Learn About Medical Treatment Provided By Workers' Compensation Benefits

In general, South Carolina Workers’ Compensation benefits provide medical treatment for an injured employee when they are injured during the course and scope of their employment. Your Employer controls your medical treatment (more accurately, the Employer’s workers’ compensation insurance carrier); meaning, the Employer chooses what doctor to send you to. As you can imagine, there often arises disagreements surrounding medical treatment through the workers’ compensation claims, such as what type of medical treatment you are entitled to, disagreements over the particular physician selected and his opinions, whether you are required to undergo certain medical examinations and several other issues.

Types of Medical Treatment You Are Provided

The South Carolina Workers’ Compensation Act states that an injured employee is entitled to “medical, surgical, hospital and other treatment, including medical and surgical supplies as may reasonably be required… and, in addition thereto, such original artificial members as may be reasonable necessary at the end of the healing period….” Thus, workers’ compensation benefits allow for various types of medical treatment to the extent the treatment is reasonably necessary. This includes treatment such as diagnostic imaging, orthopedic evaluations, physical therapy, medications and any other type of treatment deemed reasonably necessary. What is reasonably necessary is heavily dependent upon the treating physician’s opinion and orders. When a dispute arises as to what treatment is reasonably necessary, a hearing can be held in front of a workers’ compensation commissioner to determine the issue.

With that said, in regards to most injuries, you are not entitled to any and all medical treatment for an indefinite period of time. There has to be some closure for the workers’ compensation carrier. For example, if you have a fractured bone and develop arthritis twenty years later, possibly due to the fracture, that arthritis treatment would not be covered through workers’ compensation benefits. Specifically, the Act provides that an employee is entitled to medical treatment that “will tend to lessen the period of disability.” Thus, whenever the medical evidence suggests there is no additional medical treatment that will lessen your degree of disability, the insurance carrier is no longer responsible to provide your treatment. There are exceptions to these rules for certain types of injuries that can provide employees with lifetime medical benefits.

Your Employer Has the Right to Choose Your Treating Physician

As a general rule, the Employer has the authority to select the treating physician. The rational behind this is that since the employer is absorbing the cost of treatment they should have the right to select and control the treatment as a means of monitoring costs. However, that right is not absolute. The South Carolina Court of Appeals has held that the Commissioner has the discretion to authorize medical treatment from an unauthorized physician under certain scenarios. In short, the Court recognizes the fact that you should not be wrongfully deprived of reasonably necessary medical treatment due to an Employer’s choice of physician.

On the other hand, the Court will not allow you to simply refuse medical treatment from the Employer-selected physician to go seek treatment from their own physician only to have the Employer reimburse those costs later. In the event you feel like you are in need of medical treatment you are not receiving, or feel like your physician is not the best choice for you, you should likely speak with an experienced workers’ compensation attorney to learn what rights you might have. Every case is different and largely dependent on the particular facts and medical treatment of that particular case.

You Are Required To Submit To Medical Treatment

South Carolina workers’ compensation laws require you to submit to medical exams requested by the Employer or ordered by the Commission. The law essentially treats a request for medical treatment by an Employer the same as an Order from the Commission. With that said, the medical exam must be at a reasonable place and time and by a qualified physician. In practice, if you simply cannot make an appointment and must cancel that is usually not equivalent to a refusal to submit to a medical exam. A refusal would not likely result until you either outright refuse or fail to appear for multiple appointments.

In the event you refuse to submit to a medical exam, the Employer has the right to suspend your benefits until you agree to the exam or the Commission rules your refusal was justified. Therefore, if you are out of work and receiving weekly benefits but refuse to submit to an exam, the Employer has the right to suspend your benefits until you undergo the exam or a hearing is held in front of a Commissioner who rules that your refusal was justified.

How an Experienced Workers' Compensation Attorney Can Help You

I don’t believe that everyone who has been injured at work and is pursuing workers’ compensation benefits automatically needs an attorney. However, if you are having an issue receiving treatment you need or you feel like you are being provided treatment you don’t need, it would likely be in your best interest to at least speak to an experienced workers’ compensation attorney.

An attorney experienced with workers’ compensation laws and the claims process can help you get a second opinion if you feel like you do not agree with your current physician. Likewise, an attorney can also send you for an Independent Medical Examination with a different physician. This is an exam by a physician of your choosing that offers an independent opinion that can often times help carriers of Commissioners at a hearing make an informed decision about your medical treatment.

Issues regarding compliance and non-compliance with medical treatment can get fairly complex and are often heavily litigated, meaning they often need to be resolved through a hearing before a Commissioner. An attorney will be representing the insurance carrier and you should be represented as well. If you have any specific questions regarding medical treatment through the workers’ compensation claim process, feel free to contact law office in Charleston, South Carolina to discuss your claim and your options.