Have you applied for workers’ compensation in Lake Wylie, South Carolina, and your claim has been denied? If so, it is important for you to speak with an experienced attorney as soon as you can. You will likely have to request a hearing before the South Carolina Workers’ Compensation Commission, and an attorney will help you build a case to determine that your claim was wrongfully denied. In this article, we look at a few common reasons that could be argued to deny a claim.
Why Insurance Providers and Employers May Deny Workers’ Compensation in Lake Wylie, South Carolina
Here are 8 of the most likely reasons your workers’ compensation claim could be denied.
1. Injuries Suffered Off-the-Job
In some instances, your employer may claim that your injury was not related to work and that you should not receive any benefits. However, if you were indeed in the scope and course of your regular work duties at the time you suffered the injury, it may be that your claim was wrongfully denied. According to the laws of workers’ compensation in Lake Wylie, South Carolina, a “work-related” injury comes with a broad definition, even if you suffer the injury outside of your usual working hours or away from your regular job site.
2. You Missed the Deadline
Your workers’ compensation claim could be denied if you fail to tell your employer about the injury within 90 days of the on-the-job accident happening. There is also a specified time frame in which to file a claim. In some instances, it may be difficult to pinpoint exactly when your injury developed, for instance if it is a chronic illness, for example caused by continuous exposure to harmful chemicals, or a repetitive stress injury, such as carpal tunnel syndrome.
There are many employers who will try to claim that an injured worker ought to be barred from benefits if they fail to report their injury within 24-hours or another specified time period. If your employer alleges that you have missed the deadline yet you believe there were special circumstances or you did tell your employer about the injury on time, you will need to contact a Lake Wylie workers’ compensation lawyer who can help you prove your claim.
3. You Have Preexisting Conditions
Sometimes an employer will deny claims based on the fact that you had a preexisting condition at the time your on-the-job injury happened. This is usually true in neck and back injury cases where a worker may have a degenerative change in their condition. But, if this is the case for you, you could still receive workers’ compensation benefits in Lake Wylie, South Carolina, if the accident in the workplace worsened or even aggravated your preexisting condition. Attempting to prove the extent of your injuries sustained at work and your right to compensation can be a complex endeavor, but a knowledgeable attorney can help fight your case.
4. You Failed to Follow the Rules or Improper Behavior
Your employer could attempt to claim that you behaved negligently or did something wrong and as a result you should not receive any benefits. In South Carolina, workers’ compensation is a no-fault system. It is very rare that a worker is not deemed eligible for workers’ compensation benefits because of his or her own actions. Unless you were intoxicated on the job or intentionally harmed yourself, and your employer can prove that this resulted in your injury at work, you should not be disqualified based on your actions, even if you did act recklessly.
5. You Are Not an Employee
Only employees are eligible for workers’ compensation in Lake Wylie, South Carolina. Some employers try to incorrectly classify workers as subcontractors or independent contractors instead of employees in their efforts to avoid paying workers’ compensation. Under South Carolina law, determining whether or not you were an employee concentrates on the right to exercise control, the right to fire, furnishing equipment and tools, and how your employer paid you. If you are able to prove facts that show you were indeed an employee when you suffered an injury at work, you may be entitled to workers’ compensation for your injury.
6. You Failed to Correctly Report Your Workplace Injury
An employer could try to argue that your injury did not happen the way you described. Both the employer and his or her insurance provider will try to argue that you are exaggerating the injury and that it is not as bad as you claimed. Often, employers try to use the opinion of a medical professional of their choosing to show that you should not receive workers’ compensation benefits. In such cases, you may be able to request an independent medical exam.
7. Your Employment Application Was Incomplete
Your employer may try to argue that your claim ought to be denied due to the fact that you did not answer your pre-employment work application correctly or you failed to fully disclose necessary information like prior injuries, any physical work restrictions, or even your work history.
8. You Are Denied for No Good Reason Whatsoever
In some instances, your workers’ compensation claim could be denied by your employer for absolutely no good reason other than to demoralize you and try to make you feel guilty about pursuing the benefits legally owed to you.
An Experienced Lake Wylie, S.C. Workers’ Compensation Attorney Can Help
If your workers’ compensation benefit claim has been denied, our knowledgeable attorneys at Elrod Pope can evaluate your case and help you fight for compensation for your injuries suffered at your place of work. Whether you need help filing the claim, fighting for fair financial compensation, or negotiating a settlement with your employer and his or her insurance company, let us navigate the complex and sometimes daunting prospect of seeking benefits. If you have been hurt on the job or suffered a repetitive trauma, get in touch with our team today.
Thomas E. Pope is a Personal Injury, Wrongful Death, and Medical Malpractice Attorney who practices in Rock Hill, Lake Wylie, and Lancaster, SC. He graduated from the University of South Carolina School of Law, and has been practicing law for 31 years now. Thomas E. Pope believes in protecting the injured. Learn more about his experience here.