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Understand the Workers’ Compensation Claims Process

In the past 10 years, the SC Municipal Insurance Trust has experienced more than $9 million in incurred costs for burn-related injuries. Workers' compensation has been used to provide these injured workers with medical care and financial benefits.

South Carolina's workers' compensation law, first passed in 1935, has since been amended by statute, altered through administrative policies and procedures, and defined through case law throughout the years. The state's workers' compensation system is "no fault," and is meant to relieve employers from common lawsuits and to provide workers injured on the job medical care and financial benefits.

SCMIT covers workers' compensation benefits as defined in South Carolina Code Section 42. The code section provides a statute of limitations for filing a claim and determines the average weekly wage and compensation rate. The code also addresses the timing of medical treatment and the type of medical benefits covered. The law defines partial disability benefits, temporary total disability benefits and final permanent disability benefits.

In all cases with a workers' compensation claim, injured employees need to know to report all injuries to their employers immediately. The employer should then notify SCMIT immediately, since all claims must be reported to the SC Workers' Compensation Commission within 10 days of receiving notice of a claim. Injured workers who are unable to work for more than seven days are eligible for payment for lost wages. Employees out of work for more than 14 days are entitled to compensation from the day of the accident.

SCMIT claims adjusters may use nurse case managers for certain types of claims including burns, amputations, head and spinal cord injuries and back injuries. Nurse case managers are used to coordinate care for injured employees, attend appointments and obtain and develop plans of treatment. Early involvement of a nurse case manager can expedite the employee's return to work, and can lower financial exposure for the employer.

SCMIT members have access to a workers' compensation toolkit. It provides detailed information on the claims process, benefits, use-of-body-parts schedule to calculate benefits and commonly used forms.

The toolkit also explains informal conferences, hearings and mediations, and how they are used to help resolve workers' compensation claims. An informal conference provides an opportunity for the employer and the injured employee to reach an agreement on the settlement of a workers' compensation claim. A hearing may be conducted by workers' compensation commissioners to resolve disputes between the injured employee and the employer.

Mediation is another means of resolving workers' compensation claims. Commissioners may order mediation for any pending claims. Certain claims, such as those involving permanent and total disability, occupational disease, third-party lien reduction, contested death and mental/mental injuries (injuries that require proof of unusually stressful or disturbing conditions at work compared to others with the same job), must be mediated.

Finally, the toolkit explains the benefits of modified duty for employees. Employers can directly affect the cost of a claim and mitigate the impact of lost time by implementing a strong modified-duty policy for injured employees. The benefits of a modified duty program are numerous. Providing modified duty to those employees who are able to return to work in a limited capacity demonstrates to the employees that they are valued, and it enhances their relationship with their employer. Additionally, making an offer of modified duty to an injured worker who is able but reluctant to return to work allows SCMIT to terminate benefits under certain circumstances to the employee who refuses a light duty offer.

The workers' compensation toolkit is available online. SCMIT members can also request a hard copy from Risk Management Services. The toolkit serves as a valuable resource to emphasize the importance of timely reporting and explains the workers' compensation claims process to elected officials and staff.

For more information on workers' compensation benefits and the claims process, contact Cindy Martellini, claims manager, at 803.933.1235 or