If you’ve recently suffered an on-the-job injury in South Carolina, you may be eligible to receive workers’ compensation benefits. These benefits pay for medical bills and a portion of the lost wages of an injured worker. So, what do you need to do to secure South Carolina workers’ compensation benefits? What happens if a claim is denied?
Here are five facts that explain how the workers’ compensation system works in our state:
1. Report Your Work Injury ASAP.
If your injury or illness is work-related, meaning it arose within the course and scope of your employment, you must report it to your employer within 90 days. Failure to do so may disqualify you for workers’ comp benefits.
While your initial instinct may to be to “tough it out” or ignore it, it is really important to be proactive in this situation. Follow your company’s reporting procedure to a “T,” and report your work accident as soon as possible. Although it may seem like a minor at the time, additional symptoms may develop over time. This is especially true for workers who do physically strenuous work. A construction worker is not likely to report every ache and pain he feels to his supervisor (and if he did, he likely wouldn’t be employed long) but if your gut instinct tells you that your symptoms are more serious than usual, report it as soon as you can. Many workers who believe they’ve just suffered a muscle strain injury, unfortunately, discover later that their injury is more serious, such as a herniated disc in your spine. If you wait until the more serious injury is diagnosed, it could already be too late to meet the 90-day notice requirement. Claims, where there is a large gap of time between when the incident occurred and when it was reported, are also more likely to be denied.
Not every employer has a formal procedure in place to report workplace accidents or injuries. If this is true of your company, be sure to report your accident, in writing, to your supervisor, manager and/or your human resources department as soon as possible.
When applying for worker’s compensation benefits, in most cases, you’ll have two years from the date of the accident to file a claim but this is a different time deadline from the 90-day notice requirement.
2. Workers’ Comp Covers Your Medical Treatment, But You Have to See the WC Doctor
Once your claim is accepted, your benefits should cover all of the necessary medical treatment arising from your injury. This may include things like emergency care, surgery, hospitalization, rehabilitation, assistive devices and medication.
However, you have to see the doctor that the workers’ compensation insurance company chooses for you. You can seek permission to see a different doctor or to receive a second opinion but these requests are frequently denied by the WC insurance carrier.
Having no control over the direction of your medical treatment is one of the biggest frustrations for an injured worker in South Carolina. There are many excellent doctors who provide treatment under the workers’ compensation system but there are also many doctors who are authorized by the insurance companies because the companies feel they can control these doctors’ recommended treatment to some extent. Helping you deal with this frustration is where an experienced workers’ comp lawyer can help you. If certain injuries you sustained are not being adequately treated, we can gather medical evidence to help us request that the commission order the carrier to provide additional treatment. This often involves our setting up independent medical examinations for you with doctors of our choice.
3. If You Can’t Work, You May Qualify for Total or Partial Disability Benefits.
If your work injury leaves you completely unable to return to work for over seven days, you may qualify for total disability benefits. This will provide 66 and 2/3 percent of your average weekly wages, without exceeding the “maximum weekly compensation rate.” That rate is set each year by the South Carolina Workers’ Compensation Commission based on the average weekly gross earnings of South Carolina workers during the preceding year. In 2020, the Commission set the maximum weekly compensation rate at $866. 67.
If you’re able to return to work in some capacity, but your injury limits your work duties and your income is reduced, you could receive partial disability benefits, instead of full disability benefits from workers’ compensation. Partial disability benefits will make up 66 and 2/3 percent of the difference between your normal average weekly wage and your new, post-injury wage. For example, if your pre-accident average weekly wage was $600 and you are only earning $300 due to restricted hours or duties after you are hurt, your partial disability benefit would be $200 (2/3rds of the $300 difference).
4. You Have the Right To A SC Workers’ Comp Commission Hearing
Sometimes, things don’t go the way you’d like them to, and you need to press your claim. Maybe your employer is denying that your injury occurred at work. Maybe the insurance carrier is refusing to pay you the full benefits that you’re owed under South Carolina law. Whatever the reason, if you have any dispute over your claim, you can request a hearing before the Commission. In South Carolina, we have seven workers’ compensation commissioners and your initial hearing will be set before one of these judges.
However, this is the time where a lot can go wrong very quickly. If you aren’t properly prepared to state your case or fail to provide the right evidence, the hearing may go south in a hurry. Remember, the insurance company isn’t looking to do you any favors, and they won’t take any pity on you just because you’re not clear on the “rules.” Their lawyer’s job is to limit your benefits to the greatest extent possible.
This is where an experienced South Carolina workers’ compensation attorney plays an important role. While you may not be familiar with the complicated rules related to the submission of evidence or the standard of proof needed to receive workers’ comp benefits, your attorney certainly will be. An experienced workers’ comp lawyer will know exactly how to navigate the hearing, protect your rights and pursue the maximum benefits available under the law.
Choose your lawyer wisely, and remember that not all lawyers are the same. The workers’ compensation system is very complex. Attorneys that only “dabble” in workers’ comp, even if they are very talented in other areas, can easily get in over their heads quickly. Find yourself an experienced attorney that successfully deals with these unique cases day in and day out.
The Joye Law Firm certainly satisfies these criteria. Two of our lawyers have served as president of the South Carolina Injured Workers Advocates organization, the preeminent organization for injured workers in our state. Combined, our workers’ compensation lawyers have over 125 years of experience protecting the rights of men and women who were injured on the job.
5. Most Workers’ Compensation Claims Settle Out of Court
The thought of having to go to court can be a little overwhelming. Don’t worry, most South Carolina workers’ compensation disputes are worked out without a formal hearing. In fact, the bulk of workers’ comp cases in South Carolina are resolved without the need for a hearing at all. For example, our firm often resolves clients’ most serious claims at a mediation conference instead. With that being the case, being fully prepared for mediation is just as important as being fully prepared for a hearing. In many instances, we procure expert opinions to help us build the value of our clients’ claims prior to a mediation. This can include everything from a vocational consultant who does an employability assessment (which is crucial when asserting a total disability claim); a nurse consultant who completes a future medical costs assessment; to independent doctors who address impairment ratings and conditions which may have been under-treated by the doctors authorized by the insurance company.
If you are asserting that you have been permanently disabled due to your work injuries, it is CRUCIAL that you hire an experienced lawyer to help you with your claim. First, no permanent disability claim will be viable without having a supportive vocational assessment completed. Second, it is crucial that the language of the settlement agreement in these cases be carefully crafted to protect your potential future entitlement to Social Security disability benefits. Failing to include this protective language can cost you tens of thousands of dollars in future SSD payments.
OUR SOUTH CAROLINA WORKERS’ COMP ATTORNEYS CAN HELP YOU TODAY
If you’ve been hurt on the job, you deserve fair treatment under the law. You also deserve quality legal representation to ensure that happens. Since 1968, the workers’ comp attorneys of Joye Law Firm have stood alongside injured workers throughout South Carolina. We can put that experience to work for you today. If you face any problems with your workers’ compensation claim, contact us now and receive a free, no-obligation consultation about your case.