Ramie Shalabi | November 10, 2020 | Workers Compensation
There are many reasons why an insurance company will deny your workers’ compensation claim. Just because they deny your claim, it doesn’t mean you are not entitled to any benefits, including medical treatment and a disability award. You will likely need to consult with an attorney to take on the insurance company. Some of the most common reasons an insurance company will deny your workers’ compensation claim are:
- Pre-Existing Condition
They will say that your injury is pre-existing. This may not matter. Workers’ Compensation law in South Carolina provides that an injured worker is entitled to workers’ compensation benefits if the work accident aggravated the pre-existing condition. This must be proven by a “preponderance of the evidence” with “medical evidence.” In other words, a doctor must say that the work accident more likely than not (just greater than 50% probability) made your pre-existing condition worse.
We most commonly see this with back and joint injuries. For example, sometimes, a person has “degenerative disc disease” that shows up on an x-ray. This is usually caused by old age. However, someone with degenerative disc disease may not have ever felt any pain in his or her back prior to a work accident. This is a classic example of an aggravation of a pre-existing condition within workers’ compensation law. Another classic example is someone having arthritis in their knees but never feeling any pain until they get hurt on the job. Just because the work accident did not cause the arthritis in the knee, it does not mean workers’ compensation insurance should not cover it if the work accident triggered your pain or made your pain worse.
Bottom line: if you were not in pain before the work accident, and you are in pain after a work accident, you may still be entitled to workers’ compensation benefits even if the insurance company denied your benefits. You will likely need an attorney to help you prove an aggravation of a pre-existing condition in court.
2. Delay in Reporting
Many employees likely think that they have to report an injury immediately after it happens or else they can’t be covered under workers’ compensation. Maybe your manager or boss even told you that. They are mistaken. Employees in South Carolina have ninety (90) days to report an injury. Obviously, the sooner you report it, the better as the longer you wait, the more difficult it may be. Either way, injured workers have 90 days to report an injury to a supervisor. Once you report the injury to your supervisor within 90 days, you have two years to file the claim. This is called the “statute of limitations” in South Carolina.
Bottom line: you have 90 days to report the injury to your supervisor and two years from the injury date to file a claim. Don’t let anyone tell you otherwise.
3. They Say the Accident Did Not Happen at Work/No Witnesses
This may become a “he-said/she-said” argument. Injured workers in South Carolina are not required to have someone witness their accident. In fact, many accidents happen when no one else is around. Sometimes, your testimony that the accident happened at work is enough to get workers’ compensation benefits even if no one else witnessed it. Your testimony is evidence and a Workers’ Compensation Commissioner (judge) will consider your testimony at a Hearing.
Bottom line: Just because no one witnessed your accident, it does not mean you are not entitled to workers’ compensation benefits. Sometimes, your word/testimony is enough to get you covered under Workers’ Compensation in South Carolina.
4. Your Fault
Workers’ Compensation law in South Carolina is a no-fault system. In other words, it does not matter if you caused yourself to get hurt (for example, if you are a truck driver or delivery driver and you were at-fault in a car accident while you were making a delivery). It just can’t be intentional (you can’t hit yourself with a baseball bat at work and try to get workers’ compensation benefits!).
Also, your job does not have to be negligent or do something that caused you to get hurt. So, if you were injured while lifting a heavy box at work or accidentally hit the wrong button while operating a machine, you may still be entitled to workers’ compensation benefits in South Carolina.
Bottom line: As long as you were at work performing your work duties while you were injured, you could still get workers’ compensation benefits in South Carolina even if you were at fault or your Employer did not do anything that caused you to get hurt.
All in all, insurance adjusters have a job to do for the insurance company and it is not to represent you and your best interest. If your claim is denied, seek advice from a workers’ compensation attorney. Most, if not all, (including our firm) will give free consultations.
As we all know, medical treatment can get very expensive and you should not be on the hook for the bills if you were injured on the job. You should consult with an attorney to see if you are entitled to workers’ compensation benefits.
We never charge our clients up front for workers’ compensation cases. Instead, we work on a contingency fee meaning we only earn a fee if we are able to recover compensation for you at the end of your case.
If your workers’ compensation claim has been denied and you were given one of those reasons by an insurance adjuster or supervisor, give us a call at 803-973-0304 or 843-388-3368 to see if we can help. We are experienced South Carolina workers’ compensation attorneys ready to help you.