Reasons for a Workers' Compensation Denial in SC

“Every South Carolina employer and employee, with certain notable exceptions, is presumed to be covered by the State’s Workers’ Compensation Act,” according to the South Carolina Workers’ Compensation Commission. So, what are these “notable exceptions”? Generally, exceptions include casual workers, businesses that have less than four employees, real estate agents, federal employees, and railroad employees.

Workers’ compensation is a no-fault system. This means that no one is blamed for the accident. The worker isn’t blamed and the employer isn’t blamed, even though one of them may be more to blame than the other. Even if a worker is entirely at fault for his or her own injury, their fault will not reduce their claim. It won’t reduce the amount of benefits they are entitled to receive.

Are Claims Ever Denied?

Yes, absolutely. Workers’ compensation is not automatic in all cases – it is not guaranteed. There are specific times when an employer or insurance company may decide to deny a claim. Sometimes the denial is reasonable, sometimes it’s NOT.

While each state has enacted its own workers’ compensation laws, some things seem to be rather uniform from state-to-state. A claim can be denied if any of the following is true:

  • The worker was drunk when they were injured.
  • The worker was drinking alcohol before the accident (not necessarily drunk).
  • The worker was under the influence of drugs at the time of the accident.
  • The worker was intentionally trying to harm themselves.
  • The worker was intentionally trying to hurt someone else.

Suppose Dan and Mike were salesmen and they landed a big client. To celebrate, the pair decided to open a bottle of whisky. Before they knew it, Dan and Mike had three glasses of whisky each. While Dan was leaving the office, he fell down a flight of concrete stairs, hitting his head and sustaining a traumatic brain injury (TBI).

Because Dan had been drinking before the fall, his workers’ compensation claim was denied. However, if he had fallen down the stairs at the exact moment and on the same day, but he had zero alcohol in his system, Dan’s claim likely would have been approved.

On the other hand, let’s say that Anne and Tracey worked together, but they butted heads. One day, the women get into a heated argument and Anne punches Tracey. Enraged, Tracey punches Anne back, breaking her nose. Now, Anne wants to file a workers’ compensation claim to cover her medical bills and time off work. However, surveillance footage of the altercation makes it clear that Anne started the fight, and that Tracey was merely acting in self-defense. Anne is out of luck.

They Say it Wasn’t ‘Work-Related’

Sometimes, an employer or insurance company denies a claim because they do not believe the injury was work-related. If this has happened to you, and you know that it occurred while you were performing job-related duties, you should speak with a Columbia personal injury attorney from our firm. Whatever the “reason” for the denial, we’re determined to help. Contact us today to learn more about your rights to compensation.

Categories: Workers' Compensation
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