Denied Claims - The Law Offices of David L. Hood

When "Not Eligible" Isn't the Final Answer

Receiving a denial letter from your employer’s insurance carrier is a frustrating and frightening experience. You know you were hurt on the job, and you know you need medical care, yet the very system designed to protect you is slamming the door. In South Carolina, a denied claim is not a dead end; it is often just the beginning of a formal legal dispute.

At The Law Offices of David L. Hood, we see “wrongful denials” every day. Insurance companies are businesses, and their primary goal is to minimize payouts by finding any reason to reject a claim. With over 30 years of experience, attorney David L. Hood and his co-counsel legal team are skilled at identifying why a claim was rejected and building the evidence necessary to overturn that decision. We believe that an initial “no” shouldn’t stop you from getting the benefits you earned through your hard work.

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Common

Common Reasons for Claim Denials

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Insurance adjusters use a variety of excuses to justify a denial. Our firm frequently encounters and challenges these common justifications:

Failure to Report Promptly:

The carrier claims you missed the 90-day window to notify your supervisor.

Pre-Existing Conditions:

They argue that your back, neck, or joint pain is a "degenerative change" or an old injury, rather than the result of a recent workplace accident.

The "Off-the-Clock" Defense:

Alleging the injury happened during your commute, on a lunch break, or while performing tasks not related to your job.

Disputes Over Employment Status:

Claiming you are an "independent contractor" rather than an employee to avoid providing coverage.

Lack of Medical Evidence:

Asserting that your medical records do not clearly link your current disability to the specific workplace incident.

Alleged Misconduct:

Claiming you violated safety rules or were under the influence of alcohol or drugs at the time of the fall.

Turning a

Denial Into an Approval

Just because an insurance company says your claim is denied doesn’t mean a Workers’ Compensation Commissioner will agree. To fight a denial, we take a proactive approach:

1

Investigation:

We gather witness statements, security footage, and maintenance logs to prove how and when the injury occurred.

2

Medical Advocacy:

We work with independent doctors to provide a "nexus" (a clear link) between your job duties and your physical condition.

3

Correcting Paperwork:

Sometimes a denial is triggered by a simple typo or a missing form. we ensure all filings like Form 50 are technically perfect.

4

Challenging Misclassification:

If your employer calls you a "contractor" to save money, we apply South Carolina’s four-factor test to prove you are legally an employee entitled to benefits.

What to Do

After You Receive a Denial

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If your claim is rejected, you must act quickly to preserve your right to an appeal:

Save the Letter:

The denial letter contains the specific legal reasons for the rejection and starts the clock on your appeal deadlines.

Avoid Recorded Statements:

Do not call the adjuster to "argue" your case. Anything you say can be used to further justify their denial.

Keep Going to the Doctor:

Even if the insurance company isn't paying yet, continuing your treatment creates the medical trail needed to prove your case later.

Consult a Lawyer Immediately:

The window to request a hearing before a Commissioner is limited. The sooner we start, the sooner we can secure your back-pay.

Your Right to a Formal Hearing

In South Carolina, you have the right to take your case in front of a Single Commissioner. This is a formal legal proceeding where the insurance company must defend their denial. We represent you at these hearings, presenting the facts and the law to show why the denial was incorrect. If the Single Commissioner still denies the claim, we can escalate the matter to the Full Commission (a panel of three or more Commissioners) to seek a reversal.

Don't Give Up the Fight