Q: Who decides how much your workers comp payments will be?
A:
If you are referring to weekly payments, in a South Carolina claim, the amount is controlled by the workers' compensation law in south Carolina. You are entitled to receive 66.667% (2/3) of your average weekly wage (AWW). The AWW is determined by looking at what you earned in the four quarters before you were hurt and dividing by the number of weeks worked. The amounts are supposed to be provided by the employer on a Form 20.
The amount for the AWW calculation should include all gross (pre-tax) earnings - including overtime. But, keep in mind, it's averaged over a year, so, except in extraordinary circumstances, it's not based on your best weeks, but on your average of all weeks.
So, lets say you earned $30,000 in the last 4 quarters before your injury and that represents 50 weeks of pay (in this example, you had two unpaid vacation weeks). That would be an average of $600 per week. 2/3 of that would be a weekly compensation rate (comp rate) of $400 per week.
Initially, the insurance company adjuster decides what to pay you based on the employer's figures. Sometimes, employers don't follow through with providing information and the adjuster has to estimate the payment. Now, if you disagree with the amount the employer said you made or the amount estimated by the adjuster, you would need to get wage documentation (pay stubs, tax returns, wage records are some examples) to prove the correct amount. If you can prove the employer or the estimate is wrong, the adjuster should correct the payments and make up any difference. If you can not reach an agreement on the correct amount, the Workers' Compensation Commission would have to settle the dispute and determine the amount at a hearing before a Commissioner.
If you request a hearing, depending on what part of the state your claim would be heard in, it takes about 3 - 4 months to get a hearing.
If you were working more than one job at the time you were hurt, you are entitled to have the wages from your other employment included in your AWW and comp rate calculation. You would have to get this information (a Form 20) from your second employer.
If wage calculation becomes a real issue, you will probably want to have representation to be able to get the evidence you need to prove your correct earnings.
I hope this helps.
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