Getting injured on the job, or developing a disabling medical condition due to your work environment, can be devastating. What can be even more stressful, however, is if your workers’ compensation claim is denied, in full or in part. If you or someone you know has suffered a workplace injury or illness and has experienced difficulties filing his or her workers’ compensation claim, contact a seasoned Anderson workers’ compensation attorney right away.

Common Reasons for WC Claim Denials

There may be several reasons why your South Carolina workers’ compensation claim was denied. Some of the most common reasons for denials include, but are not limited to:

• Failure to report the claim on time or at all – state law requires an worker who is injured on the job to report the claim right way, sometimes within a matter of days. Additionally, the employer must also inform the state and/or its workers’ compensation insurance carrier just as quickly.

• Your employer disputes the claim –  this may happen because the employer is challenging that the incident ever happened at work or disputes that the injury or illness resulted from the work-related injury.

• Your claim is precluded by state law – some states have excluded certain medical conditions from workers’ compensation claims, such as stress-related conditions. Your claim may be barred if your medical condition falls within one of these exclusions.

• Your injuries are not severe enough – while a on-the-job accident or job-related condition may cause an injury, this condition may not rise to the level to amount to a workers’ compensation claim.

It is important to thoroughly look at your workers’ compensation claim denial letter to better understand the reasons for the insurance carrier rejecting your claim. If you are still uncertain as to why the claim was denied, contact a seasoned Anderson workers’ compensation attorney immediately.

Appealing Your Workers’ Compensation Denial

Appealing a workers’ compensation claim can be overwhelming. Injured or sick workers should not have to fight for their benefits on top of having to manage their medical condition and undergo financial stress. Nevertheless, if you wish to appeal your workers’ compensation claim denial, the first place to look is the insurance carrier’s letter. This correspondence will include the reason(s) for the denial as well as instructions on how to appeal, including important deadlines.

Before submitting an appeal, your employer or its workers’ compensation insurance carrier should be contacted to discuss the denial. If the denial was based on a simple mistake such as paperwork issues, the matter may be resolved rather quickly. If the denial is based on a more substantive reason, then a formal appeal should be pursued.

Depending on the state in which you reside, a workers’ compensation  appeal process may differ. Generally, the first level of appeal will include an administrative hearing before a judge, known as an administrative law judge (“ALJ”). This hearing before an ALJ may occur through a state labor department or state board of workers’ compensation. In South Carolina, the appeal  must be made to the South Carolina Workers’ Compensation Commission (SCWCC) along with a $25 fee and the hearing is before a commissioner. While the SCWCC is located in Columbia, hearings are held throughout the state. Typically, the hearing will take place within the county in which you reside.

At the appeal hearing, the worker seeking benefits will be required to provide medical evidence as well as factual evidence to support the existence of a claim. This is necessary whether the claim is based on a work-related injury or an occupational disease. Sometimes the commission will require that a claimant be seen by a doctor of it’s choosing. If this is requested, the doctor will examine the claimant and then testify before the commission.  After a hearing, the commission will issue a decision, known as an “order.” If you disagree with this order, further appeals may be pursued.

Legal Help in South Carolina

The purpose behind our nation’s workers’ compensation system was to provide fair and timely benefits for workers who suffered a work-related injury. This system, however, often works to the benefit of employers and their insurance companies. They have a team of aggressive lawyers working hard on their side to fight your claim. You should have competent workers’ compensation lawyers on your side to fight back. If you or anyone you know has suffered a work-related injury and is thinking of filing a claim, contact the Anderson workers’ compensation attorneys at The Law Offices of Steven M Krause PA for your initial consultation.

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Steven M. Krause

Steven Krause is a personal injury, auto accident, and workers’ compensation lawyer who practices in Anderson, SC. He graduated form the Thomas M. Cooley School of Law and has been practicing law for 40 years now. Steven Krause believes in fighting for the injured. Learn more about his experience here.