Hurt on the job in South Carolina? It is your right to file for workers’ compensation benefits. As these are no-fault benefits, they should be paid out regardless of whether or not your employer’s negligence contributed to your accident. With that being, the approval of a workers’ compensation claim in South Carolina is not automatic. Unfortunately, denials happen.
This raises an important question: what happens if a workers’ compensation claim is denied? The short answer is that a denial is not the end of the road. You have the right to file an appeal. At the West Law Firm, we are well-versed in the appeals process. Here, our Summerville workers’ compensation lawyer provides a guide to the appeals process in South Carolina.
Workers’ Compensation South Carolina: The Basics
Workers’ compensation in South Carolina is a no-fault insurance system that provides benefits to employees who suffer job-related injuries or illnesses. Under The South Carolina Workers’ Compensation Law, most employers with four or more workers must carry workers’ compensation coverage as a matter of law. Smaller employers (one to three workers) may also opt to carry it.
Any worker covered by workers’ compensation insurance who is hurt on the job is entitled to receive medical treatment, wage replacement, and compensation for any permanent disability. To be clear, fault does not determine eligibility. These are no-fault claims. Benefits are available even if the employee contributed to the accident.
Note: Workers’ compensation is a grand bargain. In exchange for access to no-fault benefits, workers generally cannot sue their employer directly for a workplace accident.
Reasons You Could Get a Workers’ Compensation Denial
Unfortunately, not all injured workers in Summerville or elsewhere in South Carolina have an easy time getting access to the full and fair benefits that they deserve. Cases can be denied for many reasons. Some of the most common reasons for workers’ compensation denials include:
- Your Employer Claims You Did Not Report the Injury on Time: You need to notify your employer of your work injury. Indeed, in South Carolina, workers must report a job-related injury to their employer within 90 days. Failing to notify your employer within a timely manner could lead to a denial of benefits as a matter of law.
- Your Employer Claims The Injury Did Not Happen at Work: To qualify for workers’ comp, your injury must arise out of and in the course of employment. If your employer or their insurer believes the incident occurred off duty or outside of work-related activities, your claim could be denied.
- Your Employer Claims it is Actually a Pre-Existing Condition: Employers and insurers may also deny claims by arguing the injury was due to a pre-existing medical condition. While South Carolina law allows compensation if work aggravated a pre-existing issue, that issue can very much be a point of contention.
- Your Employer Claims the Accident Was Caused By Misconduct: Workers’ compensation does not cover injuries caused by willful misconduct, horseplay, or intoxication on the job. If your employer or the insurer can show that your actions violated company policy or you were under the influence, they may deny your claim.
An Overview of the Workers’ Compensation Appeals Process in South Carolina
Your employer does not get the final word on your workers’ compensation benefits. They do not get to make a unilateral decision as to whether or not you are eligible to recover. You have the right to challenge a denial by filing an appeal. The claims process is overseen by the South Carolina Workers’ Compensation Commission (SCWCC). Here is a general overview of the stages for workers’ compensation appeals in South Carolina:
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- Informal Conference and/or Mediation (Optional): Before pursuing a formal appeal, the South Carolina Workers’ Compensation Commission (SCWCC) may recommend an informal conference or mediation. It is a meeting that allows the injured worker and the employer (or insurer) to try to resolve the dispute outside of a hearing. A commissioner or mediator facilitates the discussion but does not issue a binding decision. If both parties agree to a resolution, the case may be settled. Mediation is optional, but it is almost always in the worker’s best interest to give it a chance with the help of their attorney.
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- A Hearing Before a Single Commissioner: The first formal stage of appeal is a hearing before a single commissioner of the SCWCC. You will present evidence, including medical records, witness testimony, and any relevant documentation. In turn, your employer or its insurer will have the opportunity to present their side and dispute the claim. After the hearing, the commissioner will issue a written decision. Most often, you will get that decision within 30 days. It can be appealed.
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- Appeal to the Full Commission Panel: If you disagree with the single commissioner’s decision, you may file an appeal to a panel of three commissioners. This must be done within 14 days of receiving the initial ruling. The panel will review the record from the hearing and hear legal arguments from both sides. An important limitation during this part of the process is that the full panel does not accept new evidence. They will follow the record already established in previous proceedings. However, they may ask questions and clarify issues during oral arguments. Their decision can be appealed as well.
- Workers’ Compensation Litigation: The final stage of the workers’ compensation appeals process in South Carolina is litigation. It is relatively uncommon for these cases to go to court, but it does happen. If the full commission ruling is still unfavorable, the next step is to file an appeal with the South Carolina Court of Appeals. The appellate court is focused entirely on whether or not there were legal or procedural errors. Their decision can be appealed to the South Carolina Supreme Court. However, the state’s highest court has discretionary review power. They only hear a very small number of workers’ compensation cases.
How a Summerville, SC Work Injury Attorney Can Help
Navigating a workers’ compensation denial is not easy. You need an experienced advocate on your side. At the West Law Firm, our Summerville, SC workers’ compensation appeals lawyers are prepared to invest the time and resources to handle your case the right way. We are firmly committed to delivering the best possible legal representation to workers and their families. Our case results tell the story best. An initial consultation with our Summerville workers’ compensation attorney is free, completely confidential, and carries no additional obligations.
Set Up a Free Consultation With Our Summerville Workers’ Compensation Appeals Lawyer
At the West Law Firm, our Summerville workers’ compensation attorney has the skills and experience to handle appeals. If your workers’ compensation claim was denied, our firm is here as a legal resource that you can count on. Give us a call now or contact us online to set up your free, no-obligation initial appointment. We handle workers’ compensation appeals in Summerville, Dorchester County, Berkeley County, Charleston County, and throughout the wider region.