South Carolina workers’ compensation law intends a simple claim process. It addresses basic human needs for seriously injured people: medical care related to your injury, partial income replacement when you can't work, and compensation for permanent damage sustained as a result of your work injury. It’s designed to bring swift relief to injured workers. But that's often not the way it works.
Despite the intent of the law, the claim process is often thwarted by the insurance companies that pay the benefits. Injured employees are subjected to heartless delays and even outright denials of legitimate claims. Often, those who are hurt the worst suffer the most.
No one wants to rock the boat at work, especially if they love their job, as most of my clients do. But it's usually not your job that causes problems—it's the insurance company.
If you get hurt at work, the best thing you can do is get legal advice immediately. I’m an experienced Spartanburg, South Carolina workers’ compensation attorney. I'll answer your questions for FREE, and I'll tell you if you don't need a lawyer. Call toll-free at 888-230-1841 or fill out a Get Help Now form.
This article focuses on how workers’ comp insurance companies handle claims. You need to know because the more you know, the less you can be taken advantage of. To see how my firm helps take back some control of your claim, read about our process to settle your South Carolina workers’ compensation case.
Step 1: Report Your Work Injury Immediately
Reporting your injury immediately is critical. You've got a deadline to report a South Carolina workers comp injury, or you lose your rights. Tell your supervisor you got hurt as soon as possible. If necessary, force the issue by telling them you need a workers’ compensation claim started. Don't let anybody make you think you're doing anything wrong. You got hurt making them money, and they need to take care of you, as the law requires.
After you report it, your supervisor or the insurance company will fill out a First Report of Injury to start the claim, as required by South Carolina workers’ compensation law. Around that time, you meet the insurance company claim handler, who you should view as your claims gatekeeper who you can't take your eyes off for a second.
Step 2: Meet the Adjuster - Tread Carefully
In South Carolina, insurance company workers’ compensation claims handlers are referred to as “the adjuster.” Adjusters are highly trained claims experts with one goal: to get the insurance company out of your claim cheaply and quickly. When they look at you, these experienced professionals see a wounded amateur to pick off.
Make no mistake- some adjusters will stop at nothing to end your claim without giving you proper treatment or paying you. Here's what I've seen in representing seriously injured South Carolina employees in workers’ compensation cases:
- Referrals to specialists don't get scheduled
- Weekly checks are late or never arrive
I've had clients who needed spinal operations only to have them denied. If that's the case, what will an adjuster do if you've just got a “little” rotator cuff tear or need a knee scope?
A prior injury is a favorite reason for denial that often discourages workers into abandoning their claim. Adjusters love to tell injured employees, “You were already hurt,” or “This would have happened anyway.” A prior injury does not automatically exclude you from a workers’ compensation claim. You might need specific medical evidence to prove the work injury worsened the prior injury, requiring a skilled workers’ compensation lawyer to help you. Giving up can leave you in a lifetime of pain and regret for the treatment you didn't get and the settlement you got cheated out of.
You can't be careful enough with a workers compensation adjuster. But you do have to work with them since they hold the keys to your treatment and weekly checks. Before your claim moves too far, you will likely have to give a recorded statement about how you got hurt and your symptoms, in addition to some background information.
This is the best time ever to get advice - before you risk damaging your claim. Get your questions answered in a free, no-pressure strategy session with a Spartanburg, SC workers’ compensation attorney. Call toll-free at 888-230-1841 or fill out a Get Help Now form.
Hopefully, you can move on to the next step without a hitch. But don't count on it.
Step 3: Initial Benefits Start
Hopefully, the insurance company will arrange medical treatment immediately. Because the insurance company pays, they get to choose the doctor. You should expect to go to an on-site doctor, an urgent center (“doc in a box”), or another general-type doctor.
If the doctor puts you out of work or gives you work restrictions your job can't accommodate, you qualify for a weekly check after missing seven days of work. The law calls these checks “temporary total disability,” or TTD.
This is often the time when claims get really complicated. The insurance company drags its feet paying your checks. Then you get referred to a specialist because you've got a serious injury a regular doctor can't fix. The insurance company can delay even longer or even outright deny treatment. In my experience, if you get referred to a specialist, you need to speak with an experienced South Carolina workers' compensation attorney if you haven’t already. The more you're hurt, the more money and medical treatment is at stake, and the harder the insurance company will fight you.
Get peace of mind for free from a Spartanburg, SC workers’ compensation attorney. Call toll-free at 888-230-1841 or fill out a Get Help Now form.
Step 4: The Treatment Phase of Your South Carolina Workers’ Compensation Claim
This is a critical part of your claim. The doctor is one of the most important witnesses in your case. Your doctor directs your care. But you've got to help them. Be honest about your symptoms and thoroughly describe how they affect your ability to work and live your life.
Never exaggerate. The insurance company is looking for a reason to call you a liar so they can shut your case down. Don't help them.
During the treatment phase of your case, our team keeps up with you to make sure you get the treatment you need. If not, we call the insurance company out on it. A key benefit of a lawyer in this situation is that when treatment gets unjustifiably delayed or denied, the insurance company knows you have a professional on your side who can use the legal system to protect your well-being.
As treatment draws to a close, your case continues to get more complicated and risky, especially if you were seriously hurt.
Step 5: As Treatment Ends, the Claim Moves Toward Settlement
For many seriously injured employees, the doctor doesn't just schedule a final office visit and declare you healed. A critical part of the workers’ compensation settlement process involves the doctor setting an impairment rating and permanent work restrictions. Doing that sometimes requires the doctor to get an expert of their own. The doctor might refer you to a functional capacity evaluation (FCE) to help determine your impairment rating and permanent work restrictions.
The FCE is a critical aspect of your case that you must be ready for. If we're helping you, we meet with you to discuss what an FCE is and how to undergo one successfully.
Once the doctor releases you, you've got to quickly be able to answer a serious final question: what's my South Carolina workers’ compensation settlement worth?
Step 6: South Carolina Workers’ Compensation Claim Settlement Evaluations and Strategy
This is the most complicated part of a workers’ compensation case. It requires an understanding of how workers’ compensation law values a settlement and how a workers’ compensation commissioner might decide your case.
Simply put, this is when it's easiest to get cheated out of money you deserve in a fair South Carolina workers’ compensation settlement. In a nutshell, you've got to be able to take into consideration the impact of several factors:
- Your impairment rating
- Your work restrictions
- Your future medical care
- Whether you qualify for permanent and total disability, which qualifies you for the biggest settlement under South Carolina workers compensation law. This is not Social Security disability. And it doesn't require you to be helpless. But it's hard to prove, and you need an experienced attorney to help you do it.
- If you don't qualify for permanent and total disability, whether you qualify for wage loss benefits. This is another way to enhance your settlement amount if you're severely permanently injured. Again, you should get the help of an experienced South Carolina workers' compensation lawyer.
- Whether you want to continue getting medical treatment from workers’ compensation, or “clinch” the case for more money, leaving future medical care on your own.
For the seriously injured employee, these are all big decisions with permanent consequences.
You must develop a comprehensive settlement strategy to maximize your settlement amount. This is where you either act or get acted on by insurance professionals and attorneys. The insurance company will certainly have a strategy to shortchange you. If you fail to plan here, you're planning to fail.
The centerpiece of our strategy is the demand letter. We use it to kick off settlement negotiations from a strong position. It summarizes the case from your viewpoint, aiming for the highest settlement possible.
If you're worried you don't know how to value your case or develop a strategy to settle it, take heart and be warned: the insurance company might be getting professional legal help by now, too. To help them settle cases, insurance companies often hire attorneys to assert their rights and confront you. Don't go it alone. Call me toll-free at 888-230-1841.
Assuming you reach a settlement with the insurance company, you're still not done.
Step 7: Settlement Finalization
Workers’ compensation settlements in South Carolina aren't done until the paperwork is filed. You'll be given complex documents in foreign legalities you might not understand. These official documents will forever impact your rights in your case. Once you sign them, they get sent to the Workers’ Compensation Commission for filing. After these documents are filed, you can finally cash your settlement check.
What Happens if You Can't Reach a Settlement?
If you can't agree on a settlement amount with the insurance company, a workers’ compensation commissioner will decide your case. This involves the South Carolina workers’ compensation hearing process.
You'll need to file legal briefs and copies of your evidence with the Commission. You've got to strategize how to present the evidence to position yourself for the best possible result. If you're still on your own here, it’s like doing surgery on yourself.
This Is Hard - Get Professional Help
The South Carolina workers’ compensation insurance claim process is just not simple or easy for the seriously injured. So much can go wrong, and it often does. We're here to help, and the insurance company knows it. If you hire us, we will handle the dirty legal technicalities while you focus on getting better and getting back to work and your life.
I know you don't want to call a lawyer. You really didn't want to go to the doctor, either, but you knew you'd regret it later if you didn't. Don't leave your life open to regrets because you left your legal rights up to an insurance company.
Contact me to see what my team can do for you. We offer a FREE, NO-PRESSURE strategy session we work to make easy on you.
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