“Every South Carolina employer and employee, with certain notable
exceptions, is presumed to be covered by the State’s Workers’
Compensation Act,” according to the
South Carolina Workers’ Compensation Commission. So, what are these “notable exceptions”? Generally, exceptions
include casual workers, businesses that have less than four employees,
real estate agents, federal employees, and railroad employees.
Workers’ compensation is a no-fault system. This means that no one is blamed for the accident.
The worker isn’t blamed and the employer isn’t blamed, even
though one of them may be more to blame than the other. Even if a worker
is entirely at fault for his or her own injury, their fault will not reduce
their claim. It won’t reduce the amount of benefits they are entitled
Are Claims Ever Denied?
Yes, absolutely. Workers’ compensation is not automatic in all cases
– it is not guaranteed. There are specific times when an employer
or insurance company may decide to deny a claim. Sometimes the denial
is reasonable, sometimes it’s NOT.
While each state has enacted its own workers’ compensation laws,
some things seem to be rather uniform from state-to-state. A claim can
be denied if any of the following is true:
- The worker was drunk when they were injured.
- The worker was drinking alcohol before the accident (not necessarily drunk).
- The worker was under the influence of drugs at the time of the accident.
- The worker was intentionally trying to harm themselves.
- The worker was intentionally trying to hurt someone else.
Suppose Dan and Mike were salesmen and they landed a big client. To celebrate,
the pair decided to open a bottle of whisky. Before they knew it, Dan
and Mike had three glasses of whisky each. While Dan was leaving the office,
he fell down a flight of concrete stairs, hitting his head and sustaining
a traumatic brain injury (TBI).
Because Dan had been drinking before the fall, his workers’ compensation
claim was denied. However, if he had fallen down the stairs at the exact
moment and on the same day, but he had zero alcohol in his system, Dan’s
claim likely would have been approved.
On the other hand, let’s say that Anne and Tracey worked together,
but they butted heads. One day, the women get into a heated argument and
Anne punches Tracey. Enraged, Tracey punches Anne back, breaking her nose.
Now, Anne wants to file a workers’ compensation claim to cover her
medical bills and time off work. However, surveillance footage of the
altercation makes it clear that Anne started the fight, and that Tracey
was merely acting in self-defense. Anne is out of luck.
They Say it Wasn’t ‘Work-Related’
Sometimes, an employer or insurance company denies a claim because they
do not believe the injury was
work-related. If this has happened to you, and you know that it occurred while you
were performing job-related duties, you should speak with a
Columbia personal injury attorney from our firm. Whatever the “reason” for the denial, we’re
determined to help.
Contact us today to learn more about your rights to compensation.