Common Reasons an Insurance Company Denies a Myrtle Beach Work Injury Claim

The workers’ compensation system in South Carolina provides vital benefits to help all eligible employees after they have suffered a job-related illness or injury. As in other states, the medical care and wage replacement compensation can make a significant difference in an employee’s ability to recover as fully as possible and return to work. 

More than 32,000 work injuries were reported to the state workers’ compensation board in 2017, with the average cost per claim coming in at over $14,000. So, how can an injured worker ensure that he and his family obtain the medical care and wage replacement they need during a difficult time? It’s important to understand some common pitfalls and avoid them to help ensure your work injury claim isn’t denied.

Too often, workers’ compensation claims are denied for trivial or unnecessary reasons. Injured workers and their families often have never had to file a work injury claim before, and they are unfamiliar with the system. This can lead to confusion and simple, honest errors. Workers may jeopardize their claims by failing to:

South Carolina requires that work injuries must be reported to the employer within 90 days. However, you should do this in writing as soon as is possible after the injury occurs. Sometimes, a long delay in reporting the injury will put the validity of the injury in question, even if it is done within the time allowed.

Workers’ compensation claims are based on the fact that an injury occurred. The insurance company will claim the injury does not warrant compensation if it did not even warrant a visit to the doctor. Additionally, it’s important to share all your symptoms with your care provider and to make sure he knows that your injuries are work-related. These details will be reflected in your medical chart, which will support your claim for workers’ compensation benefits.

Free Report: The Truth About Your South Carolina Workers' Compensation Claim

If your condition requires ongoing treatment or rehabilitation, make sure to attend all appointments. Additionally, if a doctor has imposed limitations on your behavior, follow those instructions. Not complying with a provider’s recommendations could constitute a refusal to accept treatment, which is a reason for denial or termination of benefits.

 

Be wary when dealing with insurance adjusters. Be very cautious when talking to and sharing information with an insurance adjuster. The adjuster’s job is to save the insurance company money, and he will seek to use any facts about past injuries, medical care, and lifestyle against the injury victim. Do not offer anything more than basic information to the insurance company, and be aware that the agency may be investigating you at any time.Be honest. Too many legitimate claims have been denied because the injured worker was not completely straightforward, even about details that seem irrelevant to the claim. Be honest about how the accident occurred and about any symptoms you may be experiencing. When talking with your lawyer, answer all questions truthfully, so he can provide the most effective representation possible.

 

Consult a lawyer after suffering permanent or extended injuries. For workers who suffer permanent injuries or injuries that are likely to require future medical treatment, it’s important to be fully aware of your rights. Insurance companies will likely offer a settlement, and any times, this offer is much too low to provide future or ongoing care.