What to Do If Your Workers’ Compensation Claim Is Denied
June 20, 2025
At Jenkins Law Firm, P.A., we understand how frustrating it can be when a workers’ compensation claim is denied. You’ve been injured on the job, and now your claim for benefits is rejected. This can feel like another blow after the injury itself, but we’re here to help you understand your options and what steps to take next.
Workers’ compensation is a vital part of personal injury law in South Carolina, designed to support workers who are hurt while performing their job duties. But, unfortunately, it’s not always an easy process to get the benefits you deserve.
Reasons Why Workers’ Compensation Claims Are Denied
Before we explore what you can do, it’s important to understand the common reasons why workers’ compensation claims are denied. Here are some of the most frequent reasons:
Failure to report the injury on time: In South Carolina, you must report your injury to your employer within 90 days of the incident. Failing to report on time can result in your claim being denied.
Lack of medical evidence: If you don’t have sufficient medical documentation supporting your injury, your claim may be denied. This is often the case if your doctor didn’t properly document the severity or cause of the injury.
Pre-existing conditions: If the insurance company believes that your injury was due to a pre-existing condition and not work-related, they may deny your claim.
Non-work-related injury: Sometimes injuries that happen off the job are mistakenly thought to be work-related, leading to a denial.
Employer disputes: If your employer disputes that the injury occurred at work or challenges your version of events, the insurance company may deny your claim.
Failure to comply with procedures: Missing key steps in the claims process, such as not filling out paperwork correctly or not attending required medical exams, can also result in a claim denial.
What to Do When Your Claim Is Denied
Getting your workers’ compensation claim denied can be a huge setback, but it doesn’t mean the end of the road. There are multiple options available to you. Let’s break down the steps you should take if you’re facing a denied claim.
1. Review the Denial Letter Carefully
The first step is to carefully review the letter from the insurance company explaining why your claim was denied. This letter should provide specific details about the reason for the denial. Understanding the exact grounds for the denial is crucial, as it will help determine the next steps you need to take. Here are some things to look for in the denial letter:
The reason for the denial: Make sure you fully understand why the claim was rejected. The denial could be based on technicalities, like missing paperwork or filing after the deadline, or it could be based on a dispute about the severity of your injury.
Instructions on how to appeal: Most denial letters will include instructions on how to appeal the decision. Follow these instructions carefully and be sure to meet any deadlines.
The deadline to appeal: In South Carolina, you typically have 30 days from the date of the denial to file an appeal. Make sure you don’t miss this crucial deadline.
2. Consult With a Workers’ Compensation Attorney
If your claim has been denied, the next step is to reach out to a workers' compensation attorney. Workers' compensation laws can be complicated, and a lawyer can help you understand your rights and options. Here’s how we can help:
We’ll review your case: We’ll go through the details of your injury, the reason for the denial, and any evidence you’ve gathered. This allows us to determine whether the denial was justified or if there’s a valid case for an appeal.
We’ll advise you on the next steps: After reviewing your case, we’ll advise you on the best course of action. This may involve filing an appeal, gathering additional evidence, or negotiating with the insurance company.
We’ll handle the legal process: We can take care of the paperwork, deadlines, and negotiations on your behalf so you can focus on recovering from your injury.
3. File an Appeal With the South Carolina Workers’ Compensation Commission
If your claim has been denied and you believe the denial was unjustified, you can file an appeal with the South Carolina Workers' Compensation Commission. This is an administrative process where a judge will review your case and decide whether you should receive benefits. Here’s how the appeal process works:
File a Form 50: To begin the appeal process, you’ll need to file a Form 50 with the South Carolina Workers' Compensation Commission. This form is the official document for starting a claim or appealing a denied claim.
Attend a hearing: Once your appeal is filed, a hearing will be scheduled. This is where both parties (you and the insurance company) will present their cases. You may need to provide additional evidence to support your claim.
The judge’s decision: After the hearing, the judge will issue a decision. If the judge rules in your favor, the insurance company may be ordered to pay your benefits. If the judge upholds the denial, you may have the option to further appeal.
4. Gather Additional Evidence
In many cases, denied workers' compensation claims are due to a lack of sufficient evidence. If this is the case for you, gather more supporting documents and evidence to strengthen your claim. Here are some types of evidence that can help:
Medical records: Make sure your medical records clearly show that your injury was caused by your job. This includes treatment records, diagnostic tests, and doctors’ notes.
Witness statements: If there were witnesses to the accident, their statements can help support your version of events. This can include coworkers, supervisors, or others who were present when the injury occurred.
Photographs and video footage: If possible, collect photographs or video footage of the injury site or the accident itself. Visual evidence can often be very compelling in proving your case.
Employer’s records: If your employer has a record of safety violations, broken equipment, or hazardous working conditions, this could help demonstrate that your injury was work-related.
5. Consider Negotiating a Settlement
In some cases, rather than going through a lengthy appeal process, it may be in your best interest to negotiate a settlement with the insurance company. This is typically a lump sum payment offered in exchange for closing the case without further litigation. Here’s what to consider when negotiating a settlement:
The total cost of your injury: Consider all the costs of your injury, including medical expenses, lost wages, and any future care you may need. A settlement should cover these costs fully.
The potential for future issues: If your injury is expected to cause long-term problems or ongoing treatment, make sure the settlement accounts for this. Settlements are usually final, so it’s important that they fully compensate you for future expenses.
Working with an attorney: A workers’ compensation lawyer can help you negotiate a fair settlement. Insurance companies may offer an amount lower than what you’re entitled to, so having a lawyer makes sure that your best interests are represented.
6. Consider Filing a Lawsuit
If all other avenues fail, you may have the option to file a personal injury lawsuit against your employer or a third party. In some cases, especially if the injury was caused by a third party (like a contractor or vendor), you may have the right to seek compensation outside of the workers' compensation system.
Filing a lawsuit is usually a last resort, but it’s an option if your workers’ compensation claim is denied and other remedies aren’t working.
Contact Us Today
If your workers’ compensation claim has been denied, don’t wait to take action. Jenkins Law Firm, P.A. in Hilton Head Island, South Carolina, is ready to help you understand your options and take the necessary steps to fight for the benefits you deserve. We’re proud to also represent clients in Beaufort and Jasper County. Contact us today to schedule a consultation and start working toward the compensation you need.