You can recover workers’ compensation benefits in the State of South Carolina if you have suffered a workplace injury. The benefits you can receive under workers’ compensation include payments for medical expenses and lost earnings. Depending on the facts and circumstances of the case, other benefits may be available.
South Carolina Workers’ Compensation Claims are Denied for Many Different Reasons
It is possible that a workers’ compensation claim can be denied. You need to understand the rights you have under South Carolina to appeal a denied workers’ compensation claim. An appeal is often the first step to take after having a workers’ compensation claim denied.
A Myrtle Beach workers’ compensation attorney can help you through every stage of the workers’ compensation appeal process.
Options if Your Workers’ Compensation Claim Is Denied
Workers’ compensation claims can be denied for many reasons. It is typically the employer’s insurance company that denies the workers’ compensation claim. However, this is not the end of your attempt to seek workers’ compensation benefits.
It is possible to have an informal meeting with your employer and the insurance company. In the event that an informal meeting does not lead to a resolution, you can file an appeal with the South Carolina Workers’ Compensation Commission.
Will the South Carolina Workers’ Compensation Commission Help?
The South Carolina Workers’ Compensation Commission handles workers’ compensation claims throughout the state. If an employee files an appeal after a workers’ compensation claim has been denied, the South Carolina Workers’ Compensation Commission conducts a hearing and renders an appeal decision.
Learning more about the workers’ compensation appeals process can help you make more informed decisions regarding your legal rights. If you submitted a workers’ compensation claim that was denied, you can gather resources and sources that will help you decide whether or not to appeal the decision.
Standing up for your rights can take a lot of work and effort. It can benefit you to speak to a Myrtle Beach workers’ compensation attorney for additional support regarding your workers’ compensation appeal.
Most Common Reasons a Workers’ Compensation Claim Is Denied
Insurance companies will look for any reason to deny workers’ compensation claims. The insurance company is interested in preserving its profit, not in paying workers’ compensation claims. Therefore, an insurance company may deny a workers’ compensation claim for any of the following reasons:
- The employer claims that the injury occurred outside of the workplace or outside of the course and scope of the employee’s duties. An employer may also state that the employee was under the influence of alcohol or drugs when the accident occurred.
- The employer may claim that the injured employee had a pre-existing medical condition and that the employee did not suffer any injuries at the workplace.
- The injuries are not severe enough for an award of workers’ compensation benefits.
- The doctor who treated the employee’s injuries was not on a list of medical providers approved by the employer.
- The employee did not seek immediate medical treatment after suffering injuries.
- The employee did not notify the employer of the workplace injury.
- The workplace accident report and the injury records are incompatible.
- The workers’ compensation claim contained inaccurate information.
Steps to Protect Your Claim
It is important to document any letters you receive from the South Carolina Workers’ Compensation Commission. You need to provide these records when you submit an appeal.
Keeping copies of these records in a file can help you stay organized during this time period. You may receive many different documents from employers, insurance companies, and the South Carolina Workers’ Compensation Commission.
The Workers’ Compensation Appeals Process
The appeals process is composed of steps that must be followed sequentially. First, an informal conference is held between the employee, the employer, and the employer’s insurance company.
Some workers’ compensation claims are denied due to typographical errors or other minor issues. These mistakes typically can be corrected without consulting the South Carolina Workers’ Compensation Commission.
Hearing Request
If an informal conference does not resolve your workers’ compensation claim issue, then the employee submits a hearing request with a small fee to the South Carolina Workers’ Compensation Commission. The hearing is conducted in the county where the employee suffered the workplace injury.
An employee is often asked to visit a physician recommended by the South Carolina Workers’ Compensation Commission. Typically, the doctor will provide a written report and testify during a hearing. The South Carolina Workers’ Compensation Commission will then issue a decision.
After this decision is issued, the employee has fourteen days to file a Request for Commission Review. During this second stage of the appeal, three commissioners will examine the facts of the workers’ compensation claim. The team of commissioners will then produce a ruling regarding the employee’s appeal.
When a Lawsuit May Be Necessary
If the employee wants to appeal this ruling, then the employee has thirty days to initiate a lawsuit in the South Carolina Court of Appeals. During the period after the lawsuit is filed, the employer must pay the employee cash benefits every week, and the insurance company must provide payments for your medical treatment. The time period during this stage of the appeal process can vary depending on the facts and circumstances of each case.
Lastly, if the South Carolina Court of Appeals denies your case, then you can bring your claim to the South Carolina Supreme Court. The South Carolina Supreme Court will then make a determination whether or not to hear the appeal. The Supreme Court is not obligated to hear any case, and it has discretion whether or not to take an appeal.
Contact the Shelly Leeke Law Firm, LLC Today for Help with Your Workers’ Compensation Claim
The Shelly Leeke Law Firm, LLC has over a decade of experience representing clients in workers’ compensation cases. We have the knowledge and skill required to handle every stage of a workers’ compensation appeal. It can be disheartening to learn that your workers’ compensation claim has been denied.
However, you have the right to an appeal, and although the process is complex, we can help you enforce your legal rights. Call us today to schedule a consultation and learn more about how we can help you with your workers’ compensation appeal.
