If you are injured at work, you can usually get workers comp to take care of it. But problems can arise. There are instances when your claim gets denied or when your employer doesn’t do their part in getting the claim processed. When these issues come up, it’s best to have a lawyer on your side.
Dan Pruitt has years of experience dealing with workers comp claims in the Greenville, South Carolina area. Read on to find out how he can help you win your case.
What Does Workers’ Compensation Cover?
Workers’ comp covers the following losses and expenses:
1. Medical Expenses
These damages will cover any medical care needed immediately after the accident as well as ongoing care that may include things like prosthetics, wheelchair ramp installation, in-home nursing, medication, and more.
2. Loss of Wages
Loss of wages covers your income when you need to take off work to recover.
3. Partial Disability
Your injuries may be so severe that you are unable to perform the duties of your current position. If this is the case, you may be forced to take a lower-paying position. In this instance, partial disability benefits will cover two-thirds of the difference in wages until you are able to return to your past position.
4. Total Disability
Total disability kicks in if your injuries render you unable to return to work on a permanent basis. It will cover two-thirds of your salary for up to 500 weeks. If your injuries were especially severe, you might be able to collect benefits for the rest of your life.
5. Wrongful Death
If a worker dies due to their injuries, their family may collect wrongful death benefits that equal two-thirds of their pay for up to 500 weeks. The family may also be compensated for medical and funeral expenses.
Workers’ Compensation Statutes Employees Should Know in South Carolina
Understanding South Carolina’s workers’ compensation laws can make a significant difference in protecting your rights after a workplace injury. While the system is designed to help injured workers, the legal requirements and deadlines can be complicated. Here are the key statutes and provisions that affect South Carolina employees. Our workers’ compensation firm knows how to apply all of these laws to your claim.
The Two-Year Filing Deadline
South Carolina law gives injured workers two years from the date of their accident to file a workers’ compensation claim with the South Carolina Workers’ Compensation Commission. Missing this deadline typically results in losing your right to benefits entirely. For workplace fatalities, family members have two years from the date of death to file for death benefits.
For occupational diseases and repetitive trauma injuries, the timeline works differently. When dealing with conditions like asbestos exposure or lead poisoning, the two-year clock begins when you receive a definitive diagnosis, not when the exposure occurred. This recognizes that occupational diseases often develop gradually over years.
The 90-Day Notice Requirement
South Carolina requires employees to notify their employer of a work-related injury within 90 days of the accident. While you have two years to formally file a claim with the Commission, failing to notify your employer within this shorter window can jeopardize your benefits. It is best not to wait for 90 days to approach, but provide notice when practicable. Report your injury to your supervisor in writing as soon as possible after it occurs.
Employer Coverage Requirements
South Carolina law requires businesses with four or more employees to carry workers’ compensation insurance. Part-time workers and family members count toward this employee threshold. Certain categories are exempt, including casual employees, agricultural workers, railroad employees, and businesses with an annual payroll under $3,000.
Workers’ Compensation Is a No-Fault System
South Carolina workers’ compensation operates on a no-fault basis, meaning you don’t need to prove your employer was negligent to receive benefits. Whether the injury was your fault, your employer’s fault, or simply an accident, you’re generally entitled to compensation. However, benefits can be denied if you were intoxicated, engaged in horseplay, or committed fraud.
Retaliation Is Illegal
South Carolina law explicitly prohibits employers from firing or demoting employees for filing workers’ compensation claims or testifying in workers’ compensation proceedings. Employees who are wrongfully terminated in retaliation can sue their employer in civil court for lost wages and reinstatement. This protection ensures workers can pursue legitimate claims without fear of losing their jobs.
Employer Control Over Medical Treatment
South Carolina law gives employers or their insurance carriers control over your medical treatment. While you can see your own physician, workers’ compensation typically won’t cover those costs unless specific exceptions apply. You may be assigned a nurse case manager to coordinate your care, though you can request private examinations with your doctor.
Light Duty Work Requirements
If your doctor provides light-duty restrictions and your employer offers appropriate light-duty work, you must accept it, or your compensation benefits may cease. However, you have the right to request a hearing if you believe you cannot perform the assigned work.
Understanding Your Rights
South Carolina’s workers’ compensation statutes provide important protections for injured workers, but only if you understand and follow the requirements. Missing deadlines or failing to properly report injuries can cost you the benefits you deserve.
At Dan Pruitt Injury Law Firm, we help injured workers comply with all applicable statutes and ensure they receive every benefit they’re entitled to under South Carolina law.
How Do I File for Workers’ Comp?
There are steps you must take after an injury occurs to ensure you get your worker’s comp benefits. The process may vary slightly from workplace to workplace, but here are the general guidelines:
- You have 90 days to file your claim. If you wait longer than that, you may not be able to collect benefits. You may want to wait a few days after an injury occurs to see if it’s getting better, but beyond that, don’t delay in filing.
- Once you have filed your claim, it’s up to your employer to contact their insurance company. The insurance company will then conduct an investigation of your claim to make sure the injury is work-related. It’s likely you will have you see a doctor in their network so they can examine you and confirm the cause and severity of the injury.
- After the investigation is complete, you will receive a letter letting you know if your claim has been approved or denied. If it is approved, the letter will tell you the amount of the benefits you will be receiving as well as how long you will be receiving them. If your claim was denied, you would be able to start the appeals process.
How is a Workers’ Compensation Claim Processed in South Carolina?
After you file your workers’ compensation claim in South Carolina, the process moves through several stages that can significantly affect whether you receive benefits and how much compensation you’ll obtain.
Initial Carrier Review
Once your claim reaches your employer’s workers’ compensation insurance carrier, an adjuster will review the circumstances of your injury. The carrier examines your:
- Injury report
- Medical records
- Employment records
- Any witness statements to determine whether your injury is work-related and compensable under South Carolina law
This initial review typically takes several weeks, though timeframes vary depending on the details of the claim.
Additional Documentation Requests
During the review process, the insurance carrier may request additional information to evaluate your claim. You might be asked to provide further medical records, complete detailed written statements about how the injury occurred, or supply employment history documentation. Responding promptly and thoroughly to these requests helps keep your claim moving forward. Delays in providing requested information can stall the process and raise questions about your claim’s validity. You can always seek legal help in responding to insurer requests to ensure you do not make any errors or omissions.
Independent Medical Examinations
The insurance carrier may require you to attend an independent medical examination conducted by a doctor of their choosing. These examinations allow the carrier to obtain a second medical opinion about the nature and extent of your injuries, whether they’re work-related, and what treatment is necessary.
While termed “independent,” these physicians are paid by the insurance company, and their opinions sometimes differ from your treating doctor’s findings. You’re generally required to attend scheduled IMEs, though you can have your attorney present during the examination. You can also challenge the IME findings with your own medical examination and help from a workers’ compensation attorney.
Common Reasons for Claim Denials
Insurance carriers deny workers’ compensation claims for various reasons. Common grounds for denial include:
- Arguments that the injury didn’t occur at work or wasn’t work-related
- Claims that you failed to report the injury within the required timeframe
- Assertions that you were intoxicated or engaged in horseplay when injured
- Disputes about whether you’re actually injured
Pre-existing conditions often become contentious issues, with carriers arguing that your current symptoms aren’t related to your workplace accident. You might also have certain treatments challenged, leaving those expenses uncovered by benefits.
If you receive a denial or fewer benefits than you deserve, immediately reach out to our workers’ compensation law firm for help.
The South Carolina Appeals Process
If your claim is denied or you believe you’re not receiving appropriate benefits, your attorney can request a hearing before a South Carolina Workers’ Compensation Commissioner. The Commissioner acts as a judge, hearing testimony from both sides, reviewing medical evidence, and issuing a decision about what benefits are owed.
If you disagree with the single Commissioner’s decision, your lawyer can appeal to the full Commission, which consists of all seven Commissioners reviewing your case. Further appeals can be taken to the South Carolina Court of Appeals and potentially the South Carolina Supreme Court.
Having an experienced workers’ compensation attorney throughout this process significantly improves your chances of success, particularly when dealing with claim denials or disputed benefits.
Do I Need a Lawyer for My Workers’ Comp Claim?
In most cases, workers’ comp claims run smoothly, and you can collect benefits without issue. However, there are situations where you will want a lawyer by your side. Here are some examples.
If You Need to Appeal Your Claim: If your claim was denied, it’s a good idea to hire a lawyer to help you with the appeals process.
If Your Employer is Dragging Their Feet: After you file your paperwork, your employer must file their own set of paperwork with their insurance company. If time goes by and they aren’t doing their part, you may need to call in a lawyer.
Problems with the Network Doctor: Part of the process will involve you seeing a doctor that is approved by the insurance network. It is not uncommon for network doctors to deliver substandard treatment. They may even try to make your injuries seem less severe to help the insurance company (i.e., the person that hired them) make a lower payout. If this is the case, you can ask to see another network-approved doctor, but if you continue having this problem, you may need a lawyer’s assistance.
You are Being Offered Lump Sum Settlement: Worker’s comp is usually made in incremental payments, but in some cases, you may be offered a lump sum settlement. This amount may seem like a lot of money at the time, but once you apply it to your losses and expenses, you will find you barely have enough to go around. A lawyer will review your lump-sum settlement and see to it that you are fairly compensated.
Your Employer is Not Offering You Alternate Work: If your injuries render you unable to perform the duties of your current job, it is up to your employer to offer you alternate work that suits your capabilities. If they are unable to do so, they must compensate you for training for another position. If they refuse to provide work or compensate you for training, you may be able to go after them in a legal forum.
Why Dan Pruitt is the Best Choice for Your South Carolina Workers’ Comp Claim
It can be intimidating going after employers in a worker’s comp claim. Don’t go it alone. The right lawyer will take the stress off your hands and fight relentlessly to see to it that your claim gets approved.
Dan Pruitt has years of experience representing Greenville, South Carolina residents in workers comp claims. He is known for his caring demeanor, his affordable rates, and his winning results. He will make sure you get the best possible outcome.
Don’t let your employer get away with robbing you of your benefits. Call Dan Pruitt to schedule a free consultation. He will do all he can to help you win your case.