The South Carolina workers’ compensation system provides benefits to employees injured on the job. Workers’ compensation laws specify that unless the employer is exempt from carrying insurance, any work-related injury to an employee should be covered if it occurs in the workplace or in the scope of employment. You may have questions about why workers’ comp would deny a claim. Many injured workers in South Carolina who have valid injury claims are initially denied workers’ comp benefits. Was your workers’ comp claim denied? If so, you need to understand your legal options and how to appeal a denial of a workers’ compensation claim.
What if a workers’ comp claim is denied? Our attorneys at Joye Law Firm can guide you through the workers’ comp appeals process in SC and pursue the full benefits available for your work-related injury. A free consultation with an experienced workers’ comp lawyer can help you understand clearly the options available to you.
Joye Law Firm handles workers’ comp denied cases throughout South Carolina and has offices in North Charleston, Columbia, Clinton and Myrtle Beach. The 2021 edition of The Best Lawyers in America® recognizes several Joye Law Firm attorneys in our Charleston office as well as attorneys in our Columbia and Myrtle Beach offices for their work in the practice area —Workers’ Compensation – Claimants. Take a look at what former clients say about the legal service our attorneys provided. Our lawyers at Joye Law are ready to assist you, too.
You can reach us at 877-941-1019 or fill out an online form for a free case review.
Why Would a Workers’ Comp Claim be Denied?
There are many reasons that employers and workers’ comp insurance administrators use to deny claims of injured SC workers. An experienced SC workers’ compensation lawyer, like the ones at Joye Law Firm, can review the reasons workers’ comp was denied in your case and evaluate whether you have grounds to appeal.
Some of the reasons for workers’ comp denials that may be appealed include:
- Missed Deadlines — If you fail to notify your employer within 90 days of a workplace accident, your claim could be denied. In some cases, it may not be clear exactly when an injury developed. This is especially true with repetitive stress injuries (carpal tunnel syndrome, for example) or diseases (asbestos-related diseases, for example) that develop over time from a workplace exposure. Many employers misread the law and advise injured workers that they are barred from benefits if they don’t report a work injury “within 24 hours” or some other period of time that is less than 90 days. If your employer claims you missed the deadline, but you believe that you gave notice to your employer in a timely fashion or there are special circumstances, then you should contact a workers’ compensation attorney to discuss your claim.
- Off-the-Job Injuries — An employer may claim that your injury was not work-related and that you should not receive benefits. Remember, there is a very broad definition of “work-related” under South Carolina workers’ comp laws. If you were doing work-related tasks of any type, or if your injury arose out of doing your job, it may qualify as a work-related injury. If your job duties involve driving, then your injuries in a car accident that occurred while you were working may be covered by workers’ comp.
- Misclassification — Workers’ compensation provides coverage only to employees. Some employers improperly classify workers as independent contractors to avoid paying workers’ compensation benefits. It’s an especially common practice in the construction industry. If this has happened to you, and we can show that your work met the legal definition of employee rather than independent contractor, then you may qualify for workers’ compensation benefits.
- Improper Behavior — Your employer may try to claim that you did something wrong and that you should not receive workers’ comp benefits as a result. It is a rare situation, however, where an employee is disqualified from receiving workers’ compensation benefits as a result of his or her own actions. Unless you intentionally hurt yourself or were intoxicated at work and the employer can prove that your intoxication was the cause of your workplace injury, you should not be disqualified based on your own actions, even if you were careless. Workers’ comp covers injuries regardless of fault.
- Pre-existing Conditions — Employers sometimes deny claims based on the fact that you had a pre-existing condition when your work injury occurred. However, you can still qualify for workers’ comp benefits if your workplace accident aggravated or worsened your condition. Proving the extent of your work injuries and your right to benefits is complicated in these situations, so you should consult with our South Carolina workers’ comp lawyers at Joye Law Firm for help.
- Inadequate Proof of Injury — Your employer or the insurance administrator might believe you are exaggerating your injury and contend that your injury is not as severe as you claim. When an employer or insurer tries to use the opinion of a doctor of its choosing to show that you shouldn’t receive workers’ comp benefits, you have the right to ask for an independent medical examination. Our attorneys at Joye Law Firm can help you locate a doctor and obtain a second medical opinion about your condition.
Can My Employer Deny Workers’ Comp?
If you suffered an injury that was not related to performing your job duties, your employer may deny your workers’ comp claim.
Workers’ compensation covers full- and part-time employees. If you are an independent contractor, the employer may deny your workers’ comp claim. However, employers sometimes try to misclassify workers intentionally as independent contractors to avoid paying claims. A knowledgeable workers’ comp attorney can evaluate the terms of your employment and determine whether you may qualify for workers’ compensation benefits.
If you suffered an injury in a car accident while commuting to work, that typically is not covered by workers’ compensation. However, if your job duties include driving and you are injured in a car accident while performing your job, then that should be covered by workers’ compensation benefits.
How Do I Appeal a Denied Workers’ Comp Claim?
The workers’ comp appeals process in S.C. allows for claims disputes to be heard by an independent workers’ compensation commissioner.
The S.C. Workers’ Compensation Commission administers the workers’ comp system and hears appeals of workers’ comp denials. Our attorneys can represent you at an informal conference with a representative of your employer and the S.C. Workers’ Compensation Commission. The goal of the initial meeting is to try to resolve the dispute about your claim without going through a hearing, which is a judicial process.
If an agreement cannot be reached at the informal conference, a hearing can be scheduled before a workers’ compensation commissioner. Our attorneys can present evidence to support your claim at a formal hearing before a South Carolina Workers’ Compensation Commissioner. The appeal is heard initially by one commissioner. If the commissioner rules against you, you can request that a three-member panel of commissioners review the decision. If you are dissatisfied with the ruling of the three-member panel, you can appeal to the full Workers Compensation Commission and then to the S.C. Court of Appeals.
Do I Need an Attorney to Appeal Workers’ Comp Denial?
The workers’ compensation appeals process is complicated. You will have strict deadlines to meet and you will have to present persuasive evidence in the manner required by the workers’ compensation commissioner or panel. The rules of legal procedure at each step in the appeals process will vary.
While having legal representation is not mandatory, you will be at a disadvantage if you do not have an experienced workers’ compensation attorney representing you at a judicial hearing. It is a legal proceeding. The employer or insurance company will have legal counsel, and you should as well.
Having a SC workers’ comp lawyer guiding you through the hearing process gives you the best possible chance of winning your appeal.
Contact Our SC Workers’ Compensation Claim Denied Lawyers Today
If workers’ comp denied your claim, don’t accept “No” as the final word. Let our South Carolina workers’ comp attorneys at Joye Law review your injury claim and discuss your rights to pursue a workers’ comp appeal. We offer a no-charge consultation and only get paid if you receive benefits.
If you have been injured in a South Carolina workplace accident or job site accident, you can trust our attorneys at Joye Law Firm to make every effort to get you all the workplace injury benefits available by law.
While each workers’ compensation case has a unique set of facts and the results of previous cases are in no way predictive of a similar result in another case, the results obtained by Joye Law reflect the firm’s experience when it comes to workers’ compensation and personal injury cases. Click on the results tab to see more details about some of the case results obtained by previous Joye Law Firm clients.
Our workers’ compensation lawyers offer a free case evaluation and are ready to handle your workers’ compensation case anywhere in South Carolina. We represent injured workers throughout the state including Florence, Richland County, Orangeburg, Conway, North Myrtle Beach, North Charleston, Mount Pleasant and Summerville. Call today.