Does Workers' Compensation Cover Emergency Room Visits?

If you were hurt at work and ended up in the emergency room, you’re likely wondering if workers’ compensation will pay for that visit. The good news is, in South Carolina, workers’ compensation generally does cover emergency room visits for injuries that happen on the job. Your employer’s workers’ compensation insurance should also cover the care you need to recover, whether it is a quick fix or something more serious like a broken bone, burns, or worse.

But workers’ comp claims can be complicated. How do you know if you’re being treated fairly? If you’re uncertain about your next steps, talking to a South Carolina workers’ compensation lawyer can make all the difference in ensuring you get the benefits you deserve. At Joye Law Firm, our experienced workers’ compensation team is here to take the burden off your shoulders, so you can focus on healing.

Workplace Injuries and Emergency Care

Workplace injuries can happen to anyone, no matter how careful you are. From slips and falls to equipment malfunctions, accidents often occur without warning. When you’re hurt at work, the priority is always getting medical attention as quickly as possible. Sometimes, that means heading straight to the emergency room.

Emergency rooms treat immediate and severe injuries, like head trauma, spinal damage, or cuts requiring stitches. Workers’ compensation is designed to pay for necessary medical care related to your workplace injury, and this includes the emergency treatment you need.

However, it’s essential to follow the steps outlined by the South Carolina Workers’ Compensation Commission (SCWCC) to ensure all your medical treatment is covered—otherwise, you may be responsible for the costs yourself.

If you’ve been injured at work and require emergency care, prioritize getting medical attention first and inform your employer as soon as possible.

When at the ER, be sure to inform the medical staff that your injury occurred on the job. This ensures your medical records reflect that you sought treatment for a work-related injury, which is essential for securing workers’ compensation coverage for the visit.

If the ER refers you for follow-up treatment, do not assume it is automatically approved. Before scheduling any additional appointments, check with your employer or their representative to confirm that the treatment or physician is authorized.

Common On-the-Job Injuries in Workers’ Compensation Claims

Workplace injuries can happen in any industry, whether you’re working on a construction site, in an office, or driving a company vehicle. Workers’ compensation is designed to provide benefits for employees who suffer injuries or illnesses related to their jobs. While every case is unique, some injuries are more frequently seen in workers’ comp claims.

Sprains and Strains

Sprains and strains are among the most common injuries covered by workers’ compensation. These injuries often occur due to overexertion, such as lifting heavy objects, repetitive motions, or awkward movements. Back strains, for instance, are particularly common in jobs that require heavy lifting.

Fractures and Broken Bones

Slips, trips, and falls are leading causes of workplace accidents, often resulting in broken bones. These injuries can range from minor fractures to severe breaks requiring surgery, the installation of plates and pins, and extensive rehabilitation. Falls from heights, such as ladders or scaffolding, frequently result in broken bones and other serious injuries.

Head and Brain Injuries

Traumatic brain injuries (TBIs) can occur when a worker’s head strikes an object or if they fall. Even a mild concussion can have long-term effects, while severe brain injuries may lead to permanent disability. Construction, manufacturing, and transportation workers are especially vulnerable to these types of injuries.

Cuts and Lacerations

Workers who use sharp tools or machinery, such as construction workers or chefs, are at higher risk of cuts and lacerations. If severe, these injuries may require stitches or surgery or even lead to nerve damage or amputation.

Burns

Burn injuries are common in workplaces where workers are exposed to heat, flames, chemicals, or electricity. Thermal burns often occur in kitchens or industrial environments, while chemical burns can happen in labs or manufacturing facilities.

Repetitive Strain Injuries (RSIs)

RSIs develop over time due to repeated motions or tasks. Common RSIs include carpal tunnel syndrome, tendonitis, and bursitis. These injuries frequently occur in office jobs, factory work, and other roles requiring repetitive hand or wrist movements.

Respiratory Illnesses

Workers exposed to harmful fumes, chemicals, or dust may develop respiratory illnesses, such as asthma, chronic obstructive pulmonary disease (COPD), or even lung cancer. Industries like construction, manufacturing, and mining often pose these risks.

Hearing Loss

Prolonged exposure to loud noises in environments like construction sites, factories, or airports can lead to permanent hearing loss. Workers’ comp may cover hearing aids and other treatments for hearing damage caused by workplace conditions.

Soft Tissue Injuries

Soft tissue injuries affect muscles, ligaments, and tendons and often result from overexertion or sudden movements. Examples include whiplash, rotator cuff tears, and strained neck muscles. Soft tissue injuries can be painful and limit a worker’s ability to perform their job.

Vehicle-Related Injuries

It’s not surprising that workers who drive as part of their job may be involved in crashes. These accidents can cause severe injuries, including spinal damage, fractures, or internal injuries.

Amputations

Severe accidents involving heavy machinery or sharp tools can lead to the loss of a limb. These life-altering injuries require extensive medical treatment, rehabilitation, and prosthetics. Workers who experience amputations often qualify for significant workers’ comp benefits. They may have a third-party claim if the injury was due to faulty equipment.

Workplace Violence Injuries

Violence in the workplace, whether from co-workers, customers, or other individuals, can result in physical injuries, such as broken bones, bruises, or even gunshot wounds. Workers’ comp may cover injuries resulting from these incidents, depending on the circumstances. For example, attorney Sophie Dieckhaus at Joye Law Firm secured $50,000 for a nursing aide who was attacked by her patient, causing significant injuries to her shoulder and back.

What Should You Do After a Workplace Accident?

Even if you’ve already received emergency care, there are steps you need to take to ensure your workers’ compensation claim stays on track:

Report the Injury to Your Employer: Tell your employer or supervisor about the accident as soon as possible. Although not required, it is always a good idea to do this in writing. South Carolina law requires that you notify your employer within 90 days of the injury. But the sooner, the better.
Follow Up with an Approved Doctor: Workers’ comp typically requires you to see a doctor chosen by your employer or their insurance company after your initial emergency treatment. Keep all appointments and follow the doctor’s recommendations.
Document Everything: Save any paperwork from the ER, including bills, discharge instructions, or notes about your treatment. These records can be helpful later.
Contact a Lawyer: Workers’ comp claims are complex, and insurance companies may not always act in your best interest. A lawyer can make sure your rights are protected and handle the legal process for you.

[Process of a Workers’ Comp Claim]

Why Having a Lawyer Strengthens Your Claim

Navigating workers’ compensation laws alone can feel overwhelming especially when recovering from an injury. Hiring a lawyer means you don’t have to worry about legal deadlines, paperwork, or fighting with insurance companies. At Joye Law Firm, we handle everything for you, including:

Filing your workers’ comp claim
Ensuring you receive all benefits you’re entitled to
Communicating with the insurance company to prevent delays or denials
Helping you obtain authorization for a second medical opinion if your treating physician assigned by the insurance company is not taking your concerns seriously
Representing you in appeals if your claim is denied

Our team also looks for opportunities to maximize your compensation. For example, we’ll check if a third-party personal injury claim might apply in your case.

What Is a Third-Party Claim?

While workers’ comp provides benefits for on-the-job injuries, it also prohibits you from suing your employer for additional compensation. But in some cases, another party may share responsibility for your injuries. That’s where third-party claims exist.

A third-party claim allows you to pursue compensation from someone other than your employer. For instance:

If a defective machine at work injured you, you might have a claim against the manufacturer.
If a careless driver hit you while you were making deliveries, you could file a claim against that driver.
If you were hurt at a job site controlled by another company, that company might be liable.

You can file a workers’ comp claim and a third-party claim at the same time. Workers’ comp covers your immediate medical bills and lost wages, while a third-party claim can provide additional compensation for pain and suffering, future medical expenses, and other damages not covered by workers’ comp.

How Does a Lawyer Identify Third-Party Claims?

Experienced workers’ comp lawyers dig deeper into the details of your accident. At Joye Law Firm, we investigate your case thoroughly to uncover all potential sources of compensation. This includes:

Reviewing Safety Records: Were safety protocols followed? If not, another party may have been negligent.
Interviewing Witnesses: Co-workers, contractors, or bystanders may have information that points to third-party liability.
Working with Experts: Engineers, medical professionals, or workplace safety specialists can help us build a strong case for additional compensation.

We aim to secure the maximum recovery for your injuries, which could mean pursuing both a workers’ compensation and a third-party claim.

What Happens If Your Workers’ Comp Claim Is Denied?

A denial of your workers’ compensation claim can be a frustrating and disheartening experience especially when you’re trying to recover from a workplace injury. However, a denied claim doesn’t mean the end of the road. With the help of an experienced workers’ comp lawyer, you can appeal the decision and fight for the benefits you deserve. We help people fight unfairly denied claims every day.

Common Reasons for Workers’ Compensation Denials

Workers’ comp claims can be denied for several reasons, including:

Disputes Over Whether the Injury Was Work-Related: Insurance companies may argue that your injury didn’t happen on the job or wasn’t related to your work duties. For example, they might claim that your injury occurred outside of work hours, during a personal activity, or due to a pre-existing condition.
Failure to Follow Reporting Procedures: South Carolina law requires workers to report workplace injuries to their employer within 90 days. The insurance company might deny your claim if you missed this deadline or didn’t provide enough details when reporting the incident.
Allegations of Fault or Misconduct: Some insurers may allege that you were responsible for your injury by violating workplace rules, engaging in horseplay, or being under the influence of drugs or alcohol. These claims can be used to deny benefits.
Lack of Medical Evidence: If the insurance company believes your medical records don’t sufficiently prove your injury or its connection to your work, they may deny your claim.
Claim Was Filed After Termination or Resignation: If you filed your claim after leaving your job, the insurer might argue that your injury wasn’t related to your employment, even if it clearly was.

How a Lawyer Can Help You Appeal a Claim Denial

An experienced workers’ comp lawyer knows how to challenge these denials effectively. At Joye Law Firm, we handle every aspect of the appeals process, including:

Gathering Evidence to Prove Your Claim

We work to collect documentation, such as medical records like your emergency room visit, accident reports, witness statements, and photos or videos of the incident. This evidence helps establish that your injury occurred at work and was directly related to your job duties.

Filing a Formal Appeal

If your claim is denied, we help you file an appeal with the South Carolina Workers’ Compensation Commission (SCWCC). This involves preparing all necessary paperwork, meeting deadlines, and submitting your appeal correctly.

Challenging the Insurance Company’s Claims

If they argue the injury wasn’t work-related, we provide evidence of how your job duties directly caused or contributed to the injury.
If they claim you failed to report the incident on time, we show how and when you informed your employer or explain any reasonable delays.
If they allege misconduct, we examine the facts to disprove these accusations and demonstrate your right to benefits.

Representing You at Hearings

Your case may go before a workers’ compensation commissioner during the appeals process. We will represent you at hearings, present your evidence, and argue your case to show why your claim should be approved. In some cases, disputes may be resolved through mediation rather than a formal hearing. We handle all negotiations to seek a favorable resolution.

If the commissioner denies your appeal, we can take your case to the South Carolina Workers’ Compensation Appellate Panel and, if necessary, to the state courts.

Securing Expert Testimony

We work with medical experts and workplace safety professionals to strengthen your case when needed. Their testimony can be critical in proving the severity of your injuries and their connection to your job.

Why You Shouldn’t Navigate the Appeals Process Alone

Appealing a workers’ comp denial can be complex and time-consuming. It requires a deep understanding of South Carolina workers’ comp laws, strong evidence, and effective advocacy. Trying to handle it on your own while recovering from an injury can feel impossible.

At Joye Law Firm, we take the weight off your shoulders by managing the entire process. We’re here to fight for the benefits you need to cover medical bills, lost wages, and other costs related to your injury.

Contact Joye Law Firm for Help with Workers’ Compensation

When recovering from a workplace injury, legal red tape is the last thing you should worry about. At Joye Law Firm, we take care of everything so you can focus on getting better.

Whether you need help with a workers’ comp claim, a third-party lawsuit, or a claim denial, our team of trial lawyers is here for you. We’ve helped countless South Carolinians get the benefits and compensation they deserve, and we’re ready to do the same for you.

Contact us today for a free consultation and let us start building your case. You can reach us through our online contact form or by calling us directly at 888-324-3100.