What to Do If My Workers’ Compensation Claim Is Denied?

If you are injured in a workplace accident or incur a medical condition due to workplace conditions, you may be entitled to workers’ compensation benefits. You typically need to file a claim with your employer when seeking workers’ comp benefits. In South Carolina, you are required to report a work-related injury within 90 days. However, you can still file a claim for benefits within two years of the incident.

It is not uncommon for an employer or an insurance company to turn down your claim. This may be done for a variety of reasons. However, it is important to note that you have plenty of options you can pursue even after your claim is initially rejected. This article takes a look at these options.

Seeking an Informal Conference

If your employer denies your workers’ compensation claim, you have the option of an informal conference. This conference is arranged by the South Carolina Workers’ Compensation Commission. As the name suggests, it is an informal meeting where the Commission tries to resolve the differences between you and your employer. If the conference doesn’t resolve the dispute, you can seek a formal hearing which is a judicial process.

Employers and insurance companies can often raise unfair objections over workers’ compensation claims. This is why it is a good idea to have a qualified South Carolina workers’ compensation attorney by your side when attending the informal conference.

Workers Compensation paper cutout with person and umbrella

Filing a Request for Hearing

If you and your employer fail to resolve the dispute over your claim at the informal hearing, you can file a request for a hearing. During a hearing, you are brought together with your employer and the insurance company representatives. At this hearing, a workers’ compensation commissioner appointed by the Workers’ Compensation Commission of South Carolina will preside. The commissioner will listen to your arguments and evidence as well as the employer’s reasons for rejection.

Based on this, the commissioner will then decide whether or not the denial was correct. You can attend a hearing on your own; however, it is best to consult an attorney beforehand who can accompany you to the hearing. This is particularly important if you are up against an insurance company that may be represented by highly-paid attorneys at the hearing.

Filing an Appeal With the Full Commission

If the commissioner who hears your appeal at the first stage upholds your claim’s denial, you still have other options. You will then essentially be appealing a review of the commissioner’s decision. In such a case, your hearing goes in front of a full commission. You must file a review of the commissioner’s decision within 14 days

The fee for filing a review at this stage is $150. Once your appeal is approved, your case goes to a full commission who will review the commissioner’s decision and determine whether or not the decision was correct. If the full commission decides that the rejection of your workers’ compensation claim was not right, you get access to the comp benefits. However, if the commission agrees with the commissioner’s decision, the denial of your claim stands.

Filing a Lawsuit

If you still feel that the decision and the denial of your claim are unfair, you have the option of taking your case to the court system outside of the Workers’ Compensation Commission. If you decide to do this, you must file a lawsuit against the commission within 30 days of the full commission’s decision.

At the first court level, you can file the suit with the South Carolina Court of Appeals. If you still disagree with the decision by the Court of Appeals, you can then take your case to the South Carolina Supreme Court.

Hiring a Qualified Workers’ Compensation Attorney in Greenwood, SC

If you have suffered a workplace injury in Greenwood, SC but your employer has refused to pay compensation benefits, you need a qualified attorney on your side. A good Greenwood, SC workers’ compensation attorney will help you pursue the options detailed in the article above.

Here at ASB Law Firm, we have in-house attorneys who specialize in workers’ compensation cases. If you have suffered a denial of your benefits, our attorneys will work with you through the appeals process. If the case ultimately goes to the court system, we will still stand by you to make sure you receive the benefits you rightfully deserve. Contact us today to book a FREE consultation with our attorneys.

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