One of the first things you need to do after South Carolina worker’s compensation claim is denied is to connect with an experienced worker’s compensation attorney at the Steinberg Law Firm. You are not required to hire a lawyer to handle the appeal, but you may have a better chance of a positive outcome or a higher settlement if you do.
Why claims are denied
There are a number of reasons why insurance companies and employers deny claims, and they include:
- You failed to notify your employer within 90 days of your workplace accident. The employer may dispute you notified them within their stated timeframe and therefore missed the deadline. Contact a workers’ compensation lawyer to assist you in proving your claim.
- The employer may suggest you were negligent and did something wrong by not following the workplace rules and are not entitled to benefits. South Carolina workers compensation is a “no fault” system. Unless you intoxicated or impaired at work and the employer can prove that, you should not be disqualified based on your own actions.
- The employer suggests your injuries were sustained off the job and they are therefore not work related and do not qualify for benefits. If you were within the scope/course of your employment at the time of your injury, your claim may be improperly denied.
- Your employer says you are not an employee. You may have been classified as an independent contractor/subcontractor and the employer says you are not entitled to benefits. The law says whether you are defined as a worker or not relates to the right to exercise control, how you got paid, the right to fire you, and if you were given tools/equipment.
- Some employers deny you are entitled to workers’ compensation benefits because you had a pre-existing condition when the work injury happened. This is common with neck and back injuries. You can get compensation if the workplace accident made your condition worse. You need an attorney to help you with this.
- Your employer may suggest the accident that caused your injury did not happen the way you describe it, that you are blowing your injury out of proportion and it is not as bad as you say it is. They may want you to see their doctor. You may have the right to demand an independent medical assessment.
- Your employer may pull out your employment application and suggest you cannot get benefits because you did not fully reveal or properly answer required information such as work restrictions, work history and listing any previous injuries.
- Your employer may even just say “No,” without citing a reason. You may still contact a worker’s compensation attorney and ask about your legal rights.
If you were denied benefits or have an issue with the decision, you have the right to file an appeal to the South Carolina Workers Compensation Commission.
Filing an appeal
The Workers' Compensation Commission has seven commissioners who handle hearings, issue decisions, approve settlement agreements and so forth. The Judicial Department of the Commission handles appeals, and its mailing address is:
Workers’ Compensation Commission
1333 Main Street, Suite 500
P.O. Box 1715
Columbia, South Carolina
When filing an appeal you need to submit a hearing request and a $25.00 fee. One Commissioner hears the appeal and it is usually held in the county where your work injury occurred. You may be asked to see a Commission selected physician who later testifies at your hearing. Once all parties have been heard, including the appellant (you), a decision or order is issued, which may be appealed if you disagree with it.
If you appeal to the second level, the Commission Review, there are three Commissioners at the hearing. Any decisions made here are referred to as an award. That notice of award is sent to you with findings of fact and legal rulings relating to your case. To request a Commission Review, you need to send in a request for one within two weeks (14 days) after receiving the Commissioner’s order. You must pay a $150 filing fee or send in a Request to Waive Appeal Filing Fee.
If the case is considered to be “without merit” you may be charged another $250. This rarely happens.
To appeal an award by the Commission Review
If you want to appeal an award by the Commission Review, you need to file a lawsuit, stating the reason for the appeal, with the South Carolina Court of Appeals. And, you must also outline why you believe the decision is not correct regarding the facts or the Commission’s interpretation of the law. You would be best served by being represented by a workers’ compensation attorney from the Steinberg Law Firm.
You have 30 days from the date of the award or from the date that your registered mail “receipt of notice” was sent back to the Commission, whichever is longer. Should you wish to file an appeal it is strongly recommended you have the assistance of a workers’ compensation attorney from the Steinberg Law Firm. In the event that you lose your appeal with the South Carolina Court of Appeals, you have the further option of appealing to the South Carolina Supreme Court. It should be noted that this court does not hear all filed appeals.