In South Carolina, workers’ compensation provides no-fault insurance coverage for most employees’ work-related injuries and occupational diseases. If you’re hurt on the job and are unable to work for an extended period of time, you could be eligible to collect workers’ comp benefits covering your medical bills and two-thirds of your lost wages. In most cases, you’ll receive your wage loss benefits weekly for a specified number of weeks, after which you’ll reach maximum medical improvement (MMI) and be cleared by your doctor to return to your job.
If, however, you’re left disabled after reaching MMI, you might not be able to resume your previous job. You could be given work restrictions and a light-duty position, or you could be unable to continue working at all. In either case, your disability claim might be resolved with a lump-sum settlement. The different types of workers’ comp settlements are discussed below.
Workers’ Comp Settlements
The amount of the lump-sum settlement you might be offered for your permanent partial disability (PPD) depends on several factors:
- Your average weekly salary
- The cost of any vocational re-training you receive
- Your current and projected future wage losses
- Your particular injury or illness
- Your impairment rating and work restrictions
- Any balances on your medical bills to date
- What medical treatment, if any, you’re likely to require in the future
When considering whether to accept one of the available lump-sum settlements, you should understand the advantages and disadvantages of each.
Final Clincher Agreement
A final clincher agreement awards you a lump sum for all medical expenses and lost wages resulting from your work-related injury or illness. Your employer and its insurer typically prefer to resolve a claim with a clincher agreement because it leaves them with no further responsibility to compensate you. The clincher agreement, which will be drafted by the lawyers for the insurance company, could provide you with a fairly generous one-time settlement because the insurer wants to be done with your claim for good. If the settlement is agreed upon by all parties, it will be submitted to the South Carolina Workers’ Compensation Commission (SCWCC) for approval.
If you accept a clincher agreement and require unforeseen medical treatment in the future, you will be responsible for your own bills, so it might not be your best choice if you anticipate future medical expenses or have trouble managing money. If your doctor does not anticipate the need for future treatment and/or you have adequate health insurance to cover unforeseen future needs, the clincher might be the right option for you.
Modified Indemnity-Only Clincher Agreement
This type of settlement releases your employer from any further lost-wage compensation but leaves open the option for coverage of future medical expenses.
Form 16A Settlement
A 16A settlement might be smaller than a clincher settlement because the 16A option includes provisions for future medical care recommended by your doctor. Under this agreement, you may file for further disability compensation if your condition deteriorates, but you must do so within one year after the date of the final disability payment resulting from your original claim. This settlement takes its name from the SCWCC form 16A, which is used to finalize the agreement. It’s generally the best settlement option for most claimants who’ve completed their treatments and reached MMI.
To start the 16A process, your doctor must document your medical condition, your anticipated future medical requirements, and your work restrictions with Form 14B. Your employer’s insurer must then file a Form 18 to request an informal conference, at which a deputy SCWCC commissioner will:
- Consider your doctor’s Form 14B
- Assign you a PPD rating
- Review the terms of your proposed 16A agreement
- Submit your Form 16A (signed by all parties) to the SCWCC for approval
If an agreement is not reached in the informal conference, the deputy commissioner can schedule an evidentiary hearing before the SCWCC.
In an evidentiary hearing, the SCWCC will make a decision on the amount of your PPD settlement and the future medical care that workers’ comp will cover. Once you receive your settlement, you may re-open your claim within one year if your medical condition worsens. The services of a workers’ comp lawyer are highly recommended if your claim goes to an evidentiary hearing. The insurer’s attorneys will be present, so you will need someone in your corner who is familiar with the hearing procedures and the tactics the insurer will use to save money on your claim. Your attorney can help you by:
- Submitting a Form 50 to request the hearing
- Organizing your evidence and presenting it convincingly
- Preparing you to testify
- Presenting further evidence from your doctor, a vocational specialist, and/or other expert witnesses
- Making sure you observe all deadlines and procedural requirements.
Pros and Cons of a Lump-Sum Settlement
When you accept a lump-sum settlement, you generally save time, get your money sooner, and avoid going to court to fight for a fair award. You may also see your own doctor, rather than the doctor approved by your employer’s insurer, for any necessary treatment in the future. On the other hand, you give up the option of receiving lost-wage benefits and reimbursement of future medical expenses, for which you will be financially responsible.
Finalizing Your Settlement
Once you and the employer’s insurer have agreed on the type of settlement and the amount you’ll receive, the insurer will forward the settlement agreement to your attorney, who will review it carefully to be sure it’s correctly drafted and in your best interest. Your settlement check will generally accompany the agreement, and your lawyer will deposit the check in a special trust account. You will then be called in to review and sign the settlement agreement, as well as a Form 61 specifying the fees and costs to be paid to your attorney, which will then be submitted, by either your attorney or insurer’s attorneys, to the SCWCC for approval.
Once your attorney receives copies of the approved, filed settlement agreement and of Form 61, attorney fees will be deducted, and you’ll receive your check. It’s impossible to say exactly how long this will take, but you can hope to receive your settlement within a month or two after all documents are submitted to the SCWCC. The final step in the settlement process is your signature on a SCWCC Form 19, which confirms your receipt of your final award. Once Form 19 is signed, your case will be closed.
Have You Been Injured on the Job in Myrtle Beach, South Carolina?
If you've been hurt at your job, you can speak with a workers' compensation lawyer. Please contact us online or call our Myrtle Beach office directly at 843.488.3165 to schedule your consultation. We are also able to meet clients at our Myrtle Beach, Murrells Inlet, Mt. Pleasant, North Myrtle Beach, Florence or North Charleston office locations.