People are injured on the job every day in Charleston and across South Carolina. An injured worker may be entitled to paid medical care and reimbursement of lost wages through their employer’s workers’ compensation insurance. But some companies and their workers’ comp administrators deny valid work injury claims to try to save money.
A denied worker’s comp claim can leave you with unexpected medical expenses while you are unable to work and can least afford extra bills. It’s important to know that you have options during this difficult time. It won’t cost you anything to consult with our attorney and get a clear understanding of the legal steps available to you.
The attorneys at Joye Law Firm can help you demand the benefits that you have been unfairly denied. Our North Charleston, SC, workers’ compensation lawyers have helped thousands of injured workers since the firm was founded more than 50 years ago. Joye Law Firm’s North Charleston office was recognized by The Best Lawyers in America for having the most lawyers in Charleston listed in the 2021 edition of Best Lawyers in the practice area of Workers’ compensation claimants. We know what it takes to help injured workers win workers’ compensation appeals. If we believe your claim has been wrongly denied, we are ready to put our knowledge and experience to work for you.
Why Would a Workers’ Compensation Decision Be Denied in North Charleston?
There are many reasons why workers’ compensation claims are denied. Some of the most common reasons that workers’ compensation claims are denied include:
- The application is incomplete – There’s a lot of paperwork involved in filing a workers’ compensation claim, beginning with the initial form that must be sent to the South Carolina Workers’ Compensation Commission. This document, known as Form 50, must be filled out completely if you are to claim workers’ compensation benefits. If the form is filled out incorrectly or does not include necessary supporting medical documentation, your claim will likely be denied.
- There are discrepancies between your account of the accident and your documented injuries – If there are any discrepancies between your reported injuries and what your medical record shows, your employer or the insurer may seize on the differences as evidence that you’re misrepresenting your injuries and deny your claim.
- You missed the notification deadline – In most cases, you must notify your employer of your work-related injuries within 90 days to be eligible for workers’ compensation benefits. Failure to submit a notification in a timely fashion can lead to a denied claim. This is one of the most common reasons that claims are denied and one of the easiest to avoid. Some workers miss the deadline because they don’t think initially that they have claims, or that their injuries are not nearly as bad then, as they are now. While you must give notice to your employer within 90 days, you have two years from the date of the accident to file a claim with the South Carolina Workers’ Compensation Commission.
- You didn’t seek medical treatment, or you didn’t seek treatment quickly enough – If you haven’t seen a doctor for your injuries, your employer will likely argue that your injuries aren’t serious enough to qualify for workers’ compensation benefits or are related to a pre-existing condition. You will need medical records documenting that your injury happened on the job to support your workers’ compensation claim. Without a medical diagnosis, your employer or the insurance administrator may question the origin of your injury and deny your claim.
- You didn’t see a doctor on your employer’s approved list – Unless you require emergency medical treatment after an accident, you are generally required to go to a doctor approved by your employer for treatment of work-related injuries. Be sure to consult your employer’s approved doctors list before seeking non-emergency medical care after an injury on the job. The insurance administrator may decline a claim for medical treatment by a doctor who is not on the list of approved health care providers.
- The injury is not related to your job – If you were not engaged in a work-related activity when the injury occurred, then you are not eligible to claim workers’ compensation claims. However, there are many instances when an employee is performing a job, or in the process of performing a job, and is involved in an accident. These instances can be filed under workers’ compensation. Consult with your attorney. Don’t let a non-lawyer, who works for the insurance carrier, tell you what the law is or is not.
- Repetitive Activities of the Job – There are many occasions that a worker will perform the activities of his/her job over many months and/or years and develop injuries as a result of these repetitive activities. Employers rarely want to admit that the activities which they mandate the worker to perform could cause such an injury. Consult with an attorney to determine if your job is causing the injuries you are currently experiencing.
- Your employer disputes the claim – There are a handful of reasons employers use to dispute claims. Your employer may contend that you are not covered by workers’ compensation because you are a contract worker rather than an employee. Many workers are wrongly classified as independent contractors when in fact they meet the standards to be considered full-time or part-time employees.
Does a Person Have to File a Workers’ Comp Claim with the Insurance Company?
In most cases, your employer will notify the state Workers’ Compensation Commission and file a claim with their workers’ compensation insurance provider once you have reported your injuries to the employer. They must do so within 10 days of your injury. However, some employers delay filing claims. While this could delay the start of your workers’ compensation benefits, it should not invalidate your claim.
If you have been injured on the job and your employer is slow-walking your claim, contact an attorney right away so you can fill out the necessary paperwork yourself and start getting the money to which you’re entitled.
Appealing a Workers’ Comp Denial in Charleston
While having your workers’ compensation claim denied is certainly frustrating, you should not give up without consulting a knowledgeable attorney. An initial denial does not mean your case is over. You have the option to appeal the denied workers’ compensation claim.
You have a better chance of getting the benefits you need if you work with an experienced North Charleston workers’ compensation attorney. While it can be helpful to consult with an attorney as soon as possible after a work-related injury, it is especially important to do so if your initial claim for benefits has been denied.
The workers’ compensation appeals process is complicated and bureaucratic. It’s a good idea to have an experienced worker’s compensation attorney guide you through the process.
Steps on How To Appeal Workers’ Comp Denial in Charleston
The process of appealing a workers’ comp claim denial involves the following steps:
- Informal conference – If your claim has been denied, you have a right to request an informal conference with your employer and a representative of the Workers’ Compensation Commission. You may be able to resolve the disputed claim by sitting down with your employer and the Workers’ Compensation Commission representative and avoiding the time and expense of a formal hearing. Without the guidance of an attorney, you may be unsure of your rights. A knowledgeable attorney can help you seek a fair settlement of your claim and keep an insurance provider from taking advantage of your lack of familiarity with the process.
- S.C. Workers’ Compensation Commission hearing request – If your claim has been denied and you can’t resolve the issue in an informal conference, the next step in the appeals process is to request a hearing with a representative of the state Workers’ Compensation Commission. The hearing is usually held in the county where the injury occurred. If the workplace accident occurred in Charleston, the hearing would most likely be held in Charleston County. You may be required to see a commission-approved doctor as part of the appeal. Once the commissioner has heard evidence from you and your employer, the commission member will issue a decision. Our attorneys can represent you at the formal hearing.
- Commission review – If you disagree with the outcome of the hearing, the next step is to ask for a review by three members of the Workers’ Compensation Commission. You must submit this request for appeal within 14 days of the decision by the commissioner who oversaw your hearing. You can submit additional evidence as part of this appeal to help strengthen your case. Once the three commission members have heard your case, they will issue a ruling and provide an explanation of the decision.
- S.C. Court of Appeals – Should your claim be denied after review by the Workers’ Compensation Commission, you have 30 days to appeal to the South Carolina Court of Appeals. As part of this appeal, you must provide evidence showing how the Workers’ Compensation Commission either misinterpreted the facts of the case or misapplied the relevant laws.
- S.C. Supreme Court — The last option for appealing a workers’ compensation claim is to take your case to the South Carolina Supreme Court. Be warned that the state Supreme Court has no obligation to hear your case. Finding sufficient evidence to overturn the rulings from prior appeals is a significant challenge.
You will want assistance from an experienced Charleston workers’ compensation lawyer if you need to pursue an appeal. The sooner in the process that you seek help from an experienced lawyer who can gather additional medical evidence to support your claim, the better your chances of obtaining the benefits you need.
Contact a Work Injury Claim Denial Lawyer Today
Workers’ compensation cases in South Carolina can be complicated, particularly when they involve a disputed claim and multiple rounds of appeals. It’s important that you seek help from a lawyer who has handled these kinds of cases and knows how to navigate the system.
At the Joye Law Firm, workers’ compensation claims are one of our core practice areas. We look forward to reviewing your workplace injury claim and discussing how we may be able to assist you. If we are able to assist you, we will handle your claim on a contingency fee basis. You will not be charged for our work unless we are successful in securing workers’ compensation benefits for you. We’d like to put this knowledge and experience to work for you. Contact us today for a free consultation.