If your workers’ compensation claim is denied, your next step is to request a workers’ compensation hearing in front of a commissioner.
A workers’ compensation hearing is like a trial, except the issues may be limited, there may be fewer witnesses, and you do not have the right to a jury as you would in an auto accident or criminal trial.
Below, we will discuss the procedure for a workers’ compensation hearing in SC, what typically happens during the hearing, how to prepare for the hearing, and what to expect after your hearing.
Before the Workers’ Compensation Hearing
The first step in your workers’ compensation case is to notify your employer of the injuries, see a doctor, and get treatment for your injuries.
If your claim is denied by the insurance company, or if the insurance company refuses to pay full and fair compensation for your injuries, then you must file a Form 50 Notice of Claim and Request for Hearing (or a Form 52 for cases that involved the employee’s death).
Although many injured workers wait until after the insurance company denies their claim, you may want to contact your workers’ compensation lawyer before filing the claim.
Because insurance companies, including workers’ compensation insurance companies, routinely deny and limit claims – it’s how they remain profitable. If it cost less to pay a claim than to fight it out with your attorney in court (and then have the court order them to pay), they will pay the claim.
If the insurance company believes they can make an argument to deny your claim, especially if you don’t have an attorney who will represent you at the workers’ compensation hearing, they will deny the claim or offer less than your claim is worth.
Reasons Workers’ Comp Claims are Denied
The insurance company may deny or limit your claim if they can make an argument that you were injured somewhere other than your place of employment, that your injuries are not as serious as you claim, or that you did not properly fill out your paperwork.
In some cases, these potential defenses by the insurance company can be avoided when your workers’ compensation attorney presents your claim to the insurance company for you, anticipating their potential reasons for denying a claim.
The process of preparing your case for a workers’ compensation hearing begins as soon as your attorney steps into your case, whether that is before filing the initial claim or after the insurance company has denied your claim.
The defense (the insurance company) will usually schedule one or more depositions before the hearing, including your deposition and possibly the depositions of one or more doctors – this can be a critical stage in your case, because your testimony in the deposition may later be admissible during your workers’ compensation hearing.
Documents Must Be Filed Before Your Hearing
Weeks before your hearing date, we will need to file documents with the Court that may include our witness list, medical records or other documents we will use as evidence at your hearing, and a “pre-hearing brief” that the Commissioner will review before your hearing begins.
If your pre-hearing documentation is not filed, is not filed correctly, or is filed late, you won’t be allowed to present your evidence at the hearing…
The Procedure for a Workers’ Compensation Hearing
Your attorney has attempted to settle your claim with the insurance company, has prepared your documentation and potential witnesses, and the insurance company is still refusing to pay… what’s next?
A workers’ compensation hearing in South Carolina is less formal than a civil or criminal trial – there are fewer participants, it will be in a smaller courtroom, there are typically fewer witnesses, and the hearing will usually not last more than a few hours.
First, your attorney and the insurance defense lawyer will give their “position statements,” similar to the opening statements in a civil or criminal trial. In the position statement, your attorney explains to the Commissioner what the case is about, which issues are contested in your case, and what we are asking the Commissioner to do for you.
Presentation of Evidence
Your attorney will present your evidence to the Commissioner at your workers’ compensation hearing, which may include documentary evidence like medical records or other exhibits that may show how you were injured, where you were injured, the extent of your injuries, and your diagnoses.
The documentary evidence that is presented to the Commissioner must be prepared and organized in a way that complies with both the Administrative Procedures Act (APA) and the Commissioner’s instructions. If they are not prepared correctly and if they don’t prove that your injuries were caused by your on-the-job accident, you could lose your case.
You will need to testify to explain to the Commissioner where you were employed, how you were injured, what you were doing when you injured, the extent of your injuries, what treatment you have received for the injuries, how the injuries have affected you, whether you will need future treatment, and any other facts that the Commissioner needs to know for us to prove the issues in your case.
After your “direct examination” testimony, the defense attorney will cross examine you to disprove your case and persuade the Commissioner to deny your claim…
Additional witnesses may testify for us or for the defense, but often you will be the only witness because the doctors’ testimony will be contained in the medical records or deposition transcripts.
After the Hearing
You probably won’t find out whether you won on the day of the hearing. Instead, the Commissioner will review the case after the hearing and then issue a written order approving your claim, denying your claim, or deciding the various issues that were presented during your hearing.
If we are not satisfied with the Commissioner’s decision (or if the defense is not satisfied with the Commissioner’s decision), appeals can be filed asking a higher court to reverse the Commissioner’s Order.
The process of preparing your case for a hearing begins immediately – organizing your medical records and documentary evidence and preparing any witnesses (including you) for depositions or hearing testimony can 1) result in settlement of your claim before the hearing or 2) maximize your odds of winning your workers’ compensation hearing.