What To Do If Your Workers’ Compensation Claim Is Denied

Posted by & filed under Workers' Comp.

When you file a claim for workers’ compensation, you expect it to go smoothly, especially after research and careful planning. If your claim is denied, then, it may come as a complete surprise. There are some very common reasons, however, that seemingly routine claims are denied. Sometimes, they can be corrected. An attorney on your side can be invaluable in overcoming the bureaucracy.

Reasons For Denial

Claims are denied for many reasons, some more specious than others. A common denial regards the existence of a pre-existing condition: alleging that some condition the person already had caused the injury rather than whatever accident he or she suffered. It may be true that a pre-existing condition aggravated or exacerbated an injury, but you are still entitled to compensation for the worsening of your condition.

Another common reason is procedural: in South Carolina, a workers’ compensation claim must be filed within two years of the accident date, and an employer must be informed within ninety days of the accident (though immediately is better, if possible). If either of these deadlines are missed, you may lose your chance to apply for benefits. There are a few exceptions to these deadlines, but they are unusual. They are (1) if you were unable to inform anyone of your injuries due to physical or mental incapacity; or (2) if you were the victim of a third party’s fraud; for example, if someone told you he or she would file on your behalf and never did.

Overturning A Denial

If your claim is denied, you have the right to a hearing before the  South Carolina Workers’ Compensation Commission, where you will be able to present evidence to prove your claim.  Be advised that depending on the Commission’s docket, it may take 90 to 120 days from the date of filing to receive a hearing.

The hearing will unfold not unlike a standard court case in some respects; you will be able to present evidence as well as testimony in support of your version of events, while your employer (and your employer’s insurance carrier) will attempt to refute your statements. Documentation is critical; it is not uncommon for the commissioner to deny a claim based on what seems like vague inconsistencies. Having written documentation is the easiest way to back your claims.

If you lose your case at the commission level, further appeals are possible. You may appeal to the Commission as a whole, where your case is heard by either a three or six panel of Commissioners. After that, you have the right to file a lawsuit in the South Carolina Court of Appeals. One of the most common ground alleged is that the commissioner interpreted the law incorrectly. Some people may even file claims in the South Carolina Supreme Court (SCSC) if they fail at the appeals level, but the SCSC has the right to choose which cases it hears and which it does not.

An Attorney Can Help

Navigating the waters of workers’ compensation law can be tricky at the best of times. The workers’ compensation attorneys at  Callihan & Syracuse can help you get what you deserve. Contact us at our North Charleston office today for a consultation.