What are the stages of a workers’ compensation claim in SC?
From start to finish, there are deadlines, filing requirements, notice requirements, and other details that could prevent you from getting paid the compensation you are entitled to when you are hurt on the job.
You can get help from a SC workers’ compensation lawyer at any stage of the proceedings. If you have a serious work-related injury, however, be aware that your employer or their insurance company will attempt to minimize your claim and pay the least amount of compensation they can get away with.
The stages of a workers’ compensation claim in SC include:
- Reporting your injury to your employer,
- Filing your workers’ comp claim,
- Filing any necessary appeals,
- Getting treatment for your injuries,
- Returning to work when you can, and
- Requesting a workers’ comp hearing when your employer’s physician unfairly reduces or terminates your benefits.
Stages of a Workers’ Compensation Claim: Filing the Claim
The “stages” of a workers’ compensation claim in SC don’t necessarily happen in a particular order, and they are overlapping.
For example, the first thing you must do is report your injury to your employer and get treatment for your injuries, then file your claim and request a hearing if needed, continue treating as needed, request a hearing if your benefits are being denied or terminated too early, etc.
Report Your On-the-Job Injury to Your Employer
If you are hurt on the job, you should immediately report your injury to your employer. You have a deadline of 90 days to notify your employer, but, if you delay, it may give your employer and their insurance company an excuse to claim you were not injured on the job or that your injuries are not as serious as you claim.
Your employer then has ten days to report your claim to their insurance company, and the insurance company is then required to notify the workers’ compensation commission.
In a perfect world, if all goes well, your employer (their insurance company) will approve a medical provider, you will receive treatment for your injuries, and the insurance company will pay the benefits that you are entitled to…
If possible, you should take photographs or video of the area where the on-the-job accident happened, any job hazards or dangerous conditions that were present, and get the names and contact information for any witnesses to the accident to provide to your workers’ comp attorney.
File a Claim and Request a Hearing with the Workers’ Compensation Commission
When your employer or their insurance company denies your claim (or only agrees to part of your claim), you or your attorney can request a formal hearing with the workers’ compensation commission.
You may need to:
- File the workers’ compensation claim and request a hearing using a Form 50 Notice of Claim and Request for Hearing (for on-the-job injuries) or a Form 52 Notice of Claim and Request for Hearing in Death Cases – you have a deadline of two years to formally file a claim and request a workers’ comp hearing,
- Gather your medical evidence to submit with your claim,
- Participate in mediation with the insurer, and
- Present your medical evidence to a workers’ compensation commissioner at your hearing.
Appeals from Your Workers’ Compensation Hearing
If your claim is denied by the workers’ compensation commissioner, you can file an appeal for review by a full panel of commissioners using a Form 30 Request for Commission Review. The Form 30 costs $150 to file and must be submitted within 14 days of the commissioner’s decision.
If the full panel denies your appeal, you can then appeal their decision to the SC Court of Appeals (within 30 days), and you can then petition the SC Supreme Court to hear your case if the Court of Appeals rules against you.
Stages of a Workers’ Compensation Claim: Treatment and Workers’ Comp Benefits
You should immediately seek treatment for your injuries, follow your doctor’s recommendations, and return to work when you are able, but you have the right to request a hearing if your insurance company’s doctor sends you back to work too soon or if the insurance company attempts to reduce or terminate your benefits too early.
Treatment for Your Injury
Your employer will send you to a doctor that they approve (that the insurance company approves) for treatment – you do not pay anything for your medical treatment, even if you are sent to specialists.
On the other hand, if the insurance-company-approved doctor says you do not need treatment when you know that you do need treatment, you are entitled to a second opinion from an independent doctor.
If your need for treatment is contested, you can file a formal workers’ comp claim and request a hearing (see above) where your attorney can present medical evidence to help you get approved for your medical costs and other benefits.
Maximum Medical Improvement (MMI)
When you have completed treating your injuries and your doctor determines that there is nothing more that can be done, you have reached maximum medical improvement (MMI).
At this point, your doctor may release you to return to work, release you to return to work on light duty, or find that you are unable to return to work due to your disability caused by your on-the-job injuries.
Your doctor may also give you an “impairment rating” that estimates the impact your injury has had on your ability to perform your job. For example, if you have lost the complete use of a body part, your impairment rating would be 100%.
If you have lost the partial use of a body part, your impairment would be between 0% and 100%, and, if you have completely recovered from your on-the-job injury, your impairment rating would be 0%.
If your injuries result in disability, you could be compensated for 1) permanent or temporary impairment, or 2) partial or total disability, depending on your medical evidence.
Whether the impairment is permanent, temporary, partial, or total, SC workers’ compensation laws provide for a maximum number of weeks that your benefits will last based on the affected body part.
If Your Benefits are Wrongly Terminated or Reduced: Request a Hearing
You can request a hearing when your workers’ compensation benefits are unlawfully terminated or reduced, just as you can request a hearing when your benefits are initially denied – if you are in either situation, contact your Myrtle Beach workers’ comp attorney on the Axelrod team immediately.
Your Myrtle Beach worker’s compensation lawyer on the Axelrod team will help you to file your claim, determine how long your workers’ compensation benefits may last, and represent you before the workers’ compensation commission for any hearings and appeals.