Learn what types of benefits injured workers are entitled to in South Carolina
In 2021, the U.S. Bureau of Labor Statistics (BLS) reported that the state of South Carolina had 30,300 nonfatal workplace-related illnesses and injuries. Due to the financial hardships that ill or injured employees endure, the South Carolina workers’ compensation program was created to help injured workers in 1935. Instead of having to sue employers for compensation, the system provides workers, or their dependents, with monetary compensation for expenses realized secondary to workplace accidents.
Employer workers’ compensation insurance requirements
According to South Carolina law, any business or company having 4 or more part-time or full-time employees must cover the individuals with workers’ compensation insurance.
Failure to provide coverage may result in the loss of business assets and possibly additional fines in the event of a work-related illness or injury.
Coverage is available through any commercial insurance provider who is licensed by the state of South Carolina. Employers are exempt from the compensation insurance requirement only under the following circumstances:
- In the previous year, the employer paid less than $3,000 in wages.
- The employer is a broker employing licensed real estate agents.
- The employees are considered “casual” (work only as needed).
- The employees are agricultural workers.
- The employees are employed by the railroad or railway express companies.
- The employees are federal workers.
No-fault workers’ compensation benefits
The workers’ compensation program in South Carolina was created as a no-fault program. In other words, in most cases, the affected employee remains entitled to monetary benefits even if they caused the accident that led to their injury.
Illnesses or injuries not covered by workers’ compensation
To qualify for workers’ comp, an employee’s illness or injury must be the result of a work-related situation during the course of being at work. In the state of South Carolina, workers’ compensation benefits are payable to employees who suffer occupational or traumatic injuries.
Employees may be denied benefits in the following circumstances:
- They intentionally self-inflicted the injuries.
- The injuries occurred while under the influence of alcohol or other substances.
- The injuries occurred when traveling to or from work.
- The illness or injuries are not directly work-related.
- The injury or illness would have occurred even if the employee was not working (e.g., a heart attack caused by chronic heart disease).
Types of workers’ compensation benefits
In the state of South Carolina, injured workers are entitled to 3 types of workers’ compensation benefits.
Medical expense reimbursements
Medical expense reimbursements are payable for up to 10 weeks. However, the time may be extended depending on the type or severity of the illness or injury. Expenses typically covered include:
- Emergency medical transportation
- Initial and follow-up physician, hospital and clinic visits
- Diagnostic and laboratory testing
- Surgical procedures
- Prescribed medications, treatments and therapies
- Adaptive or medical devices
Income loss replacement
If an injury keeps you from working or only enables you to work in a limited capacity, you may be entitled to a restoration of lost wages. The amount varies depending on the classification of your injury or illness:
- Permanent total disability (PTD). If you are totally and permanently unable to work, you will receive two-thirds of your average weekly wage before your injury for up to 500 weeks.
- Permanent partial disability (PPD). If your injury is permanent, but you are able to work in some capacity, you will receive two-thirds of the difference between your old wages and your new wages for a period of time that depends on the severity of your injury.
- Temporary total disability (TTD). If you are temporarily unable to work in any capacity for more than 7 days, you will receive two-thirds of your average weekly wages during the time you cannot work up to a state maximum.
- Temporary partial disability (TPD). If you are temporarily unable to work your previous job but you can work in some capacity, you will receive two-thirds of the difference between your old wages and your new wages up to a state maximum.
Understand the concept of Maximum Medical Improvement (MMI) in workers’ compensation, its significance for injured employees, and how it affects the benefits and compensation they receive.
Death benefits are paid to the dependents of employees who die because of a work-related accident within 6 years.
Families receive $2,500 for funeral costs in addition to two-thirds of the deceased’s weekly wages for up to 500 weeks.
In the event of a work-related illness or injury
In order to gain workers’ comp benefits, workers should take the following steps.
Seek medical attention
Injured workers should seek medical attention as soon as possible after an accident or injury. With the exception of emergency care, the employee must receive medical treatment from the healthcare provider, physician or hospital stipulated by the employer. Otherwise, the worker becomes responsible for the expenses.
If a physician approves light-duty work for the employee, the worker cannot refuse to return to work even if they fear doing so might worsen their illness or injury. Failing to follow the physician’s recommendations could result in the denial of workers’ compensation benefits.
When an injured worker is out of work receiving temporary total disability payments insurance carriers will often pester the treating physician into returning the injured worker back to light duty work.
If that happens, the employer has a choice. They can either;
(1) refuse to provide light duty and continue paying weekly benefits, or;
(2) provide light duty and try to deny further weekly benefits.
Also, be aware that ill or injured employees cannot switch healthcare providers or care facilities without the insurance company’s permission. Doing so could also result in denial of compensation.
Notify your employer
Workers who suffer an injury or illness at work must inform their employer of the situation within 90 days of the accident or discovery of the illness. Even if the employer is aware of the accident, employees should still file a written report.
If the employer fails to file a claim with the workers’ compensation commission within 10 days of being notified of the event, the employee should file a claim themselves to the Workers’ Compensation Commission by submitting Form 50.
Employees should be aware that they will not receive compensation until after the first week that they are unable to return to work.
Contact an attorney and file an appeal if your claim is denied
If your employer refuses to file a claim or your claim is denied, you should contact an attorney for help with your claim. A denied claim can be appealed to the Workers’ Compensation Commission by submitting Form 50, after which time a hearing will be scheduled.
Consult an experienced South Carolina workers’ compensation attorney
Workers’ compensation cases can be complicated, so it’s vital that you understand your rights and follow all necessary procedures. Even small mistakes early on in the process can greatly impact your claim.
An attorney can ensure that all necessary paperwork is filed on time, and they can negotiate with your employer and their insurance company to ensure you get the full benefits to which you’re entitled.
If you’re injured on the job in South Carolina, contact the experienced workers’ compensation attorneys at Chappell, Smith & Arden, P.A. Our attorneys have recovered millions of dollars for injured workers across the state of South Carolina, and we’d love the opportunity to help you, too.
Contact us today for your free consultation.