Who pays for workers’ compensation? South Carolina law requires your employer to pay for workers’ compensation insurance, and the insurance company pays you if you claim workers’ compensation after being injured. Almost all businesses employing four or more people are required to pay for workers’ compensation insurance.
There are some exceptions to the rule, however. Businesses do not have to pay insurance for casual employees or independent contractors, and agricultural concerns are exempt from this requirement. If you are struggling to claim, consult a South Carolina workers’ compensation lawyer for advice.
Employers Pay for Workers’ Compensation, But Insurance Companies May Be Reluctant to Pay Out
Even when your employer has workers’ compensation insurance and supports your claim, getting insurance companies to pay compensation is seldom easy. They will want to investigate your claim from every angle and may try to reduce it.
Apart from the complexities of filing for workers’ compensation in SC, claiming for health conditions that develop over time, like carpal tunnel syndrome, can be particularly complex.
An insurance company is not responsible for injuries you may have picked up elsewhere, and they may try to argue that your problem is not work–related.
It is a frustrating state of affairs and can be distressing for injured workers who are awaiting compensation that covers their medical costs and uncompensated time off work.
Some people accept reduced settlements that do not cover their costs, only to regret it later on. You need not tolerate this state of affairs. Call Shelly Leeke now!
Insurance Companies Pay Your Workers’ Compensation Benefits
As noted, the insurance company that provides your employer’s workers’ compensation insurance ultimately decides whether it will pay your claim. If they want to decline it, they have to give reasons. Unfortunately, the complex nature of the claims process often causes delays or leads to queries.
Meanwhile, your employer may or may not be supportive. Most managers and businesspeople do want to help injured employees, but others may actively oppose the payment of your claim. This can lead to further delays and complications. You need help. Shelley gets results.
Insurance adjusters are working on your claim, and they are notoriously difficult to deal with. Anything they think is unusual can lead them to raise objections.
For example, they may question whether you really need so much time off work, arguing that your claim is higher than it should be.
What to Do if the Insurance Company Denies Your Workers’ Compensation Claim
If an insurance company denies your claim, you can follow an appeals process. However, this may be a good time to get advice from a workers’ compensation lawyer.
Team Shelly Leeke is there for you. You have already been forced to wait, and now the appeals process will take further time. If your appeal does not satisfy the insurance company, you will remain uncompensated.
Trust Shelly Leeke. We will analyze the reasons given for denying your claim and file an appeal that compels the insurance company to review your claim a second time.
Their experience in this field means they may submit a compelling appeal that improves your chance of getting paid. If you appeal on your own, you may overlook details that lead to a second denial.
There is some oversight from the South Carolina Workers’ Compensation Commission. Insurance carriers are accountable to this body, and they will be aware that they cannot decline your appeal without valid reasons. They are highly likely to approve compensation after receiving a well-prepared claim or appeal.
Who Pays for Workers’ Compensation Benefits if Someone Was Negligent
Workers’ compensation insurance works on a no-fault basis. You do not need to show that your employer did something wrong or that you were not in error. If you were hurt at work, you should be able to get compensation in most instances.
Exceptions may apply if you tested positive for drugs or alcohol. An interesting case in which a man mauled by a bear received workers’ compensation even though he had used marijuana shows that an insurance company should still pay out workers’ compensation if intoxication did not directly cause the accident.
Workers’ compensation should cover all your losses after a workplace injury. Even if your employer were grossly negligent, you would not ordinarily sue them.
This is a complex area, and if you believe your employer was breaking the law, you should discuss this with your lawyer. Although it is comparatively rare, there are occasions when it is appropriate to sue your employer.
When to Involve a Workers’ Compensation Attorney
Most minor workers’ compensation claims progress smoothly with the insurance company, which pays for workers’ compensation, fulfilling its obligations.
However, there are times when you will benefit from representation. These include:
- Your claim is denied, or approval is delayed.
- Your injury is very serious or may have permanent consequences.
- You face retaliation at work because you are claiming workers’ compensation.
- The insurance company offers a lump sum settlement that is worth less than the value of your claim.
- A third party other than your employer or a coworker was negligent and contributed to your accident. You may be able to claim workers’ comp and file a civil lawsuit.
You may also need advice from a lawyer if you are not covered by workers’ compensation insurance. An employer may misclassify a person they should recognize as an employee as an independent contractor or casual worker.
Alternatively, you could fall into a group that is not covered by insurance companies that pay for workers’ compensation. For example, you are an agricultural employee or casual worker.
If your accident happened because someone was negligent, you may try to recover compensation with help from our South Carolina personal injury lawyer.
Find Out More in Your Complementary Case Evaluation
At Shelly Leeke Law Firm, we are genuinely excited about empowering our clients. Simply knowing what your options are will help you to feel more in control of your situation. If you are struggling with a workers’ compensation claim, we will be happy to evaluate your case for free.
From answering questions like who pays for workers’ compensation to addressing legal complexities, we are here to support you. Simply contact us to get a professional opinion and to discover what we can do for you.
Remember, Shelly fights for you!
