Has Your Workers’ Compensation Claim Been Improperly Denied? A Legal Professional Can Help You Through the Appeal Process

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If your worker’s compensation claim was denied, you still have the option of appealing this denial. What this means is that you can essentially move up the chain of authority in the worker’s compensation claim arena and present your case to higher authorities in hopes that you are able to convince them to reverse the denial of your claim.

The well-known saying “It ain’t over till it’s over” certainly rings true in the worker’s compensation claim, not to mention civil litigation in general. However, appealing your workers’ compensation claim isn’t a task that you should endeavor to accomplish all by yourself. The rules and procedures which are outlined in South Carolina Worker’s Compensation law as it relates to the appeals process are complex and full of numerous technicalities and procedural requirements. If you are contemplating appealing a workers’ compensation claim in the Rock Hill area, your first step should be to contact Workers Compensation attorneys at Elrod Pope Law Firm to help you navigate your Workers’ Compensation appeal.  

Under What Types of Circumstances Might My Workers’ Compensation Claim Be Denied in the First Place?

There are various reasons that you may find yourself facing a Workers’ Compensation denial. Some of these reasons are substantive in nature while others simply come down to missing a deadline. A few examples of reasons for a Workers’ Compensation denial are as follows:

 

You were not considered to be an “employee.”

 

If you think that proving that you are actually an “employee” is a simple task, think again. Defining what it really means to be an employee is a frustratingly gray area of the law in general.

Section 42-1-130 provides a very long and complex definition of what constitutes an “employee” for Workers Compensation purposes. Some of the vague elements of this description include such ambiguities as being under an “appointment,” “contract for hire,” or “apprenticeship.” To make this statue even more convoluted, whether you happen to be an apprentice, under appointment, or hired on a contractual basis, you can still be considered an “employee” if you are a child or even if you happen to be “unlawfully employed.”

For whatever it’s worth, you are “not” an employee under South Carolina law if the nature of your employment is “casual” or if it is of a different type than the type of work that your employer typically engages in as a general part of doing business.

The main takeaway from this very detailed definition of an “employee” from a practical standpoint can be explained in just one short sentence:

If you are an independent contractor, you are not entitled to Workers’ Compensation benefits.

Clearly, understanding the difference between what constitutes as an “employee” versus an “independent contractor” is an entirely separate legal issue that is far from being delineated under South Carolina law. Ascertaining whether or not an employment relationship exists is a very fact heavy analysis that largely hinges upon the circumstances of each and every individual case.  Namely, there are various factors apply. Predicting exactly how the assigned judge will ultimately weigh these factors is yet another contingency that comes to play in many workers’ compensation cases.  

As such, it is often the case in the wonderful world of law, reasonable minds may differ. Indeed, even the minds of experienced legal professionals may differ. This is a fact-intensive analysis that absolutely requires that you have an experienced workers’ compensation lawyer in your corner. A workers’ compensation attorney can help you determine which classification best applies to your employment relationship.

 

Your injury was not considered “work-related.”

 

Thankfully, South Carolina’s definition of a “work related” injury is very broad. It essentially encompasses any type of injury sustained either while at the job site or while in the course of performing work related duties. Nevertheless, while far less common than many of the other grounds for denial, this still remains yet another possible ground for the denial of your workers’ compensation benefits.

The applicable South Carolina Code Section provides an explanation that is far from clear in this respect. Specifically, the subject accident and corresponding injury must arise “out of ” and “in” the course of one’s employment.

 

You “were asking for it,” figuratively speaking.

 

This one is fairly straight forward and hopefully not something that which you will find yourself having to worry about. If you brought the injury upon yourself by engaging in reckless behavior or otherwise unreasonably placing yourself at risk, this very well might lead to the denial of your claim. For clarity here, the idea is that if you engage in behavior such as showing up to work drunk or intentionally hurting yourself to acquire worker’s compensation benefits, you may find that your claim is ultimately denied.

 

You failed to adequately document your injury and treatment

 

Document everything. Visit a medical professional to have your injury evaluated promptly after the accident and ensured that you waste no time seeking the requisite medical care and treatment. A legitimate injury is of little consequence if you can’t prove it.

What Will the Appeals Process Be Like?

As a general overview, appealing your worker’s compensation claim may involve some or all of the following:

  • Filling out a specified form and sending it to the South Carolina Workers’ Compensation Commission whereby you request a hearing with one of the Commissioners. 
  • Following a hearing with one of the Commissioners, a decision will be made as to the merits of your claim.
  • If the decision is not in your favor, you are entitled to a Panel hearing with multiple Commissioners. However, you only have 14 days from the original order to appeal the decision from the original hearing by filing a Form 30 (Request for Commission Review).
  • If the panel decision is still not in your favor, and your injuries occurred prior to July 1, 2007, you may file an appeal with the Circuit Court within 30 days.
  • If the panel decision is still not in your favor, and your injuries occurred after July 1, 2007, you may file an appeal with the Court of Appeals.
  • Eventually, once you have exhausted these options, you may be able to file an appeal with Supreme Court of South Carolina.

Consult with a South Carolina Workers’ Compensation Attorney

Seek the workers’ compensation benefits you deserve when you reach out to Elrod Pope Law Firm to discuss the details of your case during a consultation.

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