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How to Appeal After My Workers Compensation Claim is Denied?

If you have suffered a workplace injury, you are already under a lot of physical and mental stress. The injury may leave you bedridden for a period as the medical bills for the treatment pile up. Workers’ compensation insurance, which is mandatory for most employers in South Carolina, is meant to support you in precisely such a scenario.

However, there are times when recovering these benefits may not be that easy. The standard procedure for seeking these benefits is to notify your employer at the earliest and furnish the required evidence. You may also be asked to see a designated doctor to confirm the nature and extent of your injury.

Once you submit your claim, there is still no guarantee that you will receive the benefits. Your employer, or the insurance company, may raise various objections and turn down the claim. You may feel anger, disheartened or dejected at the denial.

However, the good news is that it is not the end of the road. You still have plenty of options to appeal the original denial and with good legal representation from our Greenwood workers’ comp attorneys, you have a good chance of getting the benefits you deserve. Here is a look at how you should proceed following the denial.

Understand the Denial

This is immensely important. In many cases, an insurance company or employer may raise only administrative concerns regarding your application. This means that your claim is backed by enough evidence but didn’t meet other requirements such as deadlines or defined procedures. In such a case, you can correct the error by understanding the administrative issues and sorting them out.

However, if the denial has something to do with the lack of evidence or suspicion of fraud, you will need to appeal with the Workers’ Compensation Commission.

File an Appeal

If your claim was denied on non-administrative grounds, you have the option of filing an appeal with the Commission. The appeal must be filed within 30 days of receiving the denial. The Commission will then notify you about the date of the hearing.

Attend the Hearing

The hearing is where you present your case in front of a Deputy Commissioner in person. The Commissioner will judge you in person, take a look at your evidence, and listen to your arguments. The employer or the insurance company that rejected your claim will also be legally represented at the hearing to share their side of the story.

The hearing is one of the most critical parts of the appeals process. The Commissioner who presides over the hearing process makes a decision within three to eight weeks. You are notified about the decision via mail.

Hire a Qualified Attorney

During the hearing, you are required to present evidence, prove your injury, and meet a number of other requirements. On your own, it can be immensely tough as you have to face-off with the highly paid legal counsel on the other side.

This is why it is highly advised that you hire a qualified workers’ compensation attorney ahead of the hearing. Hiring the attorney in time is important as you will be required to submit all the relevant evidence before the actual hearing. Any lapses in filing the evidence may weaken the case and lead to a denial by the Commissioner.

Appeal the Decision of the Hearing

If the Deputy Commissioner decides against you at the hearing and denies your claim, you still have the option of taking your claim to Commission Review. At this level, a panel of three Commissioners will preside over the hearing and review your case.

You must request a Commission Review within 14 days of receiving the Deputy Commissioner’s denial. You are also required to pay a fee of $150 for filing the review. It is important to note that the Full Commission will rarely go against the original decision of the Deputy Commissioner unless there is a clear lapse of judgment.

Workers’ Compensation Attorney in Greenwood, South Carolina

If your workers’ compensation claim has been turned down by an employer or insurer, you must immediately seek professional legal help. A good attorney will help you file a review in time, prepare for the hearing and submit the right evidence.

Here at ABS Law Firm, we have been working with workplace injury victims for many years. Our attorneys can help you seek the fair benefits you deserve by furnishing the right evidence, countering the unfair objections of the other side, and meeting other important requirements. Contact us today to book a FREE consultation with our attorneys.

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