If you work for a South Carolina business or company with at least four employees, your employer is required by law to carry workers’ compensation insurance. Workers’ comp provides coverage for workers who are injured or become ill due to work-related accidents or conditions.
Because workers’ comp is no-fault coverage, you don’t have to prove that your employer was negligent or did anything wrong to cause your injury. Even if you were at fault and caused your own injury or illness, you may still file a claim with your employer’s insurance company for your medical expenses and up to two-thirds of wages lost due to your work-related accident.
Some work-related accidents are so serious that they might leave you permanently disabled. Because you will never completely recover from your injuries, you could have medical bills and lost wages for a long period of time or the rest of your life.
Since the costs related to permanent disability are so high, insurance companies and their lawyers fight very hard to dispute permanent disability claims and to pay as little as they possibly can. For this reason, it’s important for you to understand everything that you can about:
- Worker’s compensation laws
- Your disability
- Your claim
Reporting Your Work Related Accident and Filing A Claim In Horry County
If you are injured on the job, you have 90 days to report your injury to your employer, who should report it to the insurance carrier within 10 days.
You then have two years to file a workers’ comp claim, but you should not wait. Waiting to report your injury or to file could give the employer’s insurance company a reason to dispute your claim, saying that you would not have waited if your condition had been serious. To prevent this kind of dispute, you should do all of the following immediately after your accident:
- Report your accident and injury to your employer, preferably in writing.
- If your employer does not file a workers’ comp claim on your behalf and/or disputes your report of a work-related injury, file your own claim with a form 50, available from the South Carolina Workers’ Compensation Commission (SCWCC).
- See the doctor recommended by the insurance company. (Do not visit your own doctor.)
- Follow that doctor’s orders and treatment recommendations carefully.
- Consult an attorney if your employer or the insurance company disputes your claim or does not cooperate.
Maximum Medical Improvement
Your employer may not legally fire you or retaliate against you in any other way for filing a workers’ compensation claim. The employer is required to keep you on as an employee during your treatment and recovery until your doctors feel that you’ve reached maximum medical improvement (MMI). This means you’ve recovered to the extent that you’re going to recover. At that point, your doctors will determine if you’ve been left with any kind of permanent disability and certify their findings for the insurance company.
In South Carolina, the benefits you receive after a diagnosis of permanent disability can be calculated according to either of two different models:
- The medical model evaluates the loss of the use of body parts or functions.
- The economic model evaluates your lost earning capacity.
The benefits you receive also depend on whether your permanent disability is considered total or partial.
Permanent Total Disability
If your permanent disability makes it impossible for you ever to return to your job, even on light duty, you’re entitled to total disability benefits. You are presumed to be permanently and totally disabled if you have lost the use of (or had amputated, in the case of limbs) any of the following:
- Both eyes
- Both hips
- Both legs
- Both feet
- Both shoulders
- Both arms
- 50% of the use of your back
- Two different body parts
For permanent total disability, you can collect two-thirds of your average weekly wage for up to 500 weeks, which is a little less than 10 years. This time limit does not apply, however, if your injury has left you in any of the following conditions:
- Paraplegic (legs paralyzed)
- Quadriplegic (legs and arms paralyzed)
With any one of these three conditions, you can receive benefits for life.
Permanent Partial Disability
If your disability is permanent but only partial, the category of the disability determines how long you can receive lost-wage benefits:
- Loss of one eye or vision in one eye: 140 weeks
- Loss of up to 49% of the use of your back: 300 weeks
- Loss of one leg: 195 weeks
- Loss of one arm: 220 weeks
- Loss of one thumb: 65 weeks
- Loss of one big toe: 32 weeks
- Loss of one other toe: 10 weeks
Lost Earning Capacity
Workers’ compensation claimants with permanent disabilities may choose to collect benefits according to the medical model outlined above or an economic model, which bases benefits on earnings lost due to permanent work-related injury or illness. If you choose to have your benefits calculated according to the economic model, you should receive either:
- Two-thirds of your pre-injury wages
- Two-thirds of the difference between your pre-injury wages and your current wages
Informal Conference and Hearing
The SCWCC will schedule an informal conference to determine the benefits you should receive for your permanent disability. You, representatives of the insurance company, and a claims mediator must attend this conference.
If your claim is disputed or the settlement amount offered is not reasonable, you may appeal the decision and request a hearing before the Commission. Your attorney can represent you in this hearing and help you to get fair benefits for your permanent disability.
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, Myrtle Beach, Murrells Inlet, Mt. Pleasant, North Myrtle Beach or North Charleston office locations.