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SC Workers Comp and maximum weeks for comp South Carolina

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  • SC Workers Comp and maximum weeks for comp South Carolina

    I'm getting conflicting answers on this, even from the WC Commission. If you have surgery on the shoulder (labral tear) and the doctor's report states "right upper extremity", should it be 220 weeks or 300 weeks? I know the law changed in 2007, making the shoulder a seperate body part. It used to be the "right upper extremity" max comp at 220 weeks, but the new law states that the arm is 220 weeks and the shoulder is 300 weeks. The attorney for the ins. co is stating that because the doctor stated "right upper extremity" in the final sentence, then they will only compensate for 220 weeks. But the rest of the doctors notes state plainly "rt shoulder." Plus, the law states verbatim arm for 220 weeks and shoulder for 300 weeks, and no longer references the "right upper extremity" at all. What should it actually be? Any input or assistance would be appreciated!

  • #2
    As you are disputing the definitations used, and it appears to be due to the doctors statements in the report, go back to the doctor who wrote that report and get a supplemental.

    "extremitries' means just what it says... upper is 'arm, elbow, wrist, hand", but should be defined to the actual 'body part'. Shoulder is a 'body part' of/in it's own. It's difficult to determine at times...and that's why it's a medical determination, made by a physican, and not a CA.

    The number of weeks in the law is the maximum number for indemnity. The number of weeks you receive will be based on the % of your rating. If your final rating is 25%... you'd receive 75 weeks of indemnity, not the full 300.

    To get the dollar amount of your indemnity, take your % rating, X's 300, X's your TTD rate.

    How does the Commissioner or the Claims Mediator decide how much I get paid for my injury?

    Your award is based on 66 2/3% of your average weekly pay before taxes and other deductions, up to a maximum amount set under the workers’ compensation law. This is called your compensation rate. In addition, many body parts have been assigned a value measured in weeks of compensation. For example, the complete loss of the use of an arm is valued as 220 weeks of compensation. Depending on the seriousness of your injury, the percent of disability or loss of use agreed to at the conference will be multiplied by the value of the injured body part and your compensation rate. In the earlier example, if we assume that the injured worker has an average weekly wage of $450, the compensation rate would be $300(66 2/3% x $450 = $300). The worker would receive $6600 for an injury that resulted in a 10% loss of use of the arm (10% x 220 weeks x $300 = $6600).
    The FAQ's for SC is here...
    http://www.wcc.state.sc.us/CmsPortal/AgencyPostingTemplate.aspx?NRMODE=Published&NRNODE GUID={B0164A18-10C7-4BEE-9A40-3246B7BCF3BE}&NRORIGINALURL=/Welcome+and+Overview/faqs/&NRCACHEHINT=NoModifyGuest#inf_decide

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    • #3
      Max Weeks

      Yes, an offer was made by the insurance adjuster based on 300 weeks for my shoulder, BUT, the attorney for the insurance company came back and revised the offer and had knocked it down to 220 weeks based on the right upper extremity statement. The ENTIRE physicians report states right shoulder all through the text except in the final statement where it states upper right extremity. That is the ONLY place where it is mentioned. I'm thinking the attorney is looking for loopholes and wouldn't have been concerned except that when a rep from the WC Commission was assigned she said "Oh, it might be 220 weeks or I may be wrong and it could be 300 weeks, I don't know (giggle)." Doesn't inspire much confidence in my rep for the Commission does it? I have requested the informal hearing and it will be in May, I'm just looking for solid footing.

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      • #4
        The only thing I can tell you is... the DA works for the CA/IC, and the CA has the final word on any settlement...generally the DA is limited in the amount they are authorized to settle a claim.

        So, your offer from the CA would be your basis for a settlement to consider.

        But, you should think carefully about selling your future medical benefits....IF you find you are in need of additional treatment...it would be out of your pocket. No other IC is going to pick up the cost of treatment to a work related injury. (but for a VERY limited circumstance)

        The WC rep is obviously thinking of the change in the laws, the DOI, and making reference to the PTP statements. I think I would still get a supplemental report from your PTP. If nothing else, it would back up your contention at the hearing.
        Comp reps are not infallible...

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        • #5
          It is also very possible that while the injury is to the shoulder, the permanent disability is to the upper extremity. Not knowing your medical history I can't say for sure but the awards are based not on what body part was injured but where the effects of that disability are realized. 95% of the time those are the same body parts but not always. If your shoulder has full range of motion and no loss of use but your bicep is now weaker as a result of disuse, you could be rated for UE instead of shoulder.
          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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          • #6
            A labral tear is definitely in the shoulder. Make sure you get the operative report from the hospital. This is semantics, or form over substance.

            It does not surprise me that an insurance adjuster would take that kind of untenable and specious position.

            Ortho docs can use "upper extremity" to refer to everything from the side of the neck down to the fingertips.

            Go to your hearing armed with ALL of the medical records, especially the operative report, and surely the judge will see that your shoulder, rather than your arm, was operated on and injured. And hire a competent work comp lawyer to make sure this happens the correct way.
            Bob Bollinger, Attorney
            Board Certified Specialist in NC Workers' Compensation Law
            Charlotte, NC

            Comment

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