My Workers' Comp Claim Was Denied. Now What?

In the last fiscal year, more than 20,000 self-insured and state-funded workers’ compensation claims were denied. However, that same year, about 2.9 million nonfatal workplace injuries occurred. Believe it or not, insurance companies reject more valid claims than you would think. They most often list the following reasons for the denials:

  • Injury wasn’t reported soon enough
  • Injury wasn’t witnessed
  • Injury occurred offsite
  • Worker had a preexisting condition
  • There was insufficient medical evidence of the injury

Workers’ compensation providers make money by collecting monthly premiums and lose money by approving claims. A company will deny you were injured any way they can to protect their own financial interests.

Why Hire a Lawyer?

Typically, your denial will come in a letter. The insurance company will list a reason for the rejection, which you can then take to an experienced workers’ compensation attorney. Lawyers who work in this field are knowledgeable about the various reasons companies give for rejecting claims. They can help you fight the denial in court by assisting you in appealing the decision. Appeal deadlines can be very strict, so consult an attorney as soon as you receive a rejection letter in the mail. He or she will know how long you have to file the appeal and will represent you in court when your case reaches a judge. Appeals are complicated (they require rules of evidence and civil procedure), so an excellent attorney is essential to have on your side if you want to present a strong case.

You might also want to hire an attorney if your employer threatens to retaliate for your filed claim. South Carolina law is on your side if this looks like your situation. Under S.C. Code Ann. § 41-1-80, you are protected from discharge in retaliation for starting a workers’ compensation proceeding. You already have a good case against your business, but an attorney can represent you best if you must appear in court against your employer and his or her lawyer.

If your claim was denied, make sure your rights are protected. Contact us at (843) 343-5092 or fill out our online form with your details. Let our Charleston workers’ comp attorneys be your advocates.


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