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8 Common Reasons Workers’ Compensation Claims Are Denied

If your South Carolina workers’ compensation claim was denied, we encourage you to speak with a Columbia Workers’ Compensation Attorney from Goings Law Firm, LLC as soon as possible.

More than likely you will be required to request a hearing before the South Carolina Workers Compensation Commission in Columbia. Our Columbia Workers’ Compensation Attorneys have been successful on many occasions having the Commission determine that the claim was wrongfully denied.

Here are a few of common reasons that may be argued to deny your claim:

Missed deadlines

Your claim could be denied if you fail to notify your employer within 90 days of a workplace accident. You also have a short time period to file a claim. In certain cases, it may not be clear exactly when an injury develops, such as repetitive stress injuries (carpal tunnel syndrome) or chronic illnesses (continuous exposure to hazardous chemicals or asbestos-related diseases). Also, many employer may claim an injured worker is barred from benefits if they don’t report a work injury “within 24 hours” or some other period of time. If your employer claims you missed the deadline but you believe that there were special circumstances or that you actually did let your employer know on time, you should contact a workers’ compensation attorney for help in proving your claim.

Improper Behavior or Failing to Follow Rules

Your employer may try to claim that you were negligent or did something wrong and that you should not receive workers comp benefits as a result. South Carolina workers compensation is a “no fault” system. It is a rare situation, where an employee is disqualified from receiving workers’ compensation benefits as a result of his or her own actions. Unless you intentionally hurt yourself or were intoxicated at work and the employer can prove that your intoxication was the cause of your work injury, you should not be disqualified based on your own actions, even if you were careless.

“Off-the-job” Injuries

In some cases, your employer might claim that your injury was not work-related and that you should not receive benefits as a result. If you were in the course and scope of your employment at the time of the work-related injury, then your claim may have been improperly denied. Under South Carolina workers’ comp laws, the definition of “work-related” injury is generally very broad, even if the injury happens outside of normal working hours or away from your normal job site.

Not An Employee

Workers’ compensation benefits only applies to employees. Some employers will improperly classify workers as “independent contractors” or “subcontractors” instead of employees in order to avoid paying workers compensation benefits. Under the law, the determination of whether you were an employee focuses on the right to exercise control, how you were paid, furnishing of tools and equipment, and the right to fire. If you can prove facts sufficient to show that you were really an employee, then you could receive workers’ compensation benefits for your workplace injury.

Pre-Existing Conditions

Employers sometimes deny claims based on the fact that you had a pre-existing condition when your work injury occurred. This is especially true in many back and neck injuries where individual often have natural degenerative changes. However, you can still receive benefits if your workplace accident aggravated or worsened your condition. Proving the extent of your work injuries and your right to benefits is complicated in these situations, so you should consult with a lawyer for help.

Job Injury Not Correctly Reported

Your employer might argue that the injury did not happen as described. The employer and the insurance company will often assert that you are exaggerating your injury and will attempt to argue that your injury is not as severe as claimed. In many case, the employer tries to use the opinion of a doctor of its choosing to show that you are not entitled to receive the benefits, and in those circumstances, you may have the right to ask for an independent medical examination.

For No Good Reason At All

It has been our experience that your workers compensation claim may be denied by the employer for no good reason at all, other than to demoralize you as an employee and to make you feel bad about pursuing your legal rights.

Your Employment Application

Employers may argue that your claim should be denied because you did not correctly answer or fully disclose information on your pre-employment work application, such as your work history, prior injuries, or physical work restrictions.

Contact a Columbia Workers Compensation Attorney If your Claim was Denied

If your workers compensation claim was denied, call the experienced Columbia Workers’ Compensation attorneys at Goings Law Firm, LLC today at (803) 350-9230 and ask to speak with attorney and managing partner Christian E. Boesl, who is head of our Workers’ Compensation team.

Or, click here to fill out an online case evaluation form. There is no obligation or cost to see if we can help.

Last Updated : June 14, 2022
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