Handling a Workers’ Comp Denial

Workers’ compensation claims are generally paid by an insurance company to which your employer pays regular premiums, just as you do to your health or auto insurer. Because insurance companies are in business to earn profits, they typically look for ways to dispute expensive claims if they can. Claims for occupational illnesses are the most likely to be disputed. The insurer might claim that your repetitive motion injury or respiratory problem resulted from a pre-existing condition or non-work-related activities. The burden is then on you to prove otherwise.

After sustaining and recovering from a compensable work-related injury for which you’ve received benefits, you could develop CRPS as a result of that injury. In such a case, the insurer is likely to deny your new claim and refuse to recognize your CRPS as a compensable occupational illness because you’ve already received benefits for the injury that caused it.

You Can Fight Back After a Workers’ Comp Denial

Some simple workers’ comp claims for minor injuries resulting in low medical bills and little or  no time off work can be successfully pursued without the help of a workers’ comp lawyer. A CRPS claim, however, is not a simple one. It’s potentially very expensive for the insurer and likely to be denied, but that doesn’t mean you should give up. Untreated CRPS can leave you disabled and in need of lifelong medical care and pain management, so it’s important to do whatever it takes to prove your claim for work-related CRPS.

Why You Need an Attorney

While you’re dealing with your debilitating illness, your attorney can help you by:

  • Consulting with your doctors about your condition and prognosis.
  • Organizing and presenting your medical evidence.
  • Bringing in expert medical witnesses to prove your CRPS is work-related.
  • Requesting an informal conference with your employer and the workers’ comp insurer.
  • Requesting a hearing before the South Carolina Workers’ Compensation Commission (SCWCC).
  • Requesting a commission review.
  • Appealing your denied claim to the SC Court of Appeals if necessary.

What to Do If You Develop CRPS Symptoms

If you’ve recovered from a work-related injury and find yourself suffering the symptoms of CRPS, you should take the same steps you’d take with any workers’ comp claim:

Report Your Injury and File a Claim

Report your condition to your supervisor right away. Although you have 90 days to do so, do not wait. After reporting, file your claim with Form 50 from the SCWCC website. You actually have two years to do so, but again you should not delay.

Seek Medical Attention

You should have a thorough examination from either the doctor who treated you for your original work-related injury or another doctor certified by your employer’s insurer. Follow all this doctor’s medical advice, keep all appointments, take medication as prescribed, and keep receipts and other documentation of your treatment. If you’re not satisfied with the doctor you’re seeing, your attorney can petition for an independent medical exam.

Dirk J. Derrick
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South Carolina Lawyer Dirk Derrick helps victims recover from car accidents, personal injury & wrongful death.