Insider insights: What you need to know to expedite your claim

By: Attorney Danny Vega

The question I get asked most often as a workers’ compensation attorney is: “Why did my claim take so long?”

Most people go to work every day assuming their day will be like most other days, never thinking today is the day they’ll get hurt at work. When it does happen, however, life can suddenly be flipped upside down. 

Suddenly, you may be wondering: How bad am I hurt? How long will I be out of work? How will I be able to pay my bills? 

You go to the boss-man for answers (maybe HR), and suddenly they tell you, “Now hold on a minute, we don’t know for sure we are responsible for your injury!”

Wait a minute, you think to yourself, I thought work comp was a no-fault system? Then you think, Isn’t work comp there to help me? Are they saying I may not get workers’ compensation benefits? And it is at this moment you say to yourself, “Maybe I better hire me a lawyer!”

If you come to me with these questions, I can tell you the official answer is that when the General Assembly of South Carolina created the workers’ compensation system in 1935, they thought they were creating a system that would prevent hardship to both the injured employee and the employer. Great! 

But the next question then is, “How quickly can we get this done?”

The entryway into the workers’ compensation system is a workers’ compensation “injury.” However, you must demonstrate it is an “injury by accident in the course and scope of employment.” And to the extent you may need to file a claim, you will have to demonstrate to all involved, including your employer, the insurance adjuster, and even possibly a commissioner, each and every one of the elements of that sentence.

You must demonstrate what happened was an “accident.” That there is an “injury” resulting from the accident. That you were “working” or doing “work” when you were injured. But if your employer and/or their insurance carrier believe any one of these elements is missing, you may get a denial of benefits. Which is why your employer originally said to you, “Now hold on a minute…”

How to increase your chances of receiving workers’ comp benefits quickly

While I don’t have enough space or time to explain everything necessary to help an individual with a denied claim, here are a few things you can do to ensure you have a chance of getting benefits quickly:

1. First and foremost, tell your employer about the accident as soon as possible. Tell the line leader, supervisor, manager, HR, or whoever will listen as soon as you can. I can tell you from experience that people who hesitate because they think to themselves, I’ll be ok or Maybe I can sleep it off usually regret doing so. The sooner you inform your employer of the injury, the better. 
2. Right after telling your employer about the injury, ask to see a doctor right away. By doing so, you have already done 2 of the most important things you can do to help establish your claim. You now have documented both the accident and the injury.
3. The next most important thing you can do to help yourself is document, document, document all of your activities. Keep records of your calls, texts, emails or other forms of communication. Keep copies of every piece of paper you get related to the claim from your employer, insurance company and doctor’s office. Make notes on a calendar or notebook. Keep all of this information together.
4. Lastly, call an experienced workers’ compensation attorney within 10 days of the accident. You may need a few days to get well and compose yourself, but waiting a long time to file the claim will not help you.

FAQs

How much does workmans comp pay in South Carolina?

The amount that workers’ compensation pays in South Carolina can vary depending on several factors, such as the severity of the injury, the employee’s average weekly wage, and the specific circumstances of the case, but here are some general guidelines:

• Temporary total disability (TTD). If you’re temporarily unable to work due to your injury, you may be eligible for TTD benefits. These benefits are generally two-thirds of your average weekly wage, up to a maximum amount set by the South Carolina Department of Employment and Workforce, which is $1,035.78 for accidents occurring on or after January 1, 2023.
• Temporary partial disability (TPD). If you can return to work but are limited in the type of work you can do or the number of hours you can work, you may be eligible for TPD benefits. These benefits aim to make up the difference between your earnings before the injury and what you can earn in a limited capacity after the injury. The rate is typically two-thirds of the difference between your pre-injury and post-injury wages, up to the maximum amount set by the state.
• Permanent partial disability (PPD). If you have a permanent disability but can still work in some capacity, you may receive PPD benefits. The amount will depend on the body part affected and the degree of impairment (as indicated by your impairment rating).
• Permanent total disability (PTD). For severe injuries that result in a total inability to work, PTD benefits may be provided, often at a rate similar to TTD benefits but for a longer duration.
• Medical benefits. Workers’ compensation generally covers all necessary medical treatment, including surgeries, medications and rehabilitation services.
• Death benefits. If an employee dies due to a work-related injury or illness, death benefits may be paid to the employee’s dependents. These typically include funeral expenses and compensation for dependents, often at the TTD rate.
• Lump-sum settlements. In some cases, workers opt for a lump-sum settlement instead of ongoing payments. The amount is subject to negotiation and must be approved by the South Carolina Workers’ Compensation Commission.

Keep in mind that South Carolina law can change, and each case is unique. Therefore, it’s essential to consult a workers’ compensation attorney for advice tailored to your specific situation.

What is the statute of limitations for workers’ compensation in South Carolina?

In South Carolina, the statute of limitations for filing a workers’ compensation claim is generally 2 years from the date of the injury. This means you have 2 years from the date you were injured at work to file a claim for workers’ compensation benefits. Failing to file within this timeframe can result in the forfeiture of your right to claim benefits.

There are some exceptions and nuances, such as occupational diseases or conditions that develop over time, like carpal tunnel syndrome, hearing loss and arthritis. In those cases, the statute of limitations may begin from the date you discovered or should have discovered the condition and its work-related cause.

If you’re close to the deadline or have specific concerns about the statute of limitations in your case, it’s crucial to consult with an experienced workers’ compensation attorney to ensure you don’t miss any critical deadlines that could jeopardize your claim.

Can you be fired while on workers’ comp in South Carolina?

In South Carolina, it’s generally illegal for an employer to terminate an employee just because they filed a workers’ compensation claim. This protection is designed to prevent retaliation against employees who are exercising their right to seek benefits for work-related injuries or illnesses. However, this does not make your employment “bulletproof” while you’re on workers’ compensation.

Employers can still terminate employees on workers’ compensation for other legitimate reasons, such as company-wide layoffs or if the employee has engaged in misconduct. Additionally, if you’re unable to perform your job duties even with reasonable accommodations and your absence creates an undue hardship for your employer, they may have a valid reason for termination.

Because this is a complex area of law, if you’re facing termination while on workers’ comp, it would be wise to consult with an attorney experienced in workers’ compensation and employment law to review the specifics of your situation.

Can workers’ comp stop paying without notice in South Carolina?

In South Carolina, workers’ compensation benefits should not be stopped without appropriate notice and a legitimate reason. Generally, benefits can be terminated in specific circumstances, such as:

• You return to work.
• A physician clears you to go back to work.
• You reach “maximum medical improvement,” meaning your condition is not expected to improve further.
• You fail to comply with medical treatment or other requirements set forth by the workers’ compensation laws.

If benefits are stopped without proper notice or justification, it may be in violation of South Carolina’s workers’ compensation laws. Employers and their insurance carriers have specific protocols and forms they must complete to cease benefits. If your benefits are stopped suddenly, it’s advisable to immediately contact a workers’ compensation attorney to understand your rights and options.

Note that even if your benefits are stopped, there may be avenues for appeal or other actions to reinstate them. Each case is unique, so legal advice is often necessary to navigate the complexities of the workers’ compensation system.

How long does it take to get a workers’ comp settlement check in SC?

The time it takes to receive a workers’ compensation settlement check in South Carolina can vary widely depending on the specifics of your case. Once a settlement is reached and approved by the South Carolina Workers’ Compensation Commission, it typically takes about 30 days for the settlement funds to be disbursed. However, several factors can affect this timeline:

• Approval process. Even after a settlement is agreed upon, it must be approved by the Workers’ Compensation Commission, which adds time to the process.
• Insurance company delays. Administrative delays on the part of the insurance company can also add to the wait time.
• Legal formalities. Completing the necessary paperwork and legal procedures can also affect how quickly you receive your settlement.

If you still haven’t received your settlement check after a couple of months and you’re concerned about how long it’s taking, consult with your workers’ compensation attorney for advice tailored to your specific case.

Get the help and advice you need from the attorneys at Smith, Born, Leventis, Taylor & Vega

If you have questions about or need advice on your workers’ comp claim, get the help of an experienced attorney like our attorneys at Smith, Born, Leventis, Taylor & Vega as quickly as possible, and we will help you get the benefits you need to survive what may be one of the most difficult experiences you have in your life.

Contact our office today to schedule a free consultation.

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