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:
- Brain-damaged
- 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.
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