Columbia Workers’ Compensation Attorneys 

What Steps Do I Need to Take After a Work Injury?

1. Report the Injury or Illness to Your Employer

The first step in filing a workers’ compensation claim is to report the injury or illness to your employer as soon as possible. Be sure to provide all relevant details, including the incident’s date, time, location, and circumstances.

Bear in mind:

a. South Carolina has its own reporting deadline, which requires reporting within 90 days.

You are typically required to report your injury or illness to your employer within 90 days of the incident or diagnosis. Reporting as soon as possible is essential for a smooth claims process and minimizes potential disputes.

b. Failure to report the injury or illness promptly may result in a denial of benefits

You must report the injury within the 90-day deadline to avoid losing your eligibility for benefits.

To avoid this situation, inform your employer as soon as you become aware of your injury or illness. Follow up with any necessary documentation and medical evidence to support your claim.

c. Your employer is responsible for providing you with the necessary claim forms and guidance

Your employer plays a significant role in the workers’ compensation process in South Carolina. They are responsible for providing the necessary claim forms and guidance to help you navigate the process.

After you report your injury or illness, your employer should provide you with the appropriate forms and instructions on completing and submitting them.

If you encounter any difficulties or have questions about the process, contact your employer or our Columbia workers’ compensation attorneys so your claim is handled correctly and efficiently.

2. Seek Medical Treatment

Obtaining appropriate medical care is crucial for your recovery and documenting the extent of your injury or illness. Be sure to inform the healthcare provider that your injury or illness is work-related.

Bear in mind: 

a. Your employer or their insurance company may require you to see an approved medical provider

Your employer or insurance company may have specific requirements when choosing a medical provider for your work-related injury or illness. They may direct you to an approved medical provider for an initial evaluation and treatment.

Following these guidelines ensures your medical care is covered under workers’ compensation and avoids potential disputes with your employer or their insurance company.

b. Keep records of all medical treatments, expenses, and diagnoses

Maintaining accurate records of all medical treatments, expenses, and diagnoses related to your work-related injury or illness is crucial in the workers’ compensation process.

These records can serve as vital evidence to support your claim and help you receive the appropriate benefits.

Make sure to keep copies of medical bills, prescriptions, therapy appointments, and other relevant documentation.

Additionally, request written reports from your healthcare providers detailing your diagnoses, treatments, and progress to help build a strong case for your claim.

c. Follow your healthcare provider’s recommendations to support your claim and recovery

Adhering to your healthcare provider’s recommendations is crucial in both supporting your workers’ compensation claim and promoting your recovery.

Following their advice regarding treatments, medications, physical therapy, and any necessary work restrictions can demonstrate the legitimacy of your claim and make sure you receive the appropriate benefits.

Additionally, complying with your healthcare provider’s recommendations can aid in your recovery and help you return to work as soon as possible.

Discuss any concerns or questions about your medical care with your healthcare provider or consult a workers’ compensation attorney.

3. Follow South Carolina’s Work Injury Laws

After reporting the injury or illness to your employer, it’s essential to follow the procedures outlined by South Carolina’s workers’ compensation laws.

Key points to remember:

a. Be thorough and accurate when providing information about your injury or illness

It’s crucial to give all relevant details, including specifics about your injury or illness, employment, and medical treatment. If you’re injured while working more than one job, the income from both jobs can be included in wage loss calculations, so be sure to include the income from any job where you’re classified as an employee. Inaccurate or incomplete information can lead to delays in the process or even result in a denial of benefits.

b. Retain copies of all relevant documents and correspondence

Keeping copies of all pertinent documents such as medical records, receipts for expenses, and any correspondence with your employer, their insurance company, or your attorney is crucial. These records can help track the progress of your claim, provide evidence if disputes arise, and serve as a reference if additional information is required.

c. Comply with the timelines set by South Carolina workers’ compensation laws

In South Carolina, you generally have two years from the date of the injury or the date you reasonably should have discovered the occupational disease to file a claim. It’s critical to comply with these timelines to facilitate the success of your claim.

4. The Claims Evaluation Process

Once your injury has been reported, the insurance company will review the information provided and make a determination regarding your eligibility for benefits. This process may involve gathering additional information, such as medical records, statements, and witness accounts.

Key points to remember:

a. The insurance company may approve or deny your claim or offer a settlement

After the insurance company has evaluated your claim, they will decide whether to approve or deny your claim or offer a settlement. Carefully review any settlement offers and consult with an attorney to make sure the terms are fair and adequately address your needs.

b. If your claim is denied, you can appeal the decision through the South Carolina Workers’ Compensation Commission

The appeals process may involve attending mediation, presenting evidence at a hearing, and possibly further appeals to higher authorities. It’s important to understand the specific deadlines and procedures for filing an appeal in South Carolina.

c. Maintain open lines of communication

Keep all parties informed about your medical progress, work restrictions, and any changes in your circumstances. Staying engaged in the process can help create a smoother process and minimize potential disputes.

In addition, actively seeking updates can demonstrate your commitment to recovering and returning to work, which can be beneficial in securing a favorable outcome for your claim.

Our Columbia workers’ compensation attorneys can help determine which parties may be liable for your injuries and help you pursue maximum compensation. Get started on your case by calling (803) 599-2207 today.

Common Reasons Workers’ Compensation Claims Are Denied

Understanding the reasons behind a workers’ compensation claim denial is crucial for addressing the issues and building a strong appeal.

Some common reasons for denials include the following:

Insufficient Medical Evidence

To successfully obtain benefits, you must provide adequate documentation supporting your claims, such as medical records, doctors’ reports, and test results.

If the insurance company believes insufficient evidence proves your injury or illness is work-related or as severe as you claim, they may deny your benefits.

Our work injury attorneys will challenge a denied claim. We will present a solid argument to support your claim and increase your chances of obtaining the compensation you deserve.

Missed Deadlines for Reporting or Filing the Claim

Missing deadlines for reporting your injury or filing your claim is another common reason for claims denial in South Carolina.

As mentioned earlier, you generally have 90 days to report your injury to your employer and two years to file a formal claim. You must meet these deadlines to make sure your claim is accepted.

To avoid this issue, make sure you know the relevant deadlines and work closely with an attorney to submit your claim on time.

Disputes Over the Work-Related Nature of the Injury or Illness

Sometimes, disputes may arise over whether your injury or illness is genuinely work-related. If the insurance company questions the connection between your injury and job duties, they may deny your claim.

In such cases, it’s essential to provide as much evidence as possible to demonstrate the work-related nature of your condition, including witness statements, documentation of the incident, and medical opinions from your healthcare providers.

Inaccurate or Incomplete Information on Claim Forms

Inaccurate or incomplete information on your claim forms can also lead to a denial of your workers’ compensation benefits.

To avoid this issue, double-check all information on your forms for accuracy and completeness before submitting them. If you need clarification on any aspect of the forms, talk to our attorneys to make sure you’re providing the correct information.

Employee Classification Disputes 

Employee classification disputes, such as disagreements over whether you are an employee or an independent contractor, can impact your eligibility for workers’ compensation benefits in South Carolina.

Your claim may be denied if the insurance company argues that you’re not covered due to your classification. In these situations, it’s best to work with an experienced attorney who can help you gather evidence to support your case and navigate the complex legal issues surrounding employee classification.

How Do I Appeal a Denied Claim?

If your work injury claim gets denied, you can request a hearing with the South Carolina Workers’ Compensation Commission (SCWCC) to appeal but be aware that the process is often complex and time-consuming. Consider working with an experienced workers’ compensation attorney who can guide you and advocate for your best interests.

The approach to appeal a denial starts with reviewing the reasons for the denial in the letter you receive. After requesting a hearing, you must complete Form 50 and submit it to the SCWCC. You should then secure additional evidence to support your claim.

After the hearing, you will receive a written decision letter from the court and benefits if successful. If your claim is still denied, you can continue your appeal to ​​the circuit court and the South Carolina Supreme Court if necessary.