Our attorneys represent employers throughout South Carolina in defense of workers’ compensation claims. We have significant experience appearing before the South Carolina Workers’ Compensation Commission, and two of our attorneys are certified mediators who work primarily in the workers’ compensation arena.
The South Carolina workers’ compensation system presents a trade-off for employers. Insured employers are immune from employees’ personal injury claims in most cases; but in exchange, they are subject to limited “no-fault” liability for most job-related injuries and illnesses.
However, the right for employees to seek benefits is not absolute. There are strict rules and deadlines that apply, and injuries from certain causes are not eligible for benefits. In addition, workers’ compensation fraud continues to be a major financial burden for employers and their insurers, and employers must carefully assess all employee claims in order to avoid unwarranted liability.
Workers’ Compensation Defense Lawyers in Columbia and Charleston, SC
At Howser, Newman & Besley, LLC, we provide experienced legal representation for South Carolina employers in all workers’ compensation matters. From the initial investigation to appeals in the Supreme Court of South Carolina, we can advise you regarding all aspects of your employees’ claims for benefits. Disputed workers’ compensation claims frequently involve complicated factual issues and complex questions of law – and with our decades of experience in workers’ compensation litigation, we are well-positioned to help mitigate your company’s liability as much as possible.
In addition to representing employers in workers’ compensation matters, two of our attorneys are certified mediators with the Supreme Court of South Carolina who focus their mediation practices primarily on workers’ compensation. The South Carolina Workers’ Compensation Commission now requires mediation and we are able to effectively assist employers as advocates and serve as neutrals for disputed workers’ compensation claims. Regardless of your needs, we encourage you to get in touch. We are happy to discuss your situation in confidence and help you make informed decisions.
Our Services for Workers’ Compensation Claims
The workers’ compensation claims process is highly-structured, and both employers and employees are subject to various requirements at each stage of the process. Our attorneys represent employers in all workers’ compensation-related matters, at each stage of the process as detailed below.
Initial Claim Assessments
Once an employee reports a job-related injury or illness, the employer has 10 days to report the incident to its insurer or the South Carolina Workers’ Compensation Commission. At this stage, the employer (or its insurer) must make a determination as to whether to deny the claim or accept liability. This decision must be made in good faith, and must be made based upon a reasonable assessment of the evidence that is available.
Workers’ Compensation Mediation
When an employee disputes a denial of benefits, the next stage is usually mediation. During mediation, both parties are represented by counsel, and a mediator works with the parties to help them work toward a mutually-agreeable settlement. Unless otherwise agreed, this initial attempt at mediation must be completed within 60 days (the parties can choose to return to mediation during any subsequent stage of the process).
Hearings Before the Workers’ Compensation Commission
If mediation does not result in a settlement, the employee can continue to pursue his or her claim by filing a request for a hearing with the South Carolina Workers’ Compensation Commission. This initial hearing is conducted by a single commissioner, and typically takes place in the county where the alleged incident occurred.
Workers’ Compensation Commission Appeals
If either party is dissatisfied with the outcome of the initial Workers’ Compensation Commission hearing, it has 14 days to file an appeal with the Commission. These appeals are heard by a panel of three commissioners.
Appeals to the South Carolina Court of Appeals
The three-member Workers’ Compensation Commission panel is the end of the administrative process for workers’ compensation claims in South Carolina. If either party disagrees with the panel’s decision, the next step is to file a notice of appeal with the South Carolina Court of Appeals within 30 days.
Appeals to the Supreme Court of South Carolina
The final stage in the workers’ compensation appeals process involves filing an appeal with the Supreme Court of South Carolina. Although it is unusual for a workers’ compensation claim to get to this stage (most claims settle well before getting to this level of the process), if necessary, our attorneys can defend your company’s denial of benefits before the Supreme Court.
Insurance Coverage Disputes
In addition to representing employers in disputes with their employees, we also have significant experience with insurance coverage litigation. We routinely represent clients in disputes involving breach of contract, insurance bad faith, negligence, and other matters.
FAQs: South Carolina Workers’ Compensation Defense
Q: Which employers are required to have workers’ compensation insurance in South Carolina?
Under South Carolina law, the general rule is that any company with four or more employees (full-time or part-time) is required to have workers’ compensation insurance. However, there are certain exceptions. For example, agricultural employees typically are not covered, nor are real estate agents who get paid on commission.
If a company is not required to carry workers’ compensation under South Carolina law, it can still elect to purchase coverage and receive immunity for most work-related personal injury claims. But, if an employer is subject to the state’s mandatory insurance requirement, there is no way to opt out of providing coverage.
Q: Can Employers Self-Insure for Workers’ Compensation Claims in South Carolina?
South Carolina employers can self-insure for workers’ compensation claims subject to approval by the Workers’ Compensation Commission. In order to receive approval, an employer must meet certain financial and other eligibility requirements, and it must maintain reinsurance and a surety bond or letter of credit for an approved amount.
Q: When is an employee eligible for disability benefits in South Carolina?
The general rule is that an employee becomes eligible for disability benefits when he or she is unable to work for seven or more days as the result of a work-related injury or illness. If an employee misses 14 days of work or more, he or she can claim benefits dating back to the original date of injury or illness. Total disability benefits typically end at a maximum of 500 weeks, although lifetime benefits may be awarded for traumatic brain injuries (TBI) and spinal cord injuries resulting in paralysis.
Q: What are some potential defenses to employer liability for workers’ compensation claims in South Carolina?
South Carolina employers have a number of potential procedural and substantive defenses to employees’ workers’ compensation claims. When assessing employees’ claims for benefits, employers (and their insurers) should carefully consider all of the potential defenses they have available. These include (but are not limited to):
- Untimely Notice – In order to claim workers’ compensation benefits, employees must report their injuries and illnesses to their employers in writing within 90 days (with certain exceptions, e.g., if an employer is independently aware of an employee’s injury or illness).
- Statute of Limitations – South Carolina has a two-year statute of limitations for workers’ compensation claims. Certain exceptions apply, but when the statute of limitations defense is available it can serve as a complete bar to financial recovery.
- Non-Work-Related Injury or Illness – Workers’ compensation benefits are only available for work-related injuries and illnesses. If an employee cannot establish that his or her medical condition is job-related (i.e., it is a pre-existing condition or occurred outside of the scope of employment), then no award of benefits is appropriate.
- Failure to See an Approved Doctor – Under South Carolina law, employers are entitled to choose the doctors who treat their employees’ work-related injuries and illnesses. If an employee is seeking benefits based upon a diagnosis provided by his or her own physician, your company may be within its rights to deny the employee’s claim for benefits.
- Employee Fault – While workers’ compensation is considered a “no-fault” system, there are circumstances in which an employee’s fault can serve as a complete bar to financial recovery. For example, if an employee is claiming benefits for injuries suffered while under the influence of alcohol or drugs, his or her claim may not be legally supported.
- Employee Fraud – Employers and their insurance companies are not required to pay benefits to employees who fabricate injuries, intentionally injure themselves, or misrepresent that their medical conditions are work-related.
Q: What happens if an employee refuses to return to work after receiving a medical release?
If an employee refuses to return to work after receiving a medical release (including returning to light work), the employer and its insurer can stop paying benefits – as long as the medical release is valid. If the employee disputes that he or she is able to work, the employee can dispute the termination of benefits according to the process outlined above.
Contact Howser, Newman & Besley, LLC
For more information about our workers’ compensation defense and mediation practice, please contact us to schedule an initial consultation. You can reach our Columbia office at (866) 207-6209 and our Charleston office at (877) 216-6970, or you can contact one of our workers’ compensation attorneys directly: Jamie Newman, Michal Jones, or Andy Haselden.