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“What Should Workers’ Compensation Cover if I Fall?”

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Posted on June 29, 2016


Remember that great nursery rhyme about Humpty Dumpty?

 

“Humpty Dumpty sat on a wall;

Humpty Dumpty had a great fall;

All the king’s horses and all the king’s men

Couldn’t put Humpty together again.”

 

Well, from the sound of it, Humpty Dumpty’s day could have gone better.  It is safe to say that from this one fall, these injuries greatly impacted his life.  Have you ever wondered what the context was in this situation, or how he even fell off that wall?

 

If we were to retell this story, let’s say that Humpty Dumpty was working for the King, and fell off while he was on the job fixing a few bricks along the broken wall. Considering his damages caused from this serious accident, this makes for a great case for Humpty to get Workers’ Compensation.

 

These are the stages Humpty Dumpty should be going through to file a Workers’ Compensation claim:

 

  1. Determine if He has Coverage

 

He needs to figure out if there is coverage for Workers’ Compensation.  The two factors that determine his coverage are:

 

  • If he is an Employee; and
  • If his injury occurred as a result of his employment,
  • Did he sustain an injury by accident arising out of and in the course and scope of his employment – or-
  • Was his injury caused and/or exacerbated by repetitive trauma sustained in the course and scope of his employment?
  • Employment conditions causing mental injury “were extraordinary and unusual in comparison to the normal conditions of particular employment.”

 

Under the South Carolina Workers’ Compensation Act, every employer and employee, with certain notable exceptions, is presumed to be covered. However, the presumption of Workers’ Compensation coverage does not apply to:

 

  • An Employer who has regularly employed in service fewer than four Employees;
  • State and county fair associations, unless Employer voluntarily elects coverage;
  • Agricultural Employees, unless Employer voluntarily elects coverage;
  • Railroad and Railroad Employees;
  • Persons engaged in selling any agricultural product or producer of them, unless Employer voluntarily elects coverage;
  • Licensed real estate sales person on straight commission who has signed a valid independent contractor agreement;
  • Federal Employee in the State.   

 

The South Carolina Workers’ Compensation Act provides the exclusive remedy against an Employer for Employee’s work-related accident.  Even if the accident was due to the King’s fault or negligence, Humpty cannot bring a civil suit against his Employer to recover damages for pain and suffering or punitive damages.  However, if the accident was the fault or due to the negligence of an actor outside the scope of employment, Humpty could bring a civil action for damages against that actor.  The attorneys at Popowski, Callas & Shirley can help you identify and pursue a 3rd-party action.

 

  1. Employees’ Rights and Responsibilities

 

The next step for Humpty is to immediately report his injury to the employer and request medical treatment for his injuries. Humpty should also complete a first report of injury, listing all of his injuries and keep a copy.  In South Carolina, an Employee injured on the job has 90 days to give notice of the accident to his or her Employer, but should do so as soon as possible.  Some Workers’ Compensation Insurance Companies will attempt to discredit an employee’s testimony when notice is not given as soon as possible. It is also important that your employer notify his or her Workers’ Compensation Insurance Company so that your benefits can be started.

 

In a real world context, if you have fallen while working and have been injured, these benefits should be paid by your Employer’s Workers’ Compensation Insurance Company:

 

  • Medical care as directed and authorized by your Employer’s Workers’ Compensation Insurance Company;
  • Weekly benefits of 2/3 of your average weekly wage when you are held out by an authorized physician or the authorized physician has assigned restriction which the Employer chooses not to accommodate;
  • Compensation for permanent injuries or inability to earn prior wages;
  • Benefits to dependents of workers who are killed on the job.

 

  1. Consult with an Attorney

 

Humpty Dumpty may have been a good egg but he probably did not understand the complexities of the South Carolina Workers’ Compensation Act and the several changes to the law that have occurred in recent years.  It is important that you get the information you need as soon as possible.  Missing deadlines such as notice periods and statutes of limitations, or settling 3rd-party claims, or applying for Social Security may adversely affect what you are able to recover. 


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