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What Should I Do If My Workers Comp Claim Is Denied?

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In South Carolina, businesses with at least 4 employees are required to obtain Workers’ Compensation insurance for their employees. The coverage pays for all work-related injuries that occur during business hours. You may, however, be denied at any point during the process. If you were expecting your employer to cover your costly medical expenses, and you are now stuck with that burden, what should you do?

Why Were You Denied?

The first step in your appeal is to find out why you were denied. You may feel like your injuries would surely be covered, but you might learn that the perspective of your employer or the insurance company when reviewing your case feels differently. Your claim may be denied if:

  • The injury was not reported in time: In the state of South Carolina, you must report all injuries that occur at work to your employer immediately and request medical treatment, if needed. If you neglect to report the injury within 90 days of the accident you may lose your benefits. Although you must report the injury within 90 days, you have up to two years to file a claim for benefits.
  • Your insurance claim was not filed in time: If it is not filed in a timely manner, your claim will most likely be denied.
  • Your employer has successfully disputed your claim: Employers have been known to claim that injured employees were hurt while fooling around or that they were performing non-work-related tasks.
  • The injury is not compensable: For example, stress-related injuries are difficult to prove in court.
  • You did not obtain medical treatment: If you did not seek medical treatment, your employer can claim you were not truly injured.
  • You did not prove that the injury is work-related: Your claim may be denied if you cannot prove it occurred at work.

Can You Appeal the Denial?

You will most likely receive a denial letter from the insurance company or your employer. The letter will clearly state a deadline for all appeals, and the letter should be taken to a workers’ compensation attorney as soon as possible. You may be able to come to a resolution with your employer or the insurance provider. If you cannot reach an agreement, you must appeal your claim immediately.

A workers’ comp lawyer will collect evidence about the case that resolves any issues noted in the denial. For example, you can show that the claim was filed properly, you have a work-related injury, or you received the appropriate medical care. The injury might be evaluated by an independent medical practitioner, and a workers’ compensation lawyer will interview anyone involved in the case. The appeal will then be drafted and presented to the judge after a thorough investigation.

What Happens Next?

Once your workers’ compensation attorney has taken over the case, you should not contact your employer or the insurance carrier. Anything you say could be used to deny your claim, and you do not want to cause any problems while you are recovering. Your lawyer will fight for you, and your case may go to the appropriate circuit court if the appeal is denied.

Whether you have been injured on the job, in a car accident, or through the negligence of another, workers compensation attorney Tyler Lee and Lee Injury Law, LLC will be relentless in the pursuit of every possible benefit you can get – medical and financial – for your personal injury or workers compensation case.

Getting hurt is a scary process, and it can seem overwhelming dealing with doctors and insurance people, and wondering if you are making the right decisions for workman’s comp. When you turn your case over to personal injury lawyer Tyler Lee, you can finally focus on getting better – and let us deal with everything else. Call Tyler at 803-500-0000 today for a free in-home consultation.

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