Why Was My Workers’ Compensation Claim Denied?

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Many times we here at Dan Pruitt Law Firm discover a claim was denied because of an error on the part of the employer. What we believe should be a cut and dried situation, often becomes mired in delays simply because an employer either is ignorant of South Carolina workers’ compensation law or because they willfully aren’t following the statutes.

These laws are in place to ensure any worker hurt on the job is protected financially. All medical care related to the accident should be covered and if an employee is unable to work, then financial compensation will be provided. There are also specific rules concerning both temporary and permanent disability along with disfigurement and even loss of life.

One of the most common reasons for denying a claim by an employer or his insurance carrier is, “it was the employee’s fault.” South Carolina workers’ compensation law is very clear in stating workers’ compensation is a no-fault system. Circumstances surrounding the accident are secondary to the employee receiving all benefits allowed under the law.

While some reasons for denying claims are justified, others are frivolous excuses designed to stall or prevent paying legitimate claims. Common reasons for rejecting a claim include:

  • Being classified as an independent contractor instead of a regular employee. This often occurs in the construction field, when the job involves selling and a commission is paid and those workers in positions where freelancing is common. Many times the employee doesn’t realize they are incorrectly classified until an accident occurs or tax time rolls around.
  • South Carolina workers’ compensation law states your employer must be notified of all on the job injuries within 90 days. Generally this is not a problem because you are obligated, unless the injury is life-threatening, to seek medical care from a doctor or clinic selected by your employer. Often, an employer will implement their own time restrictions which are much less than the 90 days set by the state of South Carolina. Employer rules and regulations do not supersede state law. Also chronic conditions, including carpal tunnel syndrome, certain lung conditions and medical problems such as long-term muscle pain can be difficult to determine exactly when and how they began.
  • In the case of chronic medical conditions frequently your employer will try to blame the latest incident on an “off the job” injury or a pre-existing condition. If this is their argument, it is extremely important you contact Dan Pruitt immediately. There are many complex variables associated with this reasoning that will need to be dealt with by an experienced workers’ compensation attorney.

Perhaps after seeing the medical professional of your employer’s choice, they determined you aren’t injured or your injury wasn’t severe enough for you to qualify for workers’ compensation benefits. If your employer refuses to file your claim or if your claim is denied because of the opinion of your employer’s doctor of record, legally you have the right to request a second opinion from another physician or medical group.

While workers’ compensation law seems to be straightforward, if you or a loved one is getting the run-around by your employer or their insurance company, please don’t hesitate to contact workers’ compensation lawyer Dan Pruitt. There is never a charge here at the Dan Pruitt Law Firm to review your case and see if we may be of assistance.

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