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How to Appeal a Workers' Compensation Claim Denial

Workers Compensation Appeal South Carolina

How to Appeal a Workers’ Compensation Claim Denial in South Carolina

Title 42 of the South Carolina Code of Laws is the state’s workers’ compensation law. It gives a person who is injured on the job or develops an occupational illness access to medical treatment provided by workers’ compensation insurance, temporary compensation if the injured worker is out of work while receiving medical treatment, and compensation for any remaining disability after concluding medical treatment.

South Carolina requires any business with four or more workers to obtain workers’ compensation insurance. Workers’ compensation, in most instances,turn, is the sole means of recovery for an injured worker.

If you are seeking workers’ compensation in South Carolina but have had your claim denied or received benefits that were less than you believe you deserve, do not wait to get help from a lawyer. An experienced attorney will know how to prepare your application or appeal so you can pursue all of the benefits you may be entitled to.

Jebaily Law Firm has more than 100 years of combined legal experience and has been helping injured workers throughout South Carolina for Over 50 Years. Call us or complete an online contact form now to set up a free consultation.

Reasons for a Workers’ Compensation Claim Denial

Workers’ compensation claims might be denied for a variety of reasons. Some of the most common reasons that claims are denied include:

  • Injuries Not Work-RelatedAn employee may have injuries that are determined to be not work-related. An employee who has his or her claim denied for this reason will have to prove that their injuries arose out of and in the course of their employment.
  • Missed Deadlines — An employee is generally required under South Carolina law to report their injury to their employer within 90 days, but it is always best to report an injury as soon as possible. Some employers may seek to deny claims when reports are not filed within a shorter time period. Also keep in mind that the statute of limitations for workers’ compensation benefits is two years in South Carolina. In most case that means that a claim must be filed with the workers’ compensation commission within two years of the work-related injury.
  • Alleged Misbehavior — An employer may try to deny workers’ compensation benefits to an employee they claim was injured because they engaged in behavior that was prohibited. An employee may not be entitled to benefits, for example, if they were injured while under the influence of drugs or alcohol on the job. In most cases, an employer is expected to pay workers’ compensation regardless of the injured workers’  fault.
  • Incorrect Classification — An employer may have misclassified an employee as an independent contractor, which leads to workers’ compensation claims being denied. When your claim is denied for this reason, you may be able to prove that you are actually an employee. The law is more concerned with the characteristics of the employment relationship and less concerned with the label the employer applies.
  • Pre-Existing Conditions — Some employers will claim that an employee’s injuries were the result of the pre-existing conditions, but employees may still obtain benefits when accidents aggravate or worsen those conditions.
  • Inadequate Proof of Injury — Your claim may require greater proof of the nature of your injury and how it affects your ability to work in order for you to receive compensation. You may have to obtain a statement from your treating physician in such cases.

These are just a few examples of the reasons why an employer or a workers’ compensation insurance company may try to deny your workers’ compensation claim.

An initial denial is not the end of the road for your workers’ compensation claim. You have appeal options and you should make sure that you are working with an attorney to recover those benefits.

How to File a Workers’ Comp Claim and Appeal

You need to submit a hearing request to the South Carolina Workers’ Compensation Commission to pursue a workers’ compensation benefits denial. A claim will be heard by a single Commissioner.

The Commission will schedule a hearing, which is usually held in the county where your work-related injury occurred. You may be required to see a doctor selected by the Commission in some cases, and that doctor could also then testify at the hearing.

The Commission issues a decision, and an employee who has his or her claim denied by the Commission, can then seek a Commission Review. Then the claim will be heard by a panel of Commissioners. You have to submit a Request for Commission Review within 14 days of the Commissioner’s order denying the claim.

An appeal of a decision  by the Commission Review panel must be filed with the South Carolina Court of Appeals. You have 30 days from the date of the decision or the date that registered mail receipt of notice was sent back to the Commission, whichever is longer.

If an appeal in the South Carolina Court of Appeals is unsuccessful, the final appeal option is the Supreme Court of South Carolina. The Supreme Court of South Carolina does not hear every appeal, however, so it is not guaranteed that a workers’ compensation case can proceed past the Court of Appeals.

What to Do If Your Claim Is Denied

If your workers’ compensation claim has been denied, do not try to file a new claim. Do not abandon all hope about your original claim either. Instead, contact an attorney for assistance.

You have only a limited amount of time to file an appeal, but a lawyer will be able to help you meet all deadlines that apply to your case. Your attorney will also be able to represent you during your hearings and will know what evidence to collect and present during these hearings.

Some claims are denied simply because of errors that people made in submitting their original applications, and such mistakes can usually be easily corrected. Other cases may be more challenging when employers are disputing injuries or challenging the amount of benefits, but a lawyer will be able to help an injured worker fight for seek all of the benefits they may be entitled to

How Jebaily Law Firm Can Help

Was your workers’ compensation claim recently denied in South Carolina? Were you awarded benefits that are less than you think you deserve under the law? Make sure you contact Jebaily Law Firm as soon as possible.

Founding partner Ronald J. Jebaily is a recipient of the South Carolina Workers’ Compensation Educational Association’s “Lifetime Service Award” and named one of the Top 100 Workers’ Compensation Attorneys in the country in 2014. Our lawyers can discuss all of your legal options as soon as you call us or complete an online contact form to take advantage of a free consultation.