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FREQUENTLY ASKED QUESTIONS
What is workers’ compensation?
Workers’ compensation is a state system that pays for necessary medical treatment, loss of wages during a period of disability, and compensation for permanent disability or disfigurement when an employee sustains personal injury or death by accident arising out of and in the course of his or her employment.
Is my employer required to cover me with workers’ compensation benefits?
Essentially, yes. The rule of thumb is that any employer who regularly employs four or more workers full-time or part-time is required to have workers’ compensation insurance. There are some exceptions, including agricultural employees, railroads, and railway express companies and their employees, and employers who had a total annual payroll during the previous year of less than $3,000, regardless of the number of workers employed during that period. Also exempt are Textile Hall Corporation and certain commission paid real estate agents.
Although most employers must purchase workers’ compensation insurance, any employer may purchase coverage.
What must I do if I get injured on my job?
You must report all injuries at work to your employer immediately and request medical treatment, if needed. If you neglect to report the injury within 90 days of the accident you may lose your rights to workers’ compensation 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 worker’s dependents, or parents if there are no dependents, must file a claim within two years of the death to claim benefits.
What is my employer required to do if I get injured on the job?
The employer’s first obligation is to make sure that you receive medical attention. The employer is also required to report the injury to the insurance carrier, which reports it to the Commission. Minor injuries, as defined by the Commission, do not have to be reported.
What medical treatment am I entitled to receive if I suffer a workplace injury?
You are entitled to all necessary medical treatment that is related to your work injury and is likely to lessen your disability. Workers’ compensation generally pays for surgery, hospitalization, medical supplies, prosthetic devices, and prescriptions. Keep in mind that in order to receive these benefits you must go to the doctor chosen by your employer or its insurance representative.
Can my employer require me to pay for workers’ compensation insurance or some of my medical costs?
No. It is illegal to require employees to pay any portion of the premium for workers’ compensation insurance or to pay for any medical treatment resulting from a job-related injury.
Do I get reimbursed for my travel expenses under workers’ compensation when I go to the doctor?
Yes, if the round trip distance is more than ten miles from your home. You should be reimbursed for the round trip mileage at the rate allowed state employees for mileage. The current rate for mileage reimbursement is 54.5 cents per mile.
Will I get compensated for missing time from work because of my on the job injury?
There is a seven-day waiting period before benefits can be paid. If you are out of work for more than seven days, payments will come from your employer’s insurance representative. If you are out of work for more than 14 days, you will receive compensation even for the first seven days.
You can expect payments to be made directly to you and these should continue until the doctor releases you to return to work.
How much will I be compensated while I am out of work?
You are entitled to compensation at the rate of 66 2/3 percent of your average weekly wage based on the four quarters prior to your injury, but no more than the maximum average weekly wage determined each year by the South Carolina Employment Security Commission. If you were working two or more jobs at the time of accident, those wages may be included as part of the average weekly wage and compensation rate. For example, if we assume that you have an average weekly wage of $450, you will be paid at a weekly compensation rate of $300(66 2/3% x $450 = $300).
What is the maximum weekly workers’ compensation rate in South Carolina that can be paid to an injured employee?
The maximum workers’ compensate rate for accidents that occur on or after January 1, 2016 is $784.08. Generally, an individual must have earned $61,155.12 annually ($1,176.06 weekly) or more during the four quarters immediately preceding the quarter in which an accident occurs in order to be paid at the maximum compensation rate.
What must I do if the doctor releases me to light duty?
You must accept light work if it’s offered. If you do not accept, all of your compensation may be stopped as long as you refuse to return to work. You have a right to a hearing if you believe that you are not able to do the work assigned to you.
If you return to light work before you are fully discharged by the doctor at a wage less than you were earning at the time of your original injury, you are entitled to weekly compensation at the rate of the sixty-six and two-thirds (66 2/3%) percent of the difference between your average weekly wage and your new wage.
If you are released to return to work on light duty and your employer refuses to accommodate you or offer employment within your restrictions, you are entitled to continue receiving weekly work compensation benefits.
Can I get a second opinion if I am not happy with the doctor to whom the insurance carrier has referred me?
You can talk to the insurance carrier and see if he or she will allow you to go to another doctor, or you can request a hearing by completing Form 50 and then have a Commissioner make a determination on the case.
When are my workers’ compensation benefits terminated?
If within 150 days of your notification to the employer of your work-related accident, your doctor releases you to return to work with or without restrictions, the insurance carrier can stop your weekly compensation by filing a Form 15 with the Commission. You should receive two copies of Form 15 with Section II completed indicating that compensation has been stopped and setting forth the reasons for stoppage.
If the insurance carrier stops your compensation, and if you disagree, you can request a hearing before the Commission by completing Section III of the Form 15 and sending it to the Commission’s Judicial Department. The hearing will be held in approximately sixty (60) days.
If the Doctor releases you to return to work after the 150-day notification period, your employer or insurance representative will ask you to sign a Form 17, (receipt of compensation ) after you have been back to work for fifteen days. If you refuse to sign the Form 17, the employer or insurance representative must request a hearing before the Commission and get an order permitting him or her to stop paying you weekly compensation benefits.
What is a hearing?
The workers’ compensation commissioners conduct a hearing to resolve disputes between you and your employer’s representative. You may apply for a hearing if your employer does not report your accident, denies your injury by accident, or if you believe that you did not receive all your benefits.
What if I receive an impairment rating or have a scar as a result of an accident in the workplace?
When the doctor releases you with an impairment rating or if you have a non-surgical scar that can be seen at least eight feet away, you are entitled to an award of compensation for permanent disability or disfigurement. Your award is based on 66 2/3% of your average weekly pay before taxes and other deductions, up to a maximum amount set under the workers’ compensation law. This is called your compensation rate. In addition, many body parts have been assigned a value measured in weeks of compensation. For example, the complete loss of the use of an arm is valued as 220 weeks of compensation. Depending on the seriousness of your injury, the percent of disability or loss of use agreed to at the conference will be multiplied by the value of the injured body part and your compensation rate. If we assume that the injured worker has an average weekly wage of $450, the compensation rate would be $300(66 2/3% x $450 = $300). The worker would receive $6,600 for an injury that resulted in a 10% loss of use of the arm (10% x 220 weeks x $300 = $6,600).
What if my work-related injury totally and permanently disables me?
You can be compensated for total and permanent disability. The award for total disability or death is limited by law to 500 weeks of compensation. Paraplegics, quadriplegics, and brain-damaged workers are eligible for lifetime benefits. Compensation for disability is determined by the Commission from medical reports, testimony of the parties, and the impact of the disability on the injured employee’s livelihood. The loss of both hands, arms, feet, legs, or vision in both eyes, or a combination of two such losses, constitutes total and permanent disability. In addition, a commissioner can make other disability determinations based on the particular loss or impairment to the whole person.
Can I receive workers’ compensation benefits if I suffer an occupational disease?
The disability or death of an employee resulting from an occupational disease in South Carolina is treated as an injury by accident, and the employee, or in the case of death, the deceased’s dependents, may be entitled to compensation. A disease may be recognized as an occupational disease only if it is caused by a hazard recognized as peculiar to a particular trade, process, occupation, or employment as a direct result of continuous exposure to normal working conditions. In addition to occupational diseases, injury from harmful exposures to ionizing radiation is also defined for particular attention under the Workers’ Compensation Act. Some examples of occupational diseases are byssinosis suffered by cotton mill workers, silocosis suffered by granite workers, and asbestosis suffered by construction workers in certain fields, maintenance workers, and shipyard workers.
Who is an employee for workers’ compensation purposes?
The definition of an employee is quite broad. It includes full-time and part-time workers, adults and minors, and others who have been hired to do certain jobs. The critical test is the degree of control the employer exercises over the worker.
The law also recognizes “statutory employees.” These are employees who work for a subcontractor who may be working for a business or another contractor. Employers should inquire whether or not a subcontractor working for them has workers’ compensation insurance, regardless of the number of employees employed by the subcontractor. If the subcontractor does not, the subcontractor’s injured employees would be covered under the employer’s workers’ compensation insurance.
Is the owner of a business or the principal contractor on a job liable for workers’ compensation benefits to an employee or subcontractor?
Yes. If the subcontractor does not carry workers’ compensation insurance, then the owner or the principal contractor would be liable just as if the subcontractor’s employee was one of their employees.
Are volunteers covered under South Carolina’s Workers’ Compensation Act in the event of an injury?
No, unpaid volunteers are considered to be gratuitous employees, and are not subject to the Workers’ Compensation Act. Organizations that utilize volunteers can obtain coverage / insurance for volunteers.
Can I get fired from my job for filing a workers’ compensation claim?
It is illegal in South Carolina for your employer to terminate you in retaliation for filing a workers’ compensation claim. You can be fired, however, if you are injured while violating a specific company policy (i.e., not wearing safety equipment, intoxication, etc.) or if your doctor releases you to return to work with permanent restrictions that prevent you from meeting established employer work standards necessary to perform your job. For example, if your job description requires you to be able to lift 70 pounds and your physician places you on permanent restrictions which prevent you from lifting more than 30 pounds, you can be fired for not being to meet established employer work standards.
Do I need to get a lawyer?
You are not required to get a lawyer for a workers’ compensation claim; however, unless you are very familiar with the workers’ compensation laws and legal system, you can easily be taken advantage of. Regretfully, employers and insurance carriers are not in business to pay you fair compensation and provide you with costly medical treatment. Their job performance is based on how little they can get away with paying out on your claim. We recommend that you, at a minimum, consult a lawyer with extensive workers’ compensation experience before attempting to handle your workers’ compensation claim without legal representation. If you would like to discuss your workers’ compensation claim with Mr. Ernie Trammell, please call him at 1-800-483-0880 or complete the contact form.