2.3 South Carolina Workers' Compensation Law & Commission Rules

South Carolina Workers' Compensation Law provides a statutory, no-fault framework governing workplace injuries and occupational diseases. Enacted under Title 42 of the South Carolina Code of Laws, the system balances prompt medical treatment and wage replacement for injured workers with liability protection for employers.

Statutory Framework & Commission Structure (S.C. Code Title 42)

Scope and Employer Coverage Threshold

Under S.C. Code § 42-1-360, any private employer in South Carolina that regularly employs 4 or more employees is automatically subject to Title 42 and must secure workers' compensation insurance or obtain approval from the Commission to self-insure.

Statutory Exemptions: Employers exempt from mandatory coverage include:

• Employers with fewer than 4 regular employees.
• Agricultural employees and farm labor.
• Railway company employees engaged in interstate commerce.
• Casual employees whose work is not in the usual course of the employer's business.
• Licensed real estate salespeople paid solely on commission.
• Corporate officers who file a formal notice electing to exempt themselves from coverage.

South Carolina Workers' Compensation Commission (SCWCC)

The system is administered by the South Carolina Workers' Compensation Commission (SCWCC), an independent state administrative agency consisting of 7 Commissioners appointed by the Governor with Senate advice and consent for 6-year terms. One commissioner serves as Chairman. The Commissioners perform quasi-judicial functions: individual commissioners hear contested claims, while a panel of Commissioners conducts appellate reviews of single-commissioner decisions.

---

The Exclusive Remedy Doctrine & Compensability

Exclusive Remedy Principle (S.C. Code § 42-1-540)

Workers' compensation is the exclusive remedy of an employee against the employer for job-related injuries or death. In exchange for receiving guaranteed, no-fault statutory benefits, the employee surrenders the right to sue the employer in civil tort court for negligence. Employers are protected from common-law tort damages, pain and suffering awards, and punitive damages.

Third-Party Subrogation (S.C. Code § 42-1-560)

If an employee's workplace injury is caused by a negligent third party (such as a reckless driver hitting a delivery worker or a defective machine manufacturer), the employee may pursue a civil lawsuit against the third party. However, the employer or workers' compensation insurer holds a statutory subrogation lien against any third-party recovery to recoup workers' comp benefits paid.

Elements of a Compensable Injury

To be compensable under S.C. Code § 42-1-160, an injury must meet the statutory criteria of an "injury by accident arising out of and in the course of employment."

                    Compensable Injury
                            │
         ┌──────────────────┴──────────────────┐
         ▼                                     ▼
  "Arising Out Of"                   "In the Course Of"
  (Causal origin: risk               (Time, place, and
  connected to work duties)          working circumstances)

• Arising Out of Employment: Refers to the origin or cause of the injury. The risk leading to injury must be rationalized as a hazard connected to the employment duties.
• In the Course of Employment: Refers to the time, place, and circumstances of the accident. The injury must occur within the period of employment, at a place where the employee may reasonably be, while fulfilling work duties.
• Occupational Diseases & Repetitive Trauma: Conditions resulting from continuous exposure to work hazards (e.g., carpal tunnel syndrome, asbestosis) are compensable under S.C. Code § 42-11-10. Notice of a repetitive trauma injury must be provided to the employer within 90 days of when the employee knew or should have known the condition was work-related.

---

Disability Classifications & Average Weekly Wage (AWW)

Disability indemnity benefits compensate injured workers for lost earning capacity. All indemnity benefit calculations stem from the worker's Average Weekly Wage (AWW).

AWW Calculation & Statutory Rate

• AWW Formula: Calculated by taking the total gross earnings of the injured employee in the 52 weeks prior to injury divided by 52. If employed for less than 52 weeks, the AWW is based on actual weeks worked or the earnings of a similar employee.
• Weekly Compensation Rate: Disability benefits are paid at 66.67% (two-thirds) of the worker's AWW, subject to the South Carolina Maximum Weekly Wage cap established annually by the SCWCC.

Waiting Period & Retroactive Trigger (S.C. Code § 42-9-10)

• 7-Day Waiting Period: No disability benefits are paid for the first 7 calendar days of disability.
• 14-Day Retroactive Payment: If the disability extends for more than 14 consecutive calendar days, compensation is paid retroactively starting from the first day of disability.

Disability Benefit Classifications

---

Medical Benefits, Adjuster Duties & The 3-Hour CE Mandate

Employer-Directed Medical Care

In South Carolina, the employer or insurer has the statutory right to select the treating physician. Medical care is 100% covered—including hospitalizations, surgeries, physical therapy, prescription drugs, and travel reimbursement for medical visits over 10 miles round-trip. If an employee sees an unauthorized doctor independently, the insurer is not liable for those medical bills.

Claims Adjuster Reporting Obligations (SCWCC Forms)

Adjusters must adhere strictly to SCWCC reporting timelines using mandatory administrative forms:

• Form 12A (Employer's First Report of Injury): Must be filed with the SCWCC within 10 days of notice of any injury involving lost time or medical costs exceeding $500.
• Form 15 (Temporary Total Disability Payment / Denial): Used to initiate TTD payments or notify the claimant of claim denial/suspension.
• Form 17 (Receipt for Final Payment): Signed upon final payment of compensation to close the file with the Commission.

South Carolina Adjuster Continuing Education (CE) Mandate

Under South Carolina insurance licensing rules, licensed insurance adjusters must complete 24 hours of continuing education every two years. For adjusters actively handling workers' compensation claims in South Carolina, state law specifically mandates that at least 3 hours of the 24 required CE hours must be dedicated to specialized Workers' Compensation education.