If your workers’ compensation claim has been denied in South Carolina, it is not the end of the line for you. Working with a workers’ comp lawyer, you can file an appeal and fight for your benefits. Contact the Dan Pruitt Injury Law Firm in Greenville to learn about the next steps in your case.
Why Would a Workers’ Comp Claim be Denied?
The main requirement for you to receive workers’ compensation benefits is that you have suffered a work-related injury. The insurance company may deny your claim for the following reasons:
- They do not believe that you have been injured
- They think that your condition existed beforehand
- Your injury was not related to your job
- You did not meet other requirements, such as notifying your employer of your injury in time
Can My Employer Deny My Workers’ Compensation Claim?
While your employer may have their own financial interests, the insurance company is the one who makes the decision about whether to grant your claim. However, some large companies are self-insuring, meaning that they offer coverage on their own, as opposed to purchasing an insurance policy. In this case, your employer could deny your claim.
You Can Appeal a Denial of Benefits
The insurance company does not get the final say over your claim. South Carolina law gives you the right to appeal any denial of benefits. You have a legal right to have an objective third party make the ultimate decision about your case.
When you file an appeal, it begins the legal process. Your case could go all the way to a hearing. You may also begin to negotiate a possible settlement with the insurance company.
In the end, an Administrative Law Judge will determine if you have suffered a work-related injury that qualifies you for benefits. They will review the medical file and listen to testimony from witnesses.
What Is the South Carolina Workers’ Compensation Commission?
The South Carolina Workers’ Compensation Commission is the state agency that regulates coverage and the program. The SCWCC makes rules that govern workers’ compensation. You would begin the workers’ compensation process by filing your claim with the SCWCC.
Most importantly for you, the SCWCC hears appeals of workers’ compensation claim denials. The Commissioners hear appeals brought by injured workers when the insurance company will not pay benefits.
How to Appeal Your Claim Denial to the SCWCC
For your initial appeal with the SCWCC, your case would first be heard by a single commissioner. They would consider the evidence and issue a decision.
If you are not satisfied with the Commissioner’s decision, you can appeal to a larger panel of the SCWCC. They may hear the appeal with a panel of three Commissioners. For cases that involve more difficult and unique areas of the law, they may assign the entire panel of Commissioners to hear the case.
If you do not win your appeal in front of the SCWCC, you can take your case to the South Carolina state court system. Your appeal would begin in the South Carolina Court of Appeals, and it could end up in front of the South Carolina Supreme Court.
Do I Need an Attorney to Appeal Workers’ Comp Denial?
While there is no legal requirement for you to hire a lawyer, you have a better chance of winning your case when you have an experienced attorney who knows the system. When you hire an attorney, they could speak with the insurance company first in the hopes of resolving your dispute without the need for a hearing. Many denials are converted to benefits when a lawyer helps clear up a misunderstanding.
Your lawyer can build the strongest possible case on your behalf. They know how to structure an appeal to present the most persuasive arguments. You may not know how to represent yourself in front of the SCWCC. Workers’ compensation attorneys appear in front of Commissioners with regularity and understand how to compile persuasive appeal files.
How a Workers’ Compensation Appeals Attorney Can Help You
The reason why you are filing a claim is that you are injured. You are not in any condition to deal with the legal system on your own.
If you find out that your claim has been denied, you may realize that you are in for a fight that you may not have the bandwidth or knowledge to undertake on your own.
Here is what a workers’ compensation attorney can do for you:
- Help you compile your claim to file with the SCWCC, especially if you anticipate a more difficult case, such as an illness or an injury that an insurance company would deem subjective.
- Review the reason for the denial of your claim and learn why the insurance company was wrong to deny you benefits.
- Work with witnesses and experts to document your file to persuade the Commissioner that the insurance company was wrong.
- Communicate with the insurance company in the hopes of persuading them to grant benefits.
- Negotiate a potential settlement with the insurance company that could result in benefits.
- Present your case to a Commissioner to demonstrate why the insurance company was wrong.
- Elevate your appeal in the event that you are not successful at first.
You could be in for a long battle, and the stakes are certainly high. Especially if your initial claim has been denied, you cannot afford to be without a workers’ compensation lawyer. On your own, you may not be taken seriously.
Contact a Greenville Workers’ Compensation Attorney Today
If you find your workers’ comp claim denied, you should contact the Dan Pruitt Injury Law firm to learn more about the next steps in your case. We provide injured workers with vigorous legal representation when they face problems with the insurance company. We take the time to listen to your story so we can present the most effective case on your behalf.