It can happen to any South Carolina worker regardless of age, race, ethnicity, or any other characteristic: one moment you are doing your job as you have been trained to do and the next moment you are reeling in pain from a serious workplace injury. You notify your employer, seek medical attention for your injuries, and follow the doctor’s orders. Much to your surprise (or perhaps horror) you receive notification your employer’s workers’ compensation insurer is denying your claim for benefits. “Why would they do this?” you ask yourself. More importantly, what can you do about it?
Why a Workers’ Compensation Insurer May Deny Your Claim
It may seem unbelievable that a workers’ compensation insurer would deny the compensation claim of an employee. But this happens with regularity. A workers’ compensation insurer is just like any other insurance company in that they make money when they take in more through premiums than they pay out in compensation. Your employer’s workers’ compensation insurer may attempt to deny your claim or the claims of other workers as a way of cutting costs and reducing expenses. Common reasons these insurance workers may give include:
- You are not an “employee” under the law and thus not entitled to compensation;
- You did not suffer any injury;
- Even if you suffered an injury, you suffered no loss that can be compensated; or
- A preexisting injury or condition is to blame for your injuries and losses.
How to Fight Back Against a Difficult Workers’ Compensation Insurer
If your employer’s insurer is denying or claim or otherwise refusing to pay you the benefits you are due, you may try to handle the situation yourself. After an accident resulting in injury, however, you may not be in any condition to negotiate with the insurer. Most people in such a situation find the assistance of a workers’ compensation attorney to be helpful.
Whether you hire an attorney or not, you may increase your chances of having your claim eventually improved by:
- Seeking a second opinion if the insurer denies your claim after you visited with their doctor. You may need to pay for the second opinion yourself, at least initially. This doctor can confirm the existence of injuries of the type and severity you claim. You should be sure that the doctor who performs the second evaluation has access to your medical history and records so that he or she can rule out any pre existing conditions.
- Consult with industrial workplace accident experts. Your attorney may know of such experts who can evaluate the facts of your case and testify whether your injuries are consistent with that type of workplace accident.
- Be persistent. The insurer will likely be hoping that you are in need of compensation immediately so that you will settle your case quickly for a less amount of money. The longer you are able to hold out, the more costly your case becomes for the insurer and, in most cases, the more willing the insurer will become to settle your case.
South Carolina workers’ compensation attorney David R. Price, Jr. is committed to helping injured South Carolina workers recover the compensation they need following a workplace accident. Contact him today for assistance by calling (864) 271-2636.
David Price is a Personal Injury, Civil Litigation, Collections, and Criminal Defense Attorney who practices in Greenville, SC. He graduated from the University of Georgia School of Law, and has been practicing law for 12 years. David Price believes in helping those who have been injured. Learn more about his experience by clicking here.
