South Carolina Workers Compensation Claims: Eligibility, Filing and Appeals
Understand the process of workers' compensation in the state of South Carolina.
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 2017, the maximum weekly payment is $806.92. If you're able to work, but earning less due to your injuries, you can receive two-thirds of the difference in your wages, subject to the same maximum.
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 are permanently impaired in some way, you will be eligible to receive additional compensation, called permanent partial disability (PPD) payments. These benefits are two-thirds of your average weekly wage, subject to the same weekly maximum as temporary disability benefits. This weekly amount will be multiplied by a number of weeks determined by a state schedule. For example, the schedule lists 220 weeks of payment for a total loss of use of a hand. If you have a partial loss of use, you will receive benefits for a proportionate number of weeks.
Example: Your average weekly wage before the injury was $450, and you have a 10% loss of use of the left hand. Your weekly rate would be two-thirds of $450, which is $300. You would multiply this amount by 22 weeks (10% of 220), for a total of $6,600.
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 continue to receive benefits at your total temporary rate, for up to 500 weeks. Paraplegics, quadriplegics, and brain-damaged workers can receive benefits for life.
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.