Filing a Workers’ Compensation Claim
- If I’m injured at work, what should I do first?
- How do I report an on-the-job injury?
- How do I file a claim?
Understanding Workers’ Comp Benefits
- What medical treatment am I entitled to receive?
- How is the compensation rate determined?
- Will I get compensated for missing time from work because of my injury?
- When are my benefits terminated?
- What if the doctor releases me to light duty?
- Do I get reimbursed for my travel expenses when I go to the doctor?
- Can I get a second opinion if I’m not happy with the doctor to whom the insurance carrier refers me?
- Who sends me my weekly check?
- Can I draw Social Security benefits at the same time as I am drawing my time loss or pension benefits?
- What do I do if my claim is rejected or the Commission denies benefits on my claim?
Workers’ Comp Benefits and Your Employer
- Can I sue my employer or my co-worker for causing the injury?
- Why can’t I choose to file a lawsuit against my employer instead of making a Workers’ Comp claim?
- Does my employer have to hold my position open for me if I’m absent due to a Workers’ Comp injury?
Working with Don Pilzer Law, PC
If I’m injured at work, what should I do first?
First, tell your employer or supervisor about your accident and/or injury and seek immediate medical attention.
If you feel your injury requires you to seek legal advice, contact experienced Don Pilzer Law, PC.
How do I report an on-the-job injury?
Report all injures at work to your employer immediately and request medical treatment, if needed. If you neglect to report the injury within 90 days of the accident you may lose your benefits. Although you must report the injury within 90 days, you have up to two years to file a claim for benefits.
If a worker dies because of work-related injuries, the worker’s dependents, or parents if there are no dependents, must file a claim within two years of the death to claim benefits.
How do I file a claim?
You may personally file a claim if your employer doesn’t report your accident, denies your injury by accident, or if you believe you didn’t receive all of your benefits.
To file a claim you must submit a Form 50 or Form 52 to the Commission. If you are unable to download these forms, email the Commission’s Claims Department at email@example.com to request the forms be mailed to you.
When filing a claim on a Form 50 or Form 52, mark the box 13a. that states, “I am filing a claim. I am not requesting a hearing at this time.”
What medical treatment am I entitled to receive?
You are entitled to all necessary medical treatment that is likely to lessen your disability. Workers’ Compensation generally pays for surgery, hospitalization, medical supplies, prosthetic devices, and prescriptions.
Keep in mind that in order to receive these benefits you must go to the doctor chosen by your employer or its insurance representative.
How is the compensation rate determined?
You are entitled to compensation at the rate of 66 2/3 percent of your average weekly wage based on the four quarters prior to your injury, but no more than the maximum average weekly wage determined each year by the South Carolina Department of Employment and Workforce.
If you’re working two or more jobs at the time of accident, those wages may be included as part of the average weekly wage and compensation rate.
Will I get compensated for missing time from work because of my injury?
There is a seven-day waiting period before benefits can be paid. If you’re out of work for more than seven days, payments will come from your employer’s insurance representative. If you’re out of work for more than 14 days, you’ll receive compensation even for the first seven days. You can expect payments to be made directly to you and these should continue until the doctor releases you to return to work.
When are my benefits terminated?
After the doctor releases you to return to work with or without restrictions, within 150 days of notification of the accident, you should receive two copies of Form 15 with Section II completed indicating that compensation has been stopped and for what reasons.
If the insurance carrier stops your compensation, and you disagree, complete Section III of the Form 15 and send it to the Commission’s Judicial Department. This is your way to request a hearing to be held in 60 days. If the doctor releases you to return to work after the 150-day notification period, your employer or insurance representative will ask you to sign a Form 17 (receipt of compensation) after you have been back to work for 15 days.
What if the doctor releases me to light duty?
You must accept light work if it’s ordered. If you don’t accept, all compensation may cease as long as you refuse to return to work. You have a right to a hearing if you believe that you’re not able to do the work assigned to you.
If you return to light work before you are fully discharged by the doctor at a wage less than you were earning at the time of your original injury, you’re entitled to weekly compensation at the rate of 66 2/3 percent of the difference between your average weekly wage and your new wage.
Do I get reimbursed for my travel expenses when I go to the doctor?
Yes, if the round trip distance is more than 10 miles from your home. Effective August 23, 2004, the Commission approved allowance for trips to a pharmacy if the round trip distance is more than 10 miles from your home. You should be reimbursed for the round trip mileage at the rate allowed state employees for mileage.
Can I get a second opinion if I’m not happy with the doctor to whom the insurance carrier refers me?
You can talk to the insurance carrier and see if they will allow you to go to another doctor, or you can request a hearing by completing a Form 50 and have a Commissioner make a determination on the case.
Who sends me my weekly check?
Your employer is required to have Workers’ Compensation insurance if they have four or more employees and the insurance carrier will be responsible for paying compensation to you if you’re out of work for more than seven days.
Can I draw Social Security benefits at the same time as I am drawing my time loss or pension benefits?
Yes. Between Social Security and the Workers’ Comp benefits, you are entitled to receive no more than 80% of your highest year’s earnings or your time loss compensation or pension rate – whichever is higher.
Don Pilzer Law, PC, can help you with Workers’ Compensation and Social Security Disability Benefits. Contact us today if you have questions about either.
What do I do if my claim is rejected or the Commission denies benefits on my claim?
If your claim was denied, you are entitled to an appeal. Filing an appeal can be a lengthy and expensive process. Contact Don Pilzer Law, PC, immediately if you receive a denial or rejection order from the insurance company. We can review your claim and take appropriate action within the protest or appeal period.
Can I sue my employer or my co-worker for causing the injury?
Most of the time, the answer is no. The Workers’ Compensation system was established as an alternative to suing employers in court in exchange for benefits.
Why can’t I choose to file a lawsuit against my employer instead of making a Workers’ Comp claim?
Since most employers are required by law to provide Workers’ Compensation insurance, the employers are protected from personal injury claims brought by injured workers.
Does my employer have to hold my position open for me if I’m absent due to a Workers’ Comp injury?
No. Your employer is not required to hold your job open for you. Your position may remain open for a short time under the Family Medical Leave Act (FMLA), but your employer does not have to hold your job on a long-term basis.
However, it is illegal for your employer to fire you from the company because you have filed or attempted to file a Workers’ Compensation claim.
Does Don Pilzer Law, PC, offer telephone appointments?
Yes. If you’re unable to meet with us in person, we can handle your case over the phone. Contact us to schedule a free evaluation.
I’m interested in talking with Don Pilzer Law, PC. What should I do next?
At Don Pilzer Law, PC, we understand how difficult paying your medical bills, supporting yourself and your family can be if you’re injured on the job. The Workers’ Compensation process is full of deadlines and limited claim and appeal times. You deserve representation that is proactive, efficient and focused on the important issues.
Contact our office today. Or call 864-235-0234 for a FREE evaluation of your case. We’re happy to discuss your options with you over the phone and set up a telephone appointment if you’re unable to travel to our offices.