2. WORKERS COMPENSATION IN SOUTH
CAROLINA
A. General Overview of Workers Compensation
B. What Makes Up a Workers Compensation
Claim?
C. Definitions, Concepts and Explanations
D. Top 5 Pitfalls for Injured Workers
3. A. General Overview of Workers
Compensation
• History lesson!
– What is Workers Compensation?
– Why was it created?
– Exclusive Remedy through Workers Compensation
Act
4. B. What Makes Up a Workers
Compensation Claim?
• Employee/Employer Relationship
• Coverage under the SC Workers Compensation
Act
• Compensable Injury
5. Relationship between Employee and
Employer
• Employee is defined under §42-1-130
– Excludes independent contractors, casual employees,
volunteers and certain others.
• Employer is defined under §42-1-140
– Can be just about any entity, including the State,
political subdivisions, corporations, sole
proprietorships, etc.
• Employment is defined under §42-1-150
– Generally any type of work for compensation
– Adds “in which four or more employees a re regularly
employed in the same business or establishment.”
6. Coverage under South Carolina
Workers Compensation Act
• Every South Carolina employer and employee,
with certain exceptions, is presumed covered
by the State’s Workers Compensation Act.
Employers required to carry workers comp
insurance, unless exempt.
Requires 4 or more regular “employees” to be
subject to Act.
SC Uninsured Employers Fund
7. Compensable Injury
• “Injury” can include many types of conditions
– Can be acute injury, due to repetitive trauma,
psychological, or occupational disease
• Primarily seen as an Injury by Accident
– Defined under §42-1-160
– Two Pronged Test
• Arises Out of Employment
• Occurs in Course and Scope of Employment
8. C. Definitions and Explanations
1. Admitted claim vs. Denied claim
2. What is “disability” in terms of Workers
Compensation?
3. What benefits are available to injured
workers?
4. Settlement vs. Litigation?
9. 1. Admitted vs. Denied Claims
• Admitted claims
– Timely reported to employer and supervisor
– Admitted by employer and insurance carrier
– Medical and financial benefits provided
• Denied claims
– Can be denied for any number of reasons
– Is unfortunately quite common
– Right to a hearing before Commissioner
10. 2. What is “Disability” in terms of
Workers Compensation?
• Defined under §42-1-120
– “incapacity because of injury to earn the wages
which the employee was receiving at the time of
injury in the same or any other employment.”
• Temporary vs. Permanent Disability
11. Temporary Disability
• Occurs when an employee suffers a loss in
wages
• Types of Temporary Disability
– Temporary Total Disability
• Complete inability to earn wages
– Temporary Partial Disability
• Inability to earn the same wages as prior to the injury
• Likely due to reduction in hours, change of position,
sales, etc.
– Maximum medical improvement
12. Permanent Disability
• Types of Permanent Disability
1. Permanent and Total Disability
• §42-9-10
2. Permanent Partial Disability / Wage Loss
Disability
• §42-9-20
3. Scheduled-Member Disability / Loss of use
• §42-9-30
13. 3 .What benefits are available to
injured workers?
• Medical benefits
– Entitlement to medical treatment for compensable
injuries
– Medical treatment is controlled by Employer and
Insurance Carrier
• Financial benefits and compensation
– Determined by “average weekly wage” and
“compensation rate”
– Temporary financial benefits while in recovery stage of
claim
– Permanent benefits paid at end of claim
14. 4. Settlement vs. Litigation
• Settlement
– Occurs prior to formal litigation at a hearing
– Form 16 v. Full and Final Release
– Control over outcome
• Litigation
– Hearing before a Workers Comp Commissioner
– Medical and financial benefits at stake
– Always a gamble and there are no guarantees!
15. Top 5 Pitfalls for Injured Workers
1. Not reporting an accident immediately
2. Failure to follow up with medical care
3. Thinking insurance adjusters are on your side
4. Signing documents you don’t understand
5. Not talking to a lawyer!
