Why a Charleston Workers’ Comp Claim Might Be Denied
Workers’ comp benefits are almost always paid by an insurance company from which an employer purchases coverage. These insurance companies are in business to earn profits for their shareholders. To do so, they train their adjusters to look for ways to deny costly claims.
If your accidental injury is minor, your medical bills are low, your time off work is short, and your employer agrees your accident is work-related, your claim is likely to be approved, and you won't need the services of a lawyer. If, however, your claim is an expensive one involving temporary or permanent disability, high medical bills, and significant lost income, you could be in for a fight.
Common Reasons for Claim Denials
More than 10% of South Carolina workers’ comp claims are denied for one or more of the following reasons:
- Accident reported too late
- Form 50 (injury or illness) or 52 (death) filed too late
- Application form incomplete
- Pre-existing condition/injury unrelated to work
- Claimant did not seek medical treatment
- Medical provider was not approved by the insurer
- Discrepancy between accident report and doctor’s assessment
- Injury is minor and requires no medical treatment or time off work
- Injury is the result of pre-existing medical condition
- Employee is not eligible for workers’ comp
- Employee’s injury was intentionally self-inflicted
- Employee was engaged in illegal activity when injured
- Employee was under the influence of drugs or alcohol on the job
The SCWCC will inform a denied applicant of the reason(s) for the claim denial and should provide information about how to request a hearing or appeal the decision. The insurer will be represented by its attorneys at your hearing, so you’re well advised to have a workers’ comp lawyer on your side to level the playing field at this stage in the claims process.
The Cost of a Workers’ Comp Lawyer
You’re not required to have legal representation at your hearing, but it might be a good idea if your claim is expensive or complicated in any way. A workers’ comp attorney generally will offer you a free first consultation to evaluate your case and decide whether to represent you. If you do retain a lawyer, you typically will pay no attorney fees upfront.
You and your lawyer will agree on a contingency fee to be taken from your settlement if your claim is ultimately successful. The maximum contingency fee allowed by South Carolina law is one-third of your settlement, but each case is unique. It’s also important to remember that your chances of getting a fair settlement are generally better with a workers’ comp attorney than without one, so your legal services might pay for themselves and more. In some cases, your lawyer can negotiate to get you a lump sum payment rather than weekly benefits.
Other Potential Costs to Consider
If your claim is not successful, you will owe no attorney fees. Your lawyer’s firm, however, will incur certain costs in the process of representing you and fighting for fair benefits, including:
- Evidence fees
- Medical records fees
- Deposition costs
- Consultations with your doctors
- Expert witness fees (in some cases)
- Filing fees
- Mediation (in some cases)
Win or lose, you might be charged for these fees to reimburse your attorney, who will go over all anticipated costs with you in advance. Before anyone is paid, the SCWCC must examine and approve all fees and orders against your settlement.
Understanding Eligibility and Potential Benefits
A small number of employers in South Carolina are exempt from the requirement to carry workers’ compensation insurance, and some employees are ineligible to receive workers’ comp benefits. Your attorney can determine your employer’s status as well as your own and advise you accordingly. If you’re eligible to receive benefits, they should cover all your medical expenses and two-thirds of your lost wages.
In some cases, long-term disability treatment and vocational re-training are also covered. You do not have to prove that your employer did anything wrong to cause your work-related injury or illness. Even if you’re responsible for your own accident, you may still file a claim, and your company may not retaliate against you in any way for doing so. If you lose a loved one to a work-related accident or illness, you may file a claim for workers’ comp death benefits.
Have You Suffered a Work-Related Injury in South Carolina?
If you've been hurt at your job in South Carolina, you can speak with a workers' compensation lawyer. Please contact us online or call our Florence personal injury office directly at 843.488.7540 to schedule your consultation. We are also able to meet clients at our Charleston, Conway, Myrtle Beach, Murrells Inlet, Mt. Pleasant, North Myrtle Beach or North Charleston office locations.