Workers’ Compensation Denial in Rock Hill

Most employees in Rock Hill are covered by a workers’ compensation insurance policy. This insurance is supposed to cover medical treatment and lost wages when a worker is injured on-the-job. Unfortunately, many injured workers in Rock Hill have their workers’ compensation claims denied.

Common Situations in which Claims are Denied

For a workers’ compensation denial to take place, the injury must first be reported. The employer investigates the claim and determines whether it qualifies for workers’ compensation. A denial can occur for numerous reasons. For example, the employee’s injury may not be witnessed or reported in a timely manner. A claim could also be denied if the employee sought treatment on their own without going through the employer. Injuries may also be the result of an organic health condition and not associated with employment, such as a heart attack or stroke.

Denials are common in cases where the injury occurs outside the scope of the individual’s employment. For instance, the employee may be injured doing something other than their job, such as horseplay with coworkers. If the employee initiated horseplay and suffered an injury, that claim could be denied. If they are on a break or have not yet clocked into work, the claim could also be denied. A claim may also be denied if the injured worker was intoxicated.

Steps to Take After a Denial

When a worker’s claim is denied, the first thing they should do is contact an attorney who has significant experience handling workers’ compensation claims. Many personal injury attorneys do not handle a large number of these cases.

An experienced attorney typically begins by interviewing the injured worker and gathering supporting evidence. For example, they may request medical records to identify the injuries, evaluate’s the doctor’s report, and reviews what the claimant reported to the doctor. They also determine if there are witnesses, take statements, and send a representation letter to the insurance carrier or employer. The lawyer then files Form 50, Employee’s Notice of Claim and/or Request for Hearing, which puts the employer or insurance carrier on notice that a claim was filed.

The injured person’s attorney and the employer’s then scheduling depositions of witnesses and the claimant prior to the formal hearing. The injured worker has the opportunity to have their case heard by a Workers’ Compensation Commissioner who determines whether the case is compensable. If they find the employee can be compensated for a job-related injury, they make an order to pay benefits to the injured worker.

The Importance of Following the Doctor’s Orders

Sometimes, injured workers do not attend scheduled doctor’s visits. This can be a costly mistake because one of the grounds for terminating or suspending benefits to an injured worker is a failure to comply with medical treatment. In South Carolina, the employer has the right to choose the worker’s doctor. Failure to comply with the doctor’s recommendations, orders, or treatment could result in the claim being interrupted. This can also occur if the injured party goes to a doctor other than the one chosen by the employer.

Speak to a Rock Hill Workers’ Comp Attorney About Your Denial

Workers’ comp is set up as a no-fault situation to protect both the employer and the employee. It protects the employer because they choose the doctor. It protects the employee by providing medical benefits while they are out of work.

Unfortunately, these cases do not always go smoothly, and many people in Rock Hill have their workers’ compensation claims denied. If you need help appealing your case or pursuing a hearing, reach out to a qualified attorney at Schiller & Hamilton.