In South Carolina alone, $8.62 million in medical bill payments and benefits have been paid out since 2017, yet the number of claims denied vs. approved is nearly identical. The highly experienced Charleston workers’ compensation attorney practice at Auger & Auger understands that these benefits should run through the insurance policy that every employer must provide.
The code regulations for the South Carolina State Workers’ Compensation Commission define the bylaws, which make provisions for injured employees who suffer an accident during their employment. The victim is entitled to medical expenses, compensation for lost time, and permanent disability resulting from a permanent work-related injury.
How Does Workers’ Compensation Work?
This is a common question. Many people generally understand that workers’ compensation is supposed to cover on-the-job injuries but don’t know the specifics of the system until they have an injury. Workers’ compensation is a no-fault system designed to provide relief to workers who get hurt on the job, so their medical expenses and lost income are paid. “No-fault” means that you don’t have to spend a lot of time proving the injury was your workplace’s fault, the way that you might have to prove negligence in a typical personal injury lawsuit. However, the insurance company that handles your company’s workers’ comp claims can still deny your claim for many reasons. If this happens, speak with a workers’ compensation lawyer immediately – you may still be able to recover your benefits.
What is Covered in a Workers’ Compensation Claim?
If you are hurt on the job, you are entitled to coverage for the following:
- Medical expenses. In South Carolina, your employer has the right to choose your doctor and approve your treatment – they should have a list of approved providers available. If you see a doctor who isn’t approved, the insurance company is not responsible for the charges unless your situation was an emergency. Your medical costs should be covered if you use a doctor appointed by your employer and get your treatments pre-approved. However, the insurance company can refuse to pay for treatment if they don’t believe it’s necessary or will “lessen the degree of disability.” We meet many clients struggling to get the necessary treatment approved, and we understand the frustration. Our attorneys will work to negotiate with the insurer to get you the treatment you need.
- Lost income. When your doctor says you can’t work due to your injuries, you should receive compensation under the workers’ comp system. You will receive two-thirds of your usual or average weekly earnings each week that you are out of work.
- Permanent and temporary disability. If you are permanently disabled, you can apply for permanent disability benefits. This is either based on specific injuries or on lost earning ability. For example, you will receive Permanent Total Disability if you lose feeling in both hands, arms, legs, feet, shoulders, hips, or vision in both eyes. These benefits are the same as lost income, two-thirds of your previous salary, and in many cases, a 500-week limit. Permanent partial disability benefits are based on a schedule where you receive so many weeks of disability pay depending on your losses, and benefits are paid at the same two-thirds rate. Temporary disability provides similar benefits until you are released by your doctor, as this designation means you are expected to recover and return to work.
Calculating Damages
Though difficult to imagine — there is a price put on the loss of an eye or an arm, which varies across the country. The following South Carolina graphic compiled in 2015 shows the maximum Charleston workers’ compensation amount for the loss of a listed body part.
If you’re facing partial or total disability, your lawyer will go over your specific situation and help you figure out how long you should continue to receive two-thirds of your previous income.
What Should I Do If My Boss Pressures or Threatens Me About Not Filing a Worker’s Comp Claim?
This is illegal, but unfortunately, it happens more than it should. When you have some privacy, make copies of any emails or electronic messages in which this discussion took place. As soon as you get off work, call a lawyer immediately. They can help you document the situation so you will have a strong retaliation case if your boss does fire you. Additionally, your lawyer will walk you through the next steps of filing your claim, which you have every right to do.
Case Denied: What Alternatives Do I Have?
Unfortunately, claim denials are a common reason people contact us about a workers’ compensation issue. It’s challenging to see someone hurt, in pain, unable to work, and unable to claim the benefits they deserve. We work hard to address the issues behind the denial and fight for the client’s benefits.
Here are some common reasons insurance companies give for denying workers’ compensation claims:
- Missed deadlines or confusion about when a work-related illness or injury began. With some chronic conditions like carpal tunnel syndrome, you may have difficulty pinpointing exactly when your symptoms started or worsened. Injuries from a specific incident should be reported within 90 days. Sometimes we learn that a client didn’t report an injury sooner because they were told not to or threatened by a supervisor. Or, the client reported their injury right away, but the report was somehow “lost” or “misplaced,” and the employer now has no record of it. In many of these situations, the employer’s actions are illegal, and we may take it up with the employer as a separate issue. We can also argue your case to have your claim paid to the insurance company.
- The insurance company or your employer may think that your injuries were not caused by anything that happened at work and that there was some other unrelated cause. This is common with repetitive strain injuries like carpal tunnel – they may claim that you caused your carpal tunnel issues by playing video games at home, for example. Even in situations where you were hurt in an incident at work, they could still claim that you had somehow injured yourself off-work beforehand. When this happens, we try to prove the client’s case through medical documentation, witness testimony, and other evidence.
- Misclassification of employees as contractors. Employees are eligible for workers’ compensation; independent contractors are not. It probably won’t surprise you to learn that many companies “accidentally” misclassify workers as independent contractors when they meet the definition of employees. Frequently the worker in question doesn’t realize this and never questions their status as a contractor until they get hurt and either learn they aren’t eligible for workers’ comp or come to us inquiring about a possible personal injury lawsuit. When we talk to contractors who can’t get their on-the-job injuries covered, we always ask questions to determine if they are employees. This is very common in the construction industry, but it can happen in other professions as well. If we determine that you were misclassified as a contractor, we can not only seek workers’ compensation, but also other back benefits such as health insurance coverage or vacation time. If you are a contractor, we will discuss other options for seeking compensation for your injuries.
- “It’s a no-fault system, but actually, it is your fault.” This is often a surprise for workers trying to access their benefits. Although workers’ comp is a no-fault system, there are some exceptions. They shouldn’t deny your claim simply because you made a mistake, such as forgetting to secure a heavy piece of machinery, and you were injured as a result. But they can deny your claim because you were intoxicated or intentionally injured yourself (fraud). In many cases, the evidence to support these claims is thin, and we will work to refute them.
- Pre-existing conditions. This one goes back to the claims that you weren’t hurt on the job. However, it is entirely possible to have a pre-existing condition, get hurt at work, and find that your injury has made your condition worse. Our attorneys will go over your medical records and put together evidence establishing that your on-the-job injury aggravated your existing condition.
- Lack of proof of your injury’s severity. The insurance company may accept that you were injured but claim that is no proof you were hurt as badly as you say or that you need a certain treatment. Again, we will look over their objection and fight to overcome it. You have the right to seek an independent medical exam if a doctor claims your injuries are less severe than you believe they are.
- The forms weren’t filled out right. Worker’s comp claim forms confuse a lot of people. We can help you get it sorted out and resubmitted.
If your claim is unjustly denied, you need to know there are more options at your disposal. For instance, our Charleston workers’ compensation attorney can provide assistance to those who need help navigating the system to obtain their essential benefits. We will even take the insurance company to court if necessary to secure your compensation. Additionally, we may be able to pursue a civil case on your behalf against possible third parties, such as an injury sustained on a construction site where there are multiple companies involved.
Lawsuits Against Third Parties
You’re not alone if you think two-thirds of your income isn’t enough to pay your bills. Because workers’ comp allows for no-fault coverage for work injuries, you will not be able to sue your employer except in rare circumstances. However, sometimes we find that other third parties were negligent, and this negligence contributed to your accident or injuries. Here are some possible situations where you might have a case against a third party:
- If you were driving for work and another driver caused an accident in which you were injured.
- If a floor cleaner overwaxed the floor or failed to put out wet floor signs, leading you to slip and fall and hurt yourself.
- If a mechanic or repair worker made a mistake in fixing company equipment and this error led to your accident.
- If a defective device you were using at work malfunctioned and injured you.
- If you were assaulted at work even though your company contracts with a third-party security business.
These are just a few possibilities. If you suspect your on-the-job injuries were caused by the negligence of someone other than your employer, please contact a lawyer immediately to learn if you have a strong case.
What to Do if You Are Injured at Work
If it’s an emergency, seek medical attention right away. If not, get the list of approved providers from your HR department and find one who can see you quickly. Be sure to tell the doctor all your symptoms or everywhere you were hurt, even if you think some of your injuries are minor.
After receiving medical care, report the injury directly to your supervisor and do it in writing to prove that you did. Sending an email or text message will allow you to have an electronic “paper trail” to prove you reported the injury right away.
Finally, seek the help of an experienced Charleston workers’ compensation attorney to ensure your claim has the best chance of success.
Auger & Auger is All About You
Auger & Auger Accident and Injury Lawyers have over 50 years of combined personal injury background, and if there is a way to get you the compensation you deserve — we’re the ones who will find it for you. Our clients are our first concern, and we will make certain you are advised of any issues and remain up-to-date on everything happening with your case. Another way we express our confidence in our abilities is to offer a zero-fee guarantee; which puts all of the financial risk on us, not you.
Call (843) 203-5129 today for your free consultation, with no fees due until recovery!
