Why Are Workers’ Compensation Claims Denied?

Why Are Workers’ Compensation Claims Denied?

In South Carolina, employers are legally required to carry workers’ compensation insurance so long as they have at least 4 regular full-time employees. If an employee sustains a work-related injury or illness, these benefits can facilitate their overall recovery process and effectively mitigate their financial losses. Because South Carolina is a “no fault” state, employees don’t need to prove employer negligence in order to receive benefits.

Workers’ compensation insurance covers:

  • Injuries sustained while performing a job-related task
  • Job-related injuries sustained outside the workplace
  • Illnesses sustained due to the nature of the job

Unfortunately, valid workers’ compensation claims can be denied for a variety of reasons, leaving employees in a difficult and vexing position. After all, how can they pay their medical bills when their injuries prevent them from working? Fortunately, it is possible to appeal a denied workers’ compensation claim in South Carolina. But it’s important to understand why you claim could have been denied first.

Why Your Claim Was Denied

The most common reason a claim is denied is because an injury wasn’t reported correctly or in a timely manner. Once your doctor has verified your injury or illness, you need to notify your employer in writing and file a claim with the Workers’ Compensation Commission (if your employer doesn’t do it for you). If necessary, your family or friends can notify your employer on your behalf.  

Like any claim, there is a statute of limitations when it comes to filing for workers’ compensation benefits. In South Carolina, you have 2 years to file a claim for a work-related injury or illness. However, it’s important to note that South Carolina law prohibits coverage for heart attacks, stress, mental injuries, strokes, and aneurisms unless they are accompanied by a physical injury.

It’s also possible that your employer may challenge your claim and hinder your access to benefits. In most cases, this is because an employer doesn’t want to pay for increased premiums. At Pierce, Sloan, Wilson, Kennedy & Early, LLC, our Charleston workers’ compensation attorneys can represent your interests and help you fight for the benefits your injuries warrant.  

Your claim can be denied for the following reasons:

  • Your injuries don’t warrant workers’ compensation benefits
  • Your employer denied your claim
  • You can’t prove that your injury was work-related
  • Your claim was improperly filed
  • You didn’t notify your employer about your injury
  • Your claim was not filed according to the statute of limitations
  • Your injury was caused while you were intoxicated
  • You were engaging in negligent behavior that violated safety protocols   
  • Your injury is self-inflicted

File an Appeal Today

If your claim is partially or fully denied, you can file an application for a hearing before the Workers’ Compensation Commission. At Pierce, Sloan, Wilson, Kennedy & Early, LLC, our Charleston workers’ compensation lawyers can litigate on your behalf to help you secure these essential benefits. We can guide you through the entirely of the appeal process and even represent your case to the State Appellate Courts. We can also help you pursue a personal injury claim against a negligent third party to ensure that you secure the damages you need to safeguard your quality of life.

Rely on a firm with decades of experience and a track record of success. Call Pierce, Sloan, Wilson, Kennedy & Early, LLC at (843) 968-0886 to schedule a consultation.

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