What if I am At Fault for My Work Injury in a Workers’ Compensation Case?
It happens to the most focused of employees: you go to perform the same work routine you’ve done every day for the past few years. It’s become second nature, and sometimes your mind wanders while you take care of business.
This day, you’re using a piece of machinery when, by happenstance, you forget to cut a piece of metal at the necessary angle to prevent injury. The machinery jams and the metal slices into your hand – and the damage is extensive.
You know that workers’ compensation is what provides medical and employment benefits for injuries. But what if your own forgetfulness (or even general negligence) is what caused the injury? Under the South Carolina Workers’ Compensation Act, it’s likely you can still receive compensation – even if the injury was your fault.
Workers’ Compensation in South Carolina
Each state maintains its own workers’ compensation system. While the laws vary slightly from one state to another, the major themes are the same.
First, state laws require employers to purchase workers’ compensation insurance. The South Carolina Workers’ Compensation Commission is the state agency that administers our system. Note that only employees, and not independent contractors, are covered.
- Are entitled to compensation for work-related injuries
- Must report their injuries within 90 days, but have 2 years to file a claim
- May request a hearing with the state commission to resolve disputes
What does it mean to be “entitled to compensation?” Generally, benefits include:
- Medical expenses (e.g., doctor visits, prescription drugs, and specialist care)
- Lost wages (paid at a rate of two-thirds of your average weekly wages)
- “Loss of use” or “disability” benefits
However, workers’ compensation does not pay for noneconomic damages, such as “pain and suffering.” To recover such damages, you must usually file a personal injury lawsuit. But such lawsuits are not generally allowed for injuries that occur at work.
To receive workers’ compensation benefits, it’s imperative to report your injury within that 90-day window. The fact that your employer cannot fire you for getting injured should provide some peace of mind.
What Happens When You Caused Your Own Injury?
Workers’ compensation is a no-fault system. This means that there is no requirement to determine who is at fault for an injury before the commission awards benefits. This contrasts sharply with auto accidents, for example.
Let’s say a driver missed a stop sign and T-boned you at an intersection. Both drivers’ insurance companies will investigate to determine who’s at fault. If it’s the other driver, then their insurance will cover your costs. If you caused the accident, your insurance would pay and your rate will likely increase.
On the other hand, in the workers’ compensation system, you can usually receive benefits whether you caused the accident or your employer or some co-worker caused the accident. The mechanism of injury is imperative.
Workplace Injuries Caused by Forgetfulness, Mistakes, or General Negligence
Employees commonly injure themselves in workplace accidents. From improperly maintained equipment to repetitive activity injuries to car wrecks, employees suffer injuries due to the negligence of employers and others.
It’s also possible that you injured yourself due to your own forgetfulness, mistake, or general negligence. The key is that the workers’ compensation system – in most cases – cannot exclude you because something you did contributed to the injury.
The minimum requirement is that the injury occurred within the course and scope of employment. This means that you must prove your injury occurred while you were working and directly because of your job. While your employer and/or their insurance carrier may argue that your fault or contribution to the injury renders you ineligible for benefits, that’s not a winning argument in most cases.
Workplace Injuries Caused by Intoxication, Altercations, or Gross Negligence
Injuries caused by misconduct and gross negligence, however, are not compensable through the workers’ compensation system. This includes:
- Intoxication due to alcohol, illegal drugs, or inappropriately used prescription drugs
- Willfully ignoring safety procedures in an extremely dangerous manner
- Purposefully misusing dangerous equipment
- Instigating an altercation with another employee or customer
- Intentionally breaking the law
- Engaging in roughhousing
In any of these scenarios, you likely have no recourse in the workers’ compensation system.
Similarly, state laws exclude certain employers providing services in the agricultural and railroad industries from participating in the workers’ compensation system. This also applies to certain employers with a total payroll of less than $3,000 per year.
What to Do Once You’re Injured
Even if you caused (or contributed to) your own workplace injury, you can still file a claim in the workers’ compensation system. A workers’ compensation lawyer can help you prepare the best case, but here’s where to begin:
- Report Your Injury
As soon as practicable, report your injury to your employer. The statutes provide a 90-day window, but the faster you report the injury, the sooner you can receive benefits.
2. Obtain Medical Care
Note that under South Carolina law, your employer selects your medical care provider. So, ask your employer where you should go to get medical treatment. If you choose an alternate doctor, you may forfeit your right to compensation for those medical benefits.
- File a Claim with the State Commission
In a straightforward case, you can file a claim yourself with the state commission. You can access resources and forms through the Workers’ Compensation Commission’s Employee/Injured Worker page.
- Seek a Workers’ Compensation Lawyer
Other cases require some nuance and assistance. Working with a workers’ compensation attorney may prove beneficial when:
- Your employer never filed your claim
- The employer or the employer’s insurance carrier denied your claim
- The insurance carrier is too difficult to deal with on your own
- You believe you’re entitled to benefits that you aren’t receiving
- You suffered a severe injury requiring causing permanent disability or disfigurement and requiring significant medical care
- You’re seeking death benefits as the dependent of an employee who died at work
Working with a Workers’ Compensation Attorney
If you’re injured at work, you may be entitled to compensation. With the stress of your injury and continuing to make ends meet with reduced hours, don’t do it alone. Working with a workers’ compensation attorney can help you maximize your benefits. At Williams & Kamb, our team has the experience to guide you through the process.
Contact us to get started.