General Questions About Coverage

Q. What injuries and illnesses are covered under workers' compensation insurance?

A. Those injuries which are the direct result of a job-related accident, disease or condition.

Q. What injuries are not covered under workers' compensation insurance?

A. Injury or death resulting from the following conditions or actions are not covered:

  • an intentional act to injure or kill oneself or another;
  • intoxication;
  • the use of illegal drugs; or
  • activities that do not arise out of or in the course of employment.

Q. If I am injured on-the-job, what type of workers' compensation benefits can I receive from SAF?

A. Depending on the nature of your injury, you may be entitled to receive one or more of the following benefits:

  • medical treatment;
  • temporary disability income; and
  • permanent disability/disfigurement compensation.

Q. Do I pay for my workers' compensation insurance?

A. No. All premiums are paid by your employer.

Q. Are there age limits for coverage under workers' compensation insurance?

A. No.

Q. Are my spouse and children covered?

A. No. Workers' compensation insurance covers only the employees of the insured employer. Benefits may be payable to a spouse or children, however, when an employee dies as a result of a job-related accident, disease or condition.

Q. Am I covered twenty-four (24) hours per day, seven (7) days per week?

A. No. Unlike regular health or dental insurance, workers' compensation insurance only protects you while you are performing job-related duties for your employer. Generally, you are covered from the time you arrive at work until the time you leave. In other words, you are covered only during the period of employment. There are certain exceptions to this general rule. For example, you may be covered: while going to or from work if transportation is provided by the employer; when you are required to return to work after normal work hours; or when the only way in or out of your workplace is inherently dangerous and is maintained by your employer.

Q. Am I automatically covered by workers' compensation insurance if I am injured on my employer's premises?

A. No. You are covered only if you are injured by accident while performing your job duties.

Q. Am I covered if I am injured while working for my employer away from my employer's premises?

A. Yes. If you are accidentally injured while performing work-related duties away from your employer's place of business, your injury would be covered. A simple test for determining whether your injury is covered is to ask yourself this question: Did the accidental injury occur in a place where I may reasonably be expected to perform my job duties and while I was performing those duties?

Q. Am I eligible for benefits if I have a heart attack or stroke?

A. Possibly. Benefits may be paid if the heart attack or stroke was caused by unusual job-related stress, strain, exertion, or extraordinary conditions.

Q. Am I eligible to receive benefits if I develop a disease or condition as a result of performing my job duties?

A. Yes, if the disease or condition is directly related to and caused by performing your job duties. Ordinary illnesses or diseases which the general public is exposed to are not covered.

Q. Is the aggravation of a pre-existing condition covered?

A. Yes, if you have a job related accident which combines with or aggravates a pre-existing condition.

Q. Will my workers' compensation insurance pay for "pain and suffering" like other forms of insurance?

A. Not as part of temporary disability income benefits. Long-term conditions such as chronic pain may be considered when determining eligibility for a permanency award.

Q. What is the difference between State Accident Fund and the SC Workers' Compensation Commission?

A. State Accident Fund (SAF) and the SC Workers' Compensation Commission (WCC) are two separate and distinct state agencies with totally different functions. State Accident Fund provides workers' compensation insurance coverage for public employees. The SC Workers' Compensation Commission is responsible for determining what benefits all injured workers (public and private sector) may be entitled to under SC law.

You should think of SAF as the "insurance company" and think of the WCC as the administrative agency and tribunal which administers the workers' compensation law and decides issues when the employer, insurance company, and employee cannot agree on coverage or payment of benefits.

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