It can be a very worrying experience if you become injured while at work or develop a work related illness. Who is going to pay the bills while you are off work and what happens if you have a permanent disability? Each state has slightly different rules about workers’ compensation insurance but most states ensure that the majority of employees are covered by their employer’s compulsory insurance. However, that doesn’t always mean that your claim for compensation will be honored. A denied claim can be appealed, but it is a complicated process and it is advisable to use a workers’ comp. attorney for advice and legal help. Workers’ Compensation Law in South Carolina Employees have 90 days maximum to inform their employer about a workplace illness or injury although it is best to do this as soon as possible. They then have up to 2 years to file a workers’ comp. claim with the insurer. The state’s regulatory and administrative body is the South Carolina Workers’ Compensation Commission (WCC). Not all employees are covered by workers’ comp. insurance. Employers who employ less than four employees are not required to have insurance. Other exemptions are employers of fire-fighters, agricultural workers and railroad workers. Compensation, when a claim is accepted, is for medical treatment at the employer’s choice of doctor or medical center and two thirds of average earnings that have been lost as a result of the injury or illness. Most mental illnesses are not covered or stress related illnesses from heart attacks or strokes. Why a workers’ comp claim is denied in South Carolina Not all workers’ comp. claims are acceptable by the insurer and you may find that a claim is denied. This is not the end of the world as you have an opportunity to challenge the decision but you must be sure why the insurer made the decision that they did. There are many simple reasons why a claim has been denied. Examples are a failure to keep to strict deadlines and administrative mistakes, usually made by someone in your employer’s office. There are other reasons why a denial has been made such as any one of the following: injury or illness not work related (claim can be refuted though); employee was allegedly drunk at work; employee was not injured or did not become ill while at work; employee failed to use safety gear or use equipment as directed to do so. Appealing a Workers’ Compensation Denial in South Carolina A claim denied can be overturned as a result of a legal challenge to the denial. In the first instance, you should file an application for an administrative hearing. You may decide to get help from an attorney at this stage, although it is not compulsory. The WCC will appoint a commissioner to hear evidence to support your claim. This may include witnesses, medical documentation and anything else that substantiates your claim. The insurer will also have a representative there to present their side of the dispute. You may still be inclined to disagree with the commissioner’s decision so you can make a further appeal before a panel of commissioner’s who will review the claim and the dispute all over again. Further appeals may be to the Court of Common Appeals and the State Appellate Court. An Attorney Can Help You Appeal a Workers’ Comp Denial If you do decide to challenge the insurer’s claim denial you can be sure that you will not have it all your own way. The insurer will use an attorney to help represent them and this means that it is preferable for you to do t he same. An experienced workers’ comp. attorney can assess the claim and the basis of the dispute and provide a valuable opinion. If you still decide to go ahead with the appeal, the attorney can help to represent you at any of the hearings.
