The Workers’ Compensation Act in South Carolina provides that if an employee suffers injury by accident arising out of and in the course of employment, that individual is entitled to recover medical expenses, temporary total compensation for lost time, and permanent disability benefits if he/she suffered any permanent injury as a result of the work accident. The workers’ compensation laws in South Carolina can be complex, difficult to understand, and hard to navigate without the help of an experienced workers’ compensation attorney.
Under the current law, your employer and its insurance carrier has the right to select the doctor who will treat you. If you go to see your own doctor without permission of the employer/carrier, then then employer/carrier may not be responsible for paying for the the medical treatment, unless it constitutes an emergency condition. However, you have the right to choose a physician to evaluate you for the specific disability but typically it will not be paid for by the employer.
Once you suffer an injury on the job you should immediately report it to your supervisor. This should be the same day of the accident, if possible. Never, ever delay reporting the injury to your employer. You should also request that the employer provide appropriate medical treatment. In the event that medical treatment is not provided or not paid for, it would be best to consult with an attorney to determine your rights.
If the claim continues to be contested, or denied, your lawyer should file a Form 50 on your behalf with the Workers’ Compensation Commission to request a contested hearing. This sets out the various parties, the date and description of the accident, who you reported it to, the injuries suffered, whether medical treatment is needed, any disfigurement you may have received and any other relief you may be requesting.
The employer, unless self insured, is usually represented by an insurance company known as the carrier. The carrier files an answer on a Form 51, where they may admit or deny what you have said in your Form 50. The case is then placed on the Workers’ Compensation Commission’s docket, and assigned to an individual Commissioner who acts as a fact finder and also rules on the law. A hearing is usually held within three to five months, and at the hearing the employee presents his/her case. You should understand that the employer/carrier will always have an attorney defending the case. If the employer/carrier has an experienced lawyer, shouldn’t you?
Usually medical testimony is presented in the form of a deposition and your physician will not attend a hearing. The other medical evidence that the Commissioner will rely upon are the medical records you and the Carrier present.
Once a commissioner has ruled on the case, the Commissioner will issue an Opinion and Award which sets forth his/her ruling of fact and law, and what relief, if any, the employee gets. If either party is dissatisfied with the decision, the case can be appealed to the full Commission which is made up of all the Workers’ Compensation Commissioners except for the one who heard the case originally. After that hearing is held, if either party is dissatisfied with the decision, it can be appealed to the Circuit Court and on up to the South Carolina Supreme Court, depending on the procedural posture of the claim. You have 14 days from the date of the Order to file an appeal.
Fault or negligence is not an issue regarding the payment of a workers’ compensation claim unless, for example, the employee was intoxicated at the time of the injury. Remember, if you are injured on the job, report the incident to your supervisor.
If you feel like you are not getting medical treatment or not being paid for being out of work, these are tell-tell signs that seeking legal assistance may be necessary. We are happy to discuss your claim with you to see if an attorney would be your best route to protect you. Call us today for an honest and confidential evaluation of your workers’ compensation claim. The number to the Goings Law Firm, LLC is 803-350-9230.
What happens if I can’t return to work?
A common question we get is “What happens if I cannot return to work due to my work injury.” The fear of not being able to return to work is a real concern if you have been involved in a work related injury. Often we counsel with people who have given their best years to an employer only to end up with a debilitating injury caused by their work. Like any hard working individual, they are concerned with their ability to recover and get back to work as quickly as possible. Unfortunately, many individuals suffer injuries so bad that they are no longer able to meet the work requirements of their job. Sometimes these injured workers are ill informed that their injury is limited to a recovery solely based on the injured body part. The insurance company, or its attorney, will try to hurriedly rush an injured worker into a settlement that neither represents the fully injured body part or takes into account their inability to return back to work. Many injured workers will reluctantly accept a quick settlement only to find out they don’t have a job to be able to return to and can’t support their family.
Fortunately, the South Carolina Workers Compensation Laws provide a mechanism where injured workers can receive an award to address their inability to return to their job instead of just the injured body part. To be eligible for wage loss the worker must be able to demonstrate they meet the necessary elements of a wage loss claim. If left to handle these complicated issues by themselves, injured workers may end up without the benefit of the law, or worse miss the requirements to be eligible for wage loss recovery. At the Goings Law Firm we routinely assist injured workers to determine if they may be eligible for a wage loss recovery. To determine if you need help with a workers’ compensation injury contact Attorney and Workers’ Compensation Managing Partner Christian E. Boesl with the Goings Law Firm. Let us help you get the medical treatment you deserve to back to work, or get the money you are entitled to receive if you are unable to return to your job.
WORKERS COMPENSATION IS A NO FAULT SYSTEM
We often help people who have been told by their employer or the insurance company their on the job accident “has been denied by workers comp because they failed to follow a safety rule.” Sometimes employers mistakenly mislead employees into thinking they can’t bring a claim as a compensable workers compensation accident because the accident occurred as a result of some violated safety rule or was the fault of the employee. This reasoning is just simply not the law. The South Carolina legislature specifically designed the Workers Compensation Act to be a No Fault System. So what does no fault mean?
A “No Fault System” means whether the accident (an unexpected event or unintended result) was due to a freak chance of events or due to an actual violation of a work safety rule it is still a compensable accident under the Worker’s Compensation Act. The fault of an injured worker has no bearing on the right to recovery. (See Jones v. Harold Arnold’s Sentry Buick, 376 S.C. 375, 656 S.E.2d 772 (S.C. App. 2008). The only exception to this rule is the willful and intentional act of an employee to hurt themselves. Id.
So, if you were involved in an accident at work through no fault of your own or through your honest mistake it matters not, you are entitled to medical treatment, out of work pay and damages resulting from permanent injury. Let us answer your questions and guide you through the waters of workers compensation in South Carolina. For a free consultation call the Goings Law Firm, LLC and ask for the Workers’ Compensation Team lead by Christian E. Boesl, at 803-350-9230.
Question: Do I get reimbursed for my travel expenses when I go to the doctor?
Answer: Yes, if the round trip distance is more than ten miles from your home. Effective August 23, 2004, the South Carolina Workers Compensation Commission has approved allowance for trips to a pharmacy if the round trip distance is more than ten miles from your home. You should be reimbursed for the round trip mileage at the allowed state employees for mileage. Effective January 1, 2018, the reimbursement rate is 54.5 cents per mile.
If you have any questions or concerns about your case, just give us a call today. It will not cost you anything to see if we can help! The number is (803) 350-9230 and ask to speak with a member of our Workers Compensation team.
Have you been hurt on the job? Here is the best advice for what to do if you have been injured at work:
1. Report the Injury to your Employer
Report all injures at work to your employer immediately and request medical treatment, if needed. If you do not report the injury within 90 days of the accident you may lose your benefits. Although you must report the injury within 90 days, you have up to two years to file a claim for benefits. If a worker dies because of work-related injuries, the workers’ dependents, or parents if there are no dependents, must file a claim within two years of the death to claim benefits.
2. Request and Seek Medical Treatment
It is important to request and seek medical treatment as soon as possible in order to get a proper diagnosis, and to document the nature and extent of your condition. If you do not request or seek medical treatment for your injuries, the workers’ compensation insurance company will not believe that you are hurt. Do not delay your medical care!
3. Contact a Trusting Workers Compensation Attorney to Properly File your Claim
If you have been hurt at work, you need to properly file your claim. You should file your claim immediately if your employer does not report your accident, fails to provide proper treatment, denies your injury by accident, or if you are not getting the benefits that you deserve. You can file the claim yourself through a Form 50 and request a hearing, but beware!! The Workers Compensation laws in South Carolina are complex and hard to navigate alone. If you do not file your form properly, and the form is not properly served and correctly filled out, you could lose your case. The insurance company will hire a lawyer to defend the workers’ compensation to fight against the injured worker. Insurance company adjusters and lawyers will work to make sure you do not get the benefits that you deserve. Denying your claim or limiting your recovery is what the insurance company adjusters and their lawyers are paid to do.
The Workers Compensation attorneys at the Goings Law Firm, LLC are trusting, compassionate, and work hard to diligently fight for your rights. We are a team of award winning lawyers. We will make sure that your case is on track so that you get all the medical and financial benefits that you deserve. Contact us today for a free consultation. We have helped thousands of people– let us help you today. Call us today at 803-350-9230 for a free consultation.
Answer: After 90 days of the injury!
You may have heard this in connection of an accident you had at work from your employer or their insurance carrier.. “I’m sorry because you did not report your injury immediately on the day it happened your claim has been denied and Worker’s Comp. cannot cover you.” If you have heard this from an insurance company or an employer please know that this is not the law.
Although timely reporting of an injury may help your claim, South Carolina workers compensation laws only require that reporting of an accident and injury to the employer within 90 days of the date of the accident. In another words…immediately means within 90 days, regardless of the employer’s policies or rules. This 90 day rule cannot be changed or altered by an employee policy or handbook. If you fail to give notice to your employer within 90 of the accident, you could lose your right to recover any workers compensation benefits.
We find that many individuals who are injured on the job are hopeful the injury will simply go away in a few days and never report it for that reason. Often these hard working individuals are more concerned with getting the job done than taking care of themselves. Sometimes the injured employee is even bullied into thinking if they report it they will be hurting the company or jeopardizing their job. Often they will work until the job is completed that day in the hopes that taking a couple days off or easing off the amount of work they’re doing for the next week will somehow allow an orthopedic type injury to heal. Unfortunately, the injured workers intent is actually focused on helping the employer however the delay will likely provide ammunition for the insurance company to deny your case. Don’t let that happen to you. Know the law and know the attorneys who know the law. For free consultation please contact the Goings Law Firm, LLC at 803-350-9230. Let us help you get the benefits you deserve under the law.
Question: Do I have to use the workers comp insurance doctor?
This is a question that we often hear from individuals who are dissatisfied with the medical care they been receiving from their employer’s worker’s compensation insurance carrier. For individuals who choose to go through this legal process by themselves the answer is most likely yes….you are stuck with their doctor. To those who seek the proper legal representation the answer and the outcome can be quite different.
The South Carolina Worker’s Compensation Act provides that individuals who are injured while working on the job are entitled to medical benefits. These benefits need to be provided at no expense to the injured worker. At first blush, the Workers Compensation Act provides that those individuals seeking medical treatment must receive treatment initially from a doctor provided by the employer and their worker’s compensation insurance carrier. That medical treatment must continue until it lessens the period of disability or the insurance doctor has placed you at maximum medical improvement (“MMI”). Similar to how your car’s damage is devalued instantly in an automobile accident by the insurance carrier, some injured workers find the insurance carrier’s physician devalue their injuries as well. This process often leads to months of frustration treating with a physician who will not listen to their needs or hastily rushes them out the door to end treatment.
If you have the proper legal representation, however, the process may be very different. Prior to my representation of injured workers, I worked as counsel for 14 years representing workers compensation insurance carriers. I have worked with some excellent carriers and physicians and unfortunately have seen firsthand some of the struggles injured workers face when paired with some carriers and physicians who do not care. My unique perspective allows me to know which physicians to steer away from and how to utilize the insurance industry standards and protocols for changing medical providers. We work, using the law, to obtain second opinions provided by the carriers or through our own means to allow our clients to get the best medical treatment that they need. Let me see if I can provide you that same medical treatment. For free consultation on your workers compensation claim, call me at 803-350-9230.
Answered by Christian E. Boesl, Manager of the Workers’ Compensation Department
“I thought I was entitled to pay while I was out of work?”
Answer: It’s the 7/14 Rule
Every day we get asked… “I thought I was entitled to pay while I was out of work?” Our response is always the same “It’s an easy rule and I have no idea why the insurance carrier hasn’t paid you.” The reality is the Workers’ Compensation Act in South Carolina provides a very clear rule of law…injured workers are entitled to 2/3 of their gross pay (temporary total disability [TTD] benefits) while out of work from a work injury. I call it the 7/14 rule. South Carolina Coda Ann. 42-9-200 provides that once an injured worker has been out of work 7 days (does not have to be consecutive) they are entitled to start receiving 2/3 of their average weekly wages (gross). Starting the 8th day that worker is entitled to start receiving compensation from the insurance carrier.
If the injured worker is out of work the 8th through the 14th day they will receive benefits for each of those days. If the injured worker has not gotten better by the 15th day the insurance carrier has to go back and provide payment for those first 7 days that were not paid.
For the first 150 days from the reporting of the accident by the employee to the employer Weekly benefits will need to continue until the treating physician has released them to go back to work full duty (no restrictions) or they have been released to some type of light duty and the employer can accommodate those restrictions. If you have not been released or your employer cannot accommodate then the carrier has to continue to provide the payment of “timely benefits.”
The second 150 days is a crucial and often misunderstood or just blatantly ignored rule by insurance carriers as well. After 150 days has run on your claim and if you have not returned to work, the insurance carrier cannot turn stop off your benefits, even if they offer light duty or get their doctor to release you full duty (SC Code Ann. 42-9-260). Stoppage of your weekly benefits can only come by way of a signed Order by the Commissioner. As with the failure to start benefits we see often the same mistakes made by insurance carriers who fail to keep benefits running as required by the law.
Do you have Questions about Not Getting Paid by Workers Compensation for an On the Job Injury?
Let us help you navigate through and around some of the insurance carrier obstacles preventing you from receiving the full benefit of the law. If you need answers as to why you are not getting paid by the insurance carrier if you have been injured on the job, please contact the Goings Law Firm, LLC today and ask to speak with Workers Compensation Attorney Christian Boesl. The call is free to see if we can help you– workers compensation claims are tricky and you may need to hire an experienced lawyer in South Carolina to protect your legal rights.
The Goings Law Firm, LLC is pleased to announce that Columbia Workers Compensation attorney, Christian Boesl has joined the firm as Of Counsel. Christian will be managing the expanding workers’ compensation practice at the Goings Law Firm, LLC. We are blessed to have him as a valuable member of the team. More to come about Christian Boesl!