What Workers’ Compensation Covers
To file a workers’ compensation claim, you needn’t prove that your employer did anything wrong to cause your accident. 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 wages lost and for medical treatment including:
- Doctor and hospital visits
- Prescription medication
- Diagnostic testing
- Blood work
- Physical or occupational therapy
- Surgical procedures and follow-up appointments
- Ambulance transportation
- Medical devices
- Adaptive equipment
- Vocational rehabilitation
Maximum Medical Improvement
Your employer may not legally fire you or retaliate against you for filing a workers’ compensation claim. The employer must keep you on as an employee during your treatment and recovery until you’ve reached maximum medical improvement (MMI). This means you’ve recovered as much as you’re going to.
Categories of Disability
When you've reached MMI, your doctors will decide if you have sustained any kind of disability. Workers’ comp provides specific benefits to employees who are left disabled by workplace accidents or conditions. Disabilities covered by workers’ comp fall into one of four categories:
- Temporary Partial Disability (TPD)
- Temporary Total Disability (TTD)
- Permanent Partial Disability (PPD)
- Permanent Total Disability (PTD)
Temporary Partial Disability
After your accident/injury, if you recover sufficiently to return to work with restrictions causing you to earn less than you did before, you may be able to collect TPD benefits, which would be two-thirds of the difference between your wages before your injury and the wages you now receive. TPD benefits are paid until you can resume your previous job at full salary, up to a maximum of 340 weeks.
Temporary Total Disability
If you are not able to return to work at all, even with restrictions and a light-duty job, you might be eligible for TTD benefits equal to two-thirds of your previous salary. You may receive these benefits until you’re able to work again, up to a maximum of 340 weeks.
Permanent Partial Disability
If your disability is permanent but only partial, the category of the disability determines how long you can receive 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
Permanent Total Disability
If your disability makes it impossible for you ever to return to your job, even on light duty, you’re entitled to PTD 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
- Fifty percent of the use of your back
- Two different body parts (one hand and one foot, for example)
For PTD, you can receive medical care and two-thirds of your average weekly wage for up to 500 weeks, which is slightly 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, including lost wages and medical care, for life. Because these disability awards are the most expensive for insurance companies, they have teams of insurance adjusters and lawyers whose job it is to dispute, deny, and devalue your claim. Having an experienced workers’ comp attorney in your corner is vital to proving your claim and getting fair benefits.
Lost Earning Capacity
Even if you are not presumed disabled on the basis of any of the above injuries, you might be able to prove your disability on the basis of lost earning capacity. Your attorney can help you with this complex process by hiring a vocational consultant who can submit an evaluation certifying that you are disabled.
Whether you are proven disabled in this way or presumed disabled on the basis of injuries described above, you are entitled to either:
- Two-thirds of your pre-injury wages
- Two-thirds of the difference between your pre-injury wages and your current wages
For 2021, the maximum weekly compensation you may receive is $903.40.
Reporting Your Accident and Filing Your Claim
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 by 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/injury to your employer, preferably in writing.
- If your employer doesn’t file a workers’ comp claim on your behalf or disputes your report of a work-related injury, file your own claim with a form 50 from the SCWCC.
- See the doctor recommended by the insurance company.
- 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.
Informal Conference and Hearing
The SCWCC will schedule an informal conference to determine the benefits you should receive for your disability. If your claim is disputed or the 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.
Have You Been Disabled by a Work-Related Injury in Horry County?
Take the first step toward fair compensation by consulting an experienced workers’ comp attorney. Please contact us online, start a chat, or call our Charleston office directly at 843.488.2359 to schedule a free consultation. We serve clients throughout Horry County and surrounding areas, so we’re sure to have an office near you.