If your workers’ comp claim gets denied, you may be able to challenge this decision by filing an appeal. The insurance company or Workers’ Compensation Commission may reject the claim due to mistakes on the required forms, insufficient evidence, missed deadlines, or other reasons. A work injury attorney can help you prepare your case for filing and represent you throughout the claims and appeals processes.
Williams & Roche, LLC, has stood by those in various industries, including manufacturing, teaching, warehouse, shipping, and nursing.
We can help you by taking over and guiding you through the stages of your workers’ comp claim. Our team devotes its practice to fighting for those who get a severe injury at their job and need to take time off. If the insurance company or the Commission rejects your request for financial help, we can help you access what you need and deserve under the law.
Common Reasons Why Workers’ Compensation Claims Are Denied
The insurance company or Workers’ Compensation Commission may reject a claim for several reasons. For example, there may be an error in the paperwork, such as incorrect or mislabeled documents or forms. Or, some of the medical records supporting the person’s claim may not be on file. Because of this, the insurance company or Commission may not have all the evidence they need to accept the worker’s request.
Another common reason for a denial is that the employee missed a deadline. South Carolina law requires workers to tell their bosses about their injuries within 90 days of when they happen.
If they got the injury in a work accident, they may need to tell their employer about it within 90 days of the accident. If the injury is gradual — such as carpal tunnel or tendinitis — they may have up to 90 days from when they discover the wound or its cause.
The employee must also file a formal request for worker’s compensation within two years of the injury. They submit this document to the Workers’ Compensation Commission. After this, they may have other deadlines to submit records and appear for a hearing.
Understanding Your Rights After a Workers’ Comp Denial in South Carolina
South Carolina law gives you several options if the insurance company or Workers’ Compensation Commission denies your claim for benefits. If the insurer or Commission rejects your workers’ comp claim, you can ask for a hearing with the Commission. You also have a right to request a rehearing or file an appeal if the Commission denies your claim for a second time.
During this administrative process, you may still have the right to continue receiving payment for your injury-related medical expenses and, if applicable, lost wages.
How To File a Formal Appeal in South Carolina
If you and your employer’s insurance company cannot agree on whether you should receive benefits within 14 days of filing the claim, you can ask the Commission to hold a hearing. At this hearing, the Commission reads the documents, asks questions, and hears arguments from each side of the case. At the end of this meeting, the judges will decide whether to accept or reject your claim.
If the Commission rejects your request for benefits, you can appeal the workers’ comp denial by filing a rehearing or review request. At this stage, you ask the Commission to take a second look at your case and change their mind about their previous decision. If they again turn down your request for compensation, you can file a formal appeal with the Court of Appeals.
How a Workers’ Compensation Attorney Can Assist With the Appeals Process
A trained lawyer can be a valuable asset in the workers’ comp appeals process. They can review the forms and records in your case and determine the best course of action for approaching the appeal. They can identify your filing deadlines and assist you by taking steps to meet those. Additionally, a work injury attorney can help you get ready for the hearing or appeal.
Lastly, they can create and present well-researched legal arguments and present those when communicating with the Commission, court, or insurance company.
The Job of the South Carolina Workers’ Compensation Commission in Appeals
The Workers’ Compensation Commission oversees and approves job injury claims, hearings, and rehearings in this state. They review compensation agreements to make sure they meet the requirements under the current law and the insurance policies in place.
Additionally, they help resolve disagreements between workers, their employers, and their employers’ insurance providers.
Workers and their employers can appeal the Commission’s initial decision by requesting a rehearing. If the Commission rejects the person’s claim again, they may have to file a separate appeal with the Court of Appeals. In that situation, the Commission does not have a direct role in that portion of the appeals process. Instead, the Court of Appeals would handle the appeal, and the Commission would receive notice of that court’s final decision.
What Happens After You Win or Lose Your Appeal?
If you win your appeal, a couple of things may happen. The agency that issues the appeal may decide what award (e.g., compensation settlement) you should receive. Or, the organization that handled the appeal may send the case back and order a new hearing on your claim. Depending on where you are in the process, you may be able to file another appeal if you lose the first one.
Contact Williams & Roche, LLC, for Help Handling a Workers’ Comp Appeal
If your workers’ comp claim is denied, you have options. Depending on what stage you’re at, you may be able to file a request for a hearing or rehearing with the Workers’ Compensation Commission. If you took these steps and still received a rejection notice, you may be able to file a formal challenge with the Court of Appeals.
With two former Workers’ Compensation Commissioners on their team, Williams & Roche, LLC, has a well-rounded perspective on bringing, defending, and appealing job injury claims. Derrick Williams was one of the youngest to ever receive an appointment as a Commissioner. Reach out to us today by calling 803.784.0503 to set up a time to meet with us during a free initial consultation.
