If your workers’ compensation claim is denied in SC, it’s not the end of the road. If you are unjustly denied benefits, you can file workers’ compensation appeals to present your claim to a higher authority, including:
- The Workers’ Compensation Commission,
- A three-commissioner panel of the Workers’ Compensation Commission,
- A six-commissioner panel called the Full Commission,
- The SC Court of Appeals, and
- The SC Supreme Court.
When Can You File a Workers’ Compensation Appeal?
There are several reasons that an injured employee may need to file a workers’ compensation appeal. In some cases, multiple appeals can be necessary to get a fair resolution in your case.
For example, you may need to request a formal hearing or file workers’ compensation appeals when:
- Your employer (or their insurance company) denies your claim,
- Your employer’s insurance company approves only part of your claim but denies other parts,
- Your employer’s insurance company approves your claim but refuses to pay the full amount you believe you are entitled to receive,
- Your employer’s insurance company’s doctor clears you to return to work but you are unable to return to work,
- You are given an inaccurate impairment rating after you have reached maximum medical improvement,
- You are given an inaccurate disability rating that affects your final settlement amount, or
- You are denied any workers’ compensation benefits that you are entitled to under SC law.
Workers’ Compensation Mediation
In some cases, you must participate in mandatory mediation before your workers’ compensation hearing. The SC Workers’ Compensation Commission Regulations § 67-1802 requires mediation in cases involving:
- A claim of permanent and total disability pursuant to SC Code § 42-9-30(21),
- Occupational disease,
- Third-party lien reduction claims,
- Contested death cases,
- Mental injury claims, and
- Cases of concurrent jurisdiction under the South Carolina Workers’ Compensation Act and the Federal Longshore and Harbor Workers’ Compensation Act.
What is mediation?
It is a process where a neutral third-party attempts to help both parties settle the claim before they appear in court. The mediator’s job is only to facilitate a settlement – they cannot issue orders, and they do not make a final decision in a case. If mediation is unsuccessful, the parties return to court where the commissioner will decide the issues.
What is the Workers’ Compensation Appeals Process?
When you are hurt on the job, the first thing that you must do is report the accident to your employer – you must notify your employer within 90 days, or you may lose the right to file a workers’ compensation claim.
If your employer (their insurance company) approves your claim, you will begin receiving compensation for your medical expenses and wage benefits (2/3 of your average weekly wage).
If your employer denies your claim or denies part of your claim, you can appeal their decision to the SC Workers’ Compensation Commission and request a formal hearing to present your medical evidence to a commissioner.
File a Formal Workers’ Comp Claim and Request a Hearing
The first workers’ compensation appeal is to a single commissioner of the Workers’ Compensation Commission, using a Form 50 Notice of Claim and Request for Hearing (for on-the-job injuries) or a Form 52 Notice of Claim and Request for Hearing in Death Cases.
At the hearing, you will then have the opportunity to present your medical evidence and prove to the commissioner why you are entitled to benefits. After the hearing, the commissioner will issue an order that contains their decision – if the commissioner gets it wrong, however, you still have options for further appeals.
Workers’ Compensation Appeals to a Panel of Commissioners
If your claim is still denied at your workers’ compensation hearing, you can appeal the decision to a panel of commissioners using a Form 30 Request for Commission Review. There is a $150 filing fee that can be waived based on your income level using a Form 32 Request to Waive Appeal Filing Fee.
Workers’ Compensation Appeals to the Full Commission
If the three-commissioner panel denies your appeal, you can then ask the Full Commission to hear your case – a panel of six commissioners instead of three, using the same Form 30 Request for Commission Review that you used to file your first appeal to the three-commissioner panel. You must file the appeal within 30 days of the three-commissioner panel’s decision.
Although appeals from the Full Commission used to go to the circuit court, now they go directly to the SC Court of Appeals.
SC Court of Appeals
If the Full Commission denies your claim, you can appeal their decision to the SC Court of Appeals by submitting an appellate brief with case law supporting your claim that the Commission got it wrong.
There are strict rules and deadlines for each stage of the appellate process in the Court of Appeals, oral argument before the Court may be necessary, and the process can take a year or more before the court of appeals decides your case.
SC Supreme Court
If the Court of Appeals denies your claim, you can ask the SC Supreme Court to hear your appeal and reverse their decision.
In the SC Supreme Court, you must first file a “certiorari petition,” or “request for cert,” asking their permission to hear your case. If the Court agrees to take the case, you then file your appellate briefs, participate in oral argument if they request it, and wait for their decision.
Although it is best to get your workers’ compensation attorney involved early in your case, you can contact legal counsel at any stage of the proceedings.
Your Myrtle Beach worker’s compensation lawyer on the Axelrod team will help you to file your claim, determine how long your workers’ compensation benefits may last, and represent you before the workers’ compensation commission for any hearings and appeals.