Common Reasons Workers’ Compensation Claims Are Denied
Workers’ compensation is a critical safety net for employees injured on the job, providing financial and medical support during recovery. However, not all claims are approved. South Carolina workers face unique challenges when navigating this process, with some common reasons for claim denials arising frequently. Understanding these pitfalls and knowing how to address them can improve your chances of a successful outcome.
Common Reasons for Denial
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Missed Deadlines
South Carolina law mandates that employees notify their employer of a workplace injury within 90 days of the incident. Additionally, the official workers’ compensation claim must be filed within two years of the injury. Missing these deadlines can result in an automatic denial. At CFJ Injury Lawyers, our attorneys ensure clients meet all required deadlines, avoiding costly delays that jeopardize claims.
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Insufficient Documentation
Proper documentation is crucial. This includes medical records, accident reports, and witness statements. Without detailed evidence linking the injury to your workplace, insurance companies may argue that the injury occurred outside of work. Our experienced team works closely with clients to gather and present comprehensive evidence that strengthens their case.
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Pre-Existing Conditions
Claims may be denied if the injury is attributed to a pre-existing condition rather than a new workplace incident. While South Carolina workers’ compensation covers the aggravation of pre-existing injuries, proving the connection can be challenging. CFJ Injury Lawyers has extensive experience addressing such disputes and ensuring our clients’ rights are protected.
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Employer Disputes
Employers may contest a claim by arguing that the injury did not occur during work hours or that it resulted from employee misconduct. We at CFJ Injury Lawyers help counter these disputes with thorough investigations and compelling evidence.
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Failure to Seek Prompt Medical Attention
Delaying medical care can create doubt about the severity or cause of the injury. South Carolina law requires injured workers to see a medical provider approved by their employer’s insurance carrier. Our attorneys guide clients through this process to ensure compliance with legal and medical requirements.
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Injury Deemed Non-Compensable
Some injuries, such as those resulting from intoxication or horseplay, are not covered under workers’ compensation laws. We provide clear advice to clients on what qualifies and how to handle claims effectively.
Statistics Highlighting the Importance of Workers’ Compensation in South Carolina
- According to the South Carolina Workers’ Compensation Commission, nearly 70,000 claims are filed annually.
- In 2022, the average workers’ compensation settlement in South Carolina ranged between $30,000 and $40,000.
- Approximately 12% of claims are denied due to technicalities or insufficient documentation, emphasizing the need for proper preparation.
Tips to Avoid a Claim Denial
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Report Your Injury Immediately
Notify your employer as soon as the injury occurs to avoid missing the 90-day deadline. CFJ Injury Lawyers ensures clients understand their reporting obligations and assists in documenting incidents accurately.
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Document Everything
Keep detailed records of your injury, including photos, medical reports, and witness contact information. Our team’s expertise in gathering and organizing evidence can make all the difference in a claim’s success.
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Follow Medical Advice
Attend all scheduled appointments and adhere to the treatment plan prescribed by your healthcare provider. CFJ Injury Lawyers works with medical professionals to validate claims and ensure proper documentation.
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Consult an Attorney
Working with a skilled workers’ compensation attorney, like those at CFJ Injury Lawyers, can significantly improve your chances of success. Attorney Catherine F. Juhas, with over 40 years of experience, and Attorney Eric Saleme, fluent in Spanish and dedicated to the Latin-American community, offer personalized guidance to help you navigate complex claims. Our firm’s proven track record speaks to our dedication and expertise in workers’ compensation cases.
Frequently Asked Questions (FAQs)
Q: What should I do if my workers’ compensation claim is denied?
A: You have the right to appeal a denial through the South Carolina Workers’ Compensation Commission. Consulting an experienced attorney can help build a stronger case. CFJ Injury Lawyers has successfully appealed numerous claims, ensuring fair outcomes for our clients.
Q: Can I file a claim for a repetitive stress injury?
A:Yes, repetitive stress injuries, such as carpal tunnel syndrome, are covered under South Carolina workers’ compensation laws, provided you can demonstrate they are work-related. Our attorneys help gather the evidence needed to support such claims.
Q: What if my employer doesn’t have workers’ compensation insurance?
A: Employers with four or more employees are required to carry workers’ compensation insurance in South Carolina. If your employer is uninsured, you may still be able to recover compensation through the state’s Uninsured Employers’ Fund. CFJ Injury Lawyers can guide you through this process.
Q: Can I choose my own doctor?
A: Typically, you must see a doctor approved by your employer’s insurance carrier. However, you can request a second opinion if you disagree with the diagnosis or treatment plan. CFJ Injury Lawyers helps clients navigate these medical evaluations and advocate for their rights.
Q: How much does it cost to hire a workers’ compensation attorney?
A: At CFJ Injury Lawyers, we work on a contingency fee basis, meaning you pay no upfront costs. We only get paid if you win your case. This ensures that everyone, regardless of financial situation, has access to quality legal representation.
Why Choose CFJ Injury Lawyers?
At CFJ Injury Lawyers, we’ve been fighting for South Carolina workers for over four decades. Our team’s dedication to excellence is backed by impressive credentials, such as Attorney Juhas’ adjunct professorship at Charleston School of Law and Attorney Saleme’s fluency in Spanish, enabling us to serve diverse communities effectively. With personalized attention and a proven track record, we are committed to helping injured workers secure the compensation they deserve.
From the initial consultation to the resolution of your case, we stand by your side, advocating for your rights and ensuring you receive the maximum benefits allowed by law. If your workers’ compensation claim has been denied, don’t give up. Call us today at (843) 553-0007 or text us at (843) 326-0078 for a free consultation.