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Worker’s Compensation Appeals in Columbia, SC: What You Need to Know

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Worker’s Compensation in South Carolina

According to the South Carolina Bar, “the Worker’s Compensation Act in South Carolina provides that if an employee suffers injury by accident arising out of and in the course of employment, that individual is entitled to recover medical expenses, temporary total compensation for lost time, and permanent disability benefits if he/she suffered any permanent injury as a result of the work accident.” 

This rule can mean employees have help if injured while on the job. What happens if an employee makes a claim and it’s denied? Read below for more information.

Reasons Your Claim May Be Denied

It’s important to understand that though you may have a viable claim, it may be denied for reasons unbeknownst to you. Here are some of the common reasons that claims are denied.

Non-work-related injuries – sometimes, there may be questions about whether or not the injury occurred while at work. Employers may try to skirt responsibilities by challenging that the injuries occurred while outside of work. If this can be proven, the claim will likely be denied. However, if it can be proven that the injuries did occur at work, it is generally worth an appeal.

Pre-existing conditions – if you have a pre-existing condition unrelated to the work injury, it may be denied based on this information. However, if you had a pre-existing condition worsened or aggravated by the work injury, you can still be eligible for benefits. An experienced attorney can review the information and determine

Other Common Reasons for Worker’s Compensation Claims to Be Denied

South Carolina requires that you notify your employer of your injury within 90 days of its occurrence. If you miss this deadline, your claim may be denied. In some cases, however, the injuries may not present themselves immediately and can result from years of strain or stress on specific areas of the body.

If this occurs, working with an experienced attorney can ensure that though the initial timeline was blurry or was missed, there is reason to believe that the injuries occurred due to work activities. Therefore, you are eligible for benefits.

Intoxication or other non-compliant actions – one of the other ways that claims can be denied is if it can be proven that you were either acting outside of what the rules of your job were or that you were intoxicated while at work, and this directly led to your injuries.

Classified as an independent contractor – some employers will mistakenly classify you as an independent contractor. Others may intentionally do this to avoid supplying you with adequate workers’ compensation benefits.

Insufficient proof of injury – an employer or insurance administrator may contest that your injuries aren’t inadequate to require worker’s compensation benefits. If this is the case, you have options. One of them may be to ask for an independent medical examination, which can detail your injuries and why you should be eligible for benefits through a neutral third party.

First Steps to Take When Your Claim is Denied

After you are notified of your denial, one of the first steps to take is to file for a hearing. This formal process allows for you, your employer, and a representative to resolve conflicts or questions. You can file a request through the South Carolina Workers’ Compensation Commission. You can also directly contact the commissioner’s judicial department to initiate this process.

The appeals process can be significantly simplified by relying on your worker’s compensation attorney. With vast experience in this field, they can ensure that you are following the guidelines, meeting the deadlines, and presenting the facts of your case clearly so you have a better chance of your claim being approved.

What if My Appeal is Denied?

If, during the initial hearing, the outcome results in a denial, you can appeal this decision by filing a request for a commission review. The strict timeline on this is 14 days; if you wait until that timeline has passed, your request will likely be denied.

It’s important to note that a fee of $150 may also be required but is sometimes waived.

Why Hire an Attorney For My Worker’s Compensation Claims?

As you can tell from above, most employers or workers’ compensation administrators, unfortunately, will have other areas of interest rather than having your best interest at heart after an injury.

It’s important to document everything immediately after your injury occurs. Speak with others around you who may have witnessed the incident, notify your employer, seek medical help, and comply with all medically prescribed treatment.

Documentation such as a medical evaluation, proof of any physical or other therapies that may have been prescribed, and more can help you effectively prove that you are eligible for worker’s compensation.

Pictures or a journal of the injuries and their progress are also helpful. Ensure that you are following timelines that are in place by notifying your employer immediately. You can also inquire whether or not they have notified the worker’s compensation insurance of your claim.

Attempting to handle a worker’s compensation claim alone can result in frustration, unnecessary expenses, and more. By working with an experienced worker’s compensation attorney, you can gain peace of mind knowing the process was handled effectively.

With decades of experience helping clients in South Carolina with workers’ compensation claims, our team is confident and determined to help people like you pursue the benefits they rightfully deserve.

Contact our office at (803) 855-1012 to learn more.

We look forward to serving you.

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