According to data from the Bureau of Labor Statistics (BLS), there are around 30,000 people who are hurt on the job in South Carolina each year. Our state has a no-fault workers’ comp system that allows injured victims to file for benefits. Unfortunately, some employees struggle to get access to their benefits. This raises an important question: What happens if a workers’ comp claim is denied? The short answer is that you have the right to file an appeal, by way of requesting a hearing. Here, our South Carolina workers’ compensation attorney explains what happens when your claim is denied.
Most Common Reasons Why Workers’ Comp Denied in South Carolina
South Carolina is a no-fault workers’ compensation state. Injured workers do not need to prove that their employer was “at fault” to be eligible for benefits. With that being said, a workers’ comp claim will not be automatically approved. It could be denied for a wide range of different reasons. Some of the most common reasons why workers’ comp claims are denied in South Carolina include:
- Failure to Report/File promptly: Workers’ comp claims are time-sensitive. In South Carolina, a workplace injury must be reported to an employer within 90 days and a workers’ compensation claim must be filed within two years. If an injured worker misses these deadlines, their claim may be denied outright. Delays in reporting are a big deal, so it is always best to report your injury immediately.
- Alleged Non-Work-Related Injury: You must prove that your injury was “work-related” to qualify for benefits. For a workers’ compensation claim to be approved, the injury must have happened during employment. If an employer or insurer believes the injury occurred outside of work, they may deny a claim.
- Pre-Existing Condition: A claim may be denied if the insurer argues that the injury was due to a pre-existing medical condition rather than a workplace accident. South Carolina law allows compensation if work aggravated a pre-existing condition, but this must be proven. Without medical evidence linking the injury to work, the claim may be denied.
- Horseplay or Worker Intoxication: Finally, in South Carolina, both “horseplay” and “intoxication” are potentially defenses against a workers’ comp claim. If an employee was under the influence of drugs or alcohol at the time of the injury, their claim may be denied. Employees need to be prepared to fight back if this type of defense is being raised.
Workers’ Comp South Carolina: The Next Steps After a Denial
Did you receive a workers’ comp denial letter? If so, you must take immediate action to protect your rights. As frustrating as a workers’ comp denial is, it is by no means the end of the road. Neither your employer nor its insurance company has the unilateral right to make the final decision on your case. A proactive approach is a must. You can still pursue benefits. Here are four steps to take after receiving a workers’ comp denial in South Carolina:
- Review and Preserve the Denial Letter: Receiving a denial letter can feel overwhelming, but do not panic—it is important to remember this is just the one step in the claim process. Valid workers’ comp claims do sometimes get denied. With that in mind, you should carefully review the letter to understand why your claim was denied. By our state’s workers’ comp regulations, your denial letter should outline the specific reasons and any missing information. Keep the letter in a safe place. It provides key information for your appeal.
- Consult With a Workers’ Comp Lawyer: Professional legal representation can make the difference in the workers’ comp claim—especially so after a denial has already happened. A top-tier South Carolina workers’ comp lawyer can help you gather and prepare all of the evidence that you need to challenge a denial. Remember, you have the right to appeal. A workers’ comp denial is not the end of the road. An attorney can help you put together the strongest possible appeal.
- Gather Supporting Documentation: One of the most important steps after a denial is gathering strong evidence to support your claim. Among other things, it is important to gather medical records, accident reports, witness statements, and any correspondence with your employer about the injury. For example, if the denial was due to a lack of medical proof, consider getting additional evaluations or a letter from your doctor. The more evidence that you have, the better positioned you will be to bring a successful claim.
- File a Workers’ Comp Claim: Finally, you need to file a workers’ comp claim. There are specific steps that you must take to file a proper claim. A South Carolina workers’ comp lawyer can help. The claim process includes filing a formal request for a hearing—and, assuming your case is not settled before that point, this is part of the process where you can present evidence and argue your case. There are strict deadlines. Be sure to act quickly to avoid losing your chance to fight for benefits.
Why Trust Smith & Jones Law for a Workers’ Comp Denial
Dealing with the denial of workers’ comp benefits is stressful, frustrating, and even confusing. It is normal to have a ton of questions about your rights, your options, and exactly what needs to be done next in the claims process. At Smith & Jones Law, LLC, we are proud to put victims and families first. You do not have to take on the workers’ comp appeals process alone. Our South Carolina workers’ compensation attorneys provide free, confidential, and no-obligation initial consultations.
Contact Our South Carolina Workers’ Compensation Attorney Today
At Smith & Jones Law, LLC, our South Carolina workers’ comp lawyer is standing by, ready to protect your rights. If your workers’ comp claim was denied, we are here to help. Contact us today for a free, no-obligation case review. With offices in Lexington and Mauldin, we handle workers’ comp appeals throughout the surrounding region in South Carolina.