Auger & Auger believes that everyone has the right to work in a safe environment. We are dedicated to the idea that injured workers must be treated fairly. Unfortunately, our Columbia workers’ compensation attorney knows this isn’t always the case. Worker claims for compensation are denied daily. If you have been injured on the job, we are here to assist you and fight for your rights if your benefits are denied.
Employment levels are at an all-time high in South Carolina. None of the more than two million employees in the state expect to end their shift with a traumatic injury. People have the reasonable belief that once they get to their job, they can perform their duties and then go home; they’ll start all over again the next day. Sadly, this doesn’t happen to everyone. Accidents happen in the blink of an eye, but injuries can take months or years to heal.
Every Worker Has Their Rights
As an employee, you are entitled to workers’ compensation. You can view your rights in the South Carolina code of laws. Title 42 outlines your protections in the event of a workplace accident, but essentially what you need to know is this: When you are injured at work while performing the scope of your duties, you are entitled to benefits. These benefits cover your medical needs and lost wages for as long as you cannot return to work. Government benefits will take over when you are disabled due to the incident.
It’s shocking to discover that nearly 50% of all workers’ compensation claims are denied. A worker who has given their all to their job deserves the respect of coverage, but they clearly will not always receive it. No one should be forced to fight for something to which they are legally entitled. Our Columbia workers’ compensation attorney witnesses the confusion and frustration of claim denial every day.
Give Yourself a Fighting Chance
Consulting an attorney on the day of your injury is always a good choice of action. Their advice and guidance will be invaluable. There may even be a third-party claim to be pursued of which you may not have been aware.
The following basic steps will always be necessary for your claim to be considered. When you are injured in a workplace accident, you must:
- File a report with your immediate supervisor
- Visit the doctor specified by your employer
- Fill out your claim and file it appropriately
- Wait for the decision
- Call an attorney if your claim is denied
Why Are Workers’ Compensation Claims Denied?
Most workers’ comp claims are handled by an insurance carrier from whom the employer purchases workers’ comp insurance. If you receive a claim denial, it will probably be from the insurance company, although it’s likely that the employer doesn’t want them to pay your claim either. This is because the employer’s rates may go up if the insurance carrier does pay a claim.
There are numerous reasons for claim denials, but here are some of the more common reasons we see for insurance adjusters to deny a claim:
- They’re not convinced you were injured or that your injuries are as serious as you say. They may claim that your medical files show “insufficient evidence” of injury, despite your doctor’s diagnosis. Or they may accept that you were hurt, but say that your records reflect a minor injury, and you should be all better now with no further need for treatment. Unfortunately, both situations can prevent you from accessing further medical care.
- They accept that you did suffer an injury, but they’re not persuaded that it happened at work. Frequently we see claim denials for “preexisting condition.” In some cases, the condition referenced has little or nothing to do with the injury – the insurer is just hoping the worker will accept their answer and give up. In other situations, the case is complicated by the fact that the worker did have a preexisting condition, but they also had a very real injury that aggravated the preexisting condition. For example, just because you’ve had a bad knee for years doesn’t mean that you can’t hurt your knee at work and have new or worsened pain.
- Paperwork problems. Workers’ comp forms can be confusing and difficult to fill out, especially if you’re in pain or on strong medication. The person in the HR office may or may not be experienced with these forms. All this means is that it’s easy to make a mistake on your paperwork, and the insurance company will exploit that as an excuse to deny your claim. Missed deadlines are another potential problem. We recommend contacting a Columbia workers’ compensation attorney just as soon as you’re able to ensure you get your claim completed correctly and submitted on time.
- The insurance company may decide that your injury was intentional or resulted from reckless behavior. Normally, workers’ compensation insurance is a “no-fault” coverage system, meaning that neither you nor your employer has to prove anyone was at fault. You get hurt at work, and the workers’ comp insurance should cover your medical costs and two-thirds of your usual pay. However, there are a few exceptions to the “no fault” rule. If the accident was intentional or resulted from horseplay or reckless behavior, the insurance company may use that as justification to deny your claim. For example, if you intentionally ignored all safety protocols and were hurt, it may be hard to get your claim approved. Unfortunately, an insurance adjuster may confuse a situation where the employee made a mistake that caused their injury and an intentional injury. It’s important to know that even if you were at fault and your actions weren’t intentional, you still deserve workers’ compensation coverage.
- You saw the wrong doctor. Under South Carolina law, your employer can choose what doctors you can see for treatment related to a workers’ comp injury. Most businesses will have a list of “approved” providers, frequently doctors specializing in workers’ comp claims. If your company has an HR or administration department, that’s the best place to ask about approved providers. But what if your injury is an emergency? If you’re bleeding profusely or need one of your fingers sewed back on, you can’t wait for one of the doctors on the list to fit you in next Tuesday. In emergency situations, it is permissible to seek medical attention in an emergency room. However, you may need to go to an approved provider for follow-up care. If your insurance carrier protests paying for care because they don’t agree it was an emergency, your attorney may be able to argue that it was and get your claim covered.
What Can You Do If Your Claim Was Denied?
Some people have the urge to call the insurance company, or the HR department at work, and plead their case. We don’t recommend this. These conversations often get heated, and yelling at someone in the HR department can make your work life more difficult. Arguing with the insurance company may be even worse. Insurance adjusters typically record their phone calls, then go through them looking for something to use against you. They may take something innocent you said and misconstrue it to indicate that you were at fault. Aside from these risks, it’s also nearly impossible to talk the insurance company into honoring your claim if you are not an expert on insurance law.
The better solution to this frustrating situation is to contact a Columbia workers’ compensation attorney. Your lawyer will review your claim denial, ask a few questions about the situation, and determine the best way to move forward. In many cases, gathering more evidence and presenting it to the insurance company is successful. For example, we might take witness testimony or recover video of the accident to show that your injury did happen at work, that it was serious, or that your actions weren’t intentional. Or we might be able to correct and resubmit your paperwork if there were errors. Regardless of what the problem is with your application, we will work with you to fix it and negotiate with the insurer if at all possible.
Can You Reduce the Chances of Your Claim Being Denied?
Yes. If you have not submitted a workers’ comp claim already, there are two helpful steps to take to improve your odds of getting approved:
- Submit your claim on time. The best way to do this is to report your accident or injury immediately to your supervisor or the HR department. Then ask when you need to submit a claim. Try to get this info in writing in case your supervisor is mistaken.
- Contact a workers’ comp attorney right away. We can help you fill out the forms correctly and ensure they’re submitted by the deadline.
What If Your Boss Doesn’t Want You to File a Workers’ Comp Claim?
We often hear this question or a variation of it:
“My boss didn’t say it in so many words, but I got the impression that filing a claim could be bad for my career prospects.”
“My boss insinuated that my promotion might not happen if I filed a claim.”
“My supervisor told me I don’t need to file a claim for such a ‘minor’ injury, but I had to go to the hospital and got a bill for several hundred dollars. What should I do? I don’t want to make my supervisor mad.”
“The HR person told me my workers’ comp claim would be denied because I was clearly faking it, so there was no point in filing one. Were they right?”
“Ever since I filed a claim, my boss has cut my hours, which means a smaller paycheck, and she barely talks to me. The other people in the office are acting cold as well. I have to look for another job because I can’t survive on half my usual hours.”
The fact is that your boss can’t stop you from filing a workers’ comp claim, and retaliating against you for doing so is illegal. Sadly, that doesn’t stop it from happening. Often the employer won’t say in so many words that they’re firing or demoting you or reducing your hours because of the claim, making it harder to sue them for retaliation.
Unfortunately, many companies discourage workers’ comp claims because it can raise their insurance rates. In some cases, the supervisor goes so far as to claim the worker’s injury was intentional just to avoid responsibility. Although fighting for your compensation – and sometimes your job – can be challenging, your attorney will be by your side. Call a lawyer immediately if you’ve experienced retaliation or even a vague threat toward your job related to a workers’ comp claim. In addition to helping you file a claim without your employer, we will advise you on what to look out for and how to gather proof of retaliation if it exists.
Auger & Auger Stands For Workers
It can be easy to give up out of frustration when your worker’s compensation claim is denied. You are angry and feel you have been treated unfairly, and you have no other choices. We strongly urge that you continue the fight with a legal expert in your corner. Our Columbia workers’ compensation attorney knows that you deserve better, and we are here to advocate for your rights!
With nearly five decades of combined legal experience, our team knows what it takes to win. At Auger & Auger Accident and Injury Lawyers, we are ready to focus on your case and dedicate ourselves to its success. We promise to keep you informed throughout the entire process of your case. And, our zero-fee guarantee means you don’t have to worry about our fees unless we win. Don’t let the lack of a paycheck discourage you from seeking legal representation!
Call (803) 470-5298 today for your free consultation, with no fees due until recovery!
