Current Status Bill Number:3564 Type of Legislation:General Bill GB Introducing Body:House Introduced Date:19950209 Primary Sponsor:Cato, All Sponsors:Cato, A. Young, Lanford, Hallman, Sandifer, Sharpe, Cain, Richardson, Simrill, Fulmer, Wright, Walker, Riser, Trotter, Tripp, Vaughn, Meacham, Cooper, Rice, Robinson, Littlejohn, Allison, Marchbanks, Wells, Fair, Carnell, Davenport and Herdklotz Drafted Document Number:BBM\9848JM.95 Companion Bill Number:3931 Residing Body:House Current Committee:Labor, Commerce and Industry Committee 26 HLCI Subject:Workers' compensation
Body Date Action Description Com Leg Involved
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House 19950209 Introduced, read first time, 26 HLCI
referred to Committee
View additional legislative information at the LPITS web site.
TO AMEND SECTION 42-9-30, AS AMENDED, CODE OF LAWS OF SOUTH CAROLINA, 1976, RELATING TO THE AMOUNT OF WORKERS' COMPENSATION AND PERIOD OF DISABILITY FOR CERTAIN INJURIES, SO AS TO PROVIDE FOR A PRESUMPTION OF TOTAL AND PERMANENT DISABILITY IN CASES WHERE THERE IS A FIFTY PERCENT OR MORE LOSS OF USE OF THE BACK, AND PROVIDE THAT THIS PRESUMPTION MAY BE REBUTTED BY A PREPONDERANCE OF THE EVIDENCE; TO AMEND THE 1976 CODE BY ADDING SECTION 42-9-45 SO AS TO PROVIDE THAT MENTAL ILLNESS RESULTING FROM WORK-RELATED STRESS IS NOT AN ACCIDENTAL INJURY ARISING OUT OF AND IN THE COURSE OF EMPLOYMENT EXCEPT UNDER CERTAIN CONDITIONS, AND PROVIDE FOR RELATED MATTERS; TO AMEND SECTION 42-9-260, AS AMENDED, RELATING TO NOTICE TO THE WORKERS' COMPENSATION COMMISSION WHEN PAYMENTS OF WORKERS' COMPENSATION HAVE BEGUN AND SUSPENSION OR TERMINATION OF PAYMENTS, SO AS TO DELETE CERTAIN LANGUAGE AND PROVISIONS, PROVIDE THAT WHEN AN EMPLOYEE HAS BEEN OUT OF WORK DUE TO A REPORTED WORK-RELATED INJURY OR OCCUPATIONAL DISEASE FOR EIGHT DAYS, AN EMPLOYER MAY START TEMPORARY TOTAL DISABILITY PAYMENTS IMMEDIATELY AND MAY CONTINUE SUCH PAYMENTS FOR UP TO ONE HUNDRED TWENTY DAYS WITHOUT WAIVER OF ANY GROUNDS FOR DENIAL OF A CLAIM AS MAY APPEAR FOLLOWING A GOOD FAITH INVESTIGATION, PROVIDE FOR THE TERMINATION OR SUSPENSION OF TEMPORARY DISABILITY COMPENSATION, AND PROVIDE FOR RELATED MATTERS; TO AMEND SECTION 42-1-40, RELATING TO THE DEFINITION OF "AVERAGE WEEKLY WAGES" UNDER THE WORKERS' COMPENSATION LAW, SO AS TO DELETE CERTAIN LANGUAGE AND PROVISIONS, AND PROVIDE THAT "AVERAGE WEEKLY WAGE" MUST BE CALCULATED BY TAKING THE TOTAL WAGES PAID FOR THE LAST FOUR QUARTERS IMMEDIATELY PRECEDING THE QUARTER IN WHICH THE INJURY OCCURRED AS REPORTED ON THE EMPLOYMENT SECURITY COMMISSION'S EMPLOYER CONTRIBUTION REPORTS DIVIDED BY FIFTY-TWO OR BY THE ACTUAL NUMBER OF WEEKS FOR WHICH WAGES WERE PAID, WHICHEVER IS LESS; TO AMEND SECTION 42-9-360, RELATING TO ASSIGNMENTS OF WORKERS' COMPENSATION AND EXEMPTIONS FROM THE CLAIMS OF CREDITORS AND TAXES, SO AS TO ADD PROVISIONS TO THE SECTION INCLUDING, AMONG OTHER THINGS, THE PROVISION THAT IT SHALL BE UNLAWFUL FOR AN AUTHORIZED HEALTH CARE PROVIDER TO ACTIVELY PURSUE COLLECTION PROCEDURES AGAINST A WORKERS' COMPENSATION CLAIMANT BEFORE THE FINAL ADJUDICATION OF THE CLAIMANT'S CLAIM; AND TO AMEND SECTION 42-19-10, AS AMENDED, RELATING TO THE WORKERS' COMPENSATION LAW AND EMPLOYERS' RECORDS AND REPORTS OF INJURIES, SO AS TO DELETE THE CURRENT PROVISIONS OF THE SECTION, AND PROVIDE, AMONG OTHER THINGS, THAT EVERY EMPLOYER SHALL KEEP A RECORD OF ALL INJURIES RECEIVED BY HIS EMPLOYEES IN THE COURSE OF THEIR EMPLOYMENT ON FORMS APPROVED BY THE WORKERS' COMPENSATION COMMISSION AND THAT CERTAIN INJURIES MUST BE REPORTED IN WRITING TO THE COMMISSION ACCORDING TO CERTAIN GUIDELINES.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Section 42-9-30(19) of the 1976 Code is amended to read:
"(19) For the total loss of use of the back, sixty-six and two-thirds percent of the average weekly wages during three hundred weeks. The compensation for partial loss of use of the back shall must be such those proportions of the periods of payment herein provided in this paragraph for total loss as such the partial loss bears to total loss, except that in cases where there is fifty percent or more loss of use of the back, in which event the injured employee shall be deemed is presumed to have suffered total and permanent disability and must be compensated therefor for this under paragraph two of Section 42-9-10. The presumption of total and permanent disability due to a fifty percent or more loss of use of the back may be rebutted by a preponderance of the evidence."
SECTION 2. The 1976 Code is amended by adding:
"Section 42-9-45. (A) Mental illness resulting from work-related stress is not an accidental injury arising out of and in the course of employment unless it is established by clear and convincing evidence that:
(1) the stressful employment conditions causing the mental injury were extraordinary and unusual in comparison to the pressures and tensions experienced by individuals performing similar work; and
(2) the stressful employment conditions were the predominant cause of the mental injury; and
(3) the mental injury was caused by stressful employment conditions that exist in a real and objective sense.
(B) A determination of mental injury, its cause, and resulting disability or need for medical treatment must be supported by clear and convincing psychiatric evidence.
(C) A mental injury is not considered compensable if it results from a verbal disagreement with an employer or a coemployee, or results from a personnel decision by the employer, including, but not limited to, any disciplinary action, work evaluation, job transfer, demotion, promotion, salary review, or voluntary or involuntary termination of employment."
SECTION 3. Section 42-9-260 of the 1976 Code, as last amended by Act 410 of 1988, is further amended to read:
"Section 42-9-260. (A) When an employee has been out of work due to a reported work-related injury or occupational disease for eight days, an employer may start temporary total disability payments immediately and may continue such payments for up to one hundred twenty days without waiver of any grounds for denial of a claim as may appear following a good faith investigation. Upon making the first payment, the employer shall immediately notify the commission, in accordance with regulations promulgated by the commission regarding the timely filing of this notice and with a form prescribed by the commission, that payment of compensation has begun.
The Commission shall provide by rule the method and procedure by which benefits may be suspended or terminated for any cause, but such rule must provide for an evidentiary hearing and Commission approval prior to termination or suspension unless such prior hearing is expressly waived in writing by the recipient. Further, the Commission may not entertain any application to terminate or suspend benefits unless and until the employer or carrier is current with all payments due.
(B) Once payment of temporary disability compensation has been commenced, it may be terminated or suspended immediately if the employee:
(1) has returned to work; or
(2) agrees that he is able to return to work and executes the proper commission form indicating that he is able to return to work. Alternatively to items (1) and (2) of this subsection, once payment of temporary disability compensation has been commenced, it may be terminated or suspended at any time within one hundred twenty days of the date that payments are commenced if a good faith investigation reveals grounds for denial of the claim.
(C) If the employee has been released by the treating physician to work and the employer provides work consistent with the terms upon which the employee has been released, compensation may be terminated or suspended if the employee refuses to return to work.
(D) If the employee has been released by the treating physician to limited duty work and the employer provides limited duty work consistent with the terms upon which the employee has been released, compensation may be terminated or suspended if the employee refuses to accept the limited duty work provided by the employer or to return to work.
(E) If the employee refuses medical treatment under Section 42-15-60 or an examination or evaluation under Section 42-15-80, the employee is not entitled to compensation benefits during the period of the refusal. Upon the submission of documentation of the refusal by the employee of this medical treatment, examination, or evaluation to the commission and notice to the employee, compensation may be terminated.
(F) An employee may request a hearing to have temporary compensation reinstituted after termination.
(G) Failure to comply with such rule as to termination or suspension of benefits must this section may result in a twenty-five percent penalty of not more than twenty-five percent imposed upon the carrier or employer computed on the amount of benefits withheld without prior Commission approval in violation of this section, and the amount of the penalty must be paid to the employee in addition to the amount of benefits withheld. However, the penalty does not apply if the employer or carrier has terminated or suspended benefits when the employee has returned to any employment at the same or similar wage."
SECTION 4. The first paragraph of Section 42-1-40 of the 1976 Code is amended to read:
"`Average weekly wages' means the earnings of the injured employee in the employment in which he was working at the time of the injury during the period of fifty-two weeks immediately preceding the date of the injury, including the subsistence allowance paid to veteran trainees by the United States Government if the amount of such allowance is reported monthly by such trainee to his employer, divided by fifty-two. `Average weekly wage' must be calculated by taking the total wages paid for the last four quarters immediately preceding the quarter in which the injury occurred as reported on the Employment Security Commission's Employer Contribution Reports divided by fifty-two or by the actual number of weeks for which wages were paid, whichever is less. If the injured employee lost more than seven consecutive calendar days at one or more times during such period, although not in the same week, then the earnings for the remainder of such fifty-two weeks shall be divided by the number of weeks remaining after the time so lost has been deducted. When the employment prior to the injury extended over a period of less than fifty-two weeks, the method of dividing the earnings during that period by the number of weeks and parts thereof during which the employee earned wages shall be followed, so long as results fair and just to both parties will be obtained. Where, by reason of a shortness of time during which the employee has been in the employment of his employer or the casual nature or terms of his employment, it is impracticable to compute the average weekly wages as defined in this section, regard is to be had to the average weekly amount which during the fifty-two weeks previous to the injury was being earned by a person of the same grade and character employed in the same class of employment in the same locality or community."
SECTION 5. Section 42-9-360 of the 1976 Code is amended to read:
"Section 42-9-360. (A) No claim for compensation under this title shall be assignable and all compensation and claims therefor shall be exempt from all claims of creditors and from taxes.
(B) It shall be unlawful for an authorized health care provider to actively pursue collection procedures against a workers' compensation claimant prior to the final adjudication of the claimant's claim. Nothing in this section shall be construed to prohibit the collection from and demand for collection from a workers' compensation insurance carrier or self-insured employer. Violation of this section, after written notice to the provider from the claimant or his representative that adjudication is ongoing, shall result in a penalty of five hundred dollars payable to the workers' compensation claimant.
(C) It shall be unlawful for an authorized health care provider to actively pursue collection procedures against a workers' compensation claimant for charges in excess of the fee or charge provided by the commission's applicable fee or charge schedule, or to charge any fee or charge in excess of the fee or charge provided by such schedule. Violation of this section after written notice to the provider from the claimant or his representative that adjudication is ongoing shall result in a penalty of five hundred dollars payable to the workers' compensation claimant.
(D) Payment to an authorized health care provider for services shall be made timely but no later than thirty days from the date the authorized health care provider tenders request for payment to the employer's representative, unless the commission has received a request to review the medical bill."
SECTION 6. Section 42-19-10 of the 1976 Code, as last amended by Section 15, Part II of Act 612 of 1990, is further amended to read:
"Section 42-19-10. Every employer shall keep a record of all injuries, fatal or otherwise, received by his employees in the course of their employment on blanks approved by the commission. Within ten days after the occurrence and knowledge of it, as provided in Section 42-15-20, of an injury to an employee requiring medical or surgical attention, a report of the injury must be made in writing and mailed to the commission on blanks approved by it for this purpose. However, for the injury of a South Carolina National Guard member as provided for in Section 42-7-67, the ten days must be counted from the date the employer, the South Carolina National Guard, has knowledge that the federal government has denied benefits to the injured guard member or that benefits or additional benefits may be due under the provisions for South Carolina Workers' Compensation.
Such report shall contain the name, nature and location of the business of the employer and the name, age, sex, wages and occupation of the injured employee and shall state the date and hour of the accident causing injury, the nature and cause of the injury and such other information as may be required by the Commission.
An injury for which there is no compensable lost time or permanency and the medical treatment does not exceed an amount specified by regulation of the Workers' Compensation Commission may be filed in summary on a form and at a time prescribed by the commission. Provided, however, this form may not be used to report an injury to the back. Every employer shall keep a record of all injuries, fatal or otherwise, received by his employees in the course of their employment on forms approved by the commission.
If the injury requires minimal medical attention at a cost not to exceed an amount specified by regulation of the Workers' Compensation Commission, does not cause more than one lost workday or permanency, the employer is not required to make a written report to the commission or their insurance carrier, provided the employer maintains a record as prescribed by the commission and pays directly the incurred cost of the resulting medical attention.
All other injuries must be reported in writing to the commission according to the following guidelines:
(1) An injury for which there is no compensable lost time or permanency and the medical treatment does not exceed an amount specified by regulation of the Workers' Compensation Commission must be reported annually on a form and at a time prescribed by the commission.
(2) An injury involving compensable lost time, medical attention in excess of the limit established by commission regulation in (1) above, or the possibility of permanency must be reported within ten business days after the occurrence and knowledge of it, as provided in Section 42-15-20, on a form or in an electronic format prescribed by the commission.
However, for the injury of a South Carolina National Guard member as provided for in Section 42-7-67, the reporting periods must be counted from the date the employer, the South Carolina National Guard, has knowledge that the federal government has denied benefits to the injured guard member or that benefits or additional benefits may be due under the provisions of Title 42."
SECTION 7. This act takes effect upon approval by the Governor.