Filing a workers’ compensation claim can be a complex process, but it is essential for securing the financial support and medical care you need following a work-related injury or illness. 

Continue reading to learn how to file a claim and what to expect during the claims process.

1. Report the injury or illness to your employer

The first step in filing a workers’ compensation claim is to report the injury or illness to your employer as soon as possible. Be sure to provide all relevant details, including the incident’s date, time, location, and circumstances.

Bear in mind:

a. South Carolina has its own reporting deadline, which requires reporting within 90 days

You are typically required to report your injury or illness to your employer within 90 days of the incident or diagnosis. Reporting as soon as possible is essential to ensure a smooth claims process and minimize potential disputes.

b. Failure to report the injury or illness promptly may result in a denial of benefits

You must report the injury within the 90-day deadline to avoid losing your eligibility for benefits.

To avoid this situation, inform your employer as soon as you become aware of your injury or illness. Follow up with any necessary documentation and medical evidence to support your claim.

c. Your employer is responsible for providing you with the necessary claim forms and guidance

Your employer plays a significant role in the workers’ compensation process in South Carolina. They are responsible for providing the necessary claim forms and guidance to help you navigate the process.

After you report your injury or illness, your employer should provide you with the appropriate forms and instructions on completing and submitting them.

If you encounter any difficulties or have questions about the process, contact your employer or our Columbia workers’ compensation attorneys to ensure your claim is handled correctly and efficiently.

2. Seek medical treatment

Obtaining appropriate medical care is crucial for your recovery and documenting the extent of your injury or illness. Be sure to inform the healthcare provider that your injury or illness is work-related.

Bear in mind:

a. Your employer or their insurance company may require you to see an approved medical provider

Your employer or their insurance company may have specific requirements when choosing a medical provider for your work-related injury or illness. They may direct you to an approved medical provider for an initial evaluation and treatment.

Following these guidelines ensures your medical care is covered under workers’ compensation and avoids potential disputes with your employer or their insurance company.

b. Keep records of all medical treatments, expenses, and diagnoses

Maintaining accurate records of all medical treatments, expenses, and diagnoses related to your work-related injury or illness is crucial in the workers’ compensation process.

These records can serve as vital evidence to support your claim and ensure you receive the appropriate benefits.

Make sure to keep copies of medical bills, prescriptions, therapy appointments, and other relevant documentation.

Additionally, request written reports from your healthcare providers detailing your diagnoses, treatments, and progress to help build a strong case for your claim.

c. Follow your healthcare provider’s recommendations to support your claim and recovery

Adhering to your healthcare provider’s recommendations is crucial in both supporting your workers’ compensation claim and promoting your recovery.

Following their advice regarding treatments, medications, physical therapy, and any necessary work restrictions can demonstrate the legitimacy of your claim and ensure that you receive the appropriate benefits.

Additionally, complying with your healthcare provider’s recommendations can aid in your recovery process, helping you return to work as soon as possible.

If you have any concerns or questions about your medical care, discuss them with your healthcare provider or consult a workers’ compensation attorney.

3. Follow South Carolina’s work injury laws

After reporting the injury or illness to your employer, it’s essential to follow the procedures outlined by South Carolina’s workers’ compensation laws.

Key points to remember:

a. Be thorough and accurate when providing information about your injury or illness

It’s crucial to give all relevant details, including specifics about your injury or illness, employment, and medical treatment. Inaccurate or incomplete information can lead to delays in the process or even result in a denial of benefits.

b. Retain copies of all relevant documents and correspondence

Keeping copies of all pertinent documents such as medical records, receipts for expenses, and any correspondence with your employer, their insurance company, or your attorney is crucial. These records can help track the progress of your claim, provide evidence if disputes arise, and serve as a reference if additional information is required.

c. Comply with the timelines set by South Carolina workers’ compensation laws

In South Carolina, you generally have two years from the date of the injury or the date you reasonably should have discovered the occupational disease to file a claim. It’s critical to comply with these timelines to ensure the success of your claim.

4. The claims evaluation process

Once your injury has been reported, the insurance company will review the information provided and make a determination regarding your eligibility for benefits. This process may involve gathering additional information, such as medical records, statements, and witness accounts.

Key points to remember:

a. The insurance company may approve or deny your claim or offer a settlement

After the insurance company has evaluated your claim, they will decide whether to approve or deny your claim or offer a settlement. Carefully review any settlement offers and consult with an attorney to ensure the terms are fair and adequately address your needs.

b. If your claim is denied, you can appeal the decision through the South Carolina Workers’ Compensation Commission

The appeals process may involve attending mediation, presenting evidence at a hearing, and possibly further appeals to higher authorities. It’s important to understand the specific deadlines and procedures for filing an appeal in South Carolina.

c. Maintain open lines of communication

Keep all parties informed about your medical progress, work restrictions, and any changes in your circumstances. Staying engaged in the process can help ensure a smoother process and minimize potential disputes.

In addition, actively seeking updates can demonstrate your commitment to recovering and returning to work, which can be beneficial in securing a favorable outcome for your claim.