SC Workers’ Compensation Commission Carolinas AGC South Carolina Update July 16, 2020
South Carolina Workers’ Compensation Commission Commissioners Susan S. Barden Melody L. James T. Scott Beck Term Expires Term Expires Chairman June 30, 2022 June 30, 2022 Term Expires June 30, 2020 Avery B. Wilkerson, Jr. Michael R. Campbell II Aisha Taylor Gene McCaskill Term Expires Term Expires Term Expires: Term Expires June 30, 2020 June 30, 2020 June 30, 2024 June 30, 2024
South Carolina Workers’ Compensation Commission Mission Statement “To provide an equitable and timely system of benefits to injured workers and to employers in the most responsive, accurate, and reliable manner possible.”
South Carolina Workers’ Compensation Commission What we believe…… Apply facts of case to law Apply rules equitably to all All stakeholders on level playing field Promote efficiency and effectiveness Provide timely responses to all stakeholders Remember … a case involves a person
South Carolina Workers’ Compensation Commission Commissione oners’ F Functions ons Judicial Hearings Approve Settlements Motions Attorneys’ Fees Appellate Hearings Public Policy/Quasi-legislative Administrative Policies and Procedures Regulations Medical Fee Schedules Applications to self insure
South Carolina Workers’ Compensation Commission System Economic Impact $1 Bi $1 Billion Annual Premiums for: Commercial Insurance Self-Insurance State Accident Fund
South Carolina Workers’ Compensation Commission Economic Impact $ $ 1. 1.03 03 Bil illion Medical & Compensation July 1,2019 – June 30, 2020 Medical $ 451 (18%) Compensation $ 587 (-4%)
South Carolina Workers’ Compensation Commission Me Medi dical Co Cost Commission responsibility Ensure medical care is available to claimants Controlling cost of system Fee Schedules Medical Services Provider Manual In-Patient Fee Schedule Ambulatory Surgery Center
South Carolina Workers’ Compensation Commission Compens ensatio tion n Maximum Week ekly Compen ensation 66 2/3% of individual average weekly wage Not to exceed AWW $866.67 Sched eduled ed Body Part Value e of I Injury ry = = Number er of W Week eks ( (sched eduled ed body part) ) x AWW x % D Disability ty Medical cal Rati ting of I Impai airm rmen ent t Disability ty
South Carolina Workers’ Compensation Commission 67,000 accidents annually 39,000 minor medical 64,000 cases closed
South Carolina Workers’ Compensation Commission Commissi ssioner ers’ s’ Other er A Activi vities es Attorney Fee Petitions 8,754 Administrative Orders 5,298 Clincher Conferences 1,632 Motions and Approved 1,419 Relief of Counsel Motions 1,044 Prehearing Conferences 280
South Carolina Workers’ Compensation Commission Partnership with Others Venues/Hearing Sites 100 throughout state Vocational Rehabilitation 47 referrals YTD 19 counties Case manager on site in near future Probation, Pardon and Parole Partnership Incarcerated individuals Hearings held via video conference DEW Employer wage and personnel data for compliance
South Carolina Workers’ Compensation Commission Cove verag age Verify coverage for all first report of injury forms - 61,000 DEW quarterly wage and employment data 62,000 employer records 351 employers not in compliance 469 employers came into compliance 3,800 workers were covered $1,027,000 fines collected coverage and compliance
South Carolina Workers’ Compensation Commission Cove verag age Subcontractors are statutory employees of an upstream general contractor Business owners, contractors, and subcontractors required to carry insurance.
South Carolina Workers’ Compensation Commission Coverage V e Verif ifica icati tion System tem Any contractor or employer can register a policy with the Commission’s Coverage Verification System to be notified of a midterm cancellation. Go to the Commission’s website: http://www.wcc.sc.gov and select the verify coverage tab at the top of the page. Then follow the and then follow the prompts. Once you have located your policy through the search portal, you can register that policy using your email address and you will be notified if that policy is cancelled prior to its expiration date.
South Carolina Workers’ Compensation Commission http://www.wcc.sc.gov
South Carolina Workers’ Compensation Commission Coverage Verification Contact 803-737-6203 coverage@wcc.sc.gov
South Carolina Workers’ Compensation Commission Contact Gary Cannon Executive Director gcannon@wcc.sc.gov 803-737-5744 Wayne Ducote Director of Insurance and Medical Services wducote@wcc.sc.gov 803-737-5709
OCCUPATIONAL ILLNESSES & WORKERS’ COMPENSATION LAW
• America can M Medica cal A Associ ciation design gnated • Current Proced edural al Terminolog ogy (CPT) T) i is a med a edic ical al code de set et th that i at is used ed to to rep eport t Current medi dical, s surgi gical, a and diagn gnostic proced edures es and nd s servi vices Data • 3 CPT C Codes C Created f for corona navirus us • Cause o of Injury C y Code ( (DN0037) 0037) as s 83 – “Pand ndemic”; ”; Feb 1 – June 30 • Nature o of Inj njury Code ( (DN0035) as s 83 – “COVID-19” 19”; o or • “COVID” o ” or “Coronavirus us” i ” in t the Accid ident/I /Injury D Descriptio ion Narrat ative ve ( (DN0038) 0038)
Top 10 Occupations - COVID 19 Claims Claims REGISTERED NURSE 46 CNA 14 POLICEOFFICER & DRIVERS 13 LPN 12 SERVICE REP 12 FIRE FIGHTERS AND DRIVERS - VO 11 GENERAL OFFICE STAFF 7 Not provided 7 Rehab Nursing Tech 7 X-RAY/DIAGNOSTIC TECHNICIAN 7 NURSING STAFF (NOC)(I.E. PCT/I 6 REP PA II 6 RN 6 TIDLEANDS HEALTH EMPLO 6 OCCUPATIONAL THERAPIST 5 BD MEMBERS, CLERICAL OFFICE EM 4 OTA 4 PACKAGE DRIVER 4 SOCIAL WORKER 4
• Occup upational d disease se d define ned • a a disease ar arising o out o of an and i in the c e cou ourse of e of em employment • due t e to o haza zards i in ex exces ess of of The Basics those o ordin inaril ily i y inci cident t to empl ployment a and d is pe peculiar t to the oc e occupation of of the e em employee ee • S.C. . Code A Ann. . § 42 42-11 11-10(A (A). ).
The Basics • Occupa pational al d diseas ase • only i if cau aused by by a a haz azard r recognized as as pe peculiar to a a par particular t trade ade, pr process, occu ccupation o or r employment • as a dire rect ct re result o of co continuous e exposure t to the normal w work rking co conditions Grady L L. B Beard, S Shannon T nnon Till Poteat, M Marcy J Johns hnson on Lamar, V Vernon non R. . Sumwalt lt, M Margaret Blue luestein & & Alli llison P. P. Sulli ullivan, The Law o w of f Workers’ Compens nsation I on Insuranc nce i in South h Caroli olina na Ch.7 7 § I (6 (6th e ed. . 2012) 12).
The Basics • Occup upat ationa nal disease ses • May ay rese semble inj njur uries b by ac y accident • However t the hey have have sub substantive ve and and p procedural p peculiarities • Wh Which ch do o not ot perta tain in to o inju jury-by by-accid ident cl t claims ims. • Grad ady L. Bear ard, Shanno hannon n Till Poteat, Mar arcy Johns hnson n Lam amar ar, Verno non R. Sum umwal alt, , Margaret Blu luestein & & Alli llison P P. . Sulli llivan, The he Law aw of Workers’ s’ Compens nsation n Insu nsuran ance in n Sout uth h Car arolina Ch. h.7 7 § 1 1 (6t 6th e h ed. 2012) 2012). • Resul sults f from a a haz hazar ard that hat i is s ac ackno nowledged as as different f from haz hazar ards f found und in n the he g gene neral r run o un of occupat ations ns. Mohasco Corp., , Dixi xiana na Mill D Div. v. v. v. Risi sing, 289 289 S.C. 130, 130, 139, 139, 345 S 345 S.E.2d 2d 249, 249, • 254 254 (Ct. A App. 1986) 1986).
The Basics • Pe Peculi uliar t to o emplo loyment means ns t tha hat e employment i inc ncreased t the he risk k • May ay be be an an o occupational di diseas ase i if pr produced o or ag aggravated by by di distinctive condi ditions o of employ loyment nt • Grady L ady L. B Beard, d, S Shan annon T Till Poteat, M Marcy J y Johnson Lamar ar, Ve Vernon R. R. Sumwa walt, M Margaret B Blue luestein & & Alli llison P. P. Sulli ullivan, The La Law of Work rkers’ C Compensation I Insurance i in South Caroli olina na Ch.7 7 § II A 4 4 (6t 6th e ed. d. 2012 2012). • The e em employee s e shall es establish t the e dis isea ease e arose f e from ex exposure t e to the e hazards pec eculiar t to the e em employment b by a a prep eponder erance o e of the e ev evid iden ence e • S.C. C. Co Code A e Ann. § 42 42-11 11-10(A (A). ).
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