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South Carolina workers’ compensation provides injured workers with three benefits:
While these are your rights, remember you’ve got to rely on an insurance company to honor them. Insurance companies hate when people ask to use their product as intended. Sometimes, just getting to the right doctor is a mammoth task for even a severely injured worker. Weekly checks, which many employees desperately need to keep financially afloat, are unjustifiably denied or delayed. Employees face a high risk of being cheated in their final money settlement because evaluating that can involve several factors and a complicated matrix to calculate it.
Now, let’s go over the South Carolina workers’ compensation claim process and how various roadblocks or pivots can sidetrack or delay getting your case settled.
Here’s how a claim progresses through various stages and how the different stages impact the duration of the claim:
This stage often runs the smoothest. But it still might not be smooth.
The first thing you have to do is report the injury to the employer because you have a deadline of 90 days. If that deadline expires, so do your rights. Yes, it may be uncomfortable to ask your employer for help, but a work injury can leave you out of work while you recuperate and may affect your ability to earn a living for the rest of your life. You will regret it forever if you don’t report the injury within 90 days.
It’s the employer’s responsibility to file the claim with the insurance company. This is where the friction can start. Employers don’t like to make claims, fearing insurance premiums will rise. Never mind you got hurt making them money and this is what those insurance premiums got paid for: so hurt workers like you can use it when they need it.
Potential Impact on Duration: Zero-90 days
You’re at the mercy of an insurance claims representative called an adjuster just to get the medical care and income replacement you need urgently. With an insurance company comes no shortage of red tape and bureaucracy. Expect long delays, unreturned phone calls, and general indifference. They want you to give up. Don’t. Keep calling back. If you need help, get it from me by calling toll-free at (864) 582-0416.
Generally, the insurance company may take these steps in its investigation:
If you’ve ever been hurt in the same part of your body before, know that insurance companies love to deny claims for “pre-existing” injuries. But that doesn’t mean they’re right. If your prior injury wasn’t bothering you, or this injury made it worse, workers’ compensation covers it. Be precise about how it wasn’t hurting or how this injury made it hurt worse. The insurance company has a right to investigate that. Help them help you by being open about the prior injuries and who treated you so they can get those records faster to evaluate your claim.
Potential Impact on Duration: 2-4 weeks
Once the insurance company accepts the claim, they are bound by law to honor your rights. But don’t expect it to move quickly or in the right direction. Reasons for delay at this stage include adjuster indifference and incompetence. Shockingly, your treatment can even be denied by the adjuster for no good reason, as revealed below. You can also run into problems with the doctor’s office, like delays in transmitting medical records. Also, getting into a specialist can often take several weeks.
The timeframe for receiving the first check should be as soon as possible after you’ve missed eight days of work.
Potential Impact on Duration: 0-8 weeks, to months if treatment gets denied and you’ve got to request a hearing.
One thing many employees don’t expect is, you can’t use your own doctor. The workers’ compensation insurance company pays for it, so they pick the doctor.
Here’s what to expect from your initial medical treatment by a workers’ compensation doctor. Your first treatment will probably be from an in-house company doctor or you may get sent to a “doc in a box,” like an urgent care. At this stage, unless the severity of your injury is indisputable, don’t expect much: some pain meds, maybe physical therapy, possibly work restrictions.
You can get stuck here for months as the insurance company hopes conservative treatment works to keep your claim cheap. Once it’s apparent your injury is worse, they may refer you for an MRI, send you to a specialist, or both. For example, if the workers’ comp doctor gets an MRI and it reveals a tear, you get referred to the specialist.
Medical reports are vital to your case in the South Carolina workers’ compensation claims process. The adjuster reviews these to approve future visits, prescriptions, and referrals. It sounds crazy that an insurance company employee driven by the need to settle your case cheaply grades a medical professional’s papers and makes the final call on medical care, but that’s how it works. I’ve created a strategy to help my clients describe how injuries affect their lives to give them a better shot at medical records clearly depicting the severity of injuries.
Sometimes, someone wants a second opinion. The insurance company can request one, which they might if a surgeon recommends surgery. Sometimes, we ask for one if we’re convinced the doctor the insurance company sent you to isn’t giving you proper care.
What if the worker’s compensation insurance company refuses to give me medical care? You can’t afford to go it alone anymore. You’re the only amateur in the room, surrounded by insurance company professionals who already have a lawyer working for them. Level the playing field with an experienced South Carolina worker’s compensation attorney. Call me toll-free at (864) 582-0416.
It can get horrifying when an adjuster thinks she knows more than a doctor. I had a case where an adjuster denied a spinal operation because she just disagreed with the neurosurgeon. I convinced the adjuster to send my client to a different neurosurgeon for a second opinion. When the second opinion neurosurgeon walked into the examination room, his first words to my client were basically, “I read your records and looked at your scans. I have no idea why you’re here. You need surgery.” My client finally got the operation, and her case ended well despite its complexities, but it showcases how insurance companies can deny and delay even critical medical care.
Potential Impact on Duration: This is largely tied to how reasonable the insurance company is in getting you the proper care and the severity of the injury. For a simple sprain, it may be 2-4 weeks. For a case requiring an operation, like a torn rotator cuff or a torn knee meniscus, it could be three months to a year. Spinal injuries like herniated discs can sometimes add closer to two years to your case because they take so long to reach maximum medical improvement.
If care gets disputed or denied, it could take longer because you may require a hearing.
If the insurance company denies your claim or denies you treatment recommended by a doctor, you may have no choice but to fight it out in court. In that case, you go before a South Carolina workers’ compensation commissioner. But you can’t just show up and say what you need. There’s a process that involves compiling legal briefs, making legal arguments, and being sure any argument to get you medical care is supported by evidence meeting legal requirements. If you thought you didn’t need a lawyer yet, you can’t avoid it now because you’re on the verge of losing your rights.
Potential Impact on Duration: Hearings take time. It can take three months or more to find an opening on a busy commissioner’s calendar. After the hearing, you don’t get an immediate ruling. It takes time for the commissioner to review all the evidence. Bear in mind, the commissioner has other cases to rule on before reaching yours.
Sadly, a hearing can add three months up to a year to your case. But you’ll get nowhere without it. And there is a bright side: an experienced workers compensation attorney may be able to convince the insurance company to reach a faster resolution that helps you.
If you’ve been seriously hurt, the massive challenge you have is figuring out how much to ask for in your South Carolina workers’ compensation settlement. You have to know the law, and you’ve got to know the factors that can drive up your case for a bigger settlement. If you’re thinking it’s gone pretty well so far, remember at this stage, you’ve got two enormous disadvantages: (1)the adjuster values these cases for a living, and (2) the adjuster has access to experienced attorneys,
This is where a lot of hurt employees get taken to the cleaners by that nice insurance claims representative who was so helpful. But you know better, so you’ll do better. Get legal advice. Call me toll-free at (864) 582-0416.
It’s hard enough if your settlement only involves one body part. But if you’ve injured multiple body parts or suffered a serious spinal injury, you run a real risk by handling your claim on your own.
Severely injured employees can qualify for permanent and total disability benefits. And here’s the surprising thing: getting a settlement for that doesn’t mean you’re totally helpless. But it often does mean compiling hundreds of pages of medical evidence, analyzing it, and summarizing it to prove a big settlement makes sense for an insurance company or a worker’s compensation commissioner.
To do that, you’ve got to know the legal factors to prove it, and what kind of medical evidence you need. That can include whether you need an expert to do a vocational evaluation for you.
Even if you don’t qualify for permanent and total disability, you might qualify for another settlement that can give you more money in your South Carolina worker’s compensation case. It’s called wage loss. While it doesn’t give as much money as permanent and total disability, it can often provide a much bigger settlement than a typical case.
Regardless of what kind of case you have, you need to start your South Carolina worker’s compensation settlement negotiations off strong, with a powerful demand letter. A solid demand letter lets the insurance company know you know the legal factors in your case and how to arrive at a proper settlement amount, giving you the best shot had a good settlement.
Potential Impact on Duration: 1- 3 months
WARNING: you need to be ready with your settlement evaluation the instant your doctor tells you you’ve reached maximum medical improvement. After that, the insurance company’s defense lawyer can file a Form 21, which legally requires a commissioner to hold a hearing to decide your permanent disability within 60 days. If you don’t have it figured out by then, it’s probably too late.
When you first get hurt, you may have no idea how bad it is or where your case is going. You’ve got to protect yourself against the worst. The worst is, you get too deep into a case and don’t have enough time to hire a lawyer. Don’t be a lonely amateur in a room full of insurance professionals, who already have worker’s compensation defense lawyers on retainer.
As always, the more money the insurance company might have to pay, the harder they’ll fight. If you’ve been seriously hurt or think it’s possible you’ve been seriously hurt at work, don’t risk being taken advantage of.
Get your questions answered in a free*, no-pressure strategy session with a Spartanburg, SC worker’s compensation attorney. Call toll-free at (864) 582-0416 or fill out a Get Help Now form.
If you don’t need a lawyer, I’ll tell you.
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