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  • Accept or deny WC claim

    Does anyone know how long an employer has to accept or deny a WC claim in South Carolina?

    The injured is a special ed teacher who was assaulted by a student. The injury was reported and treated (broken ribs, head injury) but now there are secondary problems (grand mal seizures).

    She met with the school district and they are meeting to decide if the sizures should also be considered WC. (pretty ovbious to me). Its been almost 3 weeks and she has not heard anything, nor are they giving her a date when they will tell her.

    I know in GA, the employer had 30 days to decide but I cant find anything on the SC website. Thanks.
    I find that the harder I work, the more luck I seem to have.
    Thomas Jefferson

  • #2
    In this case the claim in compensible, the question is whether or not the seizures are causally related or not. 99 times in 100, that means at least one IME to determine this. There is no time limit on this. If the carrier is draggin their feet, the employee can file issues (or have their attorney file issues) for coverage of medical treatment related to the seizures. If it has only been 3 weeks, Iwoudn't expect an answer yet. For one any half way competent IME doc or adjuster is going to want the extended medical history for review first. That takes time to get, especially if a subpeona is required to obtain the records. No adjuster should be making that decision either and IMEs take time to set up and get reports back.
    I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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    • #3
      Thanks. She hasnt been contacted about an IME yet or had a request for her medical records. She just had a meeting with several people from the district and they said they would get back to her when they made a decision.
      I know in GA, the employer has 30 days to decide to accept or deny the WC claim. However, I cant find anything about how SC is.

      She is totally unable to work, drive, and is now wearing a helmet to protect herself from further injuries with the 15+ seizures she is having daily. The seizures started approximately 3 weeks after the initial assault.

      She did get an attorney but he is a labor attorney, not one who specialized in WC. She hired him when the school board wanted to put the child who attacked her back in her classroom and refused her requests that he be assigned to another classroom. (before the seizures started). The attorney's feeling is to wait and see if they accept it or not before doing anything else. Of course in the mean time, she has gone from 1 seizure to 15+ a day and bills are piling up.

      I have dealt with WC for a long time and seen a huge number of people scamming and I hate that. Its wrong. However, its also wrong when something like this happens to leave an employee twisting in the wind with no contact from the employer and no direction, nothing. It gives me a really bad feeling.
      I find that the harder I work, the more luck I seem to have.
      Thomas Jefferson

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      • #4
        She really needs a lawyer who knows WC. Just as I'm sure she is seeing a specialist for her seizures, she should have a lawyer who specializes in WC. It really is its own little world.

        Again, there is no time limit in any state to decide whether or not a later evolving condition is causally related. Does she have an opinion from her own doctor that related the seizures to the attack? That will help. Temporal proximately does not establish causation for WC purposes alone. There must be a sound medical opinion that relates the condition to the injury.
        I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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        • #5
          I agree with ElleMD on all those points. There is not deadline on medical causation, which is the issue with her seizures. And a "labor" lawyer will probably not even practice in work comp. She needs a more appropriate lawyer, someone who practices primarily in work comp. Try to avoid the ones who advertise on TV all the time; they are not usually the best ones to get. Their high overhead expense tends to impair their judgment. Try the directory on this site for a list of dedicated work comp lawyers: www.wilg.org I am sure there are a couple from SC in there.
          Bob Bollinger, Attorney
          Board Certified Specialist in NC Workers' Compensation Law
          Charlotte, NC

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          • #6
            If her lawyer is taking a wait and see attitude right now, he is not doing the right thing. It is the worker's burden to make things happen in work comp. The worker has the burden of proof on all issues. If she "waits and sees" she will still be waiting in 2011. She needs an aggressive lawyer with lots of work comp experience.
            Bob Bollinger, Attorney
            Board Certified Specialist in NC Workers' Compensation Law
            Charlotte, NC

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            • #7
              Thank you all. You pretty much confirm my opinion that she shouldnt just wait as the attorney suggested. I will encourage her again to seek a WC attorney.
              I find that the harder I work, the more luck I seem to have.
              Thomas Jefferson

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