Health Care

Common Causes Of SC Worker’s Compensation Claim Denials

Common Causes Of SC Worker's Compensation Claim Denials

Common Causes Of SC Worker’s Compensation Claim Denials

Cardinal Law Partners April 28, 2020

Have you filed a workers’ compensation claim? Was it denied? If so, it’s time to contact an experienced, reputable attorney to fight for your rights. There’s every chance that the South Carolina Workers’ Compensation Commission will need to hear your case. To prove that your case has been denied wrongfully, it takes know-how and commitment.

What is a Claim Denial?

It seems so simple, doesn’t it? You were hurt at work so workers’ compensation should cover your lost wages, medical expenses, etc. Sometimes, however, employers choose to fight the case. Perhaps they don’t feel they are responsible for the injury. Perhaps they feel the injured employer was careless, and that’s why they got hurt. Your company may decide to refuse or deny your claim for workers’ comp.

Understanding Claim Denials

In the next series of paragraphs, we will present reasons for possible denial of a workers’ comp. claim.

Your Application for Employment

An employer may deny a claim saying that you failed to disclose information regarding your physical condition.  They must prove the following:

  1. You knowingly and willfully made a false statement as to your physical condition
  2. The employer relied upon the false representation and this was a substantial factor in hiring, and
  3. There is a causal connection between the false representation and the injury.

Just Because

Sadly, this does happen. For seemingly no reason at all, your employer simply denies your claim.

Incorrect Reporting of a Job Injury

If you do not report the injury in the required amount of time (see below) or if you do not report it correctly, your employer may deny your workers’ comp claim. What this applies to is whether or not you reported the injury accurately. Did it happen exactly the way that you described? Doctors and independent medical examinations may factor in here.

Conditions That Were Pre-Existing Before the Injury

Your employer may claim that, when the injury occurred, you had a pre-existing condition. For example, natural degenerative changes are frequently suffered by individuals who have existing neck or back injuries. If, however, the condition worsened or was aggravated by something that happened in the workplace, you may still be entitled to workers’ comp.

The Person Is Not Officially an “Employee”

Only employees are entitled to workers’ compensation benefits. If you are listed as a subcontractor or independent contractor, the company you work for does not have to abide by workers’ compensation laws. Numerous considerations go into proving whether or not you worked as an employee, regardless of your classification.

Injuries “Off the Job”

Your employer may claim that you were not currently “on the job” when the injury occurred, so they are therefore, not liable. Fortunately, the definition of “work-related” injuries is relatively broad in South Carolina.

Failure To Follow the Rules or Improper Behavior

  • Your employer may also say that you should not receive workers’ compensation if they feel you did something wrong or that you were negligent. Here’s the thing, however – a “no-fault” system is in effect in South Carolina. However, if you were intoxicated or intentionally hurt yourself on the job, and that can be proven by the employer, your case can be denied.

The Deadline Was Missed

If, within 90 days of an accident in the workplace, you failed to notify your employer, your claim could be denied. This can, however, be hard to determine in the case of chronic illnesses resulting from things like exposure and repetitive stress injuries like carpal tunnel. The reason for the difficulty is that they happen over time. So, the exact injury date and time may not be clear.

Some employers, in fact, insist that, within 24 hours of the injury, it must be reported.

Why Should You Hire Cardinal Law Partners to Fight Your Claim Denial?

At Cardinal Law Partners, our Board Certified legal team will fight tirelessly for your rights in a workers’ compensation case. Our experience and commitment has made the difference in many cases every year.  You do not have to fight powerful employers and insurance companies alone.

If you or a loved one has been denied a workers’ compensation claim, contact Cardinal Law Partners now to schedule a free consultation with our workers’ compensation attorneys.