Top 10 Common Workers’ Comp Claim Mistakes – And How to Avoid Them

These are the top 10 mistakes that South Carolinians make when trying to file their workers’ compensation claims.

Workers’ compensation is an insurance program. Like all insurers, workers’ comp insurance companies and their policyholders (your employer) want to pay as little as possible when claims are filed.

But you can receive all of the workers’ compensation benefits you deserve if you follow the rules. Below are the top 10 mistakes the workers’ compensation attorneys of George Sink, P.A. Injury Lawyers see injured South Carolinians make when trying to properly file workers’ comp claims.

1. Failing to properly report your accident or illness.

South Carolina’s Workers’ Compensation law requires employees who are injured and plan to seek workers’ comp benefits to report their injury or medical diagnosis to their employer as soon as possible. Since some injuries are incapacitating, the law stipulates a 90-day deadline for notifying your employer in most cases (there are exceptions for extenuating circumstances). Failure to meet the deadline could leave you unable to seek benefits.

NOTIFY YOUR EMPLOYERin writing of any accident, injury or medical diagnosis as soon as possible after you are hurt or are told of an illness. Get something on the record before the 90-day deadline, even if it is an incomplete explanation of your situation. State dates and times of the accident or other factors in writing, and the fact that you intend to seek workers’ compensation benefits. If you can, obtain any workplace policies for reporting accidents / injuries / illnesses and follow them as closely as possible.

SAVE COPIES of this notice and all subsequent documents connected to your accident, injury, illness and workers’ compensation claim.

2. Not filing a claim for benefits.

South Carolina differs from many other states in that it puts the burden of filing a workers’ compensation claim on the injured employee. Your employer can and should file on your behalf, but may not, especially if they intend to dispute your claim. Do not rely on your employer. Also, do not delay in filing.

FILE A FORM 50 (available here; Form 52 is for death benefits) as soon as possible. By law, you have two years from the date of an injury or illness diagnosis in most cases to file a benefits claim.  Giving your employer notice is not the same thing as legally filing a claim.  But the sooner you file, the sooner you can begin to receive benefits. The form asks whether you want a hearing. It also asks whether you are requesting mediation. Check the box that says, “I am filing a claim. I am not requesting a hearing at this time.”

3. Not seeing the doctor your employer chooses.

Workers’ compensation law allows your employer or the workers’ comp insurer to choose the doctor who treats your injury or illness subject to a workers’ comp claim. You must see this doctor for assessment and treatment. His or her reports will be important for your claim.

SEE THE APPOINTED DOCTOR. Failure to do so may be grounds for dismissing your claim. You may also see your own doctor, but not as substitute for seeing the doctor of record. If you are unhappy with the doctor you are assigned, you may ask the workers’ comp. insurance carrier for permission to see another doctor. If the insurer will not accommodate you, you can complete a new Form 50 to request a hearing before a Workers’ Comp Commissioner.

4. Not being fully open about your condition.

The Workers’ Compensation benefits you receive will be based on reports from the doctor of record. He or she will know if you are exaggerating your condition, but may not recognize problems you fail to explain.

ALWAYS BE TRUTHFUL about your accident, injuries, recovery and setbacks. Providing false information at any point of the claims process, especially about the extent of your injuries or illness, is grounds for denial.

5. Not following the doctor’s instructions.

The doctor of record on your claim will file reports with the Workers’ Compensation Commission about your treatment and recovery. If the Commission learns that you are not trying to get better (by following doctor’s orders) your claim can be denied or discontinued.

FOLLOW DOCTOR’S ORDERS. In particular, go to doctor appointments that are set for you, including appointments for physical therapy. Missing appointments is a common mistake that causes problems with claims. If you or your personal doctor disagree with the course of treatment prescribed by the doctor of record, you must request a hearing with the Workers’ Compensation Commission for a ruling.

6. Not getting a second opinion.

Though you must consult and follow the advice of the doctor assigned to you by your employer or insurer, you should see your own doctor as well. If your doctor’s opinion of your condition or treatment varies significantly from the insurance company’s doctor, this may be brought to the Commission and could have an impact on your claim settlement.

SEE A SECOND DOCTOR. If you do not have a doctor, the George Sink, P.A. Injury Lawyers firm can help you find a doctor suitable for your injuries and who is familiar with workers’ compensation policies in South Carolina. We can also help you obtain a hearing and present your case to the Commission.

7. Refusing work offered by your employer.

The objective of workers’ compensation is to assist injured workers while they cannot work, with the goal of seeing them return to earning a living. But because employers’ workers’ comp insurance premiums may rise as the insurer’s payouts continue, employers are often overanxious about injured employees’ return to work. Your employer may offer you limited or light duty, or a different job, to get you back to work, even at partial pay. If the doctor of record says you are capable of the certain type of work your employer offers, you have an obligation to take the offer. Refusing work the doctor says you can perform could cause benefits to cease.

REPORT FOR WORK the doctor says you are capable of doing. If you disagree about your capabilities, you can request a hearing with the Workers’ Compensation Commission. You will need to be ready to prove you cannot perform the work offered. This may require a second doctor’s opinion, and his or her testimony.

8. Returning to work too soon.

Though you do have an obligation to accept work offered by your employer if you are capable of performing it, you also have a right to your medical safety. If you believe you are not ready to return to work, you have a right to appeal the request to the Workers’ Compensation Commission.

REQUEST A JOB DESCRIPTION of the work your employer plans to assign to you. Advise your employer in writing that you are not capable of returning to work and that you are seeking a doctor’s review of the job description. Have both the doctor of record and your own doctor review the job description. If you have a doctor’s opinion that supports you, appeal to the Commission.

9. Accepting a claim decision before returning to work.

Your objective should be to return to working for a living. However, you may not be able to perform the work you once did. Because the Workers’ Compensation Commission also wants you to return to earning a living, benefits available include money for occupational and vocational rehabilitation, and for education and training. If you have not yet returned to work or been declared permanently disabled, your claim is not complete.

ADVISE YOUR DOCTOR AND YOUR EMPLOYER of your interest in rehabilitation and/or education. Often, an employer will refrain from introducing a workers’ compensation recipient to the idea of vocational and occupational rehab or education. It costs them money (indirectly) and likely means they are equipping an employee to work elsewhere. But you have a right to these benefits if they will help you. Advise your employer and doctors in writing, and follow up with a hearing request to the Commission.

10. Accepting an incorrect disability rating.

Once the doctor of record on your case determines that you have recovered as well as can be expected (Maximum Medical Improvement), he or she will assign you a disability rating. This rating is an important component of your final workers’ compensation settlement. If your disability rating is too low, your benefit could be less than you deserve.

Get Experienced Assistance and Advice about a Worker’s Comp Claim

A South Carolina workers’ compensation attorney from George Sink, P.A. Injury Lawyers can investigate your case and pursue a fair settlement for you. We have helped thousands of working men and women throughout the state obtain workers’ compensation benefits.¹

We can work with you from any point in a workers’ compensation claim, and represent you in appeals to the South Carolina Workers’ Compensation Commission.

In some cases, we can reopen a workers’ comp claim that has been settled, if you have additional medical problems stemming from an occupational injury or illness that are not covered by the settlement.

Our initial consultation is always FREE, and our objective is always maximum compensation for you.