by J. South Lewis
One of the questions that a workers’ compensation defense attorney most often gets from an adjuster is “Can I stop TTD (i.e., weekly out of work benefits) at this time?” This is a source of confusion for many adjusters, particularly those who work in multiple jurisdictions. South Carolina has its own set of “rules” and, quite frankly, they are neither intuitive nor easy to remember. So let’s have a brief refresher.
At the outset, it is important to note that reaching maximum medical improvement (MMI) is never a grounds to unilaterally terminate TTD benefits, regardless of how long a claimant has been drawing benefits. Rather, once an employee reaches MMI, this serves as grounds for your defense counsel to file a Form 21 Stop Payment application with the South Carolina Workers’ Compensation Commission (SCWCC) and you will be granted a hearing within 60 days. Fortunately, if at such hearing the Commissioner agrees that the claimant is at MMI, the carrier will receive a “credit” for all TTD paid since the date of MMI…in other words, to be deducted from any disability award. However, if we do not file the Form 21 quickly enough (generally within 30 days of MMI), the Commissioner will likely only grant the credit back to the date that the Form 21 was filed.
For virtually every other basis for termination/suspending of TTD benefits, we must determine whether we are inside or outside of 150 days from the date the employer was notified of the injury—usually this is on the date of injury or within a couple days thereafter, but not always. This 150 day “window” is a crucial benchmark, as the statute allows us to unilaterally suspend/terminate TTD benefits inside that 150 day window based on the following six (6) grounds, which are laid out in Section II of the Form 15:
- Claimant has returned to work for at least 15 days and no temporary partial compensation is due;
- Claimant signed a Form 17;
- The claim is denied based on a good faith investigation;
- Claimant was released to work without restrictions and employment was offered;
- Claimant was released to work with restrictions and the employer offered employment consistent with said restrictions; or
- Claimant refused or was non-compliant with medical treatment (the benefits must resume once compliance resumes).
This stopping of benefits inside 150 days can be achieved by the adjuster directly by checking the applicable box on Section II of the Form 15 and serving a copy of same upon SCWCC and the claimant. At that point, the burden is on the claimant to sign the Form 15 indicating disagreement with the grounds for suspension and the matter will go to a hearing.
Outside of 150 days generally requires the filing of a Form 21 with SCWCC by your defense counsel. The same grounds as above apply, but outside the 150 days benefits generally cannot be stopped unilaterally and, instead, require SCWCC’s “blessing” after a hearing. A caveat, however, applies if the claimant has returned to work. You can unilaterally suspend TTD if the claimant returns to work, even outside of 150 days. At this point, you must get a Form 17 signed by the claimant and filed with SCWCC within 31 days of suspending the TTD. If the claimant will not sign the Form 17, your defense counsel should file a Form 21 with the SCWCC asking that the Form 17 be certified. Not following this 31 day deadline could result in a fine.
In summary, if you make sure to keep in mind (a) that MMI itself is not a stand-alone ground for immediately stopping TTD benefits and (b) the 150 day “window” in a benchmark for unilateral stoppage of benefits versus needing SCWCC hearing/approval, this will eliminate a source of confusion for many claims handlers.