injury, employment status, and pre-existing conditions. Oftentimes, however, they are denied simply because of missing, incomplete or incorrect paperwork.
Hiring an experienced South Carolina workers’ compensation lawyer at Joye Law Firm can improve your chances of getting the benefits you’re entitled to, especially if you were wrongfully denied because of a pre-existing condition. If your claim is denied or if you are just starting a claim, a knowledgeable workers’ comp attorney at our law firm can help you through the process.
Filing an Appeal
After a claim denial, your next step is to request a hearing with the Workers’ Compensation Commission.
You will need to complete Form 50 (Form 52 in the case of wrongful death) to file a claim. If you decide to request a hearing, ensure your attorney is present.
Some cases may require you to go through mediation before pursuing the matter in the courtroom. Mediation happens between you, a representative of your employer, and a neutral mediator to try to find a resolution before going to trial.
It can take four to six months for you to get a scheduled hearing if mediation fails to get your benefits started. If there are multiple denials, it can take twelve months or longer to get approved.
Find All Workers’ Compensations Forms Here
Let Joye Law Firm Secure Your Workers’ Comp Benefits
Whether you’re filing a workers’ compensation case due to aggravation of a pre-existing condition or an appeal for a denied claim, you need an attorney in your corner to protect your rights.
Contact the South Carolina workers’ compensation attorneys at Joye Law Firm for your free initial consultation. We have been fighting to help South Carolinians seek fair compensation since 1968. Our lawyers value each client and work hard to get you the payout you need to move forward with your life.
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