Understanding workers compensation and Social Security Disability claims

| Aug 12, 2020 | Social Security Disability, Workers Compensation

Many workers in Greenville and western South Carolina have suffered serious or fatal injuries while working. Obtaining compensation for these injuries can become a complex legal process in which the assistance of an experienced attorney is extremely helpful. Two government programs are available to provide financial assistance to injured workers and their families: Workers’ Compensation under South Carolina law and Social Security Disability insurance from the federal government. The criteria for eligibility under each program differ significantly.

Workers’ Compensation

The State of South Carolina provides financial benefits to any worker who suffers an injury while working on the job. The only criterion for eligibility is that the injury must have been suffered while working. The legislature has specified a schedule of maximum benefits that is based upon the average weekly compensation rate in South Carolina for the past year. In 2020, the maximum rate was $866.67. A worker is entitled to receive benefits up to 66-2/3% of his or her weekly wage not to exceed the maximum wage.

If a claim has been denied by a Workers’ Compensation commissioner, the claimant can take an appeal to the full Workers’ Compensation Board. If the Board denies the claim, the claim can seek review by a state district judge. The judge’s decision can be appealed to the state court of appeals, and that decision in turn can be appealed to the state supreme court. No further appeals are available.

Social Security Disability

The federal plan does not depend upon the illness or injury being work-related. Instead, the SSDI insurance will cover any illness or injury so long as:

  1. The claimant has earned enough work credits to qualify for benefits.
  2. The injury is permanent or expected to result in death in 12 months.
  3. The worker cannot perform the functions of the job he held when the disability began.
  4. The worker is unable to perform substantial gainful employment because of the injury.

Substantial gainful employment is defined as the ability to earn more than $1,260 per month. If a claimant is deemed to be able (or has in fact) earn more than this amount, the claim will be denied.

The Social Security Administration provides an internal appeal process that begins with a request for reconsideration. In a reconsideration request, the file will be reviewed by an SSA employee who did not participate in the original decision. If the reconsideration request is denied, the employee can request a hearing before an administrative law judge. If the administrative law judge denies the claim, the matter can be presented to the internal Appeals Council. If the appeals declines to hear the appeal or affirms the earlier denial, the claimant can seek review by a federal court.

The long view

As can be easily inferred from this summary of the claims and appeals processes for both Workers’ Compensation and SSDI benefits, the assistance of an experienced claims attorney can be invaluable. A knowledgeable lawyer can help the applicant file the initial application, present the evidence in the most effective manner and pursue any necessary appeals.