Workers’ compensation can help you recover lost wages and pay for causally related medical expenses if you are injured in a workplace accident. Knowing what to do if you suffer an injury on the job is vital to ensuring you get the most out of your workers’ comp benefits.
After sustaining an injury, it is common to seek out a doctor you are comfortable with; however, South Carolina’s Workers’ Compensation Act restricts injured and sick workers’ rights to see their own physicians. Instead, injured workers must visit a company-approved physician to assess their condition and treat injuries.
Read on to learn why you need to go to your company-provided doctor and how a workers’ comp attorney from Joye Law Firm can help you with your claim.
Doctor Requirements for South Carolina Workers’ Compensation
Under South Carolina law, your employer and their workers’ compensation insurance carrier have the right and responsibility to choose the doctor who will treat you. Insurance companies often provide you with a list of available medical providers.
If you visit a non-approved doctor, your compensation benefits will not cover the visit, and you may even lose your benefits. The only exception to this rule is emergency care for injuries that require immediate medical attention.
For instance, you can seek emergency care without first receiving approval if you suffer a life-threatening injury. However, your workers’ compensation insurance must approve the follow-up care provider if the emergency room refers you for follow-up treatment for your injuries. If you do have a specifically denied workers’ compensation claim (in writing), then you can see a doctor of your own choosing for treatment, but you will need to use your own insurance or pay out of pocket. This treatment will not be paid by workers’ compensation unless they specifically agree to the same, or a judge rules that they must pay for it at a Hearing.
Why Can’t I Use My Own Doctor for a Workers’ Comp Claim?
The reason you can’t use your own doctor for a worker’s compensation claim typically has to do with your employer’s insurance contract. Nearly all employers in South Carolina with more than four workers must carry workers’ compensation insurance.
Although the state regulates workers’ compensation benefits, your employer’s chosen insurance company pays them out. Workers’ comp insurance companies contract with or hire their own healthcare providers. So, similarly to private health insurance, you must see an in-network provider to receive coverage.
What to Expect with a Company-Provided Doctor
When you receive treatment under the Workers’ Compensation Act, you automatically consent to share your work-related medical records with your employer, the insurance company, the nurse case manager, and/or the Workers’ Compensation Commission.
Your treating doctor shares your healthcare history with them as long as you receive notice of communication. Your doctor is also responsible for the following:
- Evaluating your medical history for previous injuries and pre-existing health conditions
- Limiting your work duties while you heal
- Assessing to determine if you have reached your maximum medical improvement
Their medical evaluations can determine if you can continue to receive workers’ compensation benefits and when you are able to return to work, whether on light-duty or at your prior capacity.
For example, your doctor may declare you have reached your maximum medical improvement level, meaning that further improvement in your medical condition is no longer possible or can be done without the supervision of doctors.
If you have to travel more than 5 miles round trip to see a medical provider, you can also get travel reimbursement at a per-mile rate. This benefit is also available if you need to drive to a pharmacy that is a 10-mile round trip from your home.
Can I Get a Second Opinion for My Treatment?
Your employer’s representative must approve your visit to another doctor within their network if you disagree with the opinion of your treating physician. You can request a hearing if they don’t comply, and the Workers’ Compensation Commissioner will decide your case.
During your hearing, you can explain why you want to switch doctors. You can begin seeing another authorized physician if the Commission approves your request.
A workers’ compensation attorney from Joye Law Firm can help you get approval for seeing your own physician, if necessary. Our lawyers will represent you during your hearing and ensure you have the correct documentation and evidence to support your request and get it approved. Additionally, a workers’ compensation attorney may send you out for a one time evaluation from an independent doctor in order to get a 2nd opinion regarding diagnosis, restrictions or medical treatment which would be necessary in the future.
How to Handle Visiting the Doctor for a Work-Related Injury
Maintaining a working relationship with your treating physician is essential to preserving your right to a hearing. Remaining compliant with treatment before and until an appeal gives you access to your medical records and helps build a foundation for your case.
Inform the Doctor of Your Injuries
The company-approved doctor should know all the injuries you sustained in the accident. This information is crucial if you request a hearing to switch doctors. Be prepared to disclose previous injuries and pre-existing conditions, such as diabetes and heart disease. It is important to discuss all of your sources of pain and problems. Often, an injury in one body part will affect another body part through your overcompensation, gait or bodily changes. Make sure to be open and honest about all of your issues and pain with all treating entities.
Attend All Follow-Up Appointments
It is essential to follow all doctor’s instructions and attend every appointment. Failure to do so may result in your employer and its insurer concluding that your injuries are not as severe as you claim.
Obtain Your Medical Records
Review your records to ensure your doctor documents all your injuries and subsequent complaints. If the records don’t show your complaints, your employer and workers’ compensation insurers may decline to authorize treatment or additional visits to other doctors.
Begin Your Case with the Joye Law Firm
A South Carolina workers’ compensation attorney from the Joye Law Firm can help you with all aspects of your workers’ compensation claim, including appealing claim denials. We can also help you determine your options if you have concerns about the medical care you’re receiving or need help navigating your compensation benefits.
Contact our law office for a free, no-obligation case consultation to discuss your workers’ comp rights.
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