How Workers Comp Claims Are Evaluated

How Workers Comp Claims Are Evaluated

If you’re injured on the job, your first thought is probably not on the worker’s comp process. And it shouldn’t be. Instead, you should focus on getting treatment, especially if your injuries are significant.

But knowing how the worker’s comp process goes is critical to ensuring you receive the funds you need to pay for medical bills and support your income if you’re out of work due to the injury.


The Claims Evaluation Process

If you’re hurt on the job, you should immediately report it to your supervisor.

Even if it seems like an “insignificant injury,” you must report it to receive worker’s compensation coverage. This is a critical part of the process because the initial time after the injury will be evaluated by your employer, their insurance company, medical professionals, and anyone else involved.

Regulations vary by state, but most states have a statute of limitations on when you can report an injury. In South Carolina, you must report an incident within 90 days. The sooner, the better because waiting can invite scrutiny from the insurance company.

You and your employer are required to file claim information with the South Carolina Workers’ Compensation Commission. This is very important in case you need to file an appeal with the state board.

Once a claim is filed, your employer’s insurance company will review your claim.

They’ll look to see if the injury is work-related, if you have any pre-existing conditions, or any other instance for which they may deny the claim.

South Carolina law allows employers to dictate which physician an injured employee visits for care. You must explain every detail of the accident and injury to the doctor you see.

A worker’s comp insurance company will likely examine your background and whether you’ve obtained counsel through an attorney. Some of this is routine since insurers are trying to prevent fraud. But they may also use it to gain leverage.

Insurance companies will look at the complete picture of the claim. They may identify opportunities or loopholes that they can use to refuse payment.

Contact us if you’re experiencing issues with your worker’s comp injury. We’ll handle the complicated process of working with the insurance company so you can get the payment you need.