Appealing to the South Carolina Workers’ Compensation Commission
Being injured at work can be a traumatic experience. Having your workers’ comp claim denied adds a level of stress, inconvenience, and hardship to an already difficult time.
If your claim has been denied, you may miss out on the following workers’ compensation benefits:
- medical costs related to treating and diagnosing your workplace injury
- workers’ comp disability benefit payments – calculated as two-thirds of your average weekly wages in South Carolina – for missed time from work
- a lump sum payment for any permanent impairment stemming from your workplace injuries
If you feel that your workers’ comp claim was unjustly denied, you can appeal the decision with the South Carolina Workers’ Compensation Commission (SCWCC).
What Is the South Carolina Workers’ Compensation Commission?
The SCWCC is the organization that administers the workers’ compensation system in South Carolina. All on-the-job injury claims must be filed with this organization, and the appeals process for all denied claims starts here as well.
The SCWCC is comprised of seven commissioners appointed by the Governor with the advice and consent of the Senate. Each commissioner serves a term of six years.
The SCWCC conducts hearings to resolve disputes between employees and employers. If your employer does not report the work-related accident where your injury occurred, denies that your injury occurred or was work-related, or if you believe that you did not receive all due workers’ compensation benefits, you can request a hearing with the SCWCC.
How Do I File an Appeal with the SCWCC?
The SCWCC administers South Carolina’s workers’ compensation system and hears appeals of workers’ comp claim denials. There are several levels of appeals, and it is important to your case that you are prepared and informed at each step. An experienced attorney can help guide you through the process, help you assess the decisions at each level, and advise you on next steps.
Informal Conferences for Workers’ Comp Claim Appeals
The workers’ comp appeals process in South Carolina allows for certain claims (those when an employee has been released by the treating physician to return to work) to be heard by an independent workers’ compensation commissioner or claims mediator – this is called an informal conference. The goal of this initial meeting is to try to resolve the dispute about your claim without going through a hearing, which is a judicial process. You can request a conference by writing a letter to the SCWCC.
Tip: Decisions reached in an informal conference may be binding and could impact your ability to receive compensation for your harms and losses.
Mediation of Workers’ Comp Claim Appeals
In South Carolina, certain workers’ comp claims may be mediated before a hearing can be scheduled. In the mediation phase, a certified and accredited mediator tries to clarify the issues and help the parties negotiate so that a resolution is reached without having to proceed to the hearing stage. Once you file a hearing request, usually a Form 50 (PDF), and your employer files a response, usually a Form 51, the SCWCC reviews your file and determines if mediation is required. You must notify the SCWCC by email of the mediator and date of mediation.
Appeals to a Single Commissioner Hearing of the SCWCC
If the issues are not resolved and an agreement cannot be reached at the informal conference or mediation, a hearing can be scheduled before a single workers’ compensation commissioner. An employee may request a hearing if the employer does not report the accident, denies the injury was work-related, or if the employee believes that he or she did not receive all due benefits. To request a hearing, you must complete Form 50 (PDF ).
Appeals to a Three-Member Panel of the SCWCC
If in the single commissioner hearing the commissioner rules against you, you can request that a three-member panel of commissioners review the decision. To request a review, you can file a Form 30 (PDF), Request for Commission Review, within 14 days of receipt of the decision, or “order,” of the single commissioner hearing.
Appeals to the Full SCWCC
Alternatively, if dissatisfied with the single commissioner ruling, you can instead appeal to the full Workers’ Compensation Commission within 30 days of the decision, or “order,” of the single commissioner hearing.
Appeals to the South Carolina Court of Appeals and the South Carolina Supreme Court
If you are dissatisfied with the ruling of the three-member panel or full commission, you can appeal by filing within 30 days of the award with the South Carolina Court of Appeals, also called the Circuit Court of Appeals.
Decisions of the SC Court of Appeals may be appealed to the South Carolina Supreme Court. There is no appeal beyond the state Supreme Court.
Each step of the appeals process requires thorough documentation and an understanding of the process and timing requirements. While you are not required to hire an attorney to represent you during your appeal, you may have a better chance of a positive outcome or a higher settlement with the guidance of an experienced workers’ comp lawyer.1
Why Did My South Carolina Workers’ Comp Claim Get Denied?
There are many different reasons why an employer’s insurance company may deny your workers’ comp claim. Below are a few of the more common reasons. Remember, some insurance companies may be looking for a reason to deny or reduce your benefits, in order to keep expenses low.
- Missed deadlines
Failing to notify your employer within 90 days of your injury
- Seriousness of injury
Belief that your injury is not severe enough to take time from work
- Errors on claim form
Omissions or mistakes on the claim form
- Injury not related to work
Claims that your injury was not work-related
- Misclassification of employee
Incorrectly classifying you as an independent contractor
- Employee misconduct
Claims that you were drunk or purposefully broke a workplace rule when injured
- Pre-existing conditions
Belief that your condition was not made worse through work
- Failure to follow medical treatment
Assumption that you ignored the doctor’s advice and orders
Unfortunately, workers’ comp claims are denied often. Insurance companies or employers may try to minimize or avoid potential liability. But that doesn’t mean that the denial was the correct decision, and it also isn’t necessarily the final decision. You can appeal the denial of your claim, and you can seek the assistance of an experienced workers’ comp lawyer to help you through the appeals process.
Contact Our Workers’ Compensation Attorneys
Workers’ compensation law is complicated. Special rules and laws govern different kinds of workplace injuries and illnesses. Claim denials are common, and it can be hard to know when it makes sense to keep fighting.
Give the Law Offices of James Scott Farrin a call at 1-866-900-7078 for a free evaluation of your workers’ compensation case. Our workman’s comp legal team can help guide you through the workers’ compensation appeals process, communicate with the SCWCC for you, and fight for the benefits that you may be entitled to. Contact us today. Tell them you mean business.