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As of June 2018, more than 2 million people were employed in South Carolina.
Undoubtedly, very few of them believe that their shift could end in a catastrophic way. They prepared to go to work, expecting to perform their duties and return home in the same shape they were in when they left. Regrettably, things don’t always turn out that way in the workplace; circumstances can turn on a dime and land you in the hospital, or keep you homebound from work for weeks.
Auger & Auger understands that each claim for compensation for a job injury is unique. Though every incident stands alone, all victims should be treated as fairly as the last. In South Carolina, there are just as many workers’ compensation claims denied as are approved. Our experienced Greenville workers’ compensation attorney can advise you prior to filing your claim, or stand with you to fight any denial as well.
The full extent of Greenville’s worker’s compensation entitlements can be seen in the South Carolina Title 42 Code of Laws. Essentially, when you are injured in an accident either at work or arising from the scope of your employment, you are entitled to benefits; including medical expenses and lost wages. Of course, there are also specific benefits if you are permanently disabled as a result of your accident.
There have been 17,024 workers’ compensation claims filed in South Carolina to date, with approximately 50% denied. You should not have to fight for the rights which are provided to you under the law when you are injured at work. Auger & Auger’s Greenville workers’ compensation attorney sees it happen every day; people have to defend their rights to receive what they are entitled to by law.
Here are a few basic things to know when you are involved in a workplace injury:
1. You must file a report with your supervisor immediately. It’s best to inform them of the accident in writing in such a way that you will have a copy. Ideally, send an email from your personal email account so you can’t lose access to it if your employment ends.
2. Your HR department may ask you to fill out some forms about the accident and what happened. Be sure to ask for a copy of these.
3. Your employer has the right to choose the medical provider who will treat you. Ask your supervisor or HR manager for a list of providers you can see.
4. If you choose your own doctor, your employer may not be forced to cover your expenses, unless it was a serious emergency and you needed immediate care.
5. You will then file a claim for workers’ compensation.
6. If your workers compensation claim is approved, benefits will be forthcoming.
7. Should your claim be denied, you can appeal the decision. We strongly recommend seeking the help of an experienced Greenville workers’ compensation lawyer to improve your chances of success on appeal.
An employer’s representative – usually an HR staff member – is supposed to file a workers’ compensation claim after any reported accident where an employee is hurt. This representative may or may not tell you that you also need to file a Form 50 within two years of the accident to protect your rights. We recommend doing this sooner rather than later, so you are protected if the HR department “forgets” your claim, or believes they filed it when they didn’t.
The above are passive methods of avoiding filing a claim. Although most workers’ comp claims are covered by the employer’s workers’ compensation insurance, having to make a claim may raise their insurance rates. As a result, some supervisors would rather not file a claim. They may think that your injuries are not that bad and you will forget.
Sometimes employers are more aggressive about avoiding a claim. We’ve met workers who were told not to file for a variety of reasons that range from, “This isn’t covered/you’re not covered,” to “If our insurance rates go up, we might have to start laying people off.” In a few cases, supervisors outright threatened to fire employees who filed a claim.
Do not let them intimidate you about this. As an employee, you have a right to workers’ compensation for an on-the-job injury – even if you are a part-time employee or it’s your first day! Firing, harassing, or otherwise creating a hostile work environment for a worker who has filed a claim is illegal. Unfortunately, it does happen, and if it does, you should do your best to take pictures or collect evidence of the harassment, then contact a lawyer immediately.
If your supervisor is trying to talk you out of filing a claim, don’t confront them directly. Go home, call a lawyer, and let them help you with your Form 50 and advise you about your work situation. This is the best way to ensure your rights are protected. In some situations, you may have a case against your employer for harassment or retaliation if you are treated poorly after your report.
Workers’ compensation is a no-fault system, so it is not necessary to prove your employer was at fault, or that you were not at fault. However, your claim can be denied for other reasons, such as:
● You were intoxicated at the time of the accident.
● Your injuries were intentional or due to horseplay or extreme recklessness.
● Your injuries were not as significant as you claim. In this case, the insurance company may state that you don’t need the required treatment or time off work.
● The paperwork wasn’t filled out completely or submitted on time. Sometimes this is an issue with the HR department at your company rather than an error you made.
● Your injuries were due to other causes outside your job, and are unrelated to your work accident.
Regardless of the reason your claim was denied, an experienced workers’ compensation lawyer may be able to help you refute the insurer’s claims and appeal their decision. If you’ve been denied your benefits, don’t try to fight the insurance company on your own – call an attorney before you do anything else!
As long as your treatment is approved by your employer’s insurance company (always check when scheduling appointments), your medical bills should be covered in full. However, some people have difficulty accessing the specific treatment they need because the insurer won’t approve it. If you are having trouble getting a treatment approved, please contact a Greenville workers’ compensation lawyer for assistance.
Workers’ compensation also offers temporary and permanent total disability benefits. In other words, if you are unable to work for a period of time while recovering or become permanently unable to work, you should be eligible for benefits. These are paid at two-thirds of your average weekly pay rate, up to a maximum amount set by the state that changes yearly. For 2022, the maximum weekly compensation is $963.37.
You do not have to be completely out of work to receive benefits. If your doctor says you can return to work with restrictions, such as limits on heavy lifting or physical activity, your employer may be able to find you some “light duty” work to do. If this job pays less than your usual work, you are eligible to receive two-thirds of the difference in pay until you can return to your old job. South Carolina places a 340-week limit on temporary partial disability benefits, but most people don’t need them for that long. If you do, it’s possible you may qualify for a permanent partial disability rating.
Permanent disability benefits may be possible if you’ve reached Maximum Medical Improvement, or MMI, and are still unable to work. If you have been out of work for an extended period of time and are still in treatment, you may want to ask your doctor when they think you will reach MMI, or if there are other treatment options you can try first.
Once your doctor determines that you have reached MMI, you may be given a “whole person impairment rating” in which your disability is expressed as a percentage of your body. But with specific injuries, such as a loss of vision in both eyes or losing both hands, you will automatically be considered permanently disabled.
In some cases of permanent partial disability, it may make more sense to seek benefits under the lost earning capacity model. This is based on the income difference between what you used to earn and what you’re able to earn now. So if you were forced to switch to a significantly lower-paying job, this may be a good option.
However, it can be difficult to calculate the most beneficial solution on your own, and many people are confused about their eligibility for benefits. At the same time, the insurance company may unfairly deny your request for permanent disability for various reasons. We recommend speaking with a qualified workers’ compensation lawyer who can help guide you through the process and answer your questions.
In the event that a person dies in a work-related incident, their surviving dependents may receive benefits for 500 weeks or about nine and a half years. These benefits are paid at the same rate as total disability, but this amount is split among surviving dependents.
There may be other options for seeking compensation, but first, you should make sure that it’s true you are not eligible for workers’ compensation. Most employees in South Carolina are eligible, but there are a few exceptions. Here are some of South Carolina’s rules about workers’ compensation requirements for businesses:
● Absent other exceptions listed here, companies with four or more employees must carry workers’ compensation insurance. Family members and part-time workers do count as employees, so even if a business only hires part-time workers, they are still required to provide this insurance. However, “casual” employees who don’t work regularly but occasionally do small jobs for the business are usually not considered employees.
● Agricultural employees are usually exempt from workers’ compensation.
● Railroad and railroad company employees and any other federal employees are exempt from workers’ compensation. However, they are able to file a claim under the Federal Employers’ Liability Act (FELA). FELA claims are fault-based, so it’s important that you seek the help of an attorney to prove your case.
● Independent contractors, owner-operator truck drivers, and some commission-based real estate agents are not eligible for workers’ compensation.
Sometimes companies misclassify employees as independent contractors to save money on benefits like health insurance and retirement plan matching. The first thing your workplace law attorney will do is ask you some questions to determine if you might actually be an employee. If so, you may be eligible for workers’ compensation and back pay for missed benefits.
If you are indeed a contractor, there are other options for seeking damages. Workers’ compensation is designed to eliminate a number of potential lawsuits against employers by providing no-fault coverage. But if you are not an employee, you can sue your employer if their negligence led to your injury. Because you will need to prove fault, your lawyer will investigate the accident and help you gather evidence to support your case.
If there is little to no evidence of employer negligence, you may have alternatives depending on the specifics of your injury. In some cases, you might have suffered an injury due to the negligence of a third party, such as a store you were visiting for your contract work. If you were driving to a contract job, either your car insurance or the other driver’s insurance may provide coverage. In many cases, we are able to find an applicable insurance policy that will cover some or all of your expenses.
Your claim is not over simply because it has been denied. It is important to understand that you have options. The workers’ compensation system can be complicated and overwhelming, but you are not alone. Our Greenville workers’ compensation attorney is ready to litigate on your behalf. We can appeal your denial and, in some cases, file a civil lawsuit against a responsible third party.
With over 50 years of combined litigation experience, you can trust our team at Auger & Auger to have your best interests at heart. We will stand up for your rights and fight for as long as it takes. Our zero-fee guarantee means that you will not be asked to pay for our services until we win your case.
Call today for your free consultation, with no fees due until recovery!
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