Your Rights Under the SC Workers’ Compensation Act
The Workers’ Compensation Act in South Carolina provides that if an employee suffers injury by accident arising out of and in the course of employment, that individual is entitled to recover medical expenses, temporary total compensation for lost time, and permanent disability benefits if he/she suffered any permanent injury as a result of the work accident.
Under the current law, your employer has the right to select the doctor who will treat you. If you go to see your own doctor without permission of the employer, the employer may not be held liable for the medical expense, unless it constitutes an emergency condition. However, you have the right to choose a physician to evaluate you for the specific disability, but the employer will not cover it.
What If I Was Injured at Work?
Once you suffer an injury on the job, you should immediately report it to your supervisor. You should also request that the employer be responsible for the appropriate medical treatment. In the event the claim is denied, you can attempt to handle the case yourself, or you may hire an attorney.
If the claim continues to be contested or denied, you or your lawyer should file a Form 50 on your behalf with the Workers’ Compensation Commission. This sets out the various parties, the date and description of the accident, who you reported it to, the injuries suffered, whether medical treatment is needed, any disfigurement you may have received and any other relief you may be requesting.
The employer, unless self-insured, is usually represented by an insurance company known as the carrier. The carrier files an answer on Form 51, where they may admit or deny what you have said in your Form 50. The case is then placed on the Workers’ Compensation Commission’s docket, and assigned to an individual Commissioner who acts as a fact finder and also rules on the law. A hearing is usually held within three to five months, and at the conference, the employee presents his/her case.
What Happens After I File a Claim for Workers’ Compensation?
Usually, medical testimony is presented in the form of deposition, and your physician will not attend a hearing. The other medical evidence that the Commissioner will rely upon are the medical records you and the Carrier present.
Once a commissioner has ruled on the case, he/she will issue an Opinion and Award which sets forth his/her ruling of fact and law, and what relief, if any, the employee gets. If either party is dissatisfied with the decision, the case can be appealed to the full Commission which is made up of all the Workers’ Compensation Commissioners except for the one who heard the case initially. After that hearing is held, if either party is dissatisfied with the decision, it can be appealed to the Circuit Court and on up to the South Carolina Supreme Court. You have 14 days from the date of the Order to file an appeal.
Once the full Commission has decided the case, it is rare that it is appealed to the courts. Fault or negligence is not an issue regarding the payment of a workers’ compensation claim unless, for example, the employee was intoxicated at the time of the injury. Remember, if you are injured on the job, report the incident to your supervisor.
Five Things South Carolina Employees Should Know About Workers’ Compensation Law
Before pursuing a workers’ compensation claim in South Carolina, it is important to educate oneself on the complicated legal process. Many who are injured on the job are simply unaware of the many rights they have as injured workers, and as a result, miss out on opportunities to take advantage of South Carolina laws designed to work in their favor. Here are five important things to understand when pursuing your South Carolina workers’ compensation claim:
1. South Carolina Workers’ Compensation is a “no-fault” system
SC Workers Compensation Commissioners (i.e., Judges) do not weigh negligence or assess fault in determining whether you are entitled to compensation for your on-the-job injury. Though compensation may be barred due to intoxication, horseplay, fraud and other defenses, your negligence will not prevent you from recovering damages if you were injured at work. Also, your employer’s negligence will not increase the value of your case. South Carolina’s workers’ compensation laws simply state that you are entitled to losses that result from your work-related injury. Unless you intentionally hurt yourself, were injured due to your intoxication, or engaged in fraud, you are likely entitled to compensation. A South Carolina workers’ comp attorney can help you pursue the benefits our law promises.
2. Your employer cannot fire you in retaliation for filing a workers’ compensation claim
South Carolina law prohibits employers from engaging in retaliatory firings. If you are fired in retaliation for filing a workers’ compensation claim, you can sue your employer in civil court. While my firm does not handle wrongful termination lawsuits, our workers’ compensation experience has allowed us to develop relationships with many employment law attorneys. We would be pleased to refer you to one of these attorneys should you be the victim of an unjust, retaliatory firing.
3. Your employer’s workers’ compensation insurance carrier or fund, not your boss, is responsible for compensating you for your work injury
Many South Carolinians are reluctant to seek compensation for their work injuries because they are afraid it will cost their employer thousands of dollars. The truth, however, is that your employer’s insurance company – not your boss – is generally the party responsible for drafting checks and ensuring medical care is provided. Though your claim may result in a premium increase for your employer, this cost is often minimal to the loss you bear should you fail to file a complaint.
4. SC Workers’ Compensation laws are designed to pay for your medical care, the time you miss from work, and your permanent degree of injury
After suffering an on-the-job injury, you should immediately notify your supervisor/employer. If you think medical treatment is necessary, you should ask to be sent to the doctor. From that point forward, your employer’s workers’ compensation carrier (i.e., insurance company) is responsible for all medical care that “tends to lessen your degree of disability”; in other words, medical care that will improve your condition. The key is that only treatment authorized by the carrier will be paid for – except in the case of emergency, where the carrier could not be contacted or reached. We will work with the insurance company to ensure that you receive the necessary treatment promptly, though this process can be frustrating for clients and attorneys. Put just, getting the insurance company to approve medical care, even when recommended by the treating physician, is not always easy.
If a doctor places you out of work, or your employer cannot accommodate your restrictions, you are entitled to weekly compensation. The amount of weekly compensation equals approximately 2/3s of your average pre-tax wages/salary before the injury. Once you’ve reached what is known as “maximum medical improvement,” a doctor will assign you an “impairment rating.” You are entitled to additional compensation based in part on your impairment. We do caution, however, that in some instances, years pass between a client’s injury and the time they reach maximum medical improvement. Furthermore, the SC Workers’ Compensation Commission does not take pain or suffering into account when determining how much money you receive at the conclusion of your claim.
5. If someone other than your boss or a co-worker caused your injury, you might be able to pursue a civil action in addition to your workers’ compensation claim
I have handled many cases where a client was injured at work due to the negligence, recklessness or intentional acts of a “third party.” For instance, if you suffered a sudden fall at work due to a hazard created by a janitorial company, we would likely pursue two claims. The first against your employer’s insurance carrier, the second against the janitorial company. Civil actions allow you to recover money damages that workers’ compensation does not, among them damages for mental anguish, physical pain, and lost the enjoyment of life. In other words, additional benefits designed to give you back the life you enjoyed before your injury may be available should your claim allow for what we call a “third party action.”
Consult an Experienced South Carolina Workers’ Compensation Lawyer
If you have questions, don’t allow anyone – especially not an insurance representative – to mislead you. Instead, call us today for a free case evaluation and free copies of my books. Our Columbia office number is (803) 790-2800.
We look forward to helping you.
What Does Workers’ Compensation Pay?
South Carolina workers’ compensation program provides wage loss benefits, payment for medical treatment, and compensation for long-term disability.
Either your employer or its insurance company will pay for all needed and reasonable medical care related to your work-related injury or illness. (Treatment for any other medical conditions you may have is not included.)
For your work-related medical condition, your doctor’s visits, prescriptions, physical therapy, surgery, and other necessary treatment will be paid for you. If you go to the doctor selected by your employer or their insurance company, your doctor or the hospital will be paid directly by your employer or their insurance company. If you go to another doctor of your choosing, your medical care will not get paid for.
Compensation for Lost Wages
If you can’t work due to your injury or illness, then you are considered “temporarily totally disabled,” and you can be paid the wages you would have earned had you been able to continue to work during your recovery.
You are eligible for payment of lost wages if you are unable to go to work for at least seven days. If you continue to be unable to work due to temporary total disability for at least 14 days, then you can be paid your lost wages back to the date you were unable to continue working.
The payment rate is 66 2/3% of your average weekly wages, but your payment can’t exceed 100% of the average weekly salary in the State as determined by the South Carolina Department of Employment and Workforce. (For accidents or injuries occurring in 2017, the maximum weekly payment is $806.92. If you’re able to work, but earning less due to your injuries, you can receive two-thirds of the difference in your wages, subject to the same maximum.
Temporary total disability benefits will continue until your doctor “releases” you, meaning your doctor says you can return to work. These benefits will be paid to you by your employer or its insurance company.
Compensation for Permanent Disability
Permanent Partial Disability
If you are permanently impaired in some way, you will be eligible to receive additional compensation, called permanent partial disability (PPD) payments. These benefits are two-thirds of your average weekly wage, subject to the same weekly maximum as temporary disability benefits. This weekly amount will be multiplied by some weeks determined by a state schedule. For example, the plan lists 220 weeks of payment for a total loss of use of a hand. If you have a partial loss of use, you will receive benefits for a proportionate number of weeks.
Example: Your average weekly wage before the injury was $450, and you have a 10% loss of use of the left hand. Your weekly rate would be two-thirds of $450, which is $300. You would multiply this amount by 22 weeks (10% of 220), for a total of $6,600.
Permanent Total Disability
The Commission has a narrow definition of permanent total disability (PTD). If you have lost both of your hands, feet, arms, or legs, lost vision in both of your eyes, or have suffered a combination of two of these losses, you are considered totally and permanently disabled and can receive additional benefits. The Commission might consider other injuries as also constituting a permanent and total disability.
You will continue to receive benefits at your total temporary rate, for up to 500 weeks. People with paraplegia, quadriplegics, and brain-damaged workers can receive benefits for life.
If you have suffered a permanent disability, an informal conference will be held with you, the insurance company, and a Commissioner or Claims Mediator. The purpose of this brief conference is to determine the total amount of benefits you are due to be compensated for the permanent disability. It is essential to show up for this conference or to notify the Commission that you can’t make it. You can reach the Informal Conference Scheduling office at 803-737-5734.
What if You Do Not Agree With the Decision at the Informal Conference?
If you disagree with the outcome of the informal conference, do not sign the settlement agreement. You will automatically be scheduled a hearing before the Commission. Your interview will be held in about three to four months, and you will receive a notice about a month in advance. You may want to talk to a local workers’ comp lawyer about what a fair settlement amount would be.