Workers’ Compensation

Updates, Important Cases & Special Considerations

In South Carolina, Workers’ Compensation cases involving law enforcement officers and fire fighters may be complicated, by one or more of the following:

  1. the nature and potential severity of the injuries;
  2. the significance of a period of disability, and inherent difficulties in returning to work;
  3. the likelihood of suffering multiple or subsequent injuries/impairments;
  4. the potential for third party claims; and,
  5. proper calculation of weekly wage and compensation rates due to multiple concurrent employments.

Without a doubt, police officers and fire fighters face significant hazards in course of their daily work and the potential for serious injuries or death is great. (Bullock, T. 2007). Given the physical nature of these professions, disabling injuries are common. Police officers and firefighters often suffer multiple or subsequent injuries, which may ultimately constitute permanent and total disability. Police officers and firefighters are subjected to situational and environmental extremes. Cumulative injuries such as hearing loss, and psychological injuries such as post-traumatic stress disorder are not unusual in these occupations.

Although these professionals often display a high level of dedication and make every effort to return to work, police officers and firefighters nonetheless are required to meet and maintain physical requirements in order to be considered fit for their jobs. Unfortunately, a permanent injury that might not interfere with another type of worker’s return to regular duties might end the career of a police officer or firefighter, depending upon the physical requirements required by their employer.

Historically, the South Carolina Workers’ Compensation law has recognized the hazardous nature of these occupations. (Bullock, T. 2007). In an effort to address the increased likelihood that these workers will suffer serious debilitating injuries or conditions, Section 42-11-30, contains presumptions or basic beliefs about compensability concerning law enforcement officers suffering cardiac-related incidents or injuries and firefighters suffering injuries or impairments due to heart or respiratory diseases. These presumptions, however, do not mean that these injuries are automatically considered compensable under the South Carolina Workers’ Compensation law, and there are eligibility requirements which must be met by the injured police officer or firefighter. These presumptions still exist within the South Carolina Workers’ Compensation law but, have been narrowed greatly. Eligibility may rest on issues such as the hire date, the age of the claimant, the first appearance of symptoms/date of diagnosis, earlier medical documentation, etc. The police officer or firefighter with a disabling cardiac or respiratory condition should review the matter with an experienced Workers’ Compensation attorney.

Aside from the more overtly dangerous aspects of their jobs, police officers and firefighters are public servants who are routinely working among the general civilian population. Police officers and firefighters are often assigned to vehicles or equipment teams, and may be involved with managing pedestrian or vehicle traffic in the course of their work. They must also work closely with a host of other agencies (municipal, state, federal, etc.) and private businesses in carrying out their duties. Police officers and firefighters are sometimes injured through the fault of some outside party. Therefore, potential for third party claims should be carefully examined by an experienced workers’ compensation attorney in conjunction with the worker’s compensation claim of the injured police officer or firefighter.

Lastly, per the SC Workers’ Compensation law, all of the wages of an injured worker should be factored into the calculation of the claimant’s weekly compensation rate. Many police officers and firefighters routinely have one or more second jobs; some own their own businesses in addition to serving on the police force or at the fire department. Often, the employer has no knowledge of the injured officer or firefighter’s other jobs. Workers’ Compensation adjusters may fail to inquire about wages from any secondary employment or self-employment. Also, an injured police officer or fire fighter might be totally disabled from regular duties on the police force or at the fire department but, not from any secondary jobs. In order to avoid any over or underpayments in compensation, either temporary or permanent, it is important for the injured police officer or firefighter to have an experienced Workers’ Compensation attorney review all of his pre-injury income sources and communicate this information to the claims adjuster. We know to look for these additional sources of income. Call us.

Federal Workers’ Compensation Claims, Longshore Harbor Workers Claims
and Other Jurisdictions

Claims involving civil servants, miners, nuclear energy workers or railroad employees usually fall under the one of the specific Federal Workers’ Compensation laws. In a seaport as large as Charleston, however, cases involving persons injured performing work in a capacity similar to that of a longshoreman, stevedore or checker might fall under the South Carolina Workers’ Compensation Law, the Longshore Harbor Workers Act, or both jurisdictions. Also, there are many Federal government contractors in the Charleston area with local employees. Persons injured while working overseas for government contractors might have claims which fall under yet another Federal Workers’ Compensation law, the Defense Base Act. Lastly, many of the employers in Charleston, particularly in the housing and bridge construction industries, tend to be regional. The injured worker in Charleston may find that his employer has reported his work injury to the workers’ compensation authority in another state altogether. (Sengupta, I. and Reno, V. 2007) In addition to the potential for concurrent or overlapping workers’ compensation jurisdictions and potential third party claims, Workers Compensation claims might also involve legal issues pursuant to other state or federal laws, such as the Americans with Disabilities Act, Family Medical Leave Act.

In the Law Office of Peter David Brown, P.A. our South Carolina Workers’ Compensation lawyer recognizes the subtle differences, exploring the circumstances and the potential for other claims or conflicts to be involved in a given worker’s case. If it appears that your case has potential for Federal and Longshore claims in addition to the Workers’ Compensation and third-party cases, we will refer that aspect of your case to an attorney who is knowledgeable and experienced in that specific area of law.

Claims under other Benefits Systems

Workers’ Compensation benefits are typically paid by an insurance company, self-insurance fund, etc. to a worker who has suffered an on the job injury. Workers’ Compensation benefits are not the same thing as group health/disability benefits, secondary or personal health or disability coverage, retirement disability, Social Security disability benefits or unemployment benefits. Sometimes Workers’ Compensation benefits may be paid for or provided by the very same insurance carriers that also pay the employer’s group health/disability insurance claims for non-work related illnesses and conditions, such as routine surgeries with downtime for recovery, or obstetric care and maternity leave. (This is common with larger employers). Sometimes employers do not report work-related injuries to their insurance companies but, file them as regular group health/disability claims instead. (Lakdawalla, D., Reville, R. and Seabury, S. 2005).This can easily snowball into a significant problem. The injured employee may be unaware of how his employer handled “the paperwork” and believes that he has properly reported his injury and filed a Workers’ Compensation claim, only to find out later that his work injury was either never reported to the Workers’ Compensation carrier.

The injured worker might find that his Workers’ Compensation claim was actually denied by the Workers’ Compensation carrier or his Workers’ Compensation claim was never filed with the South Carolina at Workers’ Compensation Commission. This can be a costly mistake if the injured worker has a serious injury that involves permanent disability, for which Workers’ Compensation would pay additional benefits but group health/disability would not. The group health/disability carrier may realize that they are paying for a work-related injury and suddenly deny payment for medical treatment or disability, demand to know the status of the Workers’ Compensation claim and possibly, seek repayment of their payout in medical expenses and disability benefits for the work injury.

Secondary or individually-purchased health or disability insurances may provide benefits in addition to Workers’ Compensation . These types of coverage might require a credit or offset for any Workers’ Compensation payments made to the injured worker or like a group health/disability carrier, demand reimbursement for any payments made when Workers’ Compensation should have been paying. This all depends upon the specific language of the insurance contract. Again, Workers’ Compensation pays permanent disability benefits whereas the secondary or individually-purchased health or disability probably does not. Retirement disability coverage is usually provided by the employer for the long-term employees who have an injury or condition which prevents them from continuing in their employment up to the regular age of retirement. This coverage is typically available in addition to any workers’ compensation benefits but, again, some employers might have an employee apply for these benefits instead of workers’ compensation benefits. Social Security Disability is another form of insurance that is administered through the Federal Government. The determination of disability for Social Security purposes is vastly different in its requirements from any determination of disability under Workers’ Compensation. Also, Social Security has multiple formats for payment of benefits and may include eligibility for Medicaid. In Workers’ Compensation cases, it is critical that the injured worker’s potential eligibility for Social Security and Medicaid be taken into consideration during settlement of the Workers’ Compensation case. (In South Carolina, Workers’ Compensation settlements typically include some language regarding the allocation of the Workers’ Compensation benefits paid in order to minimize the potential offset requirement under Social Security disability, as well as Medicaid “set aside” arrangement).

Finally, unemployment benefits might be paid to an injured worker who has been laid off or terminated. This might be the employer’s error in processing paperwork but, it can pose a problem for the injured worker if he is unable to work because of his work injury but is receiving unemployment. Most unemployment insurance systems require that the worker sign a statement that he is be fully capable of working in order to receive those benefits. This may be in direct contradiction to the worker’s Workers’ Compensation disability claim. The bottom line is that any of these other employee benefits or coverage as well as any other forms of social insurance may potentially place liens against the proceeds of a Workers’ Compensation claim.

This is why you need to hire an experienced Workers’ Compensation attorney to handle your claim. Please feel free to e-mail us at pete@peterdavidbrown.com or call us at 843-971-0099. You can click here to reach us now and set up a no-cost conference to evaluate your claim.