Understanding How Workers’ Comp Works | MDSW Legal Firm

An injured or sick employee can be paid after a workers’ compensation claim is filed and processed if the employer and insurance carrier agree that the injuries or illness are work-related.

However, in some cases, the employer doesn’t believe that the incident was caused by work, so the claims are disputed or denied. If you have been injured or become sick after exposure while on the job, knowing how workers’ compensation insurance works may be a little confusing.

This workers’ compensation guide can help you navigate through the process and answer frequently asked questions regarding worker compensation.

Defining Workers’ Compensation Coverage

Workers’ compensation insurance provides benefits to employees in the event of a work-related injury or illness. This coverage helps cover medical expenses, lost wages, and prescription costs of injured or sick employees. It can also help to cover legal fees.

An efficient workers’ compensation insurance policy protects the company and its employees by alleviating the responsibility of paying out of pocket for work-related sicknesses or accidents.

How Much Money Can Employees Get From Filing a Workers’ Compensation Claim in South Carolina?

Calculating the value of your claim heavily depends on the circumstances of your incident. The South Carolina Insurance and Medical Services Division states that, according to South Carolina state law, it cannot be more than the previous year’s average weekly wage.

For accidents occurring after January 1, 2019, the maximum weekly rate is $845.74. The maximum weekly compensation rate is 66% of the average weekly wage. For additional benefits like unemployment, the benefits office can explain how eligibility works in conjunction with workers’ compensation payments.

How to File for Workers’ Compensation After a Workplace Injury

Workers’ compensation claims can be complicated. According to SC Code 42-15-40, the statute of limitations for a workers’ compensation claim is two years. There are, however, other deadlines that must be met, so it’s important to follow these guidelines to claim benefits:

1. Report any work-related injury or illness to the manager
2. Necessary documentation, such as doctor’s notes and the official injury form, is collected from the employee to be placed in a secure file and submitted to insurance. Employees should keep duplicate copies of all records.
3. Upper management is responsible for filing the claim with insurance once all the required documentation is submitted. There may also be a requirement for the employer to notify the workers’ compensation agency or board in your state of the injury or illness.
4. The outcome will be communicated to the employee, in which case they are entitled to appeal the decision.

As an employee, you have a limited amount of time to report an injury to management or your company’s benefits department, usually within 30 days of the injury or illness. You will be unable to file a workers’ compensation claim if you wait too long and will risk losing any benefits.

Which Employees Are Eligible for Workers’ Compensation?

Workers’ compensation insurance protects a wide range of employees. South Carolina state law requires workers’ compensation insurance for employers that have more than four staff members.

Ineligible workers may include:

• Contractors
• Owners of businesses
• Volunteers
• Employees of private residences
• Farmers and farmhands
• Maritime workers
• Employees of railroads
• Temporary employees

Stipulations may apply in states that prevent certain types of employees from being covered by workers’ compensation insurance. Consult with a compensation attorney near you to find out how workers’ compensation exemptions work in South Carolina.

What Does Workers’ Compensation Pay for in South Carolina?

Each company can elect certain coverage for its workers. For South Carolina businesses, they can choose to help cover:

1. Injuries resulting from your employee’s work
2. Sickness caused by working in an allergen- or hazardous-substance-containing environment
3. Repetitive stress injuries like carpal tunnel
4. Lost wages if your employee is absent from work to recover from a work-related injury or illness
5. Future or ongoing medical treatment, such as physical therapy or reconstructive surgery
6. Funeral costs in the event of the wrongful death of an employee
7. Benefits for disability or impairment

However, the following are some examples of what most workers’ compensation plans do not cover:

1. Injuries sustained as a result of a fight started by an employee
2. Injuries sustained by an employee as a result of being intoxicated at work
3. Intentional injuries to employees
4. Emotional harm that is not accompanied by a physical workplace injury adversity – learn more about workplace mental health

Are Employees Responsible for Paying for Workers’ Compensation Insurance?

Although employees receive benefits from workers’ compensation insurance, they are not obligated or required to pay for it. Workers’ compensation insurance is paid for by the employer to the insurance company. While rates vary, they are determined by the following factors:

• Industry
• Number of workers
• Workplace safety history
• Payroll size

If you are still uncertain about the specifics regarding your company’s workers’ compensation coverage, you can contact Human Resources to discuss how it works and what steps you can take to file a claim if you are harmed at work.