This article has been written by Sneha Jaiswal pursuing BA LLB (Hons.) from CHRIST (Deemed to be University), Delhi NCR. This article critically analyzed the Act of workers compensation with respect to South Carolina.
One of the most significant social security legislation is the worker’s compensation legislation. The major goal of the legislation is to give financial protection and aid to employees and their families through compensation in the event of an unintentional injury while on the job. It is often relevant in circumstances where such occurrences result in the worker’s death or disability. When an employee is harmed on the job, the correct key to unlocking compensation is to report the occurrence to the appropriate supervisor to begin the process of obtaining damages.
What is workers’ compensation insurance?
Worker’s compensation laws establish a legal framework through which employees can be reimbursed for injuries experienced while being on the job. The South Carolina Workers Compensation Commission, which oversees the state’s worker’s compensation system, is in charge of administering the claims process and making decisions about compensability. Workers’ compensation insurance, often known as workman’s comp or workers’ comp, provides payments to employees who suffer an injury or sickness at work. These benefits can help:
- in providing compensation due to disability.
- to cover medical expenses incurred by an employee as a result of a work-related accident or sickness.
- if they take their time to recover, they should be able to replace the majority of their lost wages.
- if an employee dies as a result of a work-related reason, provide benefits to their beneficiaries.
The Worker’s Compensation Act of South Carolina – scope and key features
According to South Carolina’s Workers’ Compensation Act, if an employee is injured as a result of a work-related accident, he or she is entitled to medical expenses, temporary total compensation for lost time, and permanent disability benefits if the employee is permanently disabled as a result of the work accident.
Employers have the freedom to choose the doctor who will treat their employees under existing legislation. If employees go to their own doctor of their choice without the employer’s authorization, the employer may not be held accountable for the medical costs unless there is an emergency situation. However, employees do have the right to choose a physician to assess them for a specific disability, but the company will not pay for it.
When an employee gets injured on the job, they must immediately notify their supervisor. Employees could also ask for the company to cover the cost of any necessary medical care. They can try to handle the issue alone if the claim is refused, or they can engage an attorney.
If the claim is still being challenged or refused, the employee or their lawyer can file a Form 50 with the Workers’ Compensation Commission on their behalf. This lists all of the individuals involved, the date and circumstances of the accident, who they reported it to, the injuries they sustained if medical care is required, any disfigurement they may have acquired, and any other remedies they may be seeking.
Unless the business is self-insured, the employer is normally represented by a carrier, which is an insurance firm. The carrier responds on Form 51, admitting or denying the employee’s statements on Form 50. The case is subsequently filed on the docket of the workers’ compensation commission and assigned to a single commissioner who functions as a factfinder and also makes legal decisions. A hearing is normally held within three to five months, and the employee presents his or her case during the hearing.
Medical testimony is usually given in the form of a deposition, and the employee physician will not be present at the hearing. The employee’s and carrier’s medical records will be used as additional medical evidence by the Commissioner.
Once a commissioner has made a decision on the matter, he or she will provide an opinion and award outlining his or her findings of fact and law, as well as what, if any, relief the employee will get. If either side is unhappy with the result, the case can be appealed to the full commission, which consists of all workers’ compensation commissioners excluding the one who initially heard the case. If either side is unhappy with the result reached after the hearing, it can be appealed to the Circuit Court and then to the South Carolina Supreme Court. Employees have fourteen days to file an appeal from the date of the order.
It is uncommon for a matter to be appealed to the courts after it has been determined by the full commission. Unless the employee was inebriated at the time of the injury, fault or carelessness is not a factor in the payout of a workers’ compensation claim.
What workers compensation covers in South Carolina
Workers’ compensation in South Carolina pays out cash benefits and provides medical treatment for accidents or illnesses that occur on the job. Employees who are injured or acquire an ailment connected to their employment as a result of circumstances in their job environment in South Carolina are entitled to benefits.
- Workers’ compensation is a “no-fault” system, which means that employees do not have to show that their employer is at fault in order to obtain compensation. All the employee needs to show is that the injury or sickness happened at work, was caused there, or was connected to employment.
- Accidents or injuries that happen as a result of an employee’s job. If a worker is injured on the job, workers’ compensation can help pay for medical expenditures.
- Working in a workplace with allergies or toxic chemicals might induce illnesses. The employee’s medical expenditures for a work-related sickness can be covered by workers’ compensation.
- Repetitive stress injuries are a type of injury that develops over time. Workers’ compensation can assist in covering the expense of treating a work-related repetitive stress injury.
- If an employee has to take time off work to recover from a work accident or illness, the employer may be responsible for lost earnings. Workers’ compensation may be able to compensate them for part of their lost salary.
- If an employee requires extra treatment for a work-related accident or sickness, the employer has to pay for it. Physical therapy and several operations are examples of continuing treatment.
- Expenses for a funeral if an employee dies as a result of a work-related sickness or accident.
- If an employee becomes incapacitated as a result of a work-related injury or illness, the employer be eligible for disability payments. Workers’ compensation insurance can assist pay for medical expenditures and missed earnings for employees who are temporarily or permanently injured.
Exceptions to the Worker’s Compensation Act
With a few exceptions, the Worker’s Compensation Act requires every South Carolina employer to have worker’s compensation insurance. Certain classes of employees and employers are not required to be covered by worker’s compensation insurance, according to Section 42-1-360 of the South Carolina legislature. The following are some of the exceptions:
- Employers in the state who have less than four regular full-time or part-time employees in the same firm;
- Agricultural workers;
- Individuals that sell agricultural products;
- Employees who work on a casual basis;
- Associations of state and county fairs;
- Employees of the federal government
- Companies that operate railroads and railway express trains, as well as;
- Employers with a total yearly payroll of less than $3,000, regardless of the number of employees on the payroll at that time.
In addition to those classifications listed above, owner-operator drivers according to Section 42-1-360 (9) of the South Carolina Code and certain commission-paid real estate agents Section 42-1-360 (7) of the South Carolina Code are also exempted from worker’s compensation coverage.
South Carolina Workers Compensation Commission
The South Carolina Workers’ Compensation Commission is made up of seven commissioners. The governor appoints commissioners with the Senate’s approval. Each commissioner is appointed for a six-year term. For a two-year period, one commissioner will serve as chairman.
The chairman is the Commission’s chief executive officer. It is the chairman’s obligation to put the Commission’s policies into effect.
South Carolina workers compensation
The following are the responsibilities of the Insurance and Medical Services Department:
- Keeping track of the workers’ compensation insurance coverage is necessary.
- Investigating and enforcing compliance with the law in cases of non-compliance.
- Managing the self-insurance scheme for workers’ compensation.
- Fee schedules for hospitals, physicians, and ambulatory surgery facilities are being established.
- Managing and supervising the development of all Commission claims that are filed.
The five types of compensation benefits under the Act
Employees who have lost wages due to a working accident are entitled to compensation under the South Carolina Workers’ Compensation system. Based on the severity of the damage and subsequent level of disability, benefits are divided into five categories into the form of cash benefits, wage replacement benefits, and medical benefits and these are mentioned below:
Temporary total disability
When an employee is unable to do adequate work for one or more calendar days after an injury, he is qualified for temporary total disability.
After the first seven days of disability, an employee who is unable to work owing to a compensable injury is entitled to weekly benefits equivalent to two-thirds of his normal weekly income, up to the maximum compensation amount. According to Section 42-9-200 of the South Carolina Code states that, if the incapacity lasts more than fourteen days, the employer is entitled to pay for the first seven days of absence. According to Section 42-9-10 of the South Carolina Code, temporary total disability compensation can be extended for up to 500 weeks.
- Clause (a) of Section 42-9-10 of the South Carolina Code deals with an injury that results in total incapacity for work, the employer must pay the injured employee a weekly compensation equal to sixty-six and two-thirds percent of his average weekly wages, but not less than seventy-five dollars a week, as long as this amount does not exceed his average weekly salary during the total disability. If in case the sum exceeds his usual weekly wage, the injured worker may not be paid less than his average weekly wage each week. The wounded worker may not be paid more per week than the state’s average weekly wage for the preceding fiscal year.
- Clause (b) of this Code deals with a total and permanent disability, which is defined as the loss of both hands, arms, shoulders, feet, legs, hips, or vision in both eyes, or any two of them, and is compensated according to the rules of this section.
- Clause (c) talks about the exception to the rule of compensation that can be extended for up to 500 weeks. Any person who has been declared to be permanently disabled, who is a paraplegic, quadriplegic, or has suffered physical brain damage as a result of a compensable injury is not subject to the five-hundred-week limitation prescribed in this section or elsewhere in this title and shall receive the lifetime benefits.
- Clause (d) says that the commission may not impose a total lump sum payment in any case under this section where the injured person is entitled to lifetime benefits, despite the provisions of Section 42-9-301.
When the employee returns to work or when the employer furnishes the South Carolina workers compensation commission with convincing evidence that the employee is no longer disabled, benefits are terminated.
Temporary partial disability
When an employee is able to work but at a lower rate of pay than his typical weekly income for his occupation at the time of the accident, he is eligible for temporary partial disability. Temporary partial disability benefits provide compensation equal to two-thirds of the difference between the post-injury and pre-injury average weekly wages, so long as the amount does not exceed the statutory maximum weekly benefit.
According to Section 42-9-20 of the South Carolina Code, temporary partial disability payments may not be extended beyond 340 weeks, and any number of weeks in which temporary total disability benefits were paid will be deducted from the 340-week maximum.
Permanent partial disability
An employee who is left with complete loss or loss of use of any member or part of the body at the conclusion of the healing period, also known as maximal medical improvement, may be eligible for permanent total disability payments notwithstanding his capacity to work.
The rate of compensation is calculated using medical data that offers an opinion on the percentage disability rating (loss of function) for the injured body part, with 100% indicating a total loss of function and 0% indicating complete functioning. The percentage disability rating is then compared to one of the bodily parts mentioned in Section 42-9-30 of the South Carolina Code’s schedule of injuries. Each body component is allotted a certain number of weeks of benefits under the injury schedule.
Following approval by the South Carolina workers compensation commission, an employee is entitled to a second opinion on a permanent partial disability rating from a doctor of the employee’s choice at the employer’s expense.
Employees who are completely and permanently unable to work in any gainful activity are eligible for permanent total disability compensation. Incapacity is defined in Section 42-1-120 of the South Carolina Code as the inability to earn the earnings that the employee was getting at the time of injury in the same or another job.
“Total disability is defined by South Carolina courts as an inability to perform services other than those that are “so restricted in quality, reliability, or quantity that there is no reasonably steady market for them.” This does not, however, need total physical incapacity” (Coleman v. Quality Concrete Products (1965); Koon v. Spartan Mills (1985)). The loss of both hands, arms, shoulders, feet, legs, hips, or eyesight in both eyes, or any two of them, is defined as a total and permanent impairment under Section 42-9-10 of the South Carolina Code.
According to Section 42-9-290 of the South Carolina Code, death benefits shall be paid to the employee’s dependents who were entirely reliant on his earnings for support at the time of the accident, a weekly payment equal to sixty-six and two-thirds percent of his average weekly wages for a period of 500 weeks from the date of the injury, and burial expenses up to but not exceeding twenty-five hundred dollars.
Section 42-9-290 of the South Carolina Code further provides that if the employee leaves dependents who are only partially reliant on their earnings for support at the time of the injury, the weekly compensation to be paid must be equal to the same proportion of the weekly payments for the benefit of persons wholly reliant as the employee’s contribution to such partial dependence bears to the deceased’s annual earnings at the time of his injury.
The Act is primarily designed to protect employees by allowing them to seek compensation from their employers for medical expenses and injury incurred as a result of an accident. The Act follows the basic norm of vicarious responsibility. The master is the employer, while the servant is the employee. Only when the accident occurs during the course of employment and in the workplace does the employee get compensation.
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