Are you dealing with the workers’ compensation insurance company doing nothing for your work-related injury in South Carolina? Here is a typical scenario injured workers may face in South Carolina:
So, it’s been several weeks since you got hurt on the job. You’ve only been to a walk-in clinic once and you’ve not seen a “workers’ comp” check. When you follow up with your employer, they tell you someone from worker’s comp will be calling you. Days or even weeks may go by and the only thing you receive is a random email from an insurance company or perhaps a call from an adjuster telling you they have your case and are investigating it. They seem quick to ask you to give a recorded statement or fill out some authorizations for your medical history, but slow to return your calls. You were compliant with your employer’s request to fill out an incident report right away, but now you are feeling like your employer is questioning if the accident really happened or maybe it was your fault. You feel like you’re out on an island by yourself and no one cares. If you are experiencing any of these things or all of them, you are not alone – and you likely need an experienced workers’ compensation attorney on your side.
Understanding that you need an experienced attorney may be key to ensuring you can get the treatment you need and get back to enjoying life and providing for your family. For the last 19 years, I’ve navigated the waters of Worker’s Compensation. Let me take a few minutes to explain what you may be experiencing and why workers’ comp. is doing nothing.
You have rights, but the insurance company won’t necessarily respect them
The South Carolina Supreme Court has set the standard for what should happen when you are injured at work . . . “the primary goal of the Workers' Compensation Act is to provide quick and efficient resolution of work-related injury claims so neither employers nor employees become bogged down in complicated and protracted litigation.” The Supreme Court went on to explain that the primary goal of the Workers’ Compensation Act hinges upon “quick recovery, relatively ascertainable awards, and limited litigation….” So, you may be asking yourself, why then is workers’ comp. doing nothing on my claim? Let’s discuss some of the reasons why the insurance company may be doing nothing for you.
First, you have been assigned an adjuster (someone designated to handle or “adjust” your claim) from an insurance company. Over the years, insurance companies have realized they can maximize their profits by minimizing the number of adjusters they have handling claims. With a reduction in adjusters, most adjusters have as many as 200 injured workers they are given to provide treatment, benefits and awards to. The problem becomes if you patiently wait on them, they will ignore you and turn their attention on someone who has an attorney. If you don’t have representation, they will not pay any attention. This means you are at the mercy of someone who doesn’t know you and doesn’t care that your rent, utilities, and car payment still come due at the same time each month regardless of whether you’ve been hurt and are out of work. You are simply a case number or a file name to the insurance company. When you go back to your employer for help, they simply tell you that they can’t do anything for you because it’s “Worker’s Comp.”
Second, your work injury may have resulted in injuries to different parts of your body. Those body parts might include your neck, back, shoulder, arms, legs, and head. Despite telling the insurance adjuster and their doctor all your injuries, the walk-in clinic they sent you to is only giving treatment to one body part. The company or occupational doctor ignores your repeated requests for things like an MRI or treatment for the other injured body parts. Maybe they tell you they’re going to focus on one injured body part first, but they never come back to your other injuries. Perhaps the workers’ comp. doctor might even tell you the truth, which is they were only given authorization to look at one injury. Regardless, you may be receiving substandard treatment or care that is less than what you would receive if you were on your own health insurance. If you try to go out on your own health insurance, your family doctor tells you that they can’t treat you because this was a work injury. You are caught in a spin cycle of getting no treatment for your real injuries. It is as though the insurance company has already made up their mind on what they will treat and what they will deny. The insurance company may try to control your claim by only allowing you to treat with their doctor.
If you know your rights, the law is on your side
The reality is the insurance company is hoping you will go away, get frustrated, give up or just give in to what terms they dictate to you. Sadly, injured workers who go it alone don’t understand that the law actually favors the injured worker. The South Carolina Workers’ Compensation Act provides that if you have been out of work seven days, the insurance company must start paying you wage benefits. The amount of workers’ compensation they should pay you in South Carolina is 2/3 of your gross wages. Those wages not only include your hourly rate, but overtime, bonus and even a second job if you were working it as well. Your checks must come regularly, meaning with consistency and weekly. Receiving and doing nothing on the part of the insurance company is never acceptable and the Workers’ Compensation Commissioners can order the insurance company to pay weekly benefits timely and accurately.
The insurance company must provide you with medical treatment which would lessen any of your injuries. The South Carolina Workers’ Compensation Act ensures that the insurance company must provide medical treatment for all of your injuries, not just the ones they accept or “authorize”. Though you may be required to meet with their doctors at first, with the correct legal counsel and doctors on your side, you can make the insurance company start to do something by way of providing real treatment for all your work-related injuries.
So why is the workers’ compensation insurance company doing nothing to help you following an on-the-job injury? It’s because they may not take you seriously without an experienced workers’ compensation attorney on your side.
