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Was Your Columbia, SC Workers’ Compensation Claim Denied? Here’s What You Can Do

May 24, 2022

Under the South Carolina Workers’ Compensation Act, employees who suffer injuries while working may be entitled to compensation for medical bills, lost wages, and disability benefits. However, the unfortunate reality is that many workers’ compensation claims are denied — even if the claim is valid.

A workers’ compensation claim can be rejected for a wide variety of reasons. If your claim has been denied, you likely feel shocked, upset, and confused about what to do next. At Bernstein & Bernstein, our Columbia, SC workers’ compensation attorneys understand what you’re going through —  and we’re here to help.

Even if your workers’ compensation is denied, you may still be able to receive compensation for your injury. So, in this article, we’ll be discussing common reasons why claims are denied, followed by an explanation of what you can do to contest the denial.

5 Common Reasons Why South Carolina Workers’ Compensation Claims Are Denied

As mentioned above, there are many different grounds on which an employer (or insurance carrier) may deny a workers’ compensation claim — but none should discourage you from disputing the denial. If your claim is denied for any of the reasons below, you should consult a Columbia, SC workers’ compensation lawyer to discuss potential recourse.

01. Negligent Conduct

Your employer may try to discredit your workers’ compensation claim by stating that your injury was the result of carelessness or negligent behavior on your part. In most cases, this is irrelevant as you will still be entitled to workers’ compensation even if you are at fault for your injuries.

02. Exaggerated or False Injury Claim

The injury itself may be brought into question if your employer argues that you’re exaggerating its severity or lying about the conditions under which the injury occurred.

03. Pre-existing Conditions

The employer/insurance carrier may assert that your injury is the result of a prior health issue and cannot be attributed to the workplace. However, even with a pre-existing condition, you may still be entitled to compensation if work aggravated/worsened your condition.

04. Off-the-job Injuries

Similar to pre-existing conditions, the employer/insurance carrier may argue that your injury is not work-related by claiming that it occurred outside the scope of your job (e.g. off the clock, offsite, etc.).

05. Administrative Technicalities

South Carolina law establishes some specific requirements regarding the timeframe and procedure for filing a workers’ compensation claim. The employer/insurance carrier may attempt to exploit these rules and catch you on a technicality in order to nullify your claim.

What to Do If Your Columbus, SC Workers’ Compensation Claim Is Denied

If your workers’ compensation claim is denied, the first thing you should do is consult a Columbia, SC workers’ compensation attorney. While it is possible to dispute the denial on your own, it’s not recommended to do so. Attempting to represent yourself during legal proceedings can greatly reduce your chances of success. Conversely, an experienced workers’ compensation lawyer can guide you through every step and help you build the strongest case possible.

Mediation & Dispute Resolution

To contest the denial of your workers’ compensation claim, you can initiate the appeals process with the South Carolina Workers’ Compensation Commission. This process can have numerous levels depending on the outcome of each stage. But, before initiating the formal appeals process, you can participate in both a mediation meeting and an informal conference with the Worker’s Compensation Commission and the employer/insurance carrier to attempt to resolve the dispute before it goes to court. 

Requesting a Hearing

If you’re unable to resolve the dispute, the next step is to begin the formal appeals process by filing an appeal and requesting a hearing before a Commissioner. At the hearing, you’ll need to present your case and provide evidence to support your claim. Representatives from the employer/insurance carrier (and their attorneys) will state their case as well — and a doctor may be called upon to provide testimony. The Commissioner will then issue an order, ruling either in your favor or against you.

Further Appealing the Decision

If the Commissioner rules against you in the first hearing, you can appeal the decision and request another hearing — this time before a panel of three Commissioners. Like in the first hearing, the panel will rule either in your favor or against you. If they reject your claim, you can appeal this decision yet again before all seven members of the South Carolina Workers’ Compensation Commission. If that ruling doesn’t go your way, you can still take your dispute one step further by filing a lawsuit with the South Carolina Court of Appeals.

Speak With a Workers’ Compensation Attorney in Columbia, SC

It’s not advisable to try to handle a workers’ compensation appeal by yourself. Legal matters are very complicated and nuanced. Without proper legal representation, you may be putting your claim in jeopardy.

If your workers’ compensation claim has been denied and you’d like to appeal the decision, trust Bernstein & Bernstein to guide you through the process and fight for the compensation you deserve. Contact us for a free consultation to learn more about how our experienced attorneys can help you with your workers’ compensation appeal.

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