Bowen McKenzie Bowen LLC

Oh no! Workers' comp denied your benefits claim -- what now?

Is your job one of those that puts your health and safety at risk every day? Knowing that the South Carolina workers' compensation system will have your back in the event of an injury that might prevent you from taking proper care of your family may give you peace of mind. However, the system is one that treats every claim with suspicion, and many others in your position have been disillusioned when their benefits claims were denied.

The claims process involves complicated administrative and legal processes, and the slightest error can result in the rejection of your workers' compensation benefits claim. Fortunately, you need not fight this battle on your own. Experienced legal counsel can navigate an appeal while you focus on recovering from your workplace injuries.

What could cause the denial of your claim?

The insurer will notify you of the reason for the rejection. If you believe your claim was legitimate, you have the right to appeal. An extensive list of reasons for denials exists, some of which follows here:

  • Reporting time rule not met: If you failed to report your injury to your employer within the prescribed period, the insurance company might deny your claim.
  • Claim filed too late: Your employer has a time limit for filing the claim with the insurance providers. If your company misses that deadline, the insurer may reject the request for benefits.
  • Injury is not compensable: Injuries that develop over time are often tough to prove, and a stress-related injury or an occupational illness claim may be denied purely for lack of proof that it is work related.
  • Lack of medical treatment: If you have no records to show you received medical treatment there will be no benefits to claim.
  • Injury is not work related: If there is a suspicion that your injury resulted from horseplay or occurred when you were not on duty, the insurers may question your eligibility for benefits.

How to proceed with an appeal

There will be a deadline for the filing of a workers' compensation appeal. The most logical step might be to retain the services of an experienced South Carolina workers' compensation attorney. He or she can meet with the insurance company and/or your employer to determine whether there might be an easy resolution. If not, the skills of your attorney can be a significant asset in pursuing fair compensation.

The legal process is complicated and may start out with an administrative hearing of your appeal. With your attorney's guidance, you can make sure you have the necessary documents to prove you are eligible for workers' comp benefits. These may include medical records of second opinions, time sheets to prove you were on duty when you were injured, and other evidence that might help. Your legal counsel can advocate for you throughout the navigation of your appeal and work toward an award of full and fair compensation.

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