injury claims with insurance companies

What To Do When Your Workers’ Comp Claim is Denied?

If you’ve filed for workers compensation and been turned down, you’re probably wondering what to do when your workers comp claim is denied. Fortunately, you always have the right to appeal a denied claim.

That’s one of the biggest benefits of working with an attorney, as well, because they are generally used to denied claims. They know where to go from that point, so they can work with you on getting your claim approved. Here’s what to consider if your claim gets denied.

Reasons a Claim Could Have Been Denied

There are a lot of reasons why your claim may have been denied. When you’re wondering what to do when your workers comp claim is denied, the first thing you should know is what caused the denial.

Common reasons can include:

  • Not reporting the injury to your employer within the first 90 days after occurrence.
  • The injury didn’t happen when you were actually at work.
  • You had a problem as a result of a pre-existing condition.
  • You hurt yourself at work on purpose.
  • Someone else hurt you on purpose.
  • The injury happened as the result of your own misconduct.

While some of those make sense as reasons for denial, there are caveats to a lot of those. For example, if you weren’t on the job, but you were on your break and still clocked in, you may qualify for workers comp. The same is true if you didn’t officially report your injury, as long as your employer already knew about it.

What to Do Next?

When you’re wondering what to do when your workers comp claim is denied, there are specific steps you can take.

  1. You’ll want to appeal the decision, and that will lead to a hearing.
  2. At the hearing, your appeal will be heard by a single member of the state’s workers compensation commission, who will then make a ruling on your case.
  3. If your claim is still denied, you can appeal to have the case heard before the full commission, instead of just one person.
  4. A denial from the entire commission can happen, and if it does the next step will be to file a lawsuit. You have only 30 days to file with the appeals court, and a denial there allows you to file with the South Carolina Supreme Court.

Naturally, this can be a stressful and time-consuming process, during which time you’re also not receiving the workers comp benefits to which you are entitled. A workers compensation claim that goes all the way to the lawsuit stage will be decided by a judge.

Contact a Workers Comp Attorney

Rather than tackle all the stress of an appeal alone, or continue to risk denials of your workers comp claim, reaching out to an attorney can be the right answer. As soon as your claim is denied, talking to an attorney can give you help and support to file an appeal that will have a higher chance of a successful outcome.

Reach out to Cummings & Lewis today, so you can have peace of mind and the quality help you need for your workers compensation claim.

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