South Carolina Workers Compensation Claims: Eligibility, Filing and Appeals
South Carolina's workers' comp program provides wage loss benefits, medical care, and compensation for permanent disabilities to those with work-related injuries or illnesses.
South Carolina workers’ compensation program provides cash benefits and medical care for injuries or illnesses caused while working. Employees who are injured while working in South Carolina or who develop an illness related to their occupation as a result of conditions in their workplace environment in South Carolina are eligible for benefits.
Workers' comp is a "no fault" system, meaning that employees are not required to prove that an employer was at fault to receive benefits. All the employee has to demonstrate is that the injury or illness occurred or was caused in the workplace or was related to the work.
Exceptions to Workers' Comp Coverage
Most South Carolina employees, but not all, are eligible for workers compensation benefits. Employees who are not eligible for benefits include:
- employees of railway express and railroad companies
- federal employees working in South Carolina
- employees at businesses with less than four employees
- agricultural workers
- some realtors
- some casual (or temporary) employees, and
- corporate officers.
What to Do When You Are Injured or Become Ill
If you become hurt at work or develop a work-related illness, report your condition to your employer as soon as possible, preferably in writing. This is important in order to protect your right to receive cash benefits and medical care. If you do not make this report to your employer within 90 days, you may lose your right to benefits. However, you have up to two years to file an actual claim for benefits.
After you notify your employer, your employer then has ten days to report your injury or illness to the South Carolina Workers’ Compensation Commission (the Commission). The Commission oversees the payment of benefits to you. The Commission commonly refers to all work-related injuries and illnesses as “accidents.”
When to File Your Own Claim
If your employer doesn’t file a claim with the Commission on your behalf, then you can file a claim directly with the Commission, using Form 50. Call the Claims Department at the Commission at (803) 737-5723 for more information or to have the application forms mailed to you.
You can also file a claim if you believe you are not receiving all of the workers compensation benefits to which you are entitled, or if your employer disputes the fact that your injury or illness is work-related.
Types of South Carolina Workers’ Compensation Benefits
South Carolina workers’ compensation program provides wage loss benefits, payment for medical treatment, and compensation for a long-term disability.
Either your employer or its insurance company will pay for all needed and reasonable medical care related to your work-related injury or illness. (Treatment for any other medical conditions you may have is not included.)
For your work-related medical condition, your doctor’s visits, prescriptions, physical therapy, surgery, and other necessary treatment will be paid for you. If you go to the doctor selected by your employer or their insurance company, your doctor or the hospital will be paid directly by your employer or their insurance company. If you go to another doctor of your own choosing, your medical care will not get paid for.
Compensation for Lost Wages
If you can’t work due to your injury or illness, then you are considered “temporarily totally disabled” and you can be paid the wages you would have earned had you been able to continue to work during your recovery.
You are eligible for payment of lost wages if you are unable to go to work for at least seven days. If you continue to be unable to work due to temporary total disability for at least 14 days, then you can be paid your lost wages back to the date you were unable to continue working.
The payment rate is 66 2/3% of your average weekly wages, but your payment can’t exceed 100% of the average weekly wage in the State as determined by the South Carolina Department of Employment and Workforce. (For accidents or injuries occurring in 2013, the maximum weekly payment is $743.72.)
Temporary total disability benefits will continue until your doctor “releases” you, meaning your doctor says you are able to return to work. These benefits will be paid to you by your employer or its insurance company.
Compensation for Permanent Disability
Permanent Partial Disability
If you have become disfigured (other than due to a surgical scar) and your scar is visible from eight feet away, or, if you are permanently impaired in some way, then you will be eligible to receive additional compensation, called permanent partial disability (PPD) payments. Compensation amounts fro PPD are based on the severity of the disfigurement or disability. In determining the severity, the Commission will consider medical records, your testimony, and the impact of your partial disability on your ability to work.
Rate of Compensation for Permanent Injury
Your rate of compensation will be based on the severity of your disability and 66 2/3% of your average weekly wages. SC rates the severity of disabilities by percentages. A minimal disability would be rated at 10% whereas a more severe disability might be rated at 60%. If your hand is permanently injured, but the injury is not severe, 10% may be assigned. If you average weekly wage is $450, the Commission will multiply 10% by $450 to reach the weekly dollar amount of $300.
In addition to this weekly amount, you will receive extra compensation for loss of use of your hand. For each limb, a different number of weeks will be paid to you. For loss of use of a hand, 220 weeks of your average weekly wages are awarded. Your compensation rate of $300 would then be multiplied by 220 to reach the figure of $6,600 that would be paid to you. This is on top of your regular weekly benefits.
Permanent Total Disability
The Commission has a narrow definition of permanent total disability (PTD). If you have lost both of your hands, feet, arms, or legs, lost vision in both of your eyes, or have suffered a combination of two of these losses, you are considered totally and permanently disabled and can receive additional benefits. The Commission might consider other losses as also constituting permanent and total disability.
You will be paid additional cash benefits based your average weekly wage for up to a total of 500 weeks. Paraplegics, quadriplegics, and brain-damaged workers can receive permanent benefits.
If you have lost one limb or have lost the use of one limb but are not considered permanently and totally disabled, you will receive extra weeks of compensation for this loss.
If you have suffered a permanent disability, an informal conference will be held with you, the insurance company, and a Commissioner or Claims Mediator. The purpose of this brief conference is to determine the total amount of benefits you are due to be compensated for the permanent disability. It is important to show up for this conference or to notify the Commission that you can't make it. You can reach the Informal Conference Scheduling office at 803-737-5734.
What if You Do Not Agree With the Decision at the Informal Conference?
If you disagree with the outcome of the informal conference, do not sign the settlement agreement. You will automatically be scheduled a hearing before the Commission. Your hearing will be held in about three to four months and you will receive a notice about a month in advance. You may want to talk to a local workers' comp lawyer about what a fair settlement amount would be.
If You Were Denied Benefits or Disagree With the Benefits Decision
You have the right to appeal a denial of benefits or a decision you disagree with. Your appeal will be heard by a single commissioner. If you disagree with the commissioner’s decision, then you have the right to file an appeal to be heard by the Commission. For more information, see our article on workers' comp appeals in South Carolina.