Who Can Receive Workers’ Compensation Insurance?

Have you been hurt as a result of your job and need clarification on who qualifies to receive workers’ compensation benefits?

According to South Carolina’s Workers’ Compensation Act, if an employee is hurt at work as a result of an accident that occurred while they were working, they are entitled to receive reimbursement for:

• Medical expenses
• Temporary compensation for lost wages
• Permanent disability benefits if they sustained any permanent injuries
• Funeral costs for wrongful death incidents

However, there are limitations on the medical provider, which employees can receive workers’ compensation benefits, as well as legal deadlines that must be met in order to get benefits. Learn more about the eligibility requirements for workers’ compensation in South Carolina.

What Is the Process for Receiving Workers’ Compensation Benefits in South Carolina?

Following a workplace accident, specific actions must be followed to receive workers’ compensation benefits from your filed claim. The following is the general process of filing a claim to receive benefits:

Report Your Incident

You must inform your supervisor right away if you get hurt while working. You should also demand that the employer pay for the necessary medical care. If the claim is rejected, you have two options: you may try to handle the issue on your own or you can employ an attorney.

You or your attorney should submit a Form 50 to the Workers’ Compensation Commission on your behalf if the claim is still being contested or refused.

Employer Submits Documentation

Unless self-insured, the employer is often represented by an insurance provider known as the carrier. The carrier responds on Form 51 and includes an admission or denial of the information you provided on your Form 50.

A Hearing Is Scheduled

Once added to the Workers’ Compensation Commission’s docket, it is assigned to a specific Commissioner who conducts an investigation and renders a legal decision. Within three to five months, a hearing is typically scheduled, and it is at the hearing that the employee presents their case.

Typically, medical testimony is offered in a deposition, and your doctor won’t appear at a hearing. The medical records you and the carrier present will be used by the Commissioner as additional medical evidence.

The Decision

After deciding on the case, the commissioner will give an Opinion and Award outlining the facts, the law, and any remedies the employee may be entitled to.

The case may be appealed to the whole Commission. If either party disagrees with the decision made during the hearing, they may appeal it to the Circuit Court and ultimately to the South Carolina Supreme Court. An appeal must be filed within 14 days of the order’s date.

Restrictions on Workman’s Compensation in South Carolina

Workers’ compensation requirements and limitations vary by state. In the state of South Carolina, there are stipulations on which types of employees are ineligible to receive workers’ compensation benefits, which doctors are covered under the benefits, and how long an employee has to file a claim.

Approved Medical Providers

The doctor who will treat you may be chosen by your employer under existing law. If you see your own doctor without the employer’s consent, the employer might not be held responsible for the associated costs unless the situation qualifies as an emergency.

However, you are free to select the doctor who will examine you for the specific handicap, but the evaluation won’t be paid for by your job.

Excluded Employees

In South Carolina, there are some workers that are not counted as employees or are exempt from receiving compensation benefits. This list includes:

• Casual workers, who just work as necessary and don’t have set working hours.
• Employers whose annual payroll in the preceding year was less than $3,000
• Agriculture workers
• Employees of a railroad or railroad express company
• Sellers of agricultural goods
• Real estate agents with licenses
• State federal personnel

Benefit Deadlines:

You only have a brief window of time as an employee—generally within 30 days—to notify management or your company’s benefits department of an injury or illness. If you wait too long, you risk being unable to make a workers’ compensation claim.

Also, the statute of limitations for a workers’ compensation claim is two years, as stated in SC Code 42-15-40. You have the right to legal representation if your claim is rejected or contested, but you must initiate a personal injury lawsuit before the two-year window following the date of the injury expires.

Do You Have to Get a Lawyer to Get Paid Workers’ Compensation?

If there is a dispute regarding your compensation claim, you can approach the South Carolina Workers’ Compensation Commission for a decision on your case.

Consult with a lawyer if your issue requires you to file an appeal with the commission. You can next file with the Court of Appeals if the verdict is still not in your favor and your lawyer thinks you have a case.

Instances Not Covered By Worker’s Compensation

Here are several instances where workman’s compensation insurance will not pay the costs:

• If blood/alcohol tests indicate the employee was under the influence at the time of the injury, benefits may be rejected
• The damage was caused by oneself
• The worker had broken the law or corporate rules, which resulted in injury or illness
• The individual wasn’t working when they got hurt

Workers’ compensation insurance covers injuries that result from workplace accidents in which the employee was not at fault. If it is still unclear who qualifies to get workman’s comp, consulting with a South Carolina compensation attorney will clarify your case details and provide insight.