Employees who are injured on-the-job in South Carolina may be eligible to receive a number of different types of benefits, including medical benefits, wage loss benefits, compensation for long-term disability or disfigurement, and more. Workers’ Compensation does not only compensate injured workers for injuries caused by traumatic accidents, but also for health conditions that are related to their occupation or workplace conditions, such as mesothelioma, carpal tunnel syndrome, and hearing loss.
Workers’ Compensation is a “no fault” insurance system. This means that when an employee is injured, if they elect to pursue benefits through the Workers’ Compensation system, they are not required to prove that their employer was somehow at fault for their injuries. They can be compensated regardless of who was at fault. The only thing that an eligible employee must establish is that their injury was work-related.
If you are injured at work or develop a work-related health condition, you should report it to your employer as soon as possible. Ideally, you should notify them in writing. Employees who fail to report their condition to their employer within a statutorily specified period of time may be ineligible for benefits. Once an injury has been reported, an employee has up to two years to file a claim for Workers’ Compensation benefits in South Carolina.
Types of Workers’ Compensation Benefits
If a worker is fatally injured on-the-job, their spouse, children, or other dependents may be eligible to receive death benefits, depending on the total compensation based on the employee’s average weekly wage, and funds that can help pay for an employee’s funeral expenses of up to $2,500. There are some exceptions to this rule. For example, if an employee received Workers’ Compensation benefits before their death, or if the death benefits are to be paid to nonresident aliens.
What Are You Entitled To?
Workers who are injured on the job or suffer a work-related illness or disease are usually entitled to their lost wages – 66.66 percent of the average weekly wage they were receiving prior to the injury – along with compensation for all of their essential related medical expenses. When a worker dies because of their work-related injury or illness, those benefits may be passed on to their survivors.
Eligible dependents can expect to receive compensation for funeral expenses and a percentage of their loved one’s weekly wages for up to 500 weeks from the date of the injury. However, if the deceased employee was receiving Workers’ Compensation payments prior to their death, the duration of payments may change. There are other exceptions as well, and for this reason, navigating the Workers’ Compensation system can be difficult. An experienced attorney can help to guide you and advocate for your rights.
Who Are Eligible Dependents?
To receive death benefits for a loved one who passed away due to a work-related injury or illness, the recipient must have been a dependent of – or “wholly dependent” on – the employee while they were living. Those who are considered wholly dependent include:
- Minor child
- Adult child who is enrolled full time at an accredited educational institution, and who is younger than 23 years old
- Adult child who is mentally or physically incapable of self-support
In addition to the above, illegitimate children, stepchildren, and other dependents may also qualify for benefits if they can prove that they were wholly dependent on the deceased for more than three months prior to their loved one’s passing. Additionally, if the deceased does not have any loved ones who were wholly dependent on them, those who were partially dependent may qualify for benefits, depending on their share of dependence. And, if there are any unutilized or remaining benefits, under certain circumstances, those funds will be distributed to any non-dependent children, or to the employee’s parents, or other relatives.
What if a Death Benefit Claim is Denied?
There are a few legitimate reasons a Workers’ Compensation death benefit can be denied to survivors. These may include:
- The employee died in the course of committing a serious crime
- The employer denies that the employee’s injury occurred on the job
- The employer claims that the employee was an independent contractor
- The employee’s injuries were intentionally self-inflicted
If there are any doubts or questions about the denial of a claim, your Workers’ Compensation lawyer can help to determine if you are eligible to receive benefits and handle any necessary appeals. When necessary, surviving parties can sue in court for the benefits to which they are entitled.
In South Carolina, most employees are eligible to receive medical benefits for illnesses or injuries sustained on-the-job through the Workers’ Compensation benefits. Workers’ Compensation is a no fault insurance system, meaning that injured employees do not need to prove that their employer was at fault in any way to receive benefits. They only need to demonstrate that their injury or illness is work related.
Injured employees are eligible to receive an array of benefits under the Workers’ Compensation system, including partial recovery for lost wages, potential vocational rehabilitation training, and medical benefits. An injured employee’s employer or their insurance company should pay for necessary and reasonable medical treatment stemming from the work-related injury. Treatment for pre-existing conditions could be covered under the program if a physician agrees the pre-existing condition has been permanently aggravated or exacerbated by the work injury.
All related medical costs covered include:
- Doctor’s visits
- Hospital stays
- Prescription copays
- Physical therapy
- Other necessary treatment
- Medical Mileage reimbursement for certain travel
Injured employees who visit a treatment provider of their own choosing may not be eligible to receive any medical benefits through the Workers’ Compensation system. However, if you visit the doctor or hospital chosen by your employer or their insurance representative, you will not have to pay any costs out of pocket. Rather, your employer or their insurer will pay your medical treatment provider directly.
Medical benefits are paid regardless of how long you are ill, or how extensive your injuries are. Medical treatment is automatic for a period of up to 10 weeks. After the 10 weeks, medical treatment can be authorized if the South Carolina Workers’ Compensation Commission determines that it will tend to lessen the employees’ period of disability. An employer can always elect to provide employees with additional treatment as needed.
Wage Loss Benefits
Employees who cannot work because they have been injured on-the-job will be eligible for wage loss benefits if unable to return to work for at least seven days. Those who are unable to work due to a temporary total disability lasting 14 days or more may be eligible to receive payment of lost wages back to the date that they were unable to work.
In South Carolina, disabled employees are eligible for two-thirds of their average weekly wages. This number should not to exceed 100 percent of the average weekly wage statewide as determined by the South Carolina Department of Employment and Workforce. Those who are able to work in some capacity, but who are earning less due to their injury, are eligible to receive two-thirds of the difference in wages, subject to the state maximum. These benefits continue until a Workers’ Compensation doctor releases the worker from benefits, clearing them to return to ordinary employment.
When you are injured on the job in South Carolina, workers’ compensation wage loss benefits can help supplement your income while you recover. In most cases, injured workers return to their jobs in a short period of time, but for others, recovery periods are longer. In either case, Workers’ Compensation wage loss benefits can help keep you and your family financially secure while you recover from your injury.
Claiming Work Loss Benefits
Depending upon the severity of your injury and resulting disability, your Workers’ Compensation claim may become complicated. Insurance companies and employers often disagree on what benefits and payments workers qualify for, which can hold up the process of receiving your benefits. An experienced and competent Workers’ Compensation lawyer can help you navigate through the complexities and expedite your benefits.
Injured workers in South Carolina receive an average weekly wage paid on a weekly basis. The amount of your benefit pay is approximately two-thirds of your weekly salary or earnings for the twelve months you worked prior to your injury. Benefits usually begin after a seven-day waiting period, but you will be paid for this waiting period if your injury prevents you from working for 14 days or more.
Permanent Disability and Disfigurement
For serious disfigurement to the face, head, neck, or other body parts that must be exposed for employment, a Workers’ Compensation judge may award up to 50 weeks of payment.
Vocation Rehabilitation Benefits
Injured workers who are unable to return to their normal job are eligible to receive certain services that can help them find new employment in a different line of work.
Personal Injury vs. Workers’ Compensation Claims
A single incident such as a slip and fall at work or an on the job car accident can give rise to several potential legal claims. If you have been injured on the job, an experienced Columbia Workers’ Compensation lawyer can help you strategize and bring the appropriate claim based on your unique situation. If the work injury was caused by an outside third party, the injured worker has three options: (1) The worker can file a workers compensation claim only; (2) the worker can file a personal injury claim only; or (3) the worker can file both claims. Typically, the worker obtains a more full recovery by filing both. However, in doing so, the claims must be filed in the proper order and certain forms must be served on the employer, the workers compensation insurance company, and the South Carolina Workers Compensation Commission. Filing the third party lawsuit or accepting a settlement from the third party without taking these steps can actually waive the workers compensation claim as an election of remedy.
Benefits in Personal Injury and Workers’ Compensation
Benefits payable in Workers’ Compensation claims include payment of medical expenses, two thirds of the worker’s average weekly pay while he is temporarily totally disabled, and an award for any permanent disability that can be shown.
These benefits are paid along as the claim progresses. In a personal injury claim any settlement or verdict is paid at one time at the end of the case. This can include compensation for medical expenses, lost wages, pain and suffering, loss of enjoyment of life, loss of consortium, and potentially punitive damages.
Burdens of Proof in Workers’ Compensation vs Personal Injury
In a Workers’ Compensation claim, the worker must prove that he suffered an injury that both arose out of his employment and was sustained in the course of his employment. Fault does not matter so it is not necessary to prove the employer caused the accident. In a personal injury claim, the injured party must show that the negligent actor had a duty and somehow breached that duty causing the accident. In South Carolina, an injured worker cannot file a personal injury claim against his employer no matter how negligent the employer may be. He does, however, have the right to proceed in a Workers’ Compensation claim which is known as his exclusive remedy.
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