Workers’ Compensation Covers a Lot, But Not Everything

In South Carolina, almost every business with four or more employees must carry workers’ compensation insurance, which covers employees’ job-related injuries/illnesses. If you’re injured on the job, chances are workers’ comp will take care of the following work-related damages:

• Medical bills related to your work injury
• Two-thirds of lost wages
• Disability benefits
• Vocational retraining
• Death benefits (after a fatal accident)

Because workers’ comp is no-fault insurance, you don’t have to prove your company did anything wrong to cause your injury/illness. Even if you’re responsible for your own accident, you can file a claim for benefits, and your employer may not take any action against you for doing so. Some employers, however, are exempt from the requirement to carry workers’ comp, and some workers are not eligible for coverage.

Exempt Employers and Ineligible Workers

South Carolina businesses in the following categories don’t have to purchase workers’ comp insurance:

• Businesses with yearly payrolls of less than $3,000
• County or state fair associations
• Agricultural businesses
• Companies with three or fewer employees
• Railroads and railway express businesses

Such employers might purchase coverage voluntarily, but they’re not required by law to do so. 

South Carolina employees in the following categories are not eligible for workers’ comp benefits:

• Sole proprietors
• Members of Limited Liability Corporations (LLCs)
• Casual/as-needed employees
• Federal employees of the state
• Realtors working on a commission for brokers
• Independent contractors

An independent contractor generally receives a 1099 wage statement, rather than a W-2, but there are exceptions. Although independent contractors are not generally eligible for standard workers’ comp, a general contractor in charge of a construction job (where accidents are common) might require subcontractors to carry insurance for the injuries of independent contractors. 

Eligible Injuries and Illnesses

There are many common work-related injuries/illnesses for which you may file a workers’ comp claim:

• Lacerations
• Burns
• Lung damage from toxic fumes
• Pulled ligaments/muscles in knees due to heavy lifting or slip-and-falls
• Shoulder damage (torn rotator cuff, dislocation, or degeneration)
• Carpal tunnel syndrome from repetitive motion
• Fractured/broken/crushed bones due to falls or impact with heavy objects
• Complex regional pain syndrome (CRPS) and reflex sympathetic dystrophy (RSD)
• Any injury sustained in a company parking lot/structure before or after your shift
• Any injury sustained at a company-sponsored event you’re required to attend
• Any injury sustained in an accident when you’re driving a company car or your own vehicle in the course and scope of your job:
  • Whiplash
  • Spinal cord damage
  • Paralysis
  • Concussion
  • Traumatic Brain Injury (TBI)
  • Internal bleeding
  • Organ damage

A normally compensable injury may not be covered, however, if it occurs under any of the following circumstances:

• You’re under the influence of drugs or alcohol at the time of the injury.
• You hurt yourself intentionally.
• You’re committing a crime or violating company policy when injured.
• You’re hurt while eating or picking up lunch outside the workplace and in your own car (unless your boss sends you to get food).

There are also some conditions that aren’t covered even if your company carries workers’ comp:

• Embolism
• Aneurism
• Stroke
• Heart attack
• Depression
• Stress
• Anxiety
• Post-traumatic stress disorder (PTSD)

Filing a Lawsuit Against Your Employer

If your employer carries workers’ comp insurance and you suffer a covered injury or illness in the course of performing your job duties, then filing a workers’ comp claim is your only recourse. You generally cannot sue your employer in such a situation. Workers’ comp exists, in part, to eliminate employees’ lawsuits against employers. You might, however, be able to file a suit against your employer if:

• Your company doesn’t carry workers’ comp insurance.
• You’re not eligible for workers’ comp benefits.
• Workers’ comp does not cover your particular illness/injury.
• Your employer has hurt you intentionally.

In any of these circumstances—or if your employer’s insurance company disputes your claim—an experienced workers’ comp attorney can examine the details of your case and recommend a sound course of action for fair compensation. 

Third-Party Claims or Lawsuits

Even if you can’t sue your employer for your work-related injury/illness, in some cases you might sue a third party who was fully or partially responsible for your accident as long as that party is not your co-worker. The following scenarios are examples of situations in which you could have a third-party claim:

• You’re hurt in a work-related vehicle accident caused by a non-employee of your company.
• An outside janitorial service that cleans your workplace leaves a wet floor or some other hazard that causes you to slip and fall.
• Your accident is caused by defective equipment manufactured or maintained by an outside company.
• Your injury is caused by the negligence of a business or client you visit in the course of your work. (A dog bite at a client’s home or a slip and fall accident at a business location are examples.)

In such cases, your attorney can help you file an insurance claim or a lawsuit against the liable third party, from whom you might recover compensation for the remaining one-third of your wages and for your pain and suffering, which workers’ comp doesn’t cover.

Do You Need a Lawyer?

Not every workers’ comp case requires the help of an attorney. If your injury is minor, you don’t miss much work, and the insurance company accepts your claim, you could handle the workers’ comp process by yourself. You should consult a workers’ comp lawyer, though, under any of the following circumstances:

• Your injury/illness is serious and your medical bills high.
• You’ve sustained a total or partial disability.
• The insurance company is slow to approve necessary treatments.
• You’re dissatisfied with your company-recommended doctor.
• The insurance company disputes or denies your claim.

Have You Been Injured On The Job?

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, Florence, Myrtle Beach, Murrells Inlet, Mt. Pleasant, North Myrtle Beach or North Charleston office locations.