You were injured at work or on the job. You filed for workers’ compensation, but your claim was denied, or is facing disputes and delays. It’s a scary situation, especially if you have bills coming due or need additional care and treatment. What should you do?
Understanding why your claim was denied.
It’s important to understand exactly why your claim was denied in order to figure out the best way to appeal the decision. Read the denial letter carefully. There are a lot of reasons claims can be denied, including:
- Delinquent reporting – In South Carolina, you have 90 DAYS to report a workplace injury. Take longer than that and the claim can be denied.
- Employer dispute – Your employer insists that your injury or illness did not happen on the job.
- Claim errors – Clerical errors or missing documents can lead to an automatic denial. All forms must be filled out correctly and completely.
- The injury was not work related – If you were injured while you were off the clock or even on a break, the claim can be denied.
- Preexisting conditions – An insurance company may say you were injured or ill before your work-related injury or illness occurred. You’ll need medical proof to support your claim.
- You didn’t get medical care quickly enough – If you delay getting medical care, the insurance company may argue the injury wasn’t serious or related to the job.
- Failed alcohol or drug test – If you fail either of these tests after the incident, it’s an automatic denial.
- You’re an independent Contractor – If you are doing contract work and aren’t a “regular” employee, your claim can be denied.
Don’t panic. You still have options.
The first things to know are you’re not alone and you’re not out of options. The first thing we’d suggest you do is contact an experience Workers’ Compensation law firm like Fulton & Barr. We can help you understand why the denial occurred and assist you in preparing and filing an appeal.
We’ll want to start by gathering all the information and documentation you have regarding the incident. This will include medical records, communications between you and your employer, medical bills, prescriptions, as well as notes from doctors and witnesses. Next we’ll contact your insurance company together to speak in-depth about your claim and the denial. If it was something simple, we may be able to get the denial reversed without filing an appeal.
How do I file an appeal?
The appeals process is your chance to fight back, and an experienced attorney can help make sure you take your very best shot at receiving a reversal.
We’ll make sure you’re using the right form and providing the correct information. We’ll also help prepare you for your hearing, which involves meeting with a commissioner from the Workers’ Compensation Commission. This is where we’ll present your case, supporting it with every bit of information and support you have gathered. If this commissioner denies your appeal…we still have a chance.
The next step is to file another form and appeal the decision to a panel of commissioners. They will review everything you have already submitted as well as the decision passed down by the single commissioner. You will not be able to present any new evidence. If the panel denies your appeal…we still have a chance to file an appeal with the South Carolina Court of Appeals.
Experience counts every step of the way.
It’s in your best interests to get your claim resolved in your favor as quickly as possible. That means having an experiences attorney by your side right from the start is the best way to go. Remember, time is of the essence, so call Andrew Barr or Valerie Fulton today and schedule your appointment. We’re ready to fight for you!