If you're an employee who's been accidentally injured or developed an occupational illness in the course of performing your job duties in South Carolina, you're probably eligible to file a claim for workers' compensation benefits. If your claim is accepted by the insurance company, you should be able to submit your medical bills to the insurer for payment and receive weekly wage reimbursements for a pre-determined number of weeks. Once you've reached maximum medical improvement (MMI), your doctor can clear you to return to your previous job or to a "light-duty" job with restrictions.
If your doctor determines that you are permanently disabled, you might be able to negotiate a lump-sum settlement for your current and future medical care.
How a Lump-Sum Settlement Works
If you opt for a lump-sum settlement, you will get all of the money owed to you for your disability in one large payment. Advantages of this option include:
- You get your settlement money sooner.
- You save time and avoid going to court to resolve your case.
- You may now seek treatment from your own doctor.
However, there are also disadvantages, including:
- You give up workers' comp payments for long-term medical treatment.
- You may no longer claim weekly benefits for lost wages.
- You might have to pay out-of-pocket or through your own health insurance for future treatments or medication.
If you opt for a lump-sum settlement, your claim is likely to be resolved in one of three ways.
Form 16A Settlement
Named for the South Carolina Workers' Compensation Commission (SCWCC) form that is used for this type of agreement, a Form 16A settlement closes your case with a negotiated award and provides for future medical treatment related to your disability as long as that treatment has been recommended by your physician. You also have the option to re-open your claim within one year if your condition changes. A claimant who's finished all treatment and simply wants the best possible financial settlement might choose the Form 16A option.
If your claim is uncontested, a 16A settlement can be approved by a deputy SCWCC commissioner in an informal conference, at which you need not have an attorney present. The employer generally requests an informal conference by filing Form 18, and your treating physician must file Form 14B, listing the specific details of your medical condition, your work restrictions, and your projected medical care needs. At the conference, the deputy commissioner will rate the percentage of your permanent partial disability (PPD), review the terms of the proposed settlement agreement, and submit it to the SCWCC for approval after all parties have signed. If the parties do not reach an agreement in the informal conference, the deputy commissioner will schedule a full evidentiary hearing before the Commission.
If your case goes to an evidentiary hearing, the SCWCC will determine the settlement you receive for your permanent disability and what medical treatment you're entitled to in the future. Once those decisions are made, you should receive your permanent disability benefits, and you will have one year to re-open your claim if your medical condition changes.
In a clincher agreement, you give up the right to future medical treatment and the right to re-open your claim if your condition changes in the future.
When a Clincher Agreement Might Be Right for You
Employers and their insurers generally prefer to resolve a claim with a clincher agreement, which relieves them of all responsibility for your future care. For this reason, you're likely to receive a larger settlement in a clincher agreement than you'll receive through either of the other two settlement options.
If you're permanently disabled and anticipate the need for future surgery, additional treatment, and expensive medication—and you are not good at managing a large sum of money—a clincher agreement may not be your best choice because it leaves you with full responsibility for all future medical expenses. If, however, you don't anticipate ongoing medical care, you commit to setting aside some of the settlement money for future medical needs, or you have good health insurance, a clincher agreement might be the right option for you. There are also some cases in which the parties may agree on an "indemnity only" clincher that does provide for some ongoing medical treatment.
Clincher Agreement Approval
The insurer's attorney normally drafts the clincher agreement and submits it to the SCWCC for approval. If you don't have a lawyer, a clincher conference with the Commissioner is required to approve the agreement, which will be carefully scrutinized by the Commission. If approval is not forthcoming, a hearing will be scheduled. If you do have legal representation, though, no conference is required. The parties may simply sign and submit the agreement to be filed with the Commission.
Once your settlement has been paid, your employer or insurer will submit to the Commission a Form 19, which is essentially a receipt you must sign to show you've received your award. It allows the Commission to close your case file. Until the file is closed, the employer or insurer must continue to file Form 18 reports periodically.
When You Might Need a Lawyer
Not every workers' comp claim requires legal representation to succeed. You might be able to pursue your claim successfully on your own if:
- Your injury is minor.
- Your medical bills are low.
- You miss little or no time from work.
- Your employer does not dispute your claim.
- You are not seeking a lump-sum settlement.
In some cases, however, workers' comp law can be very complex. If your claim is an expensive or complicated one, your employer's insurance company, which actually pays workers' comp benefits, is apt to dispute or deny your claim. This happens in at least 10% of workers' comp claims. In such a case, you may require a workers' comp lawyer to get the benefits you deserve, especially when you're seriously hurt and focused on your medical treatments and recovery while pursuing your claim. If a lump-sum settlement is an option, you will want an experienced lawyer to negotiate the best deal for you.
Have You Been Injured on the Job in South Carolina?
If you've been hurt at your job, you can speak with a workers' compensation lawyer. Please contact us online or call our Charleston, South Carolina office directly at 843.488.2359 to schedule your consultation. We are also able to meet clients at our Conway, Myrtle Beach, Murrells Inlet, Mt. Pleasant, North Myrtle Beach, Florence or North Charleston office locations.