Workers’ Comp Claims After an Injury at Prisma Health

Workers’ Comp Claims After an Injury at Prisma Health

As one of the biggest employers in South Carolina, Prisma Health has its share of work injury and occupational illness claims from employees. After all, workers in healthcare face unique risks of getting hurt or sick on the job, including exposure to diseases and other workplace hazards.

Fortunately, the South Carolina workers’ compensation system provides qualifying employees who suffer a work injury or occupational illness on the job with specific financial resources to assist them as they recover from their injury or illness. These benefits cover the costs of medical treatment, replace lost income, and provide payments for disability.

Although the workers’ compensation system guarantees no-fault benefits for work-related injuries or illnesses, employers often contest liability for an employee’s injury or illness.

Sometimes, employers doubt the necessity and reasonableness of the benefits the employee claims. Or they argue the injury or illness did not occur during the scope of the employee’s work.

An experienced workers’ compensation attorney can provide an injured or ill worker with the legal advice and advocacy they need to navigate the complexities of the workers’ comp claims process. And if an employer or their insurer denies a claim, a lawyer can help an injured worker fight back to obtain the benefits they need.

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About Prisma Health

Prisma Health is a private, nonprofit healthcare provider and the largest healthcare organization in South Carolina. The company employs approximately 30,000 medical professionals and staff across 18 acute and specialty hospitals.

Prisma Health has 305 physician practice sites and over 5,200 employed and independent clinicians working through the company’s inVio Health Network.

Prisma Health serves approximately 1.5 million patients in a 21-county market that covers about half of South Carolina. The company has nearly 700 residents and fellows, and it affiliates with 123 medical nursing, pharmacy, and other healthcare professional schools.

With tens of thousands of employees working at dozens of facilities across South Carolina, Prisma Health ranks among the state’s largest employers. Due to the significant number of people it employs, Prisma Health experiences its share of workplace accidents and injuries. The healthcare profession exposes workers to unique accidents that can lead to work-related injuries or occupational illnesses.

Examples of Work-Related Injuries and Occupational Illnesses

Working with heavy or potentially dangerous equipment and treating sick patients may expose Prisma Health workers to the risk of various injuries or illnesses on the job.

Examples of work injuries or occupational illnesses that Prisma Health employees might suffer include:

• Lacerations and puncture wounds
• Burns, including thermal, chemical, electrical, or radiation burns
• Degloving injuries
• Dislocated joints
• Ligament sprains or tears
• Muscle and tendon strains or tears 
• Overexertion injuries
• Repetitive stress injuries
• Herniated spinal disc injuries
• Nerve damage
• Injuries from assault and battery, including blunt force trauma, stab wounds, or gunshot wounds
• Infection by communicable diseases, such as COVID-19
• Diseases or chronic health conditions by exposure to toxic or radioactive sources
• Crush injuries
• Internal organ injuries and internal bleeding
• Spinal cord injuries or paralysis
• Facial and dental injuries
• Traumatic brain injuries

Workers’ Compensation Benefits Available in South Carolina

In South Carolina, the workers’ compensation system provides eligible employees with specific financial benefits as they recover from a work injury or occupational illness.

All paid employees of covered employers can receive workers’ comp benefits, including part-time or seasonal employees. A worker who suffers an injury or illness in the course and scope of their work might be eligible.

Under the workers’ comp system, an injured or ill worker does not need to prove that their employer bears any fault for the worker’s injury or illness. Instead, once a worker proves the work-related nature of their injury or illness, an employer generally must provide the worker with workers’ compensation benefits.

However, in exchange for guaranteed benefits from the workers’ compensation system, an employee gives up the right to pursue a personal injury or other legal claim against their employer for the work injury or occupational illness. With limited exceptions, a workers’ compensation claim becomes an employee’s sole legal recourse against their employer for a work-related injury or illness.

Depending on the type and severity of a work injury or occupational illness, an employee might receive various benefits from workers’ compensation, including:

• Medical benefits: Workers’ compensation medical benefits pay for all reasonable and necessary medical treatment for a work injury or occupational illness, including doctor’s visits, specialist appointments, surgeries, physical and occupational therapy, prescriptions, medical and mobility equipment, prosthetic devices, and some transportation expenses.
• Lost income benefits: When workers cannot work or have reduced earnings due to a work injury or occupational illness, they may receive partial reimbursement of their lost income. These benefits pay two-thirds of a worker’s average weekly income or the difference between their average weekly income and their reduced earnings.
• Permanent disability benefits: A worker who continues to suffer physical impairment or loss of bodily function even after maximum medical improvement may receive financial payments for a permanent disability. Partial disability can provide temporary payments depending on the type and severity of disability.

What Steps Should You Take After Suffering an Injury at Work at Prisma Health?

If you’ve gotten hurt on the job at Prisma Health, act quickly to preserve your workers’ compensation eligibility and improve your chances of obtaining the benefits you need.

After sustaining a work injury or occupational illness: 

• Report your injury or illness to Prisma Health as soon as possible. Ask whether the employer intends to require you to see a doctor it chooses.
• Follow your provider’s treatment recommendations and recovery instructions. Keep all follow-up appointments. 
• Request copies of the medical records of your treatment and rehabilitation.
• Gather your pay stubs or income statements if you need to take time off work or transfer to a modified duty position due to your injuries.
• Keep copies of any bills, invoices, or receipts of expenses related to your care, especially any out-of-pocket costs, such as mileage to and from medical appointments.

Finally, contact a workers’ compensation attorney as soon as possible, especially if the employer delays or denies your workers’ compensation claims, refuses to approve specific medical treatment, attempts to terminate your benefits, or requires you to return to work before you’ve recovered.

The Workers’ Comp Claims Process

Under South Carolina’s workers’ compensation system, workers should report a work injury or occupational illness to their employer as soon as possible. Waiting more than 90 days to report an injury or the onset of symptoms of an occupational illness may render a worker ineligible for benefits. Workers may report their injury or illness to supervisors, managers, or human resources officers.

Once an employer receives notice of an employee’s work injury or occupational disease, the employer or its workers’ compensation insurer or claims administrator usually will file an official claim with the South Carolina Workers’ Compensation Commission. Injured employees must file a claim form within two years of a work injury or onset of an occupational illness to preserve their right to benefits. 

An employee might request a hearing with the Workers’ Compensation Commission if their employer denies liability for workers’ compensation benefits or refuses to pay specific benefits the employee believes they have the right to receive. The Commission will schedule a hearing within 60 days of a request.

The hearing will occur before a commissioner, who may direct the parties to an informal conference or a mediation to resolve their dispute before the scheduled hearing. At a workers’ compensation hearing, the parties may present documentary evidence, medical experts, and other testimony relevant to the issues in dispute, such as whether an injury occurred in the course of an employee’s work.

Any party dissatisfied with the commissioner’s ruling following the hearing may appeal the decision to a panel of commissioners or the full Commission within 14 days of receiving the initial decision.

If either party still believes the Commission decided in error following an appeal, they may further appeal the claim to the South Carolina Circuit Court or Court of Appeals, depending on the facts.

Tips for Pursuing Workers’ Comp Claims

A Prisma Health employee injured on the job or who develops a disease or illness because of their work might improve their chances of successfully recovering benefits from workers’ compensation if they:

• Report a work injury or occupational illness as soon as possible after you notice the injury or symptoms of illness. Your supervisor or human resources manager might help you formally notify Prisma Health of your claim. Remember to put any notices in writing (including in electronic format) so you have a record of when you sent the notice, when someone received it, and who received it. 
• Seek prompt medical attention for your work injury. Employers can choose the primary physician for an employee’s work injury, although employees might have the right to obtain emergency treatment from any provider. Workers should seek ongoing treatment from the provider of their employer’s choosing to ensure workers’ compensation covers the treatment. 
• If your treating physician deems you unable to work or imposes restrictions on your work duties, ask for a doctor’s note to provide to the employer. Keep a copy of the note for your records.
• Follow your physician’s treatment plan and medical restrictions. An employer may deem you able to return to work if you fail to attend appointments or treatments or engage in activities precluded by your medical restrictions.

How Can an Attorney Assist You With a Workers’ Compensation Claim?

If your employer creates challenges when you are seeking workers’ compensation benefits, hiring an experienced workers’ compensation attorney can give you the resources you need to stand up for your rights and demand the benefits you deserve under the workers’ compensation law.

An attorney might assist you with your workers’ comp claim by:

• Investigating the accident, incident, or underlying events that led to the injury or illness if an employer denies that the injury or illness occurred in the course and scope of work
• Filing the worker’s claim form with the state Workers’ Compensation Commission to preserve benefits eligibility
• Documenting your injury or illness along with medical care costs for reimbursement
• Calculating your average weekly income to help you seek the correct benefits
• Pursuing a hearing on your behalf when an employer denies or terminates benefits or filing appeals of adverse decisions if appropriate
• Evaluating legal options, including the suitability of a workers’ compensation settlement once you reach maximum medical improvement

Prisma Health Employees Injured on the Job Might Have the Option for Seeking Workers’ Compensation Benefits

Workers in the healthcare industry, including employees at Prisma Health, may suffer various work-related injuries and illnesses. Healthcare workers face increased risks of injuries or illness due to exposure to diseases or other unique workplace hazards.

Fortunately, South Carolina’s workers’ compensation system gives employees like those at Prisma Health the opportunity to obtain benefits.

These financial benefits can help injured workers during the recovery process, including paying for medical treatment and rehabilitation, partially reimbursing lost income, and providing payments for permanent disabilities. However, employers such as Prisma Health often make the workers’ compensation claims process more challenging for employees.

For instance, an employer might dispute the work-related nature of an employee’s injury or illness or the necessity of proposed medical treatment. When an employee faces obstacles to receiving workers’ compensation benefits, an experienced workers’ comp attorney can help the employee pursue the benefits they need by guiding them through the claims process.