Workers Compensation Act
The South Carolina Workers Compensation Act provides a system for workers injured on the job to receive medical care and financial benefits without having to prove anyone was at fault. The workers’ compensation laws apply to most workers who work for an employer with four or more employees regularly employed in the same business.
If an employer has not rejected the Workers Compensation Act and the employee is hurt on the job, benefits provided by the laws are the worker’s sole remedy. Under most circumstances, employees who are covered by the Act cannot sue an employer for injuries received on the job. However, if a third party, such as the manufacturer of a defective machine, is responsible for the injury, then the employee can sue the third party and also file a workers’ compensation claim. Another example would be a worker who is injured on the job in an automobile accident by a driver who works for another company. The injured worker could file a workers’ compensation claim and bring a separate action against the driver of the vehicle that caused the injury. When a workman recovers money from a third party, the worker is required by law to reimburse the workers’ compensation insurance company for any benefits the worker received. Usually the carrier will not expect to be paid back dollar for dollar.
The primary benefits provided to an injured worker are: (1) The worker is paid something for the time he or she is out of work; (2) the worker’s medical expenses are paid by the employer or the employer’s insurance company; (3) the injured worker is compensated for any lost earning capacity by the accident. Workers’ compensation also pays compensation also pays compensation when certain parts of the body are permanently injured, even if the worker can still perform the job requirements. For example, a worker who suffers a back injury on the job is entitled to compensation for the permanent back injury – even where there is only a partial loss of use and the injury does not keep the worker from returning to the job.
What Happens During Recovery From An Injury?
Workers who qualify for workers’ compensation receive two-thirds of their average salary, not to exceed a maximum weekly amount that is set by the Workers Compensation Commission and changes annually. These are temporary total benefits.
Benefits paid under the Workers Compensation Act are not taxable. Benefits are payable for a maximum of 500 weeks for all injuries except those that result in brain damage or cause the worker to be paraplegic or quadriplegic. For these types of injuries, benefits are paid for the lifetime of the worker.
If an employee returns to light duty or works part-time during recovery and the wages are less than the amount normally received, the employee is entitled to compensation for two-thirds of the difference between his or her normal salary before the injury and the amount received for light duty work, until maximum medical improvement is reached.
All medical expenses for a job-related injury can be paid by workmans comp, even if the worker does not miss any time from work. However, workers are not entitled to compensation for the first seven days they cannot work, unless the disability period extends for more than 14 days. For disability periods of more than 14 days, workers are entitled to two-thirds of the average salary for all time missed, including the first seven days, until the maximum medical improvement is reached.
A worker who is permanently impaired by an on-the-job injury is entitled to payment of medical expenses and two-thirds of his or her average weekly wages for a given number of weeks, depending on the nature of the impairment. If the worker is permanently impaired but not totally disabled, the workers comp laws specify how many weeks of compensation a worker may receive for a specific injury.
What Types of Accidents Are Covered?
To be eligible for workers’ compensation benefits, the worker must have been injured while working within the scope of his or her employment. Generally, any injury suffered by an employee at the employer’s place of business during working hours is within the scope of employment. An injury that occurs while traveling to and from work is usually considered outside the scope of employment. However, if the employer provides transportation to a work site and the injury occurs while in route, the injury is within the scope of employment. Whether an accident occurs within the scope of employment depends on how much control the employer had over the circumstances when the accident occurred.
The workmans comp laws cover such accidents as falling from a high place or getting foreign matter in one’s eye. Compensation is also provided for injuries caused by normal work requirements, including back injuries from lifting, occupational diseases resulting from exposure to harmful substances in the workplace, and physical and emotional problems resulting from job-related pressures.
The employer can try to avoid paying for the injuries if the employer can prove the employee’s injury was caused by the employee’s intoxication from alcohol or drugs, or if the employee failed to use safety equipment provided by the employer and the failure to use the equipment resulted in the injury.
What To Do If An Accident Occurs
If an injury occurs on the job, the injured worker should immediately report the injury to his or her supervisor and to the medical facility recommended by the employer. Under the workers compensation laws, the employer has the right to choose which doctor treats an injured employee. The employee must accept the treatment provided or lose the right to receive compensation until he or she agrees to accept the treatment. The employee has the right to consult his or her own physician but must pay the expense of that consultation.
When reporting an accident, the worker should inform his or her employer of the time, place and circumstances of the accident, the extent of the workers’ injuries and the names of all witnesses who may have observed the accident. The worker also should keep a copy of this information in his or her possession, in case the employer later denies the claim for workers comp benefits.
The employer’s worker’ compensation insurance company will pay the doctor directly for medical bills. If the employee is disabled more than seven days, the insurance company normally will begin making compensation payments to the worker within several weeks after the injury.
Any on-the-job injury should be reported immediately to the employer. The employee is required to report an injury to the employer within 90 days of the injury. To received benefits, a claim must be filed within two years of the date of the injury, although some exceptional circumstances will extend the time limits.
The South Carolina Workers’ Compensation Commission is comprised of seven members appointed by the governor to six year terms. Every workers comp claim that is filed is assigned to one commissioner, who will conduct a hearing within several months to determine whether the claim is valid. The commissioner also may decide whether the employee is entitled to any benefits, whether temporary benefits should be continued or stopped, whether an employee is capable of returning to work, and the award for any permanent disability.
Should A Lawyer Be Hired On Every Workers’ Compensation Case?
Many on-the-job accidents may not result in claims for which the injured worker needs to be represented by a lawyer. However, because many lawyers, including ourselves, do not charge a fee for an initial consultation on a personal injury or workers compensation case, any employee who is injured on the job should seek legal advice. Even if representation is not needed, the lawyer can help the worker understand his or her rights under the workers compensation system.
When consulting a lawyer, the injured worker should bring along as much information as possible. This information should include:
-the workers’ social security number, address, telephone number, education and job history, and a description of the workers’ job;
-the employer’s address and type of business;
-the names, addresses and telephone numbers of all potential witnesses;
-the names, addresses and telephone numbers of any doctors consulted; and,
-as much information as possible about the accident and any similar accidents sustained by the worker or by any other employees.
Before a lawyer can charge a fee on a workmans compensation case, the fee must be approved by the South Carolina Workers Compensation Commission. The Commission’s rules require that no lawyer’s fee exceed one-third of the amount recovered. The one-third must be based on the amount disputed and may not be calculated on weekly benefits the employer voluntarily paid to the injured worker.
(From Brochure Produced by SC Bar Association)
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