Employees get short-term disability coverage through their employer’s insurance plan, but in South Carolina, not all companies are required to have it. Enrollment in workers' compensation, however, is required.
Through its State Accident Fund (SAF), South Carolina offers workers’ compensation benefits to workers who have a job-related injury. To qualify, a doctor must show that the employee can’t work due to their injury or has limitations in doing so.
Disability Insurance in South Carolina
Disability insurance protects a worker's ability to earn a living in the event they experience an injury or serious illness. It does not protect them from short periods away from work due to illnesses like a cold or flu.
It provides coverage if the worker has been out of work for a predetermined waiting period, or elimination period, due to conditions that would keep them off the job for a specific amount of time.
A worker can have long-term disability insurance or short-term disability insurance. Long- and short-term disability packages have different benefit and elimination periods, and pay different benefit amounts.
Employee Benefits for Temporary Disability Claims
If a South Carolina worker cannot work as the result of an injury or illness, they’ll need to ask their employer about what coverage they offer – not all companies offer short-term disability coverage. If the employer does have disability insurance, they can help the worker file a claim with their disability insurance company.
Workers' Compensation in South Carolina
South Carolina employers must provide workers’ compensation. If a worker is hurt on the job, workers' compensation covers authorized medical expenses for that individual. The injured worker must give their HR department or supervisor a work excuse after they visit a medical provider to treat the injury.
If the treating physician determines that the worker can’t work due to the injury, they may be able to collect workers' compensation disability benefits through South Carolina’s State Accident Fund (SAF).
If the SAF accepts the claim, all authorized medical treatments will be paid according to the state’s Workers’ Compensation Fee Schedule. If the authorized treating physician has stated that the injured worker cannot work, or that they have restrictions their employer cannot accommodate, they may be entitled to compensation to cover their weekly wage.
When Does Workers’ Compensation Eligibility Begin?
Workers’ compensation eligibility starts when an injured employee misses at least seven days of work due to a compensable injury. An employee who misses at least 15 days of work is eligible for compensation, provided they have a physician’s note, from the day the injury occurs until the day they go back to work.
If their employer pays for leave for the worker for any specific period of time, they are not eligible for workers’ compensation for those dates. The SAF also does not reimburse an employee for missed work time to attend a doctor’s appointment or go to physical therapy.
It is the responsibility of the injured employee to provide a work status note to their employer after each authorized medical visit.
Temporary Total Disability in South Carolina
Temporary Total Disability is used when an injured worker cannot work or has restrictions that cannot be accommodated at work. This benefit pays 66.67 percent of the worker's weekly wage as the compensation rate for the period they miss work.
The employer calculates this rate. This benefit is paid each week until the injured worker returns to work and no longer needs medical care.
Temporary Partial Disability in South Carolina
Temporary Partial Disability is used when an injured worker is spending fewer hours at work or gets a reduced wage due to their injury. This benefit pays 66.67 percent of the workers weekly wage for the hours they miss work.
It can also be used when a worker has dual employment before their injury takes place and one employer cannot accommodate their work restrictions.
The company provides wage records for the worker to the SAF and their compensation rate is calculated accordingly. They are then paid weekly until they return to work full time or are released from medical care.
Initiating a Workers’ Compensation Claim in South Carolina
To start a claim for a worker, the employer fills out a First Report of Injury (WCC Form 12-A) on their behalf. Once the SAF receives the form, they’ll assign a claim number to it. This unique number is used to identify the claim.
After receiving the claim, its initial reserves – estimation of total cost for the monthly benefits – are set. The SAF will send letters to the claimant and employer acknowledging that it received the claim.
How the SAF Determines Compensation
If a worker’s claim involves a heart attack, mental stress, or other psychological disorder, the SAF sends it to a Special Investigation Unit to further gather evidence that it will use to recommend acceptance or denial of the claim for insurance benefits .
In all other instances, the worker’s claim is sent to an adjuster assigned by the agency. They will review the report, gather additional information, if needed, and determine compensability. The adjuster will make a decision regarding a claim within five to 10 business days.
Claims Review Team Decision
If the adjuster decides that the claim is compensable, they send it to the Claims Review Team, who upholds the adjuster’s recommendation, reverses it, or asks for more information before making a decision.
When a determination is made, the SAF sends a decision letter to the company, its employee and to the state Workers' Compensation Commission, if applicable. If the SAF denies the claim, it will state the reason for the denial in its letter.
Michelle Nati is an associate editor and writer who has reported on legal, criminal and government news for PasadenaNow.com and Complex Media. She holds a B.A. in Communications and English from Niagara University.