After an injury on the job, you may be wondering whether you can see your own doctor for treatment while having the costs covered by workers’ comp. This is understandable. Many people feel comfortable with and trust their normal doctor but may be less willing to see another physician chosen by their employer. However, South Carolina law places restrictions on injured and ill workers’ ability to choose their medical provider under workers’ compensation.
For more than 50 years, the South Carolina workers’ compensation attorneys of Joye Law Firm have been helping injured individuals obtain the benefits they deserve after on-the-job accidents. Our legal team brings a combined 250 years-plus of legal experience to each case we handle. Our track record of success has been recognized with numerous awards and accolades, including the Super Lawyers designation awarded to both of our partners. You can trust that our firm has the knowledge and resources necessary to pursue the results you deserve.
Contact us for a free case review. A knowledgeable South Carolina workers’ compensation attorney will review your case and explain you rights for receiving treatment.
Initial Doctor’s Visit
Under South Carolina’s workers’ compensation law, your employer or its workers’ compensation insurer has the right to select the medical provider you receive treatment from. That provider will be covered by workers’ compensation benefits. Even if you go to see your primary care physician for an initial exam of a possible work injury, your employer is not required to cover the visit.
Injured workers are entitled to seek out emergency treatment for a work-related injury or illness from any provider and have that treatment covered by workers’ compensation benefits. If you go to the emergency room following a workplace accident, you need to tell the ER staff that you were injured at work. Having your medical record reflect that you were seeking treatment for a work-related injury will help you pursue workers’ compensation coverage for that ER visit.
Treatment Guidelines and Restrictions
For ongoing treatment for a work injury or occupational illness, your employer or its workers’ compensation insurer can require you to see a provider they choose or require you to select a provider from a list of approved providers. Only those providers approved by your employer or its insurer can render treatment that will be covered by workers’ compensation benefits.
If you wish to change providers, you can contact your employer or the insurer to request a different provider. If you are denied a switch of providers, you can request a hearing with the South Carolina Workers’ Compensation Commission. You can plead your case for a change of providers to a commissioner, who may order your employer or its insurer to allow you to switch providers.
If you’re required to see a provider or seek treatment from a facility where the round-trip distance is greater than 10 miles from your home, South Carolina workers’ compensation law requires that you be reimbursed for the cost of your transportation at a per-mile rate established by the South Carolina Workers’ Compensation Commission.
Do I Have the Right to See My Own Doctor?
An injured worker has the right to see his or her own doctor for treatment of a work injury or occupational illness. But if the worker does so, the employer and its workers’ compensation insurer can deny coverage for the costs of that treatment. The worker may then have to turn to his or her own health insurance coverage to help pay for that treatment.
Many health insurers deny coverage for treatment of work-related injuries and illnesses. They expect you to turn to the workers’ compensation benefits you are entitled to under South Carolina law. If your own health insurer denies coverage for treatment of a work injury or occupational illness, you may be required to pay out-of-pocket to see your own doctor.
One possible exception occurs when your employer or its workers’ compensation insurer initially denies coverage for an injury or illness. If you pursue a workers’ compensation hearing and a commissioner rules that you are entitled to workers’ compensation benefits, you may be entitled to reimbursement of expenses you incurred in obtaining treatment from your own doctor for your injury or illness.
Your Treating Physician’s Role
When you seek treatment that will be covered by workers’ compensation benefits, your medical care will usually be overseen by one doctor who is considered your treating physician. Your treating physician will perform many tasks during your recovery, including:
- Referring you to specialist physicians, such as orthopedic surgeons, neurologists, or pain management specialists, and to other medical providers such as physical or occupational therapists
- Authorizing your medical leave from work
- Dictating work restrictions if you return to part-time or light-duty work during your recovery
- Determining when you can return to light duty or full duty, or when you have reached maximum medical improvement for your condition
- Evaluating whether you have suffered any permanent impairments from a work injury or occupational illness
If you want or need specialized treatment, it will need to first be authorized by your treating physician for workers’ compensation to cover the cost. If your own physician’s recommendations are denied by the insurer, a workers’ compensation hearing will need to be conducted before a commissioner to obtain an order requiring the insurer to cover the treatment.
How to Best Deal with Doctors Who Treat You for Your Injury
When dealing with doctors and other medical providers treating you for your work injury or occupational illness, remember that those providers have been selected by your employer and its workers’ compensation insurer. These entities have an interest in minimizing the cost of your treatment and in getting you back to full duty as quickly as possible.
You can help yourself by making notes prior to any appointment with your treating doctor, documenting every complaint you may have. That way, you can let your treating doctor know about every part of your body that is causing you problems. You should also make sure that your treating physician is documenting all your complaints in your medical record.
You have the right to obtain a copy of your medical record. This will help you ensure your treating physician is recording all your complaints. If things that are bothering you are left out of your medical record, your employer and its workers’ comp insurer may later decline to authorize treatment for a particular complaint.
You should also attend every doctor’s appointment and follow all treatment recommendations and instructions. If you begin missing appointments or slacking off on your treatment, your doctor or your employer and its workers’ comp insurer may conclude that your injuries are not as serious as you claim or that you can return to work. If you do need to miss an appointment, call the doctor’s office to reschedule.
If you genuinely disagree with your treating provider’s opinion, South Carolina law gives you the right to obtain a second opinion (typically at your own expense). If you obtain a contrary opinion from another physician, you also have the right to contest your employer’s or its insurer’s denial of workers’ comp benefits.
Joye Law Firm Can Help You
If you’re concerned about the treatment you are receiving for your work injury or occupational illness, the dedicated attorneys at Joye Law Firm can help you by:
- Fighting to ensure that emergency treatment of a work-related injury or illness is covered by workers’ compensation regardless of where you sought treatment
- Helping you deal with your employer or its workers’ compensation insurer if you want to obtain a different treating physician
- Arranging for you to get a second opinion if your treating physician declines to recommend treatment or determines that you can return to light or full duty or have reached maximum medical improvement
- Seeking a hearing if your employer or its insurer declines to authorize treatment recommended by your physician
- Fighting for reimbursement of medical expenses you incurred if your employer and its insurer initially denied coverage for an injury or illness that was later ruled by a workers’ compensation commissioner to be work-related
Contact Joye Law Firm online or give us a call at 888-324-3100 to get answers to your questions about the workers’ compensation process. Our South Carolina workers’ compensation law firm has four conveniently located offices in Charleston, Myrtle Beach, Columbia, and Clinton to serve our South Carolina community.
Our lawyers will review your case for free. There is no charge for our team to get started on your workers’ compensation claim. In fact, you only pay us if we recover compensation for you.