South Carolina Code of Regulations Chapter 67 - SOUTH CAROLINA WORKERS' COMPENSATION COMMISSION
South Carolina Code of Regulations Chapter 67
South Carolina Workers' Compensation Commission (SCWCC)
— In-Depth Explanation with Case Law Themes (No External Law Referenced)
I. Overview: What Is the Workers' Compensation Commission?
The South Carolina Workers’ Compensation Commission (SCWCC) is the state agency responsible for administering the workers’ compensation system. It ensures that employees who suffer work-related injuries or illnesses receive timely medical treatment, wage replacement, and other benefits — while also protecting employer interests.
The regulations under Chapter 67 govern:
Claim procedures
Hearings and appeals
Settlements
Medical services and billing
Employer and insurer responsibilities
II. Core Functions and Responsibilities
1. Claim Filing and Adjudication
Workers injured on the job must file a claim with the SCWCC.
The Commission sets rules for how and when claims must be filed, and by whom (employee, employer, insurer, or attorney).
2. Hearings and Dispute Resolution
The Commission conducts hearings before single Commissioners or Panels.
Disputes may involve claim denial, extent of injury, benefit amount, or responsibility between multiple parties.
3. Medical and Disability Benefits
Regulations guide the approval of medical treatment, selection of treating physicians, and fee schedules.
The Commission determines permanent partial or total disability ratings.
4. Settlements and Lump Sum Payments
SCWCC must approve most settlements to ensure fairness to the injured worker.
It considers whether the worker understands their rights and whether the settlement is adequate.
5. Employer and Insurer Compliance
Employers must carry workers’ compensation insurance (or be self-insured).
The Commission enforces compliance through penalties or other regulatory action.
III. Key Legal and Administrative Principles
⚖️ Exclusive Remedy Doctrine
Workers' compensation is typically the sole remedy for workplace injuries. An injured employee cannot sue the employer in civil court (with rare exceptions).
⚖️ No-Fault System
Employees are generally entitled to compensation regardless of who caused the injury, as long as it occurred within the scope of employment.
⚖️ Due Process and Procedural Fairness
Injured workers and employers are entitled to notice and a hearing when disputes arise.
All decisions (initial, appeal, final) must be made with substantial evidence and subject to judicial review.
IV. Common Case Law Themes (Illustrative)
📌 Theme 1: Arising Out of and In the Course of Employment
Issue: An employee was injured during a lunch break off-site.
Commission Decision: Denied the claim.
Court’s View: If the injury wasn’t closely related to the job duties or location, it may not be compensable.
Key Principle: For a claim to succeed, the injury must both “arise out of” and occur “in the course of” employment.
📌 Theme 2: Employer's Right to Choose the Physician
Issue: A worker seeks reimbursement for treatment from their own doctor, not one authorized by the employer.
Commission Decision: Denied payment for unauthorized treatment.
Court’s View: Employer has the right to select treating physicians unless there’s abuse or delay.
Key Principle: Employer control of medical care is balanced with worker’s right to necessary treatment.
📌 Theme 3: Degree of Disability
Issue: A dispute arises over whether the worker is partially or totally disabled.
Commission Decision: Found partial disability based on medical evidence.
Court’s View: Deference to the Commission’s findings if supported by medical records and testimony.
Key Principle: Disability ratings are fact-specific and require expert input.
📌 Theme 4: Failure to Timely File a Claim
Issue: An employee files a claim months after the injury, arguing they didn’t realize the extent of harm.
Commission Decision: Dismissed for being time-barred.
Court’s View: A delayed claim can sometimes be excused if the worker was unaware of the injury’s severity.
Key Principle: Timeliness is critical but may be tolled in certain circumstances.
V. Illustrative Hypothetical Example
Scenario:
A warehouse worker suffers a back injury while lifting heavy boxes. The employer sends the worker to a company doctor, who diagnoses a mild strain. The employee continues to experience pain and visits their own doctor, who recommends surgery.
Dispute:
The insurer refuses to pay for surgery, citing unauthorized treatment.
The employee files a hearing request with the Commission.
SCWCC Procedure:
A Commissioner reviews evidence and hears testimony from both doctors.
The Commission rules in favor of the employee, stating the company doctor misdiagnosed the injury and delayed care.
Outcome:
If the employer appeals, the reviewing court will assess whether the Commission’s decision is supported by substantial evidence. Courts usually defer to the Commission on medical questions, unless there's clear error or bias.
VI. Summary Table
| Area | Explanation |
|---|---|
| Claim Procedures | Filing deadlines, documentation, parties involved |
| Hearings and Appeals | Adjudication of disputes over benefits or injury scope |
| Medical Benefits | Rules for treatment, fee schedules, and physician authorization |
| Disability Ratings | Determines compensation based on loss of function or wages |
| Settlements | Must be reviewed and approved to protect employee interests |
| Employer Obligations | Insurance requirements, compliance, and penalties |
VII. Conclusion
The South Carolina Workers’ Compensation Commission, through Regulations Chapter 67, plays a vital role in balancing the rights of injured workers with the responsibilities of employers and insurers. Its framework ensures a structured, no-fault, and accessible system for workplace injury compensation. Courts generally uphold the Commission’s decisions when they are procedurally fair and supported by substantial evidence, especially in medical and factual disputes.
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