Workers’ Compensation 101
Workers’ compensation claims can be a difficult journey for those injured on the job. There is the physical injury and medical treatment, being out of work and dealing with your employer, their insurer, and the entire claim process which is different in each state. It can be confusing, stressful, and emotionally taxing.
There are two important factors if you are injured at work. The first is reporting the injury to your supervisor, manager, or HR department. In South Carolina, you have 90 days to report the injury to your employer. It’s imperative that you inform your employer which puts them on notice that an injury has occurred. Secondly, seek medical treatment if necessary. In South Carolina, you have two years to file a workers’ compensation claim. If you do not provide your employer with notice of your injury or file a claim within these strict time constraints, your claim may ultimately be barred.
A doctor may have you placed on “light duty” or declared you unable to work due to the injury. If you are placed in another position or on light duty and you make less than you made prior to being injured, workers’ compensation will owe you weekly temporary partial disability (“TPD”) benefits. If you are declared unable to return to work then workers’ compensation has to pay you weekly temporary total disability (“TTD”) benefits. The amount of both TPD and TTD benefits are based on your compensation rate.
Compensation Rate Calculation There is a formula to calculate compensation rates in each state regarding workers’ compensation coverage. In South Carolina, your wages at the time of your injury are reviewed for the previous four quarters to get your average weekly wage (“AWW”). Your compensation rate is 66 2/3% (.6667) of that figure. For purposes of TPD, however, your compensation rate would be 66 2/3% (.6667) of the difference between what you were making before the injury and your current wages.
Whether you receive TTD or TPD, you will not be making the same as you did prior to the injury, but all workers’ compensation payments are tax-free. If you are placed on permanent disability and awarded a lump sum by the insurer that payment is tax-free as well.
Your employer’s insurance carrier controls and determines where you go for medical treatment. Remember, they are paying for it and this is standard. It’s important to be totally compliant in making those appointments because if you aren’t your treatment may be stopped.
The South Carolina Workers’ Compensation Commission and Process
Each state has a workers’ compensation commission. In South Carolina (https://wcc.sc.gov) your claim will be heard by a workers’ compensation commissioner. It is not a jury trial. You appear before a single commissioner who hears arguments from both sides and reviews the claim. Each side can appeal the decision. If it is appealed then it escalates to an appellate panel consisting of three commissioners. From there it would advance to the South Carolina Court of Appeals and ultimately the Supreme Court of South Carolina.
Workers’ compensation cases can be lengthy. Typically the process can take one to two years from the time of injury, depending upon the seriousness of the injury and treatment plan, the employer, and their insurance carrier.
The Income Gap Injured workers unable to work struggle to pay bills because of their limited income and loss of work while they are fighting a comp claim. This takes a toll on families trying to pay their bills and make ends meet with little to no income. Those who have short and long-term disability coverage may be okay because they have coverage to “bridge the gap” until their temporary benefits are started or their claim is resolved.
A lot of employers do not offer long and short-term disability and many of those whose employers do offer it are unable to afford it. If you can afford those benefits it’s really a smart choice for peace of mind and “cushion” while your claim is being litigated.
There is a standard process to determine a permanent disability. The injured worker goes through their medical treatment and at the end of the treatment the doctor will declare that you are at the maximum medical improvement (“MMI”) for your injury. That means you have plateaued in your medical treatment and are going to get as good as you can get with the particular injury. At that point, you are assigned an impairment rating for the injury. The rating is usually derived from the American Medical Association guidelines. Additionally, the physicians will make a recommendation of any permanent work restrictions and any ongoing, or future medical treatment if needed.
If the injured worker has to have surgery that requires hardware (e.g., plates, pins, etc.) lifetime replacement, repair, and maintenance are provided by the employer’s insurance carrier. However, many times these claims get closed out completely for additional compensation so the insurance company can avoid hardware replacement, repair or maintenance down the road.
Awards The maximum workers’ compensation award in the state of South Carolina is 500 weeks of benefits, unless the injured party is a paraplegic, quadriplegic, or has a physical brain injury. In those cases, the injured worker is entitled to lifetime benefits. The maximum award of 500 weeks is reserved for those who have been found permanently and totally disabled, and have injured two body parts. A lump sum award for the 500 weeks is further discounted to its present value after deduction of the weeks of TTD already paid.
If the injured worker is not entitled to lifetime benefits or is not permanently and totally disabled he or she may be entitled to a wage loss claim, which is based upon the compensation rate of the difference between the pre-injury and post-injury wages. Wage loss is calculated at 340 weeks and is discounted to its present value.
Under the scheduled member statute, an award is calculated based upon the impairment rating received by your doctor. South Carolina workers’ compensation laws assign a certain number of weeks for various body parts. For instance, your shoulder is worth 300 weeks. If you receive a 10% impairment rating from your doctor, you would be entitled to 30 weeks of benefits. Of course, the impairment rating can be inflated based on several factors, including permanent work restrictions, ongoing or future medical treatment, and the type of settlement entered into.
At Smith Jordan Attorneys at Law, we are in the business of helping injured workers get the compensation they need and deserve for work-related injuries.
Attorney Thomas S. Phillips’s practice is primarily focused on helping injured workers. Thomas went to law school to help others and he takes great pride in helping hard-working individuals who have been hurt at work. He works diligently for his clients to help them receive the benefits to which they are entitled, whether that be medical care, weekly checks, or money for a permanent disability.
Images: SC Workers’ Compensation Commission, Unsplash.co