News flash – insurance companies love saying “no” to paying benefits. Many of our workers’ compensation clients reached out to us after getting a denial letter from their employer’s workers’ comp carrier. If this happens to you, don’t just accept the insurer’s decision, get help from a reputable workers’ comp attorney.
Initial claim denials are not at all unusual. Filing a request for a hearing before a South Carolina Workers’ Compensation Commission commissioner is typically the next action step when we feel a claim has been wrongfully denied. Hearings are also requested when a worker is not receiving all of the benefits we believe they should. The hearing gives us an opportunity to present supportive medical evidence and other testimony to prove your entitlement to benefits. Oftentimes, the insurance company agrees to accept a previously denied claim due to the pressure of an approaching hearing.
Joye Law Firm has successfully recovered tens of millions of dollars for injured workers in South Carolina. Our workers’ compensation lawyers are well-qualified to help you develop a compelling case for benefits. Give us a call at 888-324-3100 to start your free case evaluation.
Why You Should Request a Workers’ Comp Claim Hearing
If you receive a denial letter from the workers’ compensation insurance company, it may explain why your workers’ comp claim has been denied. Three of the most common reasons claims are denied include:
- Disputes over whether your injury occurred on the job
- The severity of your injury
- issues or mistakes in your claim application itself
Each of these defenses can be overcome with proper preparation for a hearing.
To assert a claim for benefits, you will need to request a hearing, which is done by filing Form 50 with the Workers’ Compensation Commission. The form requires you to summarize your accident, injuries, lost time from work, wages, medical needs, and more. It also asks you to state an estimated time needed for a hearing. In response to filing Form 50, your employer’s insurance provider will file Form 51.
As your workers’ comp attorneys, Joy Law Firm can file a Form 50 hearing request on your behalf and prepare for the hearing.
How to Win a Workers’ Comp Hearing: Case Studies
Our attorneys frequently request hearings on behalf of our clients. They allow us to present the facts in front of a commissioner and prove that the treatment and benefits our client is requesting are necessary. 
In one instance, Attorney Sarah Khouri represented a forklift driver who suffered damage to his spine when an inadequately secured load bar fell on his neck. He had already started the workers’ compensation process on his own by the time he came to Joye Law Firm. He had been instructed to attend physical therapy, and was placed on light duty by the doctor appointed to him by his employer’s insurance carrier. Despite his efforts to push through the pain, he was unable to perform the assigned tasks and was fired from his job. When Attorney Khouri first met with this client, she could immediately tell he was in bad shape and needed a second medical opinion. That doctor asserted that attempting physical therapy may have actually worsened his condition, and that he desperately needed a spinal fusion surgery. To get approval for the surgery, Khouri requested a hearing with the South Carolina Workers’ Compensation Commission. Attorney Khouri prepared for the hearing by asking the surgeon to fill out a questionnaire demonstrating the severity of the injury and linking it to the client’s work accident. Due to her diligent preparation, the surgery was approved without a hearing. The case concluded with our client receiving a $175,000 settlement for Permanent and Total Disability.
In another case, a construction worker on the Ravenel Bridge suffered a herniated disc that required surgery. He did not initially report the injury to his supervisor, as he originally believed it to be a normal muscle strain or pinched nerve, but when the pain worsened and began to send shooting pain down his leg, he knew it was serious. Due to the delay in reporting the injury, his employer’s insurance carrier initially denied the claim. At that point, he knew he needed help, and contacted Joye Law Firm. Attorney Ken Harrell took on the case and filed a hearing request on his behalf. The hearing commissioner issued an order finding our client’s claim fully compensable. He ordered the insurance company to cover all treatment costs to date, pay our client back-owed weekly disability benefits for the previous 15 months, and place him on a weekly benefits payment status until he reached maximum medical improvement.
Hearing Preparation: Depositions, Evidence, and Witnesses
A hearing in front of a South Carolina workers’ compensation commissioner essentially works like a quick, informal trial. Ultimately, your claim will only be successful if you can persuade the commissioner that the initial denial of benefits was made in error. This usually requires the presentation of supplemental evidence. For example, you might need a second medical opinion to provide additional evidence.
Before the hearing, your employer’s workers’ compensation insurer’s lawyer will usually conduct an interview with you, known as a deposition. This sworn statement gives the defense an idea of what you intend to claim at the hearing. Your lawyer will prepare you for the deposition and will be present when it takes place.
If you have mobility problems or you’re experiencing other issues that prevent you from traveling, you can request a virtual hearing. But please be aware that you should immediately notify your attorney or the jurisdictional commissioner of your need to testify for your deposition or hearing remotely. The request must be agreed upon by all parties and approved by the jurisdictional commissioner ahead of time.
A couple of weeks before the hearing, your lawyer will submit several documents to the commissioner about your case that they intend to present. This includes the Form 58 Pre-Hearing Brief, a list of witnesses, and other evidence including the actual exhibits (such as medical records) they intend to submit.
Before the hearing starts, lawyers for both sides and the hearing commissioner will meet privately to review the issues in question. The hearing will begin with your lawyer presenting a very brief opening statement as to why you deserve benefits, followed by the other side stating why they believe your claim should be turned down.
The commissioner will then review the facts that both sides agree to, so each lawyer can state their agreement for the record.
The Crux of Your Workers’ Comp Claim: Documented Evidence
Once opening statements have been completed at a workers’ comp hearing, each side will present its evidence to the commissioner.
Most evidence for a workers’ compensation claim is documented – accident reports, employment records, and medical records. In almost every case, the medical evidence is the most important. Therefore, evidence packets must be compiled and presented by both sides to the commissioner. They are known as “APAs,” for the state law governing workers’ comp procedures: the Administrative Procedures Act (APA).
To demonstrate your eligibility for benefits, the contents of your evidence packet must establish that you were injured while performing an activity related to your job. Further, it must show that you needed medical care for your injury and whether your injuries have prevented you from working.
How To Prepare for Workers’ Compensation Hearing Testimony and Cross-Examination
You will be called to testify about your injuries and how they occurred. In many cases, the injured worker is the only witness who testifies at a hearing. However, in appealed cases, both sides may have other witnesses who will testify about the facts surrounding your work accident. Your doctors rarely testify at a workers’ comp hearing, as the APA allows their records to come into evidence. In some cases, depositions of doctors are submitted as evidence.
What Questions Are Asked at a Workers’ Comp hearing?
Your lawyer will prepare you to testify. While your lawyer cannot tell you what to say, they will lead you through the types of questions they intend to ask, and will also explain the important facts that will be crucial for you to talk about in your testimony. Essentially, they will ask you to tell your story:
- What your job is
- What you were doing when you were hurt
- How you were injured
- The initial medical care and diagnosis you received, including orders to not return to work
- That you notified your employer of your injury and they advised you to stay out of work
- Medical care you have received in the time since your injury
- Physical limitations you are experiencing due to your injury
- How your injury has adversely affected your ability to perform your job, as well as other activities in your life
After you testify, the defense lawyer can cross-examine you. Your lawyer will prepare you for what the defense will likely ask you. They will most likely attempt to rattle you and get you to contradict your testimony or other evidence you have submitted. If your testimony at the hearing is inconsistent with your prior deposition testimony, the defense lawyer will almost always focus on that. This is why it is crucial that you are properly prepared prior to your deposition.
Here are some tips for effectively handling cross-examination:
- Stay calm: Remain composed and answer questions directly and honestly.
- Listen carefully: Pay close attention to the questions being asked and answer only what is asked. Avoid rambling or offering unnecessary information.
- Be completely truthful: Sticking to the truth is paramount. Don’t speculate or try to fabricate details.
- Take your time: Don’t feel pressured to rush your answers. Take a moment to collect your thoughts before responding.
- Don’t be afraid to say when you don’t know: It’s okay if you can’t remember specific details. Simply state that you don’t recall.
By following these tips, you can approach cross-examination with confidence and ensure your voice is heard during the workers’ compensation hearing. If the defense has witnesses, they will present them after your side rests its case. Your lawyers will be able to cross-examine them as well.
After all testimony has been provided, the commissioner will review the evidence and issue a written decision. Given the impracticality of reviewing all medical evidence while hearing witness testimony, it’s uncommon for commissioners to make decisions from the bench. Most commissioners advise the parties of their decision within a few weeks of the hearing, but in some cases, it could be months before you are advised of the outcome of your case.
The decision time can vary widely from commissioner to commissioner. Based on our ample experience handling South Carolina work injury claims, we can give you some idea of what to expect in terms of how long it will take your assigned commissioner to make a decision based on the specific details of your case.
Contact Our South Carolina Workers’ Compensation Attorneys 
As you can see, careful preparation is essential to a successful workers’ comp hearing in South Carolina. Knowing what to expect is just one part of preparation; the other is having an experienced team of lawyers on your side. You have the legal right to fight a denied workers’ compensation claim, but it requires know-how and preparation to win these cases. Our workers’ compensation lawyers have fought for injured workers in South Carolina since 1968. Several attorneys from Joye Law Firm have served in leadership roles for Injured Workers’ Advocates, the workers’ compensation organization for attorneys in South Carolina. Our Managing Partner, Attorney Ken Harrell, and the Head of our Workers’ Comp Department, Attorney Matt Jackson, have both served as President of the organization.
To discover how our workers’ comp attorneys at Joye Law Firm can assist you, please call us at 888-324-3100 or fill out this online case evaluation form to schedule your free initial case evaluation. Our firm has offices in North Charleston, Myrtle Beach, Columbia, Clinton, and Summerville, and we represent injured workers throughout the state of South Carolina.
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