If you work for a Horry County company with four or more employees, your employer is required by South Carolina law to carry workers’ compensation insurance. Workers’ comp provides no-fault coverage of employees’ work-related injuries and occupational illnesses. If you’re injured in an accident during the course of your work or develop an illness over time on the job, workers’ comp covers:
- Your medical expenses
- Two-thirds of your lost wages
- Disability care if you can’t return to your job
- Vocational re-training (in some cases)
You don’t have to prove that your employer did anything wrong to cause your accident or illness. Even if it was your own fault, you may still file a workers’ comp claim, and your employer may not fire you or retaliate against you for doing so.
Who Is Covered
Nearly every employee who receives a W-2 tax statement is eligible for workers’ comp, but there are some exceptions:
- Federal, railroad, and agricultural workers
- Casual workers
- Independent contractors
- LLC members
- Sole proprietors
- Business partners
- Employees of a business with less than $3,000 in yearly payroll
If you work in one of the positions above, you aren’t eligible for workers’ comp benefits. Furthermore, even if you are eligible, you can be disqualified from receiving benefits if:
- You were under the influence of drugs/alcohol when you were injured.
- You hurt yourself intentionally on the job.
- You were hurt in the process of committing a crime.
Filing a Workers’ Compensation Claim
If you’ve been accidentally injured while working or become sick because of workplace conditions, you should take the following steps:
- Report your injury or sickness to your employer or the claims administrator where you work.
- If your employer doesn’t file your workers’ comp claim within 10 days, do so yourself with a form 50, which is available from the South Carolina Workers’ Compensation Commission (SCWCC).
- See the doctor to whom your employer’s insurance company sends you.
- Submit to that doctor’s treatment and follow all medical advice.
- To prevent billing errors, remind the doctor’s office staff during each visit that you’re being treated for a work-related injury or illness covered by workers’ comp. Your healthcare providers will generally bill the insurer directly.
- Keep documentation of all your medical expenses and of any denials of treatment by your employer’s insurance company.
The law allows you 90 days to report your injury and two years to file a claim, but you should not wait. If you delay reporting or filing, the insurance company might dispute your claim on the basis of your delay, contending that you would have filed sooner if your condition were serious. Your employer might also contend that your injury or illness is not work-related. If your claim is disputed or denied for any reason, you may appeal the insurance company’s decision.
If your claim is approved by your employer’s insurance company, workers compensation should pay all medically necessary expenses related to your injury or illness:
- ER visits
- Doctor’s appointments
- X-rays and other diagnostic tests
- Physical therapy and rehabilitation
- Home care
- Home or vehicle modifications
- Assistive equipment
- Travel to/from medical appointments (in some cases)
There is no deductible amount for you to pay as you do with most health insurance policies, but your employer and the insurance company do have the right to oversee your medical treatment. This means:
- You may not simply visit the doctor of your choice. You must see a doctor certified by the insurance company.
- You are required to undergo medical treatment and exams requested by the insurance company or the SCWCC. If you don’t comply, your benefits could be suspended.
- The insurance company must evaluate and approve each one of your medical expenses before paying it.
- Although there are some cases in which permanently disabled employees might receive benefits for life, most workers’ comp benefits will end when you’ve reached the point of maximum medical improvement (MMI) and have recovered to the extent that your doctors feel you can. If you’re offered a light-duty job that your medical restrictions allow you to perform, you must accept and attempt to carry out the duties of that job.
Disputes and Appeals
Under ideal circumstances, the insurance company will approve and pay for all your medical expenses until you recover and return to work, but there are many circumstances that are not ideal. The company might question the necessity of a medical procedure your doctor feels that you need, especially if it’s an expensive one like surgery. If you had a pre-existing medical condition at the time of your injury, the insurance company might argue that your need for surgery is the result of that condition, not of your workplace injury, and refuse to approve the payment.
The insurer’s primary duty is to remain profitable for its shareholders. The less it pays out for your medical bills, the more profitable it will be, so it might be slow in paying for expensive procedures or refuse to approve/pay for tests and treatment that you legitimately need. You may appeal the decisions of your employer’s insurance company if you feel that:
- The doctor you’re seeing is not the right one for you.
- You’re not receiving the treatments you need in a timely fashion.
- You’re receiving treatments that are not helpful to you.
- The insurance company refuses to approve/pay for a necessary surgery or other procedure.
The skills of an experienced workers’ comp attorney are recommended for anyone entering the complex appeals process, which includes many deadlines and rules of procedure that must be followed in order for you to collect fair benefits.
The Role of Your Lawyer
If your employer’s insurance company denies or is slow to pay your legitimate medical expenses for treatment related to your workplace injury or illness, a workers’ comp attorney can help you by:
- Representing you at an informal conference or SCWCC hearing
- Pressuring the insurance company with the threat of a hearing before the SCWCC
- Presenting your medical evidence to the insurance company and/or the SCWCC
- Helping you to get an independent medical exam (IME) or a second medical opinion
- Calling in expert witnesses
- Dealing with the nurse case manager assigned to your claim
- Appealing the insurer’s decisions at higher levels:
- Commission review
- SC Court of Appeals
- SC Supreme Court
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.