So you’ve been injured on the job and hopefully by now made it to the proper doctor specialist to help diagnose and treat your injuries. Once you get over this initial trauma and emergency situation the next thought naturally turns to what benefits am I entitled to under South Carolina Workers’ Compensation law and importantly how does Workers’ Compensation insurance carrier pay you? To get the answers to these questions, you should hire and experienced South Carolina workers compensation lawyer. In the meantime, here are some pointers.
If you have a minor injury and are able to return to work then you will continue to receive your paycheck from you employer just as you did before the work accident. However when the injuries from your work accident are more serious, and you are not able to return to work or you return to work earning lesser pay or fewer hours or a combination of the two then it is upon your employers Workers’ Compensation insurance carrier to pay you disability benefits. While there can be a battle between your employer their insurance carrier and you as to whether or not you’re entitled to Weekly Disability Benefits, in the event that you win this battle or the event that your employer and their insurance carrier agree that you’re entitled to these benefits then the Workers’ Compensation insurance carrier is suppose to pay you a check each week for your Temporary Total or Temporary Partial Wage Loss. For Temporary Total Wage Loss benefits you can find the law at S.C. Code Ann. §42-9-10 (hyperlink to code section).
What you will find in this statute is that the insurance company is supposed to pay you 2/3 of what you were earning up to the time of the work accident up to what is known as a “Maximum Compensation Rate”. In South Carolina the current Maximum Compensation Rate is (hyperlink to max compensation rate for 2015 on Commission website). What that means is if you are earning moneys and 2/3 of it is somewhere at the Maximum Compensation Rate or below it then you will get that amount of money in a check each week from the Workers’ Compensation insurance carrier. In the event that you are earning a salary or wages that are above the Maximum Compensation Rate then you will cap out at this Maximum Compensation Rate per week. This of course can cause great heart ache and can cause you to get behind on your monthly bills inside your household. The next way you can also be paid is in the event that you’re able to return to work but in a different job or at fewer hours or at lesser money for whatever reason or some combination of the two. In that event than you would be entitled to Temporary Partial Wage Loss under the Act. S.C. Code Ann. §42-9-20 lays out the law as to what benefits you should be entitled to in the even that you are suffering Temporary Partial Wage Loss in South Carolina. Under the law it is clear that you are entitled to 2/3 of the difference between your pre accident wages and your post accident wages.
No matter what type of benefit you’re entitled to, your weekly check is suppose to come to you on a weekly basis. It also is suppose to come to you on a “regular” basis. Now this is the way the law is written but in many cases the insurance carrier fails to send checks on time or in some instances fails to send them at all. That’s why it is very important to get a lawyer involved in your case early on to help keep the scheduled weekly benefits on track so as to cause as little of an interruption to your inability to pay your monthly bills as possible. Your weekly check should be paid to you until you reach what is called “Maximum Medical Improvement” hereinafter “MMI”. MMI is the point in time when your authorized treating doctor says that you’ve reached a plateau and have gotten about as good as you’ll get from recovering from your work related injuries. It is not to say that you’re all better it’s just to say that you’ve reached a point where the doctor says that you may get worse or you may get better but basically you’ve achieved the maximum result that could be expected in recovering from you injuries. This point is usually six to twelve months down the road after the accident or after the surgery or surgeries that you had to undergo as a result of you work related injuries.
Under South Carolina law if you’ve been receiving weekly checks for more than 150 days then the insurance carrier is not allowed to turn off your weekly benefits without having a merits hearing in your case. If it is any time within the first 150 days then the insurance company can stop benefits on their own and it would be incumbent upon you file the necessary paperwork to ask for a hearing to decide whether or not those benefits could be lawfully terminated at that time. In the event that you are to go to a merits hearing you would need evidence from the authorized treating doctor or at least some doctor that states that you are unable to return to work at all or unable to return to work in the capacity that you were prior to the work accident.
There are some insurance companies that are experimenting with giving out “debit cards” in which the idea would be that the insurance company would transfer money into your bank account and that you would use your debit card just as you would a traditional debit card to pay for your weekly and monthly household expenses. Also in some situations I’ve seen it where the insurance company is willing to do an automatic transfer into your bank account however in my experience that has been the exception and not the rule. For the most part you can expect to be paid in checks that are issued to you by the Workers’ Compensation insurance carrier.
The next question after you have been receiving your weekly benefits checks as you make a recovery in your case, is how does Workers’ Compensation pay you at the end of your case. Workers’ Compensation can be paid out either in continued weekly checks for your Permanent Total Wage Loss, Permanent Partial Wage loss, or General Disability under S.C. Code Ann. §42-9-10, 42-9-20, and 42-9-30. In the event that you’re able to establish that you are competent to handle your financial affairs and in most cases that you’re in need of the money to handle your monthly expenses including food clothing and shelter or perhaps to pay off other debts such as credit card debt mortgage debt car loan debt and so forth then the South Carolina Workers’ Compensation Commission can award you your final disability in a “lump sum” check. This use to be something that would happen as a regular course although I’ve noticed in recent years that the Commission is more open to arguments from the employer and their insurance company that your benefits be paid out on a weekly basis whether than paying in a lump sum. Your lawyer can assist you in developing the proper evidence to make a demonstration to the insurance company and ultimately to the Workers’ Compensation Commission if necessary that you are a candidate for or entitled to a lump sum payment of your disability check in your case. In the event that you settle your case many times the lump sum check can be negotiated without having to have a ruling on this issue by the Workers’ Compensation Commission. In the event that the insurance company is unwilling to settle your case or is unwilling to pay you in a lump sum then a merits hearing may be necessary in order to present the proper evidence and make the proper arguments in an attempt to get you your check in a lump sum format.
Sometimes Workers’ Compensation will try to pay you for your future medical care and treatment. As a general rule I’ve always advised my clients that I think it is not in their best interest to settle out their future medical care and treatment that has been recommended by their authorized treating doctors. There are many reasons for this but the biggest argument is that Workers’ Compensation pays 100% of your medical care and treatment with no co pays or deductibles that you’re responsible for. This means that in the event that you need that medical treatment down the road whether it be a future surgery or physical therapy, injection therapy, medication management, office visits or repeat imaging and so on that you at least have an argument that you’re entitled to that medical treatment and that the Workers’ Compensation carrier has to pay for all of it. While this may not be money coming into your pocket it also is not money coming out of your pocket which is very important. Furthermore this medical treatment can help you maintain your current level of disability and help you with your “daily living activities”. For that reason I always advise clients that they leave their future medical care and treatment open. Some clients choose not to do this and choose to accept the cash settlement payout that the Workers’ Comp. Insurance carrier is offering for future medical care and treatment. Simply put though in my experience the Workers’ Comp. Insurance carrier is generally not willing to pay enough value to you the injured worker for the amount of future medical care and treatment you’d be entitled to under the Act. With that in mind there is a potential for the Workers’ Compensation insurance carrier to not only pay you for your temporary disability and for your permanent disability but also for future medical care and treatment.
So to answer the question of how does Workers’ Compensation pay you as you can see above it comes in many forms and in different forms at different stages of your case. The take home message is that there are a lot of moving parts in these areas of the law and it would be in your best interest to hire a qualified South Carolina Workers’ Compensation lawyer to help you understand what benefits you are entitled to and to help you obtain all the benefits that you’re entitled to under the law. If you have questions about how does your Workers’ Compensation insurance carrier pay you, call one of our experienced South Carolina Workers’ Compensation lawyers now. We are happy to meet with you for the initial consultation for free and give you any advice and understanding of the issues that you are seeking. In the event that you decide that you want our help, we are happy to assist you with any and all of your Workers’ Compensation needs. Call Howell and Christmas now.