Getting hurt on the job is already more than anyone can handle. You may be missing work, facing piling medical bills, and worrying about how to provide for your family. Workers’ compensation in South Carolina is supposed to help cover your medical treatment and replace lost wages after a workplace injury. But many workers in Aiken are surprised to learn that even strong claims can be denied by the insurance company.
Was your Aiken workers’ comp claim denied? A denial does not mean you are out of options. Workers injured on the job whose workers’ comp claims are denied in Aiken and across South Carolina have the right to challenge the decision through the South Carolina Workers’ Compensation Commission. With the right steps, you can give your claim, and your future a second chance.
At Johnson, Johnson, Whittle & Lancer, Attorneys, P.A., our Aiken workers’ comp lawyers guide injured workers through appealing denied workers’ comp claims every day. So don’t lose hope. We can help you fight this denial and get you the benefits you deserve under South Carolina Law.
Common Reasons Workers’ Comp Claims Are Denied
No one expects to be injured at work, and when a denial letter arrives, it can feel like another blow. Understanding why your Aiken workers’ comp claim may have been denied is the first step toward turning things around.
1. Missed Deadlines for Reporting or Filing
How long after your workplace injury did you wait before filing your claim? South Carolina law requires you to report your injury to your employer within 90 days and to file your Aiken workers’ comp claim within two years. If these deadlines aren’t met, the insurance company may use that as grounds for denial. Unfortunately, many workers don’t realize these timelines exist until it’s too late.
2. Employer Disputes the Injury Happened at Work
Sometimes, your employer or their insurance company may argue that your injury didn’t happen on the job or wasn’t work-related. For example, if you hurt your back lifting a box at work but the employer claims it happened outside of work, your claim could be denied.
3. Insufficient Medical Evidence or Documentation
Insurance companies often look for gaps in medical records to justify denying claims. If the doctor’s notes don’t clearly link your injury to your job, or if you missed appointments, they may argue that there isn’t enough proof.
4. Claim Filed for an Injury Not Covered Under Workers’ Comp
South Carolina workers’ compensation covers most accidental injuries at work, but not all conditions qualify. For instance, stress-related issues, pre-existing conditions, or injuries sustained while breaking company rules might not be covered.
Review the Denial Letter Carefully
When you receive a denial of an Aiken workers’ comp claim, don’t set the letter aside. This document is your roadmap to what went wrong and how to fix it.
The denial letter usually includes:
- Denial code or reason: A specific code tied to the insurer’s explanation.
- Deadlines: The time limit for responding to the denial or filing an appeal.
- Missing evidence: Details about missing medical documentation or witness reports.
- Next steps: Instructions for appealing or requesting a hearing.
Keep the workers’ comp denial letter safe because it will play a crucial role in your appeal. Many of our clients bring these letters to their first consultation, so we can immediately spot where the insurer is pushing back.
Gather Additional Evidence
After filing your Aiken workers’ comp claim, receiving a denial letter is not the end. You still have a chance to collect stronger evidence to support your claim. The more documentation you can provide, the better your chances of reversing the decision.
Examples of evidence you need to build a strong case:
- Medical records and doctor’s reports: Ensure your doctor clearly connects your injury to your work duties.
- Witness statements: Coworkers who saw the accident or know about unsafe conditions can provide vital testimony.
- Photos, accident reports, or safety records: Visual proof or official documentation strengthens your case.
- Work restrictions: Written instructions from your doctor showing how your injury limits your job functions.
Our personal injury lawyers in Aiken know where insurers tend to poke holes in Aiken workers’ comp claims. We will work directly with treating physicians, gather workplace evidence, and interview witnesses to ensure your file is as strong as possible before appeal.
This thorough approach is often what makes the difference between another denial and getting the benefits injured workers deserve.
File an Appeal in South Carolina
Once you’ve gathered more evidence, the next step is filing an appeal with the South Carolina Workers’ Compensation Commission (WCC). Here’s what the process looks like:
- File Form 50 or Form 52: Form 50 is required for injured workers to file an appeal. A $50 fee is required for Form 50. On the other hand, Form 52 is for dependents of a worker who passed away from a job-related injury.
- Request a hearing: This puts your case before a Workers’ Compensation Commissioner, who will hear both sides.
- Prepare for the hearing: Both you and the employer’s insurer present evidence, medical reports, and witness testimony. Here is what to expect.
- Commission decision: The Commissioner will issue a ruling after reviewing the facts.
- Further appeals: If the ruling is unfavorable, you may appeal to the Full Commission, the South Carolina Court of Appeals, or even the South Carolina Supreme Court.
South Carolina’s workers’ comp appeal process can feel overwhelming, but with experienced legal guidance, you’ll understand your rights and the deadlines every step of the way.
How an Aiken Workers’ Compensation Lawyer Can Help
Being denied workers’ compensation benefits can be stressful, frustrating, and confusing. It’s natural to have many questions about your rights, your options, and what steps to take next in the claims process.
Wherever you are in that process, our skilled Aiken workers’ comp lawyer is here to provide answers and guide you through every stage. Our attorneys can step in and handle the complexities so you can focus on recovery.
We can help with:
Navigating Complex Deadlines and Paperwork
We make sure every form is completed accurately and submitted on time for your Aiken workers’ comp claim and/or appeal. One missed deadline can sink a case, and we won’t let that happen.
Building a Strong Case with Expert Testimony and Evidence
Our team works with medical professionals, vocational experts, and coworkers to prove the full extent of your injury and its impact on your life.
Negotiating Settlements or Representing You at Hearings
Sometimes a fair settlement can be reached before a hearing. Other times, a hearing is unavoidable. Either way, we’re ready to protect your rights.
Increasing Chances of a Successful Outcome
Statistics consistently show that injured workers represented by attorneys are more likely to succeed in workers’ comp appeals. Our firm’s deep experience in Aiken and across South Carolina gives our clients a decisive advantage. Let us provide the vigorous representation you need to elevate your Aiken workers’ comp appeal.
Let Our Experienced Attorneys Help You Fight a Denied Aiken Workers’ Comp Claim
At Johnson, Johnson, Whittle & Lancer, Attorneys, P.A., we have helped injured workers in Aiken challenge unfair denials and secure the benefits they need to move forward. You don’t have to face the workers’ comp appeals process on your own. Our Aiken workers’ comp attorneys offer free, confidential consultations with no obligation.
If you were injured at work and your claim has been denied, don’t wait. We are here to help. Call us today at (803) 649-5338 or reach out online to schedule your free consultation.
