South Carolina Workers’ Compensation Frequently Asked Questions (FAQ)
Why do I need a Workers
Workers’ compensation laws are very complex… Your employer will have an insurance company that is fully versed in the nuances of your state’s laws to represent his interests. To level the playing field, it is important that you seek the help of an experienced workers’ compensation attorney when you are injured on the job.
It is particularly important to consult with a workers’ compensation attorney if your injuries are severe. You may be entitled to benefits that cover medical expenses, lost wages, and rehabilitation expenses. Also, if your injuries are serious enough to prevent you from earning a decent wage in the future, you may be able to collect damages related to lost future wages as well.
Your employer’s insurance company will do everything possible to minimize payouts made on your claim. In some cases, they may even deny your claim. A workers’ compensation attorney will help ensure that you receive the appropriate damages for your injuries and help prevent insurance companies from trying to unjustly deny your claim.
It is essential to consult with an attorney if:
- You don’t receive the proper amount for your claim
- Your employer retaliates against you or fires you for filing a claim
- Medical care is denied
- You earned a very high wage before the injury
- A third party’s negligence contributed to your injury
- You will be unable to return to work after your injury
- You have a permanent disability as a result of your injury
- Your claim is outright denied
Many lawyers deal with these matters on a daily basis and can help walk you through this confusing process. There are many variables for you to think about after sustaining a work-related injury, including:
- Choosing the right doctor
- Filling out your claim form properly
- Documenting every aspect of the incident and your injuries
- Dealing with insurance companies
A workers’ compensation lawyer can help ensure that you don’t overlook any of these important steps.
What is Workers’ Compensation?
Worker’ Compensation is an insurance policy your employer must carry to make sure that employees injured at work can obtain necessary medical treatment and financial assistance for lost wages, plus additional compensation for any work-related injury, sickness, or disease that causes total or partial impairment to work. Workers’ compensation is available regardless of fault when the injury arises out of, and in the course of, employment.
By law, every South Carolina employer with four or more full-time employees must have workers compensation insurance.
The protection provided under the South Carolina Workers Comp Act is only the beginning of your right to compensation for a workplace injury.
Who qualifies for workmans’ comp benefits?
Any full-time employee (working for an employer with four or more employees) who has an employment related injury and needs medical attention should be covered under workers’ compensation insurance. It doesn’t matter if the injury was a complete accident or the fault of a co-worker.
The employee MUST notify his or her employer within 90 days of the injury or risk losing the right to benefits under workers compensation. (It is recommended that you record details of your accident and to whom you reported it.)
What qualifies as a Workers
- Physical injury; or
- Repetitive injury: an injury acquired by repeating the same acts over and over through work. This could be accumulative hearing loss, debilitating back pain, carpel tunnel, neck pain; or
- Disease: an occupational disease is one that is acquired because of your job such as lung diseases (ex. Asbestosis) from work environments and hazardous work-related materials, or disease contracted because your work in a hospital; or
- Mental issues: Mental issues from extreme or unusual work conditions or from an ongoing work injury.
How do I report an on-the-job injury?
Report all injuries at work to your employer immediately and request medical treatment, if needed. If you neglect to report the injury within 90 days of the accident you may lose your benefits.
Although you must report the injury within 90 days, you have up to two years to file a claim for benefits. If a worker dies because of work-related injuries, the worker’s dependents, or parents if there are no dependents, must file a claim within two years of the death to claim benefits.
How do I file a claim?
You may personally file a claim if your employer does not report your accident, denies your injury by accident, or if you believe you did not receive all of your benefits.
To file a claim you must submit a Form 50 or Form 52 to the Commission. If you are unable to download these forms please contact the Commission’s Claims Department at (803) 737-5723 to request the forms be mailed to you.
When filing a claim on a Form 50 or Form 52, mark the box at the signature line which states “I am filing a claim. I am not requesting a hearing at this time.”
What medical treatment am I entitled to receive?
You are entitled to all necessary medical treatment that is likely to lessen your disability. Workers’ compensation generally pays for surgery, hospitalization, medical supplies, prosthetic devices, and prescriptions. Keep in mind that in order to receive these benefits you must go to the doctor chosen by your employer or its insurance representative.
How is the compensation rate determined?
You are entitled to compensation at the rate of 66 2/3 percent of your average weekly wage based on the four quarters prior to your injury, but no more than the maximum average weekly wage determined each year by the South Carolina Employment Security Commission. If you were working two or more jobs at the time of accident, those wages may be included as part of the average weekly wage and compensation rate.
Will I get compensated for missing time from work because of my injury?
There is a seven-day waiting period before benefits can be paid. If you are out of work for more than seven days, payments will come from your employer’s insurance representative. If you are out of work for more than 14 days, you will receive compensation even for the first seven days.
You can expect payments to be made directly to you and these should continue until the doctor releases you to return to work.
When are my benefits terminated?
After the doctor releases you to return to work with or without restrictions, within 150 days of notification of the accident, you should receive two copies of Form 15 with Section II completed indicating that compensation has been stopped and for what reasons.
If the insurance carrier stops your compensation, and if you disagree, complete Section III of the Form 15 and send it to the Commission’s Judicial Department. This is your way to request a hearing to be held in sixty days.
If the Doctor releases you to return to work after the 150-day notification period, your employer or insurance representative will ask you to sign a Form 17, (receipt of compensation ) after you have been back to work for fifteen days.
What if the doctor releases me to light duty?
You must accept light work if it’s offered. If you do not accept, all compensation may cease as long as you refuse to return to work. You have a right to a hearing if you believe that you are not able to do the work assigned to you.
If you return to light work before you are fully discharged by the doctor at a wage less than you were earning at the time of your original injury, you are entitled to weekly compensation at the rate of the sixty-six and two-thirds (66 2/3%) percent of the difference between your average weekly wage and your new wage.
What if I receive an impairment rating or have a scar?
When the doctor releases you with an impairment rating or if you have a non-surgical scar that can be seen at least eight feet away, the insurance carrier will request an informal conference/viewing. This is an opportunity for you to meet with a representative from the commission and the insurance carrier to determine the amount of compensation due.
What is a Workers
The workers’ compensation commissioners conduct a hearing to resolve disputes between you and your employer’s representative. You may apply for a hearing if your employer does not report your accident, denies your injury by accident, or if you believe that you did not receive all your benefits.
You may download the form to apply for a hearing online or obtain it by contacting the commission’s judicial department at (803) 737-5675 or by email to email@example.com.
Do I get reimbursed for my travel expenses when I go to the doctor?
Yes, if the round trip distance is more than ten miles from your home. You should be reimbursed for the round trip mileage at the rate allowed state employees for mileage.
Can I get a second opinion if I am not happy with the doctor to whom the insurance carrier refers me?
You can talk to the insurance carrier and see if he or she will allow you to go to another doctor, or you can request a hearing by completing Form 50 and have a Commissioner make a determination on the case.
Who sends me my weekly check?
Your employer is required to have workers’ compensation insurance if they have four or more employees and the insurance carrier will be responsible to pay compensation to you if you are out of work for more than seven days.
(Source: South Carolina Workers Compensation Commission)
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