Every South Carolina business or company with four or more employees is required to carry workers’ compensation insurance, which provides no-fault coverage for employees who suffer work-related injuries or illnesses. You may file a workers’ comp claim for medical expenses, lost wages, and disabilities that result from a work-related accident.
You needn’t prove that your employer did anything wrong to cause your injury. Even if your accident was your own fault, you may still file for benefits. You have 90 days to report your injury to your employer and two years to file a workers’ compensation claim, but you shouldn’t wait. Your employer is not permitted to fire you or retaliate against you for filing a workers’ comp claim.
Some Charleston Workers' Compensation Claims Are Disputed or Denied
In most cases, if you follow the correct filing procedures, your claim is likely to be approved, and the insurance company will cover your medical bills and two-thirds of your lost wages. However, more than 10% of South Carolina workers’ compensation claims are denied for one or more of the following reasons:
- The injury is not severe enough to warrant benefits.
- Medical treatment was not sought.
- The medical care provider was not on the insurance company’s certified list of providers.
- There was a discrepancy between the accident report and documented injuries.
- The applicant missed notification and/or filing deadlines.
- The application provided incomplete information.
- The injury didn’t happen at work.
- The employer maintains that the claimant:
- Had a pre-existing medical condition
- Was a contractor, not an employee
- Was impaired by drugs or alcohol when the injury occurred
Claim denials are most common in cases of severe injury and/or disability, which are very expensive for an insurance company. Its adjusters are trained to dispute, deny, and devalue such claims to keep the company profitable.
If your claim is denied, you have the right to file an appeal with the South Carolina Workers’ Compensation Commission (SCWCC) at any time within two years after your accident. Again, it’s not a good idea to wait. If you do, the insurance company might cite your delay as evidence that your injuries are not as serious as you say they are.
The Need for Expert Witnesses Rergarding Your Workers' Compensation Denial
If you disagree with the denial of your claim or the benefits you’re offered, you should first meet informally with your employer and/or the insurance company to see if there has been some sort of clerical error or another mistake that led to the denial or low settlement offer. You don’t necessarily need a lawyer for this conference. If it does not resolve the issue, there are four levels in the formal SCWCC appeals process:
- SCWCC hearing request
- SCWCC review
- SC Court of Appeals
- SC Supreme Court
At your hearing or at any higher level of appeal, you need the services of a workers’ comp attorney to present your evidence in the most convincing way. You might also require the testimony of one or more expert witnesses to prevail:
Medical Witnesses.
A doctor can give evidence regarding your maximum medical improvement (MMI) from your injuries, as well as your past and future treatments, medication, physical therapy, and prognosis. Your attorney might prefer someone other than your own doctor as a witness because an objective medical opinion could strengthen your claim.
Vocational Rehabilitation Witnesses.
If your injury or disability makes it impossible for you to do your former job, a vocational rehab expert can prove that it does and determine what other job(s) you can now perform with further training or education.
Economic Witnesses.
To determine future medical expenses and wage losses that should be included in your settlement, you might need the help of an economic expert. In some cases, you might have a claim against a negligent third party as well as your employer. An economic expert can help to be sure you’re fully compensated for all your damages, including pain and suffering.
Accident Reconstruction Witnesses.
Your employer’s insurance company might claim that your injuries are due to a pre-existing condition or an accident unrelated to your job. An accident reconstruction expert can reenact what happened to you in order to show that your injuries are work-related.
Engineer.
If your accident was caused by faulty equipment or unsafe conditions in the workplace, an engineer can explain exactly how you were hurt. You might also have a product liability claim against the manufacturer of faulty equipment, the defects of which can be credibly explained by an engineer.
Scientist.
If you’ve contracted an occupational illness after being exposed to toxic chemicals or other substances, you might require a chemist or another scientist to explain the details of this exposure and the effects of the toxic substances on you.
Family member.
In some cases, a family member makes a good witness and can point out objectively what daily activities are difficult/impossible for you to perform or what aspects of life you can no longer enjoy due to your injuries.
Have You Been Injured On The Job?
If you've been hurt at your job you can speak with a workers' compensation lawyer. Please contact us online or call our Charleston, South Carolina office directly at 843.488.2359 to schedule your consultation. We are also able to meet clients at our Conway, Myrtle Beach, Murrells Inlet, Mt. Pleasant, North Myrtle Beach or North Charleston office locations.
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