Workers' compensation in South Carolina is meant to aid workers financially when they have been injured or fallen ill on the job or due to their job. Sometimes, disputes arise. An employee may not agree with the employer and the employer's insurance, while the latter may not agree with the employee. Disputes can lead to delays and denials. Disputes can also be costly.
At Jung Disability and Injury Advocates, our workers' comp lawyer in Charleston handles workers' comp disputes alongside other workers' comp matters. If you have questions and need legal assistance, contact us at (843) 576-4200. We will schedule a free consultation so that you can get the answers you need and take the next step to solve your workers' comp dispute.
Do You Have the Right to Workers' Compensation in South Carolina?
Many workers, prior to actually suffering a work-related injury, believe that if they are injured on the job their workers' compensation benefits will just kick right in without any further effort on their part. Unfortunately, this is not true.
Every state has a system for workers' compensation claims. While they may differ from jurisdiction to jurisdiction, all require an injured worker to take some action before they are able to receive their benefits. Also, a worker must be able to prove their injury. If not, benefits can be disputed or denied.
So, if a worker is injured on the job, they typically have a right to workers' compensation. That right, however, is not automatic and is dependent on state law.
Common Disputes in South Carolina Workers' Comp Claims
Once a worker has filed for benefits, two main types of disputes often arise. These disputes could involve (1) the insurer and commission or (2) the employer. For employees, it is important to know what could instigate a dispute so that they can proactively avoid them.
Insurer and Commission Disputes
Generally speaking, an injured worker has the burden to prove their injury meets all the criteria to enable them to recover benefits. Insurers and commissions on workers' compensation benefits often challenge claims on the basis that not all criteria have been met.
Common reasons insurers and commissions reject claims involve allegations that:
- The worker's injury pre-existed and is not connected to their employment
- The worker's injury was not sustained in the commission of their work-related duties
- The worker failed to notify their employer of the injury within the specified time frame
- The worker was not an employee and therefore not entitled to workers' compensation benefits
- The workers' injuries are not as serious as the worker claims
- The worker has failed to comply with requests, like getting a physical examination by an employer-based physician
Insurers and commissions may also refuse claims when they suspect fraud.
Employer disputes can crop up for a number of reasons. One of the most common reasons relates to premium costs. Successful claims for workers compensation benefits typically cause a significant increase in the premium costs for employers. As it affects their bottom line, employers push back on workers' comp claims. They will gather evidence to contest the payment of benefits.
Other employers will contest a claim for benefits because they doubt the validity of the claim. Typically, they either believe that
- The injury did not occur
- The injury did occur but is not as serious as claimed
- The injury did occur but is the fault of the worker.
Like insurers, employers may dispute workers' comp claims when they suspect fraud.
Workers' Comp Dispute Resolution Options in South Carolina
There are options available to a worker whose claim for benefits has been disputed. In some cases, it is possible to work directly with the insurance provider. When possible, it is best to speak with a supervisor or a case manager. When this does not resolve the issue, there are other options available. Keep in mind, the laws for workers' compensation vary from state to state and the options listed below may not apply in every jurisdiction.
Alternative Dispute Resolution
Alternative dispute resolution (ADR) may be available as a method of resolving a workers' compensation benefits dispute. Mediation is one popular form of ADR as it is less formal than traditional court hearings and participation is generally voluntary.
Formal hearings regarding a workers' compensation claim are held before the workers' compensation commission. In this process, evidence will be presented by both sides and both parties will have the opportunity to present witnesses. A judge will preside over the hearing and issue a judgment.
After a decision has been made by the workers' compensation judge, it is possible to appeal the decision in state court. An appeal must be properly worded and filed within a certain time frame after the decision was issued.
Can a Workers' Comp Attorney in South Carolina Help with Disputes?
No matter what option an injured worker pursues, it is best to seek the assistance of counsel experienced in this area of the law. A skilled workers' compensation lawyer will be able to take over all communication with the insurer and the commission. They will speak on the injured worker's behalf and relieve them of that responsibility. A workers' compensation attorney will focus on obtaining the best possible outcome for their client, and not on what is best for the insurer or the commission.
Other ways they help include:
- Completing and filing the appropriate paperwork
- Gathering evidence on behalf of the injured worker
- Representing the worker in negotiations and before the workers' compensation commission
Speaking with a workers' compensation lawyer to find out how they are able to help is always a good idea.
Workers' comp is designed to help workers injured on the job and who cannot work for a certain period of time. It is not designed to help workers who are injured but not due to their job. It's a costly program, and so tensions can rise when an employer or insurer suspects the injury does not qualify.
If you have questions about a workers' comp claim, speak to our workers' comp lawyer in South Carolina. We handle all types of cases and will provide honest, direct advice and solid representation. Contact Jung Disability and Injury Advocates today either using the online form or calling us directly at (843) 576-4200 to schedule a free consultation.