South Carolina employees who are injured at work or suffer from an employment-related illness are entitled to benefits under the state workers’ compensation system. The workers’ comp system in South Carolina covers medical bills related to your workplace injury and pays disability benefits while you are unable to work due to your illness or injury.
Almost all South Carolina employers with four or more employees are required to carry workers’ compensation insurance. The South Carolina workers’ comp system is overseen by the South Carolina Industrial Commission, but most claims are paid by insurance companies that cover employers’ workers’ comp claims. In order to receive the maximum benefit from your employer’s insurance company, you will need to follow South Carolina’s workers’ comp rules for reporting your injury and getting medical treatment.
After a workplace injury, you will be most concerned about getting immediate medical care. In an emergency, you should seek treatment at the nearest emergency room. In non-emergency situations, you must notify your employer of the injury and seek treatment from the doctor selected by your employer or its insurance company. South Carolina workers’ comp covers all reasonable medical bills associated with authorized treatment for your work injury. You will not be reimbursed for medical bills from unauthorized providers.
South Carolina law requires you to report a workplace injury to your employer within 90 days of its occurrence. However, the best approach is to notify your employer of your injury as soon as it happens and before seeking medical treatment. Sometimes, this will be impossible either because your injury requires emergency care or because your supervisor is unavailable. In those cases, report the injury as soon as you can, but before the 90-day deadline.
When you report your injury, tell your employer when and where the injury occurred, how the injury occurred, and what type of injury you sustained. This is the official start to your workers’ comp claim. At this point, it is your employer’s responsibility to report the injury to its insurance company so you can begin receiving benefits.
South Carolina workers’ comp also pays temporary disability benefits, which are intended to replace part of your lost wages while you are recovering from your injury. These benefits are available once you miss work for more than seven days. You will receive two-thirds of your average weekly wage prior to the injury, but no more than a maximum amount set by the Industrial Commission on an annual basis. If you end up having a permanent disability due to your workplace injury, you are entitled to receive wage-replacement benefits for up to 500 weeks. The amount of your benefit is determined by the severity of your permanent disability. (To learn more, see our article on how to calculate South Carolina workers’ comp benefits.)
You do not need to file a workers’ comp claim unless your employer fails to report your injury or the insurance company refuses to pay your benefits. You can file your claim directly with the South Carolina Industrial Commission by filing Form 50. Form 50 must be filed within two years of a workplace accident or within two years of the diagnosis of a work-related illness.
Box 13a of Form 50 asks if you are requesting a hearing. When you initially file Form 50, you do not need to request a hearing. You will only need to request a hearing if there is a dispute between you and your employer or its insurance company and you need intervention from the Industrial Commission in order to resolve the dispute.Hearings are scheduled within 60 days of submitting Form 50 along with a $25 fee. Your case will be initially heard and decided by one of seven commissioners.
If you are unsatisfied with the decision of the commissioner who hears your case, you can appeal the decision within 14 days to a three-member panel and then to a six-member panel. To file an appeal, you must submit Form 30 with a $125 fee. Form 30 also allows you to request mediation. Mediation is a much less formal method of trying to resolve a dispute. In mediation, a neutral third-party listens to both sides and tries to help you and your employer come to a settlement agreement.
Within 30 days of an unsuccessful appeal, you may file a case in a South Carolina Circuit Court or with the South Carolina Supreme Court. The court will make a final non-appealable determination in your case.