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    Ken Harrell and Columbia SC Attorneys discussing a case

    Although workers’ compensation is designed to protect employees who are injured on the job, navigating the process can be confusing. From reporting your injury to filing the paperwork, one mistake can destroy your chance at benefits. That’s why consulting an experienced South Carolina workers’ compensation attorney as soon as possible after an accident is vital. Here’s a detailed look at the workers’ comp claim process:

     

    Report Your Workplace Injury

    Reporting your injuries to your employer is the first step to getting your claim started. South Carolina law gives you 90 days from the accident to notify your employer and still qualify for workers’ compensation benefits, with a few exceptions.

    These exceptions include situations where your employer already knew about the accident if you were physically or mentally unable to give notice, or if there was fraud or deceit involved. For repetitive injuries like tendonitis or carpal tunnel syndrome, the law says to notify your employer within 90 days of discovering the condition.

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    Filing a Workers’ Compensation Claim in South Carolina

    Typically, your employer will file the claim for you. But if they don’t, you can file it yourself with the South Carolina Workers’ Compensation Commission. You’ll need to submit a Form 50 by registered mail, or Form 52 if the case involves death.

    You can also file the claim on your own if your employer denies the injury, or if you believe you haven’t received all the benefits you deserve. Since the process can be complicated and has strict deadlines, it’s a good idea to consult an experienced South Carolina workers’ compensation attorney to make sure you get your full benefits.

    Workers’ Compensation Claim Filing Process

    Claim is Approved

    After your workers’ compensation claim is accepted your medical care will be covered by your employer’s insurance provider. This will allow you to move forward with healing from your injuries without having to worry about how to pay for it.

    Medical Treatment Begins or Continues

    Your employer’s workers’ compensation insurance provider will pay for all necessary medical treatment for your injury or illness. This includes doctor visits, surgeries, physical therapy, prescription medications, and any other treatments deemed necessary by your authorized treating physician.

    For your medical care to be covered, you must be treated by a medical provider chosen by the insurance company. If you feel you are not receiving adequate care, you can seek a second medical opinion. Keep in mind that any changes must be approved by the Workers’ Compensation Commission through a request, typically submitted by your attorney.

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    Begin Receiving Weekly Wage Replacement Checks

    If your claim is accepted and your injury prevents you from working, you will begin receiving weekly wage replacement checks. These benefits provide a portion of your wages while you recover. In South Carolina, the rate is two-thirds (66%) of your average weekly wages, up to the current state maximum.

    Some workers’ compensation benefits, like temporary or permanent disability payments, cannot be paid immediately. South Carolina Code § 42-9-200 prevents injured employees from receiving wage benefits for the first 7 days of their injury.

    If your injury is severe enough to keep you out of work for more than 7 days, you can start receiving wage benefits after the 8th day. If your injury is serious enough to keep you out of work for more than 14 days, you can retroactively receive benefits for those first 7 days.

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    Claim is Denied: Appealing a Workers’ Compensation Claim

    Many injured workers in South Carolina are surprised when their valid injury claims are denied. Employers and insurance administrators often deny claims for several reasons, many of which are mere technicalities. Common reasons for denial include:Businessman In Blue Jacket Giving Form For Compensation Claim To An Injured Man

    • Missed Deadlines
    • Off-the-Job Injuries
    • Not Seeing Your Approved Medical Provider
    • Misclassification
    • Improper Behavior
    • Pre-existing Conditions
    • Inadequate Proof of Injury

    If your claim is denied, don’t give up. You can – and should – appeal the decision. In South Carolina, your appeal will be heard by one of the seven commissioners on the Workers’ Compensation Commission. While you don’t have to have a lawyer, it’s smart to get one.  In addition to gathering other evidence, an attorney can help you obtain an Independent Medical Exam (IME). This can strengthen your appeal and help you better understand your treatment options.

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    Mediation

    In South Carolina, disputed and complex workers’ compensation claims, like those involving permanent and total disability, may be referred to mediation by a commissioner. Either the employee or employer can request mediation, too. Mediation must be completed within 60 days of the order unless otherwise agreed by the parties.

    During mediation, a neutral mediator uses communication and negotiation techniques with both sides to find a solution.

    What Happens at a South Carolina Workers’ Comp Mediation?

    In workers’ comp mediation, the mediator starts by meeting with everyone to discuss each side’s position. After that, the parties split into separate rooms, and the mediator goes back and forth to relay offers, demands, and information. Each side may present evidence, like medical records, to support their suggestions.

    If an agreement is reached, everyone signs a workers’ compensation settlement agreement that outlines the terms of the deal.

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    Workers’ Compensation Hearing in South Carolina

    If you believe your workers’ comp claim was wrongly denied or you didn’t get all your benefits, the next step is to request a hearing. This gives you a chance to present medical evidence and testimony to prove you deserve benefits.

    To request a hearing, you’ll need to file Form 50 with the South Carolina Workers’ Compensation Commission. The form asks for details like how the accident happened, your injuries, lost time from work, wages, medical needs, and more.

    Hearing Preparation: Depositions, Evidence, and Witnesses

    A hearing before a commissioner is like a quick, informal trial. To win your case, you’ll need to convince the commissioner that the original denial was made in error. Your employer’s workers’ compensation insurer’s lawyer will conduct a deposition, which is a sworn interview to learn what you plan to claim at the hearing. Your lawyer will help you prepare for this and will be there during the deposition.

    A few weeks before the hearing, your lawyer will submit key documents to the commissioner, such as the Form 58 Pre-Hearing Brief, witness lists, and other evidence. Medical evidence is often the most critical part. Your evidence must show that you were injured on the job, needed medical care, and whether the injury has impacted your ability to work.

    At the hearing, you’ll testify about how the injury happened and the impact it’s had on your life. Afterward, the defense lawyer will cross-examine you, but your lawyer will help prepare you for this. Once all the testimony and evidence is reviewed, the commissioner will issue a decision. It usually takes a few weeks, sometimes months, to get the decision.

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    Length of Workers’ Compensation in South Carolina

    Injured workers can get workers’ compensation benefits to cover medical bills, partial lost wages, and more without needing to prove their employer was at fault. Benefits can last up to 500 weeks, or even a lifetime for cases of permanent and total disability, such as paralysis or severe brain injury.

    Workers’ compensation benefits may end when your doctor clears you to go back to work, whether with restrictions or not. They may also stop when you reach maximum medical improvement.

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    Reach Maximum Medical Improvement

    In your workers’ compensation case, your doctor will eventually determine when you’ve reached Maximum Medical Improvement (MMI). MMI means that, in your physician’s assessment, your injury or condition is unlikely to improve further, even with additional treatment. This assessment is made after a thorough evaluation, taking into account your medical history, the treatments you’ve received, how you’ve responded to those treatments, and your current physical and mental condition.

    The MMI evaluation is a critical milestone in your claim, affecting the remaining time allowed for recovery, eligibility for long-term disability benefits, and any accommodations you might need upon returning to work.

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    Return to Work

    If your doctor clears you to return to work, you may go back to your job. You may have limited to modified duties or light duty, based on your medical restrictions. If your employer cannot accommodate your restrictions, you may continue receiving TTD benefits until suitable work becomes available or you reach MMI.

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    File for Additional Benefits

    Once you reach MMI, if you have a lasting impairment or disability, your doctor may assign a permanent impairment rating. This could qualify you for Permanent Partial Disability (PPD) or Permanent Total Disability (PTD) benefits.

    If eligible, you may continue to receive weekly checks or may choose a lump-sum settlement based on your impairment rating, the severity of your injury, and other factors related to your case.

    Permanent Partial Disability Benefits

    In some cases, an injury that causes a partial disability will never completely go away, and your earning power may be permanently reduced as a result. For instance, if you were working in a labor-intensive job, you may not be able to continue doing the same work. Although you might not be totally disabled and you could get a job elsewhere or doing something else, your income might be permanently lower as a result. If this is the case, then you could receive benefits for permanent partial disability.

    Many workers are not aware that these types of benefits exist since insurance companies and their lawyers aren’t going to voluntarily offer these benefits to you or even inform you about them. That’s why it is important to have your own lawyer assisting you as you settle your workers’ compensation claim.

    Total and Permanent Disability Benefits

    If your injuries are severe enough that no reasonably stable job market exists for you, you may qualify as totally and permanently disabled. This would entitle you to permanent disability benefits. Several factors help determine if a stable job market is available, including the nature of your injury, permanent physical restrictions, age, education, work history, and local economic conditions.

    For total and permanent disability claims, an experienced workers’ compensation attorney can arrange an evaluation with a vocational consultant to address these factors. Generally, benefits are limited to 500 weeks, except in cases involving a brain injury, paraplegia, quadriplegia, or other forms of paralysis, which may entitle you to lifetime benefits.
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    Third-Party Claims

    Workers’ compensation is a no-fault system, meaning you don’t have to prove negligence in order to receive benefits. However, workers’ comp has limits. The biggest one is that you can’t sue your employer for a work injury.

    In some cases, a third-party workplace injury claim may allow you to sue someone other than your employer if they are responsible for the accident. This type of lawsuit can get you compensation for things like pain and suffering, which workers’ comp doesn’t cover.

    It’s crucial to speak with an attorney to understand how these claims work together. Settling a third-party claim before workers’ comp could impact your benefits if you don’t follow the right steps.

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    Get the Legal Help You Need for Your Workers’ Comp Claim

    If you’re having trouble getting your workers’ comp benefits, contact Joye Law Firm for help. Our workers’ compensation attorneys fight to get injured workers the full benefits they need to recover and move forward. We have offices in North Charleston, Columbia, Clinton, Summerville, and Myrtle Beach, serving workers across South Carolina.

    Joye Law Firm has been advocating for injured workers in South Carolina since 1968.

    Our Managing Partner, Ken Harrell, and Workers’ Compensation Department Head, Matt Jackson, have both proudly served as Presidents of Injured Workers’ Advocates (IWA), the premier workers’ compensation organization for attorneys in South Carolina. Additionally, several Joye Law Firm attorneys have contributed their expertise by serving on the boards of IWA and the South Carolina Workers’ Compensation Educational Association (SCWCEA).

    To see how we can help, call (888) 324-3100 or fill out this online case evaluation form to schedule your free initial case evaluation.

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