Workers’ compensation insurance provides critical benefits to workers injured on the job. Qualified workers can receive reasonable and necessary medical care, as well as wage loss benefits. However, not everyone who applies for benefits is approved. Far too many injured workers receive a denial notice in their mailboxes, and few know what to do.
Call our experienced Greenwood workers’ compensation lawyers at McCravy, Newlon, Sturkie & Clardy if you are fighting to get your workers’ comp claim approved. Below, we look at the most common reasons a workers’ comp claim is denied, and encourage you to reach out to our firm for a free case review.
9 Reasons for a Denial
If you are wondering why your workers’ compensation has been denied, here are nine potential reasons.
- You Weren’t Injured While Working
Workers’ compensation benefits are reserved for those hurt while working. If you were hurt before or after your shift, then your accident is probably not covered. The same is true if you were injured on a lunch break, unless your employer had you run errands.
It is not always obvious whether you were working or not. For example, your boss might have had you make a delivery on your way into work one morning, and you are involved in a collision. Since you are doing something for your boss, you are probably working.
- Your Injury Is Pre-Existing
This is another way of saying you were not injured while working for your employer. You might have hurt your back or neck a year ago in a car accident or while on vacation. The workers’ comp insurer might argue that your pain and disability stem from this earlier injury.
- You Aren’t a Covered Employee
Workers’ compensation policies should cover all full- and part-time workers. You are covered as soon as you begin working.
However, some workers are excluded:
- Independent contractors
- Farm workers
- Casual workers
- Domestic workers (such as a babysitter)
Call our office if you have questions. You might be an employee instead of an independent contractor. Worker misclassification is a silent problem in South Carolina, and someone who is an employee should receive benefits.
- You Waited Too Long to Notify Your Employer
Workers must immediately report workplace injuries to someone in a supervisory role. This protects other workers. Prompt reporting is also necessary to protect your rights. According to the South Carolina Workers’ Compensation Commission, a failure to report a work injury within 90 days could disqualify you from benefits.
- You Filed a Claim Too Late
Injured workers must file their workers’ compensation claim within two years of the accident. Reporting your injury to your employer is not enough. Instead, you need to fill out either Form 50 or 52 and send it to the state’s Commission.
- You Did Not Receive Medical Care from an Approved Provider
South Carolina employers can select the doctor who treats you. If you go to an unapproved provider, then your medical care will not be covered.
There are some exceptions. For example, if you are seriously injured and need emergency care, the ambulance can race you to the hospital to save your life. But it is best in non-emergency situations to find out whether a doctor is in the approved network.
- You Were Chemically Impaired when Injured
Workers’ compensation benefits are usually no fault, which means your carelessness will not prevent you from receiving benefits. But if you were intoxicated when you were injured, that is a different issue entirely. Some employers test workers after an accident to see if they were under the influence of drugs or alcohol, and then they will deny your claim.
- Your Medical Condition is Not Covered by Workers’ Compensation
Not all debilitating injuries are covered by workers’ compensation. For example, mental injuries will only be covered if they meet strict qualifications, such as being caused by an unusual or extraordinary event. Suffering from depression due to normal workplace stress is typically insufficient.
Other diagnoses might be too experimental, and the insurer rejects the claim. You should reach out to a lawyer if you have questions about the denial of a workers’ compensation claim.
- You Lack Sufficient Medical Evidence
Medical evidence is important for workers’ compensation for various reasons:
- Connecting the injury to work. Records can help prove you suffered the injury in an on-the-job accident, otherwise, you will not be covered.
- Showing the severity of the injury. The insurer might think the injury is too minor to keep you out of work. Medical documentation can prove that you need care.
- Proving you are trying to get well. An insurer will constantly try to get you back to work and cut off benefits. You need to convince them you are making efforts to heal.
Some claims lack a sufficient medical basis, so the claim is denied until the worker pulls together supporting medical documentation. Contact an attorney if you do not have easy access to medical treatment, or if you think the doctor you are forced to go to is not helping you.
How to Fight a Denial
A denial is frustrating, especially when a worker needs medical care and can’t work. Money is tight, and there is no way to get back on the job when you are feeling such extreme pain. Instead of losing hope, call an experienced lawyer.
Our legal team can review the reason for the denial and analyze your medical records. We are interested in hearing your story about why you were hurt. Based on this information, we can pull together evidence for an appeal.
Many workers whose claims are denied initially will receive benefits when they file a timely appeal and work with an attorney.
Supporting evidence is critical. For example, if the insurer alleges you suffered a pre-existing injury, we can show how your current job has made it worse, which is why it’s covered.
Schedule a Free Consultation
A Greenville workers’ compensation lawyer at McCravy, Newlon, Sturkie & Clardy is ready to meet to review your claim and what information you need to successfully bring an appeal. Contact us today for more information.