Workers’ compensation is no-fault insurance coverage for employees who suffer work-related injuries or illnesses. If you work for a South Carolina company with four or more employees, your employer is required to carry workers’ compensation insurance. When you’re hurt or get sick as a result of doing your job, you’re entitled to file a workers’ comp claim for:
- Medical expenses
- Lost wages due to time off work
- Future long-term care if you’re disabled
- Death benefits if you’ve lost a loved one in a work-related accident
When You Don’t Need a Lawyer Following A Work Injury
Some workers’ compensation claims are fairly simple. You can probably handle your own claim if:
- You suffer a minor injury requiring a visit to the ER/doctor’s office but no hospitalization.
- You were off work for less than a week to recover.
- Your employer doesn’t dispute your claim.
- You completed the claims procedure correctly and on time.
Under these circumstances, workers’ compensation is likely to accept your claim, pay your medical bills, and reimburse you for most of your lost wages. There’s probably no need for an attorney.
Claims That Workers’ Compensation Might Dispute or Deny In Charleston, South Carolina
Workers’ compensation benefits are paid by your employer’s insurance company, which might try to dispute or deny your claim if your accident or injury appears to be a high-value claim. Some examples of injuries that could be costly for the insurance company are:
- Injuries requiring referrals to specialists
- Broken or crushed bones
- Joint injuries
- Any injury requiring surgery and/or hospitalization
- Neck, back, and spine injuries
- Paralysis, which can leave you totally or partially disabled
- Brain injuries, which may lead to serious mental and physical effects
If you have an expensive claim for such an injury, the insurance company generally looks for ways not to give you the benefits you deserve. Its adjusters and attorneys are well trained to fight your claim. This means you need someone who also knows workers’ comp law to fight back on your behalf.
When You Do Need a Lawyer Following A Work Related Injury
The services of a workers’ comp attorney are highly recommended under any of the following circumstances:
- You have a pre-existing condition related to the body part affected by your accident. The insurance company might claim that condition caused your injury, especially if it’s a repetitive stress injury that’s developed over time.
- You receive government benefits like Social Security Disability Insurance (SSDI) or Medicare already. These benefits could be reduced if you get workers’ comp benefits. An attorney can help you minimize any loss of benefits.
- Your injury/illness leaves you disabled and prevents you from returning to your job. You’ll need an attorney’s help in getting sufficient benefits to see you through your disability, structuring benefits to your advantage over time, and getting vocational re-training for a new job in some cases.
- The insurance company is slow to approve necessary medical treatment/surgery. Your lawyer will know how to apply pressure to get you the treatment you need.
- The insurance company disputes your disability rating. If you’re permanently disabled, your doctors will give you a numerical disability rating that will determine the amount of your benefits. The insurance company might dispute that rating and send you to a different doctor for a second opinion. If the second exam results in a lower rating, your lawyer can fight to get you the disability benefits you deserve.
- The insurance company denies your claim or offers an unreasonably low settlement.
The South Carolina Workers’ Compensation Commission (SCWCC) gives you the right to appeal a claim at five different levels if necessary:
- Informal conference
- SCWCC hearing request
- Commission review
- SC Court of Appeals
- SC Supreme Court
At every level of appeal, there are filing deadlines to meet and specific rules of procedure to follow. You must also organize all your evidence and present it convincingly. Doing so on your own is very difficult, especially if you’re recovering from your injury/illness, and you’re likely to get a much better settlement with a lawyer than without one. You’ll pay your attorney an agreed-upon percentage of that settlement after you win your case, so your legal representation essentially pays for itself.
The Role of Your Attorney In A Workers' Compensation Case
If you have a workers’ comp claim that’s expensive, complicated, disputed, or denied and try to pursue it without legal representation, you’re just doing the insurance company a favor. Its lawyers know countless ways to give you less than the benefits you deserve. They’re skilled legal professionals who will eat you alive in the very complicated process of workers’ comp settlement.
If you try to fight them alone, they won’t even take you seriously because you pose no risk to them. A knowledgeable workers’ comp attorney fighting for you, however, does pose a risk that motivates the insurance company’s lawyers to give you a fair settlement. They know that your attorney will:
- Collect, organize, and present your current medical bills
- Consult with healthcare providers to predict future medical expenses
- Deal with your primary doctor, who is the most important witness in your case
- Call in expert witnesses if necessary
- Decide if/when you need a second medical opinion or independent medical exam (IME) and help you get it for no out-of-pocket expense
- Handle a nurse case manager that the insurance company might assign to attend your doctor’s appointments
- Put pressure on the insurance company with threats of an SCWCC hearing if you suffer delays in treatment, referral to specialists, or weekly checks
- Understand the complex workers’ comp disability categories and how they apply to you
- Handle third-party action if someone else was partially responsible for your accident
- Negotiate with the insurance company and get results in a reasonable time frame
- Fight for you in court if your appeal gets to that level
Filing Your Workers' Compensation Claim In Charleston, South Carolina
If you’re hurt on the job, you have 90 days to report the accident to your employer, but you should do it immediately. Although you have two years to file your workers’ comp claim, do so right away. You should then see a doctor certified by the insurance company and consult an attorney if:
- Your claim is expensive/complicated.
- Your claim is disputed/denied.
- Your employer retaliates against you for filing a claim.
Have You Been Injured On The Job?
If you've been hurt at your job you need to speak with an experienced workers' compensation attorney as soon as possible. Please contact us online or call our Charleston, South Carolina office directly at 843.488.2359 to schedule your free consultation. We are also able to meet clients at our Conway, Myrtle Beach, Murrells Inlet, Mt. Pleasant, North Myrtle Beach or North Charleston office locations.