Workers’ Compensation Overview

There are also two deputy commissioners who can conduct Viewings and Informal Conferences, other than Clincher approvals.

On average, about 150,000 on-the-job accidents are reported each year in South Carolina. Of that, around 2% go to a contested hearing before a Commissioner. When an employee hires an attorney, the value of the claim typically increases significantly. Iinsurance adjusters are taught that preventing an employee from hiring an attorney is the single greatest cost reducer. In some instances, an attorney for the injured worker can cause the value of the claim to increase ten times (10x) or more.  Having an experienced work accident and injury attorney makes a huge difference.

Coverage

South Carolina’s Workers’ Compensation Act applies to “all private employments in which four or more employees are regularly employed in the same business or establishment.” S.C. Code Ann. §42-1-150.

The Workers’ Compensation Act defines a covered employer to include “the State and all political subdivisions thereof, all public and quasi-public corporations therein, and every person carrying on any employment. . .” S.C. Code Ann §42-1-140.

Every covered employer is required to maintain workers’ compensation insurance by statute. Additionally, an exempt employer may voluntarily elect to be covered by obtaining workers’ compensation insurance.

South Carolina’s Act specifically exempts the following employers: 1) Textile Hall Corporation, 2) state and county fair associations, 3) railroads, 4) railway express companies, and 5) any person who has regularly employed in service less that four employees in the state, or had a total annual payroll during the previous calendar year of less than three thousand dollars regardless of the number of persons employed. Agricultural employees and real estate agents are also exempted from coverage.

A sole proprietor or partner must elect to be covered by the Act. A corporate officer must file a Form 5 with the Commission if he/she wishes to be excluded from coverage. Regular employees, i.e. not corporate officers, may not elect to be excluded from coverage. Agreements between an Employer and employee to exclude coverage are void. Charitable Organizations are not exempt from coverage.

The most often debated provision under the coverage statute is whether a particular individual is a covered employee. A full-time employee is covered. Part-time employees are covered. Temporary employees may be covered, unless at the time the employee was engaged to perform the work, the temporary agency provided a copy of its proof of insurance coverage to the contracting employer.

The Accident

Whenever an employee is involved in an accident at work, there is a potential workers’ compensation claim. South Carolina has adopted a liberal definition of “accident.”  In Creech v. The Ducane Co., No. 2435 (S.C. Ct. App. Dec. 20, 1995) (1996 Davis Adv. Sh.#1), the Court reversed the Commission and Circuit Court who had denied the claim because it was not the result of an external event such as a slip, trip, sudden effort, etc.

The Court of Appeals ruled that:

… [A]n ‘injury by accident’ includes not only an injury the means or cause of which is an accident, but also an injury which is itself an accident, that is, an injury occurring unexpectedly from the operation of internal or subjective conditions, without the prior occurrence of any external event of an accidental character.

The claimant had previously suffered a back injury and been compensated. He later re-injured his back, when he bent over to lift an object weighing less than one pound.

Why do I have to go to their doctor?

Your employer has the right, by South Carolina law, to select the doctor that its workers attend for on-the-job accidents. Employers, with the assistance of their insurance companies, typically use conservative doctors that will provide minimal treatment and not write employees out of work. This allows your employer to contain costs.

Employers want workers released to return to work in order to avoid paying weekly checks (temporary benefits). Light duty is offered when injuries prevent an employee from doing all the physically demanding duties of their regular job. Complying with the company doctor’s instructions is vital because benefits may be suspended otherwise. If you go to your own doctor, the employer is not obligated to pay for that medical treatment.

You need a work accident and injury lawyer in Greenville SC to help you.  We regularly meet with and depose doctors to get to the truth regarding our clients’ injuries. Second opinions, independent medical evaluations (IME), Functional Capacity Evaluations (FCE), Magnetic Resonance Imaging (MRI) and other diagnostic tests may be necessary before a worker is written out of work by the company doctor. Referral to a specialist or surgeon may be necessary.

Employers are allowed to contact your authorized doctors directly, but there are strict guidelines concerning such contact. An injured employee should be given 10 days notice of any communication and has the opportunity to be present and participate, or have their attorney participate, in any meeting between the doctor and employer’s representative. When Employers or insurance adjusters fail to comply with these guidelines, medical records may be objected to and excluded from the evidence at a hearing.  Its easy to be taken advantage of without  experienced work accident and injury lawyers in Greenville looking out for your interests.  

Why was my claim denied?

As noted above, most employers are required by state law to purchase workers’ compensation insurance. Insurance premiums are based on the number of reported losses and the type of work performed. If an adjuster successfully denies a claim, the premium doesn’t go up. Also, some employers have high deductibles.  Hiring experienced work accident and injury lawyers in Greenville SC will help protect your rights. 

When an insurance company evaluates an adjuster, the primary focus is usually…

1. Why did they pay a claim, or
2. Why did they pay that much.

Insurance companies are not as interested in reviewing denied claims, because those claims did not cost them money.

Many defenses are asserted to workers’ compensation claims. Some of the most common relate to the definitions of an “accident”, an “injury”, and the phrases “arising out of” and “in the course of employment”. Cases are also litigated over factual issues/defenses regarding whether medical treatment is necessary, the severity of injuries, and the amount of disability suffered.

The defenses which are established by the definitions of terms under the Workers’ Compensation Act involve the following:

1. Is an injured person an employee?
2.  Did an accident occur at work?
3. Did an injury result from the accident?
4. Was the injured employee “on the job” at the time of the accident?
5. Was the injured employee doing the employer’s business at the time of the accident?

When the insurance adjuster thinks the answer to one of these questions is “no”, they use that as grounds for denial of the claim. Without the assistance of  experienced work accident and injury lawyers in Greenville SC, valid claims can go unpaid.