Has your workers’ comp claim been denied in Greenville, SC? What you do next is important. From our experienced Greenville workers’ compensation lawyer at Bobby Jones Law, here’s how to fight a denied workers’ comp claim.
Why Do Workers’ Comp Claims Get Denied in South Carolina?
Workers’ comp claims get denied in South Carolina because of:
- Qualification. The case doesn’t qualify for benefits.
- Reporting. The person doesn’t take the right steps to claim their benefits.
- Benefits. There are disputes about appropriate benefits.
As the injured worker, it’s important to report the injury properly and take the right steps to claim your benefits. Involving an attorney early in the process can ensure that you receive the benefits that you deserve.
What Are the Most Common Reasons for Workers’ Comp Denial in SC?
Reasons that workers’ comp claims get denied in South Carolina include:
- Reporting. You did not report the workplace injury within 90 days.
- Pre-existing condition. The injury did not worsen a pre-existing condition.
- No accident. There was no accident or incident that caused the injury.
- Contractor. The injured person is a contractor, rather than an employee.
- Off the job. The injury did not happen on the job.
- Safety violation. The employee intentionally violated an enforced safety rule.
- Medical necessity. The healthcare you are seeking is not medically necessary.
- Non-compliance. There has been non-compliance with treatment directives.
- False statement. You made a false statement of physical condition at the time of hiring.
- Work refusal. There was a refusal of work that fell within limitations.
- Intoxication. The injury was caused by your own intoxication.
- Intentional harm. The injury resulted from your own intentional harm.
Some reasons for denial are related to the incident itself; for example, the person doesn’t qualify because they were not an employee. Other matters related to the workers’ compensation case include disputes over appropriate medical care, wage calculations, or refusal to return to work.
What Is the Workers’ Comp Appeals Process in South Carolina?
The workers’ compensation appeals process depends on the stage in the case. Usually, the employee files Form 50 – Employee’s Notice of Claim and Request for Hearing. This preserves your right to compensation and takes your case to a single commissioner. If the case involves an employee death, it’s Form 52.
The employer answers with Form 51. They must respond specifically, affirm or deny the statements in Form 50, and state any affirmative defenses.
The case is assigned to a commissioner for a hearing. This is the evidentiary hearing, so it’s extremely important. The injured person may submit evidence and argue their case. The employer may respond.
You may participate in mediation before your hearing. An attorney can represent you in negotiations.
How Long Do You Have To Appeal a Denied Workers’ Comp Claim in SC?
How long you have to appeal a denied workers’ compensation claim in SC depends on the stage of the case:
- Initial denial: Two years
You have two years to file Form 50. This is after the initial report of injury within 90 days.
- Single commission review: 14 days
If the single commissioner denies your claim, you have 14 days to appeal to the full commission.
- Three-panel review: 30 days
If the three-person panel denies your case, you have 30 days to file in the South Carolina Court of Appeals.
- Court of Appeals. If you’re unsuccessful at the Court of Appeals level, you have 30 days to file a writ of certiorari with the South Carolina Supreme Court. The Supreme Court will decide whether to hear the case.
How to appeal depends on the stage. An experienced Greenville workers’ compensation attorney can assist you.
What Evidence Strengthens a Workers’ Comp Appeal in Greenville?
Evidence that strengthens a workers’ comp appeal in Greenville depends on the disputed issues. To strengthen your appeal, you must address the issues.
If it’s your first hearing before a commissioner, it’s your opportunity to present evidence. If you’re appealing the commissioner’s decision, your written documents must argue legal issues and conclusions drawn from facts.
What Is the SC Workers’ Compensation Commission, and How Does It Handle Disputes?
Workers’ compensation cases don’t go to court right away as traditional court cases do. Instead, they go to the South Carolina Workers’ Compensation Commission (SCWCC), a government agency that administers workers’ compensation in South Carolina. Instead of traditional courts with judges, personal injury claims go before commissioners who are part of the SCWCC. These commissioners decide disputes and process cases.
Can Your Employer Retaliate After a Denied Workers’ Comp Claim in South Carolina?
It’s against the law for an employer to retaliate against someone for exercising their workers’ comp rights. That doesn’t mean that you keep your job no matter what while on workers’ compensation. You can still be fired for cause, and there are circumstances where the employer is not required to hold the job for you. But if the employer retaliates against you for appealing a workers’ comp denial, they may face penalties and owe additional compensation.
What Is Bad Faith Workers’ Comp Denial and Does SC Law Address It?
The South Carolina workers’ compensation system is meant to be an efficient way for injured workers to get the help they need. Employers must act in good faith. If they don’t, they may owe you additional compensation as a penalty. Usually, the employee seeks bad faith penalties through the SCWCC, but a retaliation claim may be filed in court.
Why Greenville Workers Need an Experienced Attorney After a Workers’ Comp Denial
It’s not enough to file paperwork. To make an appeal successful, you need the right evidence, arguments, and legal strategy. An experienced attorney can investigate, build evidence, and file documents on your behalf. They can represent you at your hearing and negotiate your case.
Attorney Robert “Bobby” Jones of Bobby Jones Law represents clients in workers’ compensation denials. It’s best to involve an attorney as early as possible. We invite you to contact us to talk about your case.
