What are some of the more common problems with workers’ compensation claims in SC?
Worker’s compensation insurance is mandated by law for many SC businesses – it is a supposedly fair compromise between the interests of workers and the interests of employers: you will be taken care of if you are hurt on the job in exchange for losing your right to sue your employer.
The system hardly runs smoothly, though. How could it when the system relies on insurance companies – who are in business to make profits – to make the payments?
Below, we will cover some of the more common problems with workers’ compensation claims in SC – issues that may affect your claim or the amount of compensation that you receive for your on-the-job injuries.
The most obvious problem that arises in workers’ compensation cases is denied claims – sometimes for legitimate reasons and other times because the insurance company thinks it has found a way to get out of paying your valid claim…
The insurance company may deny or limit your claim for many reasons which could include:
- Claims that you are faking or exaggerating your injury,
- The location of the injury – the insurance company may claim that you were not injured “on the job,”
- The cause of the injury – the insurance company may claim that you were intoxicated or that the injury was not received during the course and scope of your employment for another reason, or
- Medical professionals might have claimed the injury was not work-related because they had insufficient, incomplete, or incorrect information.
When your claim is denied, you must pay for your medical treatment or rehabilitation. If you must miss work because of your injury, you will lose your income. If you are not going to work, your employer can fire you – if your claim has been denied, they aren’t firing you because you filed a workers’ compensation claim, rather they are firing you because you didn’t show up for work…
When your workers’ compensation claim is wrongly denied, call your Myrtle Beach workers’ compensation lawyer on the Axelrod team immediately to find out if we can help.
Employers Who Do Not Follow Up on Your Claim
Sometimes employers will fail to follow up on your workers’ compensation claim after you have reported your injury.
Whether it is intentional or an oversight on your employer’s part, this can cause a delay in your benefits getting paid, and it may even cause your claim to be denied.
Follow up with your employer, make sure that you have filled out the proper forms, and make sure that the forms have been submitted on your behalf. If your claim has not been filed or if your employer refuses to provide you with documentation, contact your workers’ comp attorney immediately to get help filing your claim.
Hesitation to File a Workers’ Compensation Claim
For many people, our job is our life – if you have a family and children to support, you probably do not want to do anything to put your livelihood at risk.
Many people have a reasonable fear that their employer will retaliate against them for filing a workers’ compensation claim by demoting them, cutting their hours, cutting their pay, or firing them.
Although some employers may resent workers’ compensation claims (and the potential rise in their premiums), there are two things it is important to understand:
- In most cases, the employer does not pay workers’ compensation claims – their insurance company pays the benefits when an employee is injured, and this is how the system is intended to work, and
- It is unlawful for an employer to retaliate against an employee who files a workers’ compensation claim (see SC Code § 41-1-80), and, if the employer does retaliate, the employee will have a civil cause of action against the employer.
Delayed Payment of Claims
Sometimes the insurance company may delay the payment of your claim rather than outright denying it, requiring you to provide additional information or documentation.
Your workers’ comp attorney can help you to ensure that you have the medical documentation you will need to 1) persuade the insurance company that your claim is valid and they must pay your benefits, or 2) persuade the courts that your claim is valid and the insurance company must be ordered to pay it.
There are strict deadlines in SC workers’ compensation laws, including time limits to 1) report your injury to your employer, 2) file your workers’ compensation claim, and 3) file an appeal after a denial of your claim.
If you miss a deadline, your case may be over, and you may have lost your opportunity to recover compensation for your on-the-job injury.
Report your injury to your employer immediately. Call your workers’ compensation attorney immediately and ensure that you do not miss any critical deadlines in your case.
Confusion Over Doctor Appointments and Treatment
The insurance company can refuse to pay or terminate payment of your benefits if they can claim that you are refusing to cooperate with your doctors or your treatment.
You may be required to see a doctor who was recommended by your employer or their insurance company. You may also seek a second opinion when appropriate, but you cannot miss your appointments or refuse to follow the doctor’s advice.
- Make all appointments with doctors or treatment providers,
- Provide the doctor with details about your injury and how it affects your everyday life but never exaggerate your injuries,
- Follow all treatment recommendations to the letter, and
- Get copies of all medical records from all doctor visits.
If you have been injured on the job in SC, call your Myrtle Beach workers’ compensation attorney at Axelrod and Associates immediately for a free consultation to determine what your next steps are.