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Can a South Carolina Workers’ Compensation Claim Be Denied?

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Under the law, most employers in South Carolina have to offer Workers’ Compensation Insurance to their employees. This insurance coverage is designed to cover medical costs and financial losses that a worker incurs due to a work-related injury. For all practical purposes, the underlying objective of the entire Workers’ Compensation Act to ensure that workers that file a workers’ compensation claim do not have to bear the burden of dealing with the financial consequences of a work-related injury. By providing this support, workers can be assured they have their expenses covered, and they can focus on recovering and getting back to work so that they can start being productive again.

In Chester, SC, all employers who employ four or more full time or part time employees are required to carry Workers’ Compensation coverage. This is a mandatory requirement which the employer must fulfill. If they fail to do so and if they are reported to the Workers’ Compensation Board, they can be heavily penalized. Penalties can be much worse if such a report is made after a work-related injury is reported, and the worker informs the Board that the employer has either refused to take responsibility or does not carry Workers’ Compensation coverage.

Types of Injuries Covered by South Carolina Workers’ Compensation Claims

Workers’ Compensation Insurance covers the following:

  • Injuries sustained at the workplace while performing a work-related task or activity;
  • Injuries sustained outside the workplace but while engaged in a work-related activity or event;
  • Injuries sustained suddenly but clearly due to a work-related activity or task

Chester, SC, Workers’ Compensation Claim Benefits

If a worker is injured at the workplace and sustains serious injuries that require medical treatment and that also result in loss of wages because of the worker’s inability to work, their financial losses will be compensated by Workers’ Compensation Insurance. Specifically, this could include:

  • Medical bills, prescription costs, and rehabilitation costs
  • Wage loss replacement
  • Permanent partial disability benefits
  • Permanent total disability benefits
  • Death benefits

Exceptions to Workers’ Compensation Claim Coverage in South Carolina

It is important to keep in mind that while all workers in South Carolina are covered by Workers’ Compensation, there are certain exceptions to this coverage. The entire premise of Workers’ Compensation is to compensate workers for injuries that are work-related. If the injuries in question are not work-related or due to a work-related task, event or activity, they will not be covered by Workers’ Compensation. Additionally, any injuries that the worker sustains while going to or coming back from work or during their scheduled and unscheduled breaks are not typically covered by Workers’ Compensation Insurance.

Reasons for SC Workers’ Compensation Claim Denials

Workers’ Compensation is a basic right of every worker. However, there are specific conditions and clauses that govern this coverage, and these must be met for a workers’ compensation claim to be approved.

Workers’ Compensation claims can be denied due to several reasons which include:

  1. Failure of the employee to report the injury to the employer as well as failure to file a claim with the Workers’ Compensation Commission. Whenever an injury occurs, the employee has to inform the employer as soon as possible. If the employee is seriously hurt and is unable to do so immediately, they should still do it as soon as they are able to talk to their employer. If the situation is such where the employee cannot report the accident in the near future, their family members or friends can inform the employer on their behalf. The point is that the employer has to be notified within 90 days of the accident. Failure to do so can result in the denial of your claim.
  2. Failure to file a claim within the deadline. There is a statute of limitations when it comes to Workers’ Compensation Claims. All workers who sustain an injury at the workplace or due a work-related task, activity or event, must file their claim with the Workers’ Compensation Board within two years of the accident. Failure to meet these timelines can result in your claim being denied.
  3. Failure to prove the injury was work-related. If the injury was the result of the employee’s intoxication or willful intention, the employer could not be held accountable for the injuries even if they were sustained at the workplace. If the employer can prove that the workplace or work duties had not played any role in the injuries sustained by the worker and the worker cannot prove this otherwise, it is very likely that the Workers’ Compensation claim will be denied. Even if you do not have to prove fault in such cases, you still cannot claim an injury is work-related if there is no evidence to prove that it is actually the case.

Hire a Skilled South Carolina Workers’ Compensation Attorney

Our experienced workers’ compensation lawyers understand that sustaining an injury at the workplace can be very difficult to deal with, especially if you are the primary breadwinner for your family with people who depend on your income. However, in the realistic world, there are all sorts of situations and all sorts of employers. Even if your injury is work-related, it is possible that your employer simply refuses to accept this claim. It might also be possible that your employer does not carry any Workers’ Compensation coverage and hence does not want to take responsibility for your injuries. In any case, you will likely need legal counsel.

Call one of our attorneys at the Elrod Pope Law Firm. Our legal team has dealt with numerous such cases and is well aware of how the legal system works in South Carolina. They will help guide you as to how you should proceed, what you should say or do and what documentation you should file to ensure your claim is not denied.

Get in touch with us today to get started with your FREE case review. We’re only a call, click, or short drive away.

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Fee Disclosure: If your case is taken on by the firm, the fee arrangement will be a percentage of the final value of the case as follows: up to 40% for litigation, 35% for pre-litigation, and 33% for workers comp. This calculation will be done before the deduction of expenses. Additionally, the client will be responsible for the expenses resulting from the case.