This document provides an overview of workers' compensation law in South Carolina. It discusses the main types of risk employers face, including medical, indemnity, and insurance risks. It outlines the key elements of a workers' compensation case, including the employee/employer relationship, coverage under the act, and what constitutes a compensable injury. The document also defines important terms like disability, average weekly wage, and choice of healthcare provider. It provides tips on litigation procedures for both contested and uncontested cases, as well as the appeals process.

1. Andrew Fajardo, Esq.
Chappell, Smith & Arden

2. Sterling Educational Services, Inc.
General Principles of Workers
Compensation
January 27, 2016

3. Overview
A. General Overview of Workers Compensation
B. Elements of a Workers Compensation Claim
C. Practice Tips, Definitions and Concepts
1. Disabilities: Temporary and Permanent
2. Vocational Rehabilitation Benefits
3. Psychological Injuries
4. Scheduled Injuries and Loss of Use Valuation
5. Average Weekly Wage and Compensation Rate
6. Medical Care and Choice of Health Care Provider
7. Litigation Process and Procedures

4. A. Discussion of Risk in Workers
Compensation
• History of South Carolina Workers
Compensation Act
• Three Main Types of Risk in Workers
Compensation from an Employer’s Perspective
1. Medical Risk
2. Indemnity Risk
3. General Insurance Risk

5. B. Elements of a Workers
Compensation Case
• Employee/Employer Relationship
• Coverage under the SC Workers Compensation
Act
• Compensable Injury

6. Relationship between Employee and
Employer
• Employee is defined under §42-1-130
– Excludes independent contractors, casual employees,
volunteers and certain others.
• Employer is defined under §42-1-140
– Can be just about any entity, including the State,
political subdivisions, corporations, sole
proprietorships, etc.
• Employment is defined under §42-1-150
– Generally any type of work for compensation
– Adds “in which four or more employees a re regularly
employed in the same business or establishment.”

7. Coverage under South Carolina
Workers Compensation Act
• Every South Carolina employer and employee,
with certain exceptions, is presumed covered
by the State’s Workers Compensation Act.
 Employers required to carry workers comp
insurance, unless exempt.
 Requires 4 or more regular “employees” to be
subject to Act.
 SC Uninsured Employers Fund

8. Compensable Injury
• “Injury” can include many types of conditions
– Can be acute injury, due to repetitive trauma,
psychological, or occupational disease
• Primarily seen as an Injury by Accident
– Defined under §42-1-160
– Two Pronged Test
• Arises Out of Employment
• Occurs in Course and Scope of Employment

9. Two Pronged Test:
“Arising Out Of”
• Accident must “arise out of “ the employment
– Refers to origin and cause of accident
– Test of proximate causation
• Injury arises out of employment if it is proximately
caused by the employment.
• Must be apparent to the rational mind, considering all
the circumstances, that a causal relationship exists
between the conditions under which the work is
performed and the resulting injury.
• Special requirements for Occupational Diseases and
Repetitive Trauma

10. Two Pronged Test:
“Occurs in Course and Scope”
• Accident must occur in course and scope of
employment
– Refers to the time, place and circumstances under
which the accident occurs.
– Generally, will be compensable if it happens at
work in furtherance of employer’s interests.
– However, there are always exceptions and special
circumstances

11. C. Definitions, Concepts and Practice Tips
1. Disabilities: Temporary and Permanent
2. Vocational Rehabilitation benefits
3. Psychological Injuries
4. Scheduled Injuries and Loss of Use Valuation
5. Average Weekly Wage and Compensation Rate
6. Medical Care and Choice of Health Care Provider
7. Litigation process and procedures

12. 1. Disability
• Defined under §42-1-120
– “incapacity because of injury to earn the wages
which the employee was receiving at the time of
injury in the same or any other employment.”
• 500 week limit for recovery
• Exceptions: Lifetime weekly benefits for
paraplegia, quadraplegia, or severe physical brain
damage

13. Temporary Disability
• Occurs when an employee suffers a loss in
wages
• Types of Temporary Disability
– Temporary Total Disability
• Complete inability to earn wages
– Temporary Partial Disability
• Inability to earn the same wages as prior to the injury
• Likely due to reduction in hours, change of position,
sales, etc.

14. Permanent Disability
• Occurs when the incapacity to earn similar
wages becomes permanent.
• Types of Permanent Disability
1. Permanent and Total Disability
• §42-9-10
2. Permanent Partial Disability / Wage Loss
Disability
• §42-9-20

15. 2. Vocational Rehabilitation Benefits
• No specific provision requiring employers to
provide vocational rehabilitation services
• South Carolina Vocational Rehabilitation
Department
• Distinguished from “occupational therapy”
• Role of Vocational Experts
– Used as evidence of permanent disability

16. 3. Mental Injuries
• Refers to psychological or psychiatric conditions
proximately caused by employment
• Two types of mental injuries
1. Physical – Mental injuries
2. Mental – Mental injuries
• Must be caused by “unusual or extraordinary” conditions
of employment
• Many factors involved with these types of claims, including
type of employment, reasonable expectations, etc.

17. 4. Scheduled Injuries and Loss of Use
Valuations
• Permanent Impairment Ratings (PIR) and the
AMA Guides
• Limit on recovery to scheduled members, unless
exceptions apply.
• Almost every body part, organ, or other system is
addressed in the Act and assigned a value in
terms of “weeks.”
 §42-9-30
 Covers most commonly injured body parts
 Reg. 67-1101
 Covers most everything else

18. Valuation of PIR for Indemnity
• Examples are easiest!
• Employee has a compensable right knee injury, undergoes surgery and
returns to work. After reaching maximum medical improvement, he is
assigned a 10% permanent impairment rating.
• Under §42-9-30 (16), the right lower extremity is worth a maximum of
195 weeks of compensation.
• Do the math
• 10% of 195 weeks = 19.5 weeks
• 19.5 weeks x Compensation Rate = Base Value
• Permanent Impairment ≠ Loss of Use
• “Loss of Use” incorporates a number of factors, including work
restrictions, ongoing medical care, and effects on daily living.
• Decided by Commissioner

19. 5. Average Weekly Wage and
Compensation Rate
• AWW and C/R
• Gross earnings (pre-tax) of Claimant in the
employment in which he was working at the time
of injury.
• Can also include wages from other concurrent
employers at the time of injury.
• Maximum C/R per year, regardless of actual
income. Max for 2016 is $784.03.
• Critical in determining indemnity value of claims

20. Calculation of AWW/CR
• AWW – Four Methods
1. Employee’s income in the four quarters preceding, but not
including, the date of injury and divided by 52 weeks
2. Employee’s income divided by the total number of weeks the
employee has worked (if less than a year).
3. Income of similarly situated employee
4. Other methods as required in exceptional cases, so as to be most
fair to the employee.
• Compensation Rate
• 66 and 2/3rds percent of the AWW (66%)
• Maximum C/R per year

21. 6. Medical Care and Choice of Health
Care Provider
• Role of Employer/Carrier
• Pay for all medical expenses that are reasonably necessary
to effect a cure or give relief for the employee’s
compensable injuries
• Retain right to control medical providers, within reason
• Addressed in §42-15-60.
• Role of Employee
• Must accept and undergo medical treatment offered
• If refused without reasonable excuse, employee may lose
right to pursue additional benefits.
• Addressed in §42-15-80

22. 7. Litigation Process and Procedures
• Litigation process is primarily driven by Forms
– All Forms are available on SCWCC website!
– Most Forms are self-explanatory and are designed
to allow injured workers to complete on their
own.

23. Uncontested Cases
• Notice given  accident accepted by Employer/Carrier 
treatment provided  MMI reached
• Temporary Benefits
– Prior to 150 days, TTD checks can be cut off without court order
– After 150 days, TTD checks can only be cut off by agreement or
court order
• Permanent Benefits
– Form 14B
– Determined by either settlement or Commissioner
• Resolution of Claim
– Order of Commission
– Settlements: Form 16A vs. Clincher
– Subsequent Change of Condition

24. Contested Cases
• Form 50 – Employee’s Request for Hearing
• Form 51 – Employer’s Response
• Form 21 – Employer’s Request for Hearing
• Form 22 – Employee’s Response
• Form 58 – Pre-Hearing Brief and Evidence
• Hearing, Decision & Order
• Appeals

25. Appeals
• Form 30 – Request for (Full) Commission
Review
• Subsequent Appeals
– Pre-2007 injuries are first appealed to Circuit
Court, then to SC Court of Appeals
– Post-2007 injuries are appealed directly to the SC
Court of Appeals
– Supreme Court

26. Works Cited
Beard, Poteat, Lamar, Sumwalt, Bluestein, Sullivan, The Law of
Workers' Compensation Insurance in South Carolina. 6th ed.
Columbia, SC: Continuing Legal Education, South Carolina Bar,
2012. Print.
South Carolina Workers' Compensation Law Annotated.
South Carolina: Thomson Reuters, 2016. Print.