It is not unusual for an injury suffered in a job-site accident to require surgery. For most workers employed in South Carolina, the state’s workers’ compensation system should pay for surgery related to any injury suffered in a workplace accident.
Your employer’s workers’ compensation insurance policy should pay for your surgery and other medical care as well as a portion of your lost wages if you were injured while on the job. If your employer tells you otherwise, you should speak to an experienced South Carolina workers’ compensation lawyer as soon as possible.
Joye Law Firm has helped thousands of workers in Summerville and across South Carolina seek the workers’ compensation benefits provided to them by South Carolina law. If you have questions about a workers’ comp settlement, the experienced Summerville worker’s compensation attorneys at Joye Law Firm are ready to help you.
While each workers’ compensation case has its own considerations and complexities, we are proud of our record of results in workers’ comp cases. Eight of our attorneys were recognized in the 2022 edition of The Best Lawyers in America in the workers’ compensation practice area. Contact us today to learn how we may assist you during a free consultation.
Does S.C. Workers’ Compensation Pay for Surgery?
Workers’ compensation should pay for 100% of reasonable medical care related to a work-related injury or illness. Payments for surgical procedures cover the basic service and the normal range of care required before and after surgery. This includes:
- Immediate preoperative care, including the initial exam by the surgeon whether performed in the hospital or elsewhere, completion of hospital records, and initiation of the treatment program
- Anesthesia, such as infiltration, digital block, or topical anesthesia
- The surgical procedure
- Follow-up care.
Workers’ compensation should pay for your hospital stay, any medication required after surgery, such as for pain, and for all prescribed rehabilitation therapy.
Does Workers’ Compensation Cover Lost Income While I Am Recovering from Surgery?
If any work-related injury or illness causes you to be unable to work for a living while you are receiving causally related treatment, you should receive compensation for lost wages at a rate of two-thirds (66.6%) of your average gross weekly wages prior to your injury. Temporary disability payments begin after you have missed one week of work because of your injury and then include payment for the first week and subsequent weeks as you recover.
If you are written out of work or your employer is unable to accommodate your restrictions, then wage-replacement benefits should continue until your physician declares that you have reached maximum medical improvement. At that point, you will either return to work if you are able to do so, or receive a diagnosis as being permanently disabled.
If you have a permanent impairment to the body part that you injured as a result of your work related accident, you should qualify for a disability settlement in the form of:
- Permanent Partial Disability (PPD). This benefit is paid when your injury causes a partial disability to the body part you injured.
- Permanent Total Disability (PTD). If you have a permanent disabling condition that prevents you from returning to work, total disability benefits are to provide compensation that covers up to two-thirds of your average pre-disability wages for up to 500 weeks (9.6 years). In certain cases, such as paralysis or severe traumatic brain injury (TBI), PTD benefits may be available for life.
If you suffer certain types of permanent injuries, such as the surgical loss of a limb, then you are entitled to a specific scheduled benefit set by South Carolina law. For the loss of a leg, for example, the payment is two-thirds of your average weekly wages before the injury for 195 weeks (3.75 years).
Many workers are unaware of the extent of benefits available through workers’ compensation. Most workers never have a reason to learn about the workers’ compensation program until they are injured. Then, they are thrust into a complex system while they are dealing with an injury, impending surgery, loss of work, and a disrupted life. As a result, many workers who would qualify for benefits never claim them.
Let Joye Law Firm help you seek the full benefits available.
Can I Settle My Workers’ Comp Case Before Surgery?
It is possible to settle your workers’ compensation claim before having surgery that you know you will have to undergo. But it’s important to discuss the pros and cons of this with a knowledgeable workers’ compensation attorney.
The advantage of settling a workers’ comp claim before having surgery is that, because the insurance company will have agreed to pay you, you can schedule your surgery as you wish without the insurer’s further interference. It may give you peace of mind to know that you have the money necessary to pay for your procedure. Some insurers will delay or deny surgical authorization to avoid the expense, which can exceed $100,000 for major surgery. Their hope is that you will give up trying to obtain payment for surgery through workers’ comp.
However, the disadvantage of settling before undergoing surgery is that, if there are complications, you may not have the right to seek additional payment. If surgery is not totally successful and your earning ability is adversely affected, you may no longer be able to claim disability benefits.
If you are represented by Joye Law Firm, we can advise you if the circumstances warrant settling your claim prior to surgery. We can advise medical providers of your workers’ comp claim and that we represent you.
How We Can Help You Recover Workers’ Comp Surgery Benefits?
If your employer or their insurer has balked at paying for recommended surgery or has denied your workers’ compensation claim, you have the right to request a hearing before a commissioner with the South Carolina Workers’ Compensation Commission. An attorney can represent you.
At the hearing, you will be allowed to present evidence of your injury and need for surgery — chiefly, your medical records and physician testimony. You have the right to obtain a second opinion about your medical needs — known as an independent medical exam, or IME — to support your claim. Joye Law can refer you to physicians who understand your injury and the S.C. workers’ compensation system and can provide testimony on your behalf at the hearing.
If the outcome of the hearing in front of the commissioner is not the desired outcome, you have the right to appeal the decision and have your case reviewed by a three-member panel of commissioners. After that review, it is possible to appeal to the S.C. Court of Appeals or even the South Carolina Supreme Court. Joye Law can represent you in all necessary appeals.
If you have a serious work injury or need surgery for a work-related condition, the sooner you get a lawyer involved, the more likely it is that you will be able to fully protect your right to obtain surgery and other care and benefits you need in a timely manner.
Contact a Summerville Workers’ Compensation Attorney
Workers’ compensation is a complex program, which allows employers and insurers to oversee an eligible worker’s medical treatment and have input on costly procedures, such as surgery.
The Summerville workers’ compensation lawyers of Joye Law Firm can help you establish a strong claim for you to receive all necessary medical treatment if your employer is disputing your claim and associated workers’ comp benefits. Joye Law Firm has been successfully assisting injured workers like you in Summerville and across South Carolina for more than 50 years. We know what you are going through, and we know how to help.
Our lawyers and staff treat each client with respect, compassion, and care. Contact us online or by phone at 888-324-3100 on today to discuss the details of your Summerville workers’ comp case with an experienced South Carolina attorney.