Filing A Claim

Q. What must I do to assure prompt determination and payment of benefits if I am injured on-the-job?

A. You should notify your employer immediately. This notification may be verbal or written (although written notification is best) and should include your name, address, and the time, place, and cause of the accident, as well as, a description of the injury. You should keep a record of the date of the accident, the date you told your employer, the name of the person to whom you reported the accident, and the names of any persons who saw the accident. Make sure all of the information asked for on the WCC Form 12-A/First Report of Injury is given to your employer and is accurate. Incomplete or inaccurate information will cause a delay in the processing of your claim.

Q. Is there a time limit for reporting an on-the-job injury?

A. Yes. You must notify your employer immediately after the injury occurs or as soon thereafter as practical. If you do not notify your employer within 90 days after the injury occurs, you may be ineligible to receive workers' compensation benefits.

Q. What happens after I have notified my employer of my on-the-job injury?

A. Your employer should complete and mail a WCC Form 12-A/First Report of Injury to SAF within ten (10) days after you give them notice of the job-related accident, disease or condition. Prompt completion and mailing of this report to SAF is very important because SAF cannot determine your eligibility for benefits without receiving a properly completed WCC Form 12-A.

Q. Do I need to take any further action to receive workers' compensation benefits?

A. Ordinarily, the only additional action on your part is to furnish such additional information as may be requested by SAF or your employer. If your recovery is slow and might continue for more than two (2) years from the date of accident, you must file a claim for continued benefits before the end of the two (2) years or your right to receive further compensation can be barred. Your claim may be filed by simply writing a letter to the SC Workers' Compensation Commission, PO Box 1715, Columbia, SC 29202-1715 and stating that you are filing a claim for benefits, giving as much information as you can about the benefits sought and the facts of your job-related accident, disease or condition.

Q. What can I do to help get my claim processed more quickly?

A. Include your claim number (a 9 or 10-digit number...SF#2099-012345) on all paperwork which you are submitting as part of your claim. Your claim number appears on the notification letter you received when your claim was processed by SAF. Always give your claim number to the SAF employee you talk to about your claim. You should also notify SAF of any changes in address, phone number, or employer.

Q. What should I do if I receive a request to contact my claims adjuster?

A. Contact SAF immediately. Your claims adjuster may need important information from you to help process your claim. Failure to contact SAF may delay the payment of benefits.

Q. Do I need to hire an attorney to represent me on my claim?

A. That decision is left up to you. SC law allows you to proceed with your claim without being represented by a lawyer. If you choose to be represented, you may do so at your own expense. If you hire an attorney, that attorney will be responsible for communicating with SAF on your behalf. Because of the nature of the attorney-client relationship, all correspondence and communication regarding your claim will be handled between SAF and the attorney. You should not be in direct contact with SAF.

Q. What if I think my accident, disease or condition is job-related but am not sure whether or not I am entitled to benefits? What should I do?

A. You should report the situation to your employer immediately. Your employer will complete the WCC Form 12-A/First Report of Injury based on information you provide and forward it to SAF. SAF will then determine whether the claim is covered under SC law. If SAF does not have sufficient information to make a decision, an investigator will be assigned to get such further information from you, your employer, and your doctor as is required to make a fair determination. In addition to seeking information to assure that you receive all benefits to which you are entitled, the investigator will also be seeking information about safety in your workplace so as to help prevent others from receiving similar injuries. After the investigation is concluded, SAF will either pay benefits or deny the claim and notify you of that decision.

Q. What if I disagree with the decision or action of SAF pertaining to my claim?

A. If you disagree with any decision or action of SAF pertaining to your claim, you may appeal to the agency Director by writing a letter to the Director at the address on page 1 of this handbook. If you disagree with the decision or action of the Director of the State Accident Fund you may request a hearing before the
SC Workers' Compensation Commission
1612 Marion Street
P. 0. Box 1715
Columbia, SC 29202-1715
803-737-5700.
Please note that certain time restrictions apply to the filing of a request for SAF review, and/or a WCC hearing. Contact SAF or the WCC for specific information.

Q. Are there penalties for filing a fraudulent workers' compensation claim?

A. SC law provides civil and criminal penalties (up to $15,000, ten (10) years imprisonment, and restitution) for anyone convicted of workers' compensation fraud. The definition of fraud under SC law includes the filing of a false claim, as well as, any false statements or misrepresentations related to an accepted claim.

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