Insurance

Is the employer/insurance carrier required to provide medical treatment?

The South Carolina Workers’ Compensation Act has instituted a standard of treatment for employees hurt on the job. They are entitled to receive medical treatment for injuries they suffered on the job. However, they are required to go to the doctor that is selected by their employer or insurance carrier.  Employees are entitled to receive the following types of treatment:

  • Hospital care
  • Surgery and surgical supplies
  • Medications and prescriptions
  • Reasonable follow-up care
  • Orthopedic evaluations
  • Physical therapy

Any treatment that is deemed reasonable by the physician will be covered by the workers’ compensation carrier. There are often disputes on what is a reasonable type of treatment and when a dispute arises, there is a hearing in front of a commissioner to ultimately decide the course of action.

While most workers’ compensation injuries allow medical treatment, it is usually to an extent and for a certain period of time. Just because an injury may cause arthritis in the distant future does not mean an individual will be entitled to unlimited care for years to come. There is closure to these claims with time frames put on the allowance of treatment. Treatment stops when a person reaches maximum medical improvement per the authorized treating physician.

Employer Chooses Physician

Employers are required to provide medical care, but they have the right to choose the doctor. Most workers would like to go to a doctor they trust and not one chosen by the insurance carrier. This means injured workers cannot go to any doctor for treatment or a plan of care. In instances where a worker feels as though he/she is deprived of appropriate care, they have the right to file for a hearing to request the Commission determine what is fair. Nevertheless, employees are not simply permitted to refuse medical care from a company-appointed physician. If medical care is refused, then the carrier is allowed to stop benefits.

Following Medical Treatment

Injured workers are expected to attend the medical exams that are set up and proceed with the proper treatment of care. A refusal to submit to an exam could create issues with your workers’ compensation benefits. A refusal can give an employer thee grounds to deny the workers’ compensation benefits. And if you are deemed capable of performing light work, you must accept it, under most circumstances. There is room to get a second opinion although those situations are best handled by a qualified workers’ compensation attorney.

The bottom line is that you are afforded medical care and treatment for injuries sustained at work. The situation could become sticky if you are denied or unhappy with the care. That is why it is best to seek out a workers’ compensation attorney in South Carolina to help facilitate and navigate through this process.

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Former Executive Committee Member
Injured Workers’ Advocates

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