Although work environments are much safer than in years past, work injuries still happen. Approximately 35,000 claims are filed each year in South Carolina for work related injuries or illnesses. South Carolina's Workers Compensation law can cover the costs of medical care and provided compensation for time off work required for recovery after an on-the-job illness or injury. Additionally, if the injury results in permanent disability, you may also be entitled to additional benefits for that disability
If your workers compensation claim was denied, you may be wondering what to do next. Should you take your boss or company to court to attempt to recover the costs of medical care and time spent off work? Today, we'll walk through the basics of why a claim might be denied, and what steps you should take to ensure your individual rights are respected.
Why Your Workers Compensation Claim Was Denied
Companies and employers have many reasons for the initial denial of a workers compensation claim, but one of the most common is that it wasn't reported quickly enough. If you are injured on the job or become ill either on the job or as a direct result of your working environment or conditions, you need to fill out your workplace Workers Compensation forms immediately. Even turning in your report less than 24 hours after the cutoff could mean your claim is automatically denied by the employer, no matter how legitimate it is. Make sure your report is filed with your boss (and ensure that you receive a copy signed and dated by your supervisor as soon as you turn it in) within 24 hours of the injury, if possible.
Another common reason given by supervisors and employers to deny a workers comp claim is simply that the employer does not believe or is not willing to acknowledge that the accident, injury, or illness happened at work.
If this is the reason given for denying your claim, you'll need to gather whatever evidence you can that proves that the injury or illness happened at work or because of your work. One of the strongest pieces of evidence will be witness statements. Did multiple coworkers witness your injury? Can they back you up on the unsafe conditions or environment that led to the accident? In the case of some illnesses or injuries, your doctor may be able to give a statement attributing your injury to your workplace.
While your relationship with your employer may previously have been a positive one, that will not necessarily stop the company denying your workers compensation claim as often times hte employer's insurance company makes the decision as to whether to accept or deny a claim.
If your employer denied your workers compensation claim, can you take them to court? Should litigation be the next step?
Don't Take 'No' For An Answer.
If you know that your workers compensation claim is valid, but your employer has denied it, you shouldn't take 'no' for an answer.
Read the letter you receive that includes your claim denial carefully. You may see a description of ways to appeal, and should look for any specific deadlines given as the final date you are able to appeal your claim denial. If you are informed that your appeal was denied in-person and no denial letter is given, ask for a dated letter of denial. If they are unwilling or unable to provide that letter, make note of this and include that refusal in the evidence and documentation you are keeping.
Consider asking why your claim was denied and contacting the workers comp insurance carrier your employer uses to find out why the claim was denied. Otherwise, ensure that you maintain copies of your attempts to ask about the denial, reasons given by the insurance carrier or your employer, and then contact a legal representative before filing your appeal or claim with the Workers' Compensation Commission.
Things Don't Necessarily Need to Go to Court
Many employees hear 'litigation' and are nervous about the idea of going to court against their employer, as it may be a corporation or large company that could drag the case out in court.
A very small number of claims filed actually make it all the way to a hearing before a Commissioner. A claim may be admitted by the insurance company after its filed and more evidence of a compensable claim is provided to the insurance company. Be prepared to present all the documentation and evidence you have been collecting since your original injury or illness took place. Remember that proof of medical care, a workplace-injury form filled out within your company's given deadlines, and any witness statements you are able to put together will be invaluable support that your claim is compensable.
If you do end up needing to take your employer to court over a denied workers compensation claim, it may be helpful to have an attorney involved from the beginning of the process to assist in preparing the claim for a hearing before the Workers' Compensation Commission. The injured worker bears the burden of proving that the claim is compensable and a lot of information must be gathered to get the claim ready for a hearing.
Thinking About Filing a Workers' Comp Claim?
If your workers compensation claim was denied by your employer and you're considering filing a claim for benefits, you should speak with a legal representative before you file. At BNTD Law, we have experience working with employees who have been denied workers compensation benefits, and we'd be happy to sit down with you for a FREE consultation to help you determine the next step. Reach us by phone at (803) 779-7599 or contact us online to request your free consultation today!