Under South Carolina law, you may be entitled to workers’ compensation benefits if you suffered a work-related injury. The reality is that many claims are initially denied. If you cannot persuade the insurance company to reverse their denial, you may need to file an appeal.
Eventually, you will have a hearing in front of a judge, where both sides may present evidence and testimony. Some of the most important testimony will come from you. Here are some questions that you may be asked at a workers’ compensation hearing. Dan Pruitt Injury Law Firm would be happy to assist you in preparing for this important process.
Why You May Need to Have a Workers’ Compensation Hearing
Potential issues in your workers’ compensation case include:
- Whether you suffered an injury that will entitle you to benefits
- Whether the injury you suffered is considered work-related, such that you will qualify for coverage
- Whether you comply with the procedural requirements of the state workers’ compensation law
- Whether the circumstances of the accident are such that you can receive benefits (the injury did not involve intentional wrongdoing on your part)
Most Questions Will Focus on Your Medical Condition and Ability to Work
With that in mind, you can expect that most of the questions you are asked will be about your specific injury. One of the reasons why an insurance company will deny a workers’ compensation claim is that they do not believe that you suffered an actual injury. Therefore, you can expect a large part of the hearing to focus on your actual medication condition.
You will be asked detailed questions about what you have experienced and what your life is like at present. From your standpoint, you are aiming to establish that you have suffered an injury that requires medical treatment and may leave you unable to work.
There are many conditions that can be considered an “injury,” even if they do not result from an actual accident. For example, you can suffer from a repetitive strain injury or an occupational disease that was caused by something that you were exposed to at work. The insurance company may contend that you are not really injured, especially when they cannot see it on a scan or an MRI.
You will have the burden of proof to establish that you suffered an injury. Thus, your lawyer will ask you questions about your condition, while the insurance company will use its own questions to undermine whatever evidence you have introduced.
The Questions May Focus on Whether the Injury Is Work-Related
There will also be a focus on how you suffered an injury. Under South Carolina law, workers’ compensation benefits are limited to “only injury by accident arising out of and in the course of employment and shall not include a disease in any form, except when it results naturally and unavoidably from the accident.”
Again, there is nothing that limits workers’ compensation benefits to one single and specific accident. In addition, you can also qualify for benefits if your injury is not necessarily physical in nature.
However, these types of injuries can present more difficult cases. For example, if you are suffering from an emotional injury that comes from workplace stress, you can expect many questions that are intended to establish whether the injury actually came from your job. You may face a situation (for certain chemical exposure diseases) where there can be uncertainty about when and how you were exposed to the substances.
You may also be asked questions about when specifically an accident occurred. You are only entitled to benefits when the injury was work-related. If you were not on the job at the time that the accident happened, you would not qualify for benefits. For example, if you suffered an injury on the way to work, that is not considered a work-related injury.
Finally, even though workers’ compensation benefits do not depend at all on fault, you may still be asked questions about your own actions leading up to the injury. You may still not qualify for benefits when you have committed any type of intentional misconduct.
You Should Hire an Attorney for a Workers’ Compensation Appeal
Workers’ compensation hearings can be very technical and complex, with scientific and financial evidence. If your case has gone to a hearing, it is because your initial claim has been denied, and you need to file an appeal. Your hearing is the chance to show why the insurance company erred in denying you benefits and why the denial should be converted to benefits.
The appeal is not something that you should try to handle on your own, given the high stakes involved. It gets harder to appeal once you have lost at the initial hearing.
Contact a Greenville Workers’ Compensation Attorney Today
If you have suffered a work-related injury, Dan Pruitt Injury Law can help you file a workers’ compensation claim or an appeal when one has been denied. We understand the difficulties that you are facing, and we provide you with caring and vigorous legal representation. Your first step is to contact us for your free initial consultation. You can send us a message online or call us at (864) 280-7660 to discuss your case.
Workers’ Compensation FAQs
What happens if the insurance company denies my workers’ compensation claim?
You can file an appeal with the South Carolina Workers’ Compensation Commission to have them review the denial and issue their own decision.
Do I need a workers’ compensation lawyer?
You will certainly need one if your claim has been denied, and you should strongly consider one if you have a more complex claim, such as an emotional injury or a repetitive strain injury.
Will I need to testify at a workers’ compensation hearing?
Since the hearing is aimed at establishing your condition, you will almost always have to give testimony under oath and be cross-examined.