There are several reasons a legitimate claim could be denied or limited. The most common reason is that injured workers fail to meet the state deadlines for filing or forms aren’t correctly completed.
Other reasons a claim could be denied include:
- Missing forms or documentation
- Lack of credible evidence (i.e. medical records, witness testimony, etc.)
- Disputes with the employer or insurance company
- The injury isn’t severe enough to qualify
In North Carolina, any injury or illness must be reported orally and in writing to the employer within 30 days of the accident. Workers must also formally file the claim (Form 18) with the North Carolina Industrial Commission. This form establishes a legal injury claim on the victim’s behalf and must be filed within two years of the injury.
In South Carolina, you must report a work-related accident to your employer within ninety (90) days; however, it is best to report your injury to your employer as soon as possible, so there is no confusion about what happened or when it occurred. To file a claim, an injured worker (or dependent) must complete Form 50 (workplace injury claim) or Form 52 (workplace death claim) and submit it to the S.C. Workers’ Compensation Commission before the 2- year deadline.
If you receive a letter from the Commission denying the claim, note the appeal deadline, and contact a workers’ compensation law firm immediately.
To appeal the decision, you must first notify the North Carolina Industrial Commission or the South Carolina Workers’ Compensation Commission, as the case may be, of your intent to appeal within 14 days of the denial. You will attend a mediation conference with your workers’ compensation lawyer, and the mediator will make a recommendation based on the evidence in your claim.
The appeal process will start with a hearing with a judge, which will require organization and evidence gathering to ensure a fair outcome. Presenting detailed medical records, medical bills, and other evidence can be key to your success at this step. Having a workers’ compensation attorney experienced with workers’ compensation appeals is very important, as the process can be complex.