3 FAQs About Appealing a Denied Workers' Comp Claim in South Carolina

If you were injured at work, you were likely counting on workers’ compensation benefits to help you get through the challenging times ahead.  Hearing your claim was denied can feel like a punch in the gut. Unable to work, and with no compensation in sight, it feels like you’ve been left stranded alone with a mountain of medical bills and other debts.

Fortunately, in South Carolina, injured workers have not one—but three—opportunities to appeal a denied claim. In this article, we will answer common questions about the appeals process and explain your rights at every stage of proceedings.

1. Why Was My Workers’ Compensation Claim Denied?

As workers’ compensation benefits can add up to a considerable sum, it’s not uncommon for employers and insurance companies to deny claims they receive. Paying out claims affects their bottom line, so carriers will be looking for any reason to dispute aspects of your case.

Let’s take a look at some reasons why workers’ compensation claims are unsuccessful:

• The Treating Physician Was Not an Approved Provider: In the state, injured employees must typically seek care from a healthcare provider selected by their employer or employer’s insurer. However, if your injuries are life-threatening, you can’t be expected to browse the internet to find an approved provider. Regardless, even if you required emergency care, the insurance adjuster might still deny your claim on these grounds. Fortunately, a skilled workers comp attorney may be able to help you overcome such disputes.

• You Do Not Have Enough Evidence to Prove the Accident Happened: Proving liability is an essential part of the Workers’ Compensation claims process.  If you do not have sufficient evidence to demonstrate that you were hurt while performing on-the-job activities, the insurer may deny your case. Evidence that could help you prove liability can include photographs, eyewitness deposition, and surveillance camera footage.

• You Made Mistakes While Filing: Not only are there strict deadlines for filing a claim, but errors in your forms and inconsistencies in your evidence could bring your case crashing down. A skilled workers’ compensation attorney can guide you through the claims process, helping you avoid common errors that might otherwise hurt your chances of receiving benefits.

2. How Do I File an Appeal?

If your Workers’ Comp Claim was denied, you have the option to submit a hearing request to the South Carolina Workers’ Compensation Commission. You will also need to send $25 for the filing fee.

Initially, your claim will be heard before a single Commissioner. The hearing usually takes place in the county where the workplace injury occurred. 

An independent medical evaluation arranged by your lawyer may level the playing field against the company doctors. 

If the initial hearing is unsuccessful, you can file a request for Commission Review. This request must be submitted within 14 days after the Commissioner’s decision is received. At Commission Review, three Commissioners oversee the hearing. They may disagree with the Commissioner’s initial decision and decide to award Worker’s Compensation benefits. An appeal to the Full Commission requires an effective brief and oral argument. 

The next level of appeal is in the South Carolina Court of Appeals.  There are many requirements and time deadlines which must be met at this level of the appeal process. 

3. What Will Happen during My Medical Examination?

During an independent medical examination, the doctor chosen will evaluate your injuries, recovery progress, and the procedures you’ve undergone. Before the exam, it’s likely that he or she will review your medical records to get a better understanding of your treatment thus far. The doctor will likely ask you questions about your injuries and the impact they have had on aspects of your everyday life.

Ultimately the goal is to compile a report for the Commissioner that answers specific questions about your condition, such as:

• Are the patient’s symptoms related to the workplace accident?
• Are the patient’s injuries consistent with this type of accident?
• Is the patient in significant pain?
• How serious is the patient’s impairment or disability?
• Has the patient achieved maximum medical improvement? (This is the point in a patient’s recovery where their condition is unlikely to improve with additional treatment.)
• Does the patient have any physical or mental limitations that may prevent them working?

An effective IME goes a long way in helping the case be awarded. 

Find a Workers’ Compensation Attorney in South Carolina Today

At the Hodge & Langley Law Firm, we have more than 50 years of experience representing injured workers. Whether you are appealing a decision or you are in the early stages of building a claim, we can help you collect the necessary evidence to build a convincing case. Dial 864-585-3873 or head over to our Contact Page to lock in a free case review with one of our South Carolina workers’ compensation lawyers.