After getting hurt at work, you may prefer to see your own doctor – someone you’re comfortable with and who knows you and your medical history. However, injured workers in South Carolina must follow specific requirements for seeking medical care to qualify for workers’ compensation benefits. Workers’ compensation rules may affect which doctor you can see and whether your care is covered by workers’ comp benefits.
At Jebaily Law Firm, clients often ask our South Carolina workers’ compensation attorneys, “Can you see your own doctor on workers’ comp?” There are several considerations injured workers need to know to preserve their workers’ comp status, but the laws can be confusing.
If you have problems with your claim or questions about your benefits, please contact a South Carolina workers’ comp lawyer at Jebaily Law Firm for a free claim review.
Basics of Medical Treatment in Workers’ Compensation Claims
If you get hurt at work, inform your supervisor or human resources representative right away. They will direct you to the employer-approved doctor or healthcare clinic. Once you arrive, tell the clinic you are there for a workers’ comp injury and your employer’s name.
If you’re in an emergency and need to go to the hospital immediately, let the hospital know you’re suffering a workplace injury, and then report the injury to your employer as soon as you can.
Workers’ comp medical benefits cover:
- Treatment of your injury
- Prescription medication
- A durable medical device like a brace or prosthetic
- Rehabilitative therapy
- Hospital stays
If you have to travel to see your employer-chosen doctor, you may also be eligible to have your travel expenses covered for each appointment you must attend and to the pharmacy for your medications.
Who Selects the Treating Physician During My Workers’ Compensation Claim?
In South Carolina, your employer chooses the doctor you see for workers’ compensation treatments, according to the South Carolina Workers’ Compensation Commission (SCWCC). You may not receive medical care benefits if you go to a doctor other than those approved by your employer.
The doctor you see in a workers’ comp claim is referred to as your treating physician. To retain your benefits, you must comply with their directives, including how long you wear a brace or other device, when to attend follow-up appointments, and any work restrictions or movement restrictions, like performing only light-duty work or not lifting anything heavier than a certain weight.
Workers’ compensation medical benefits can also cover an occupational illness or disease, like respiratory disease caused by working with toxic chemicals. Your own doctor may have diagnosed you with a work-related medical condition, but to receive coverage, you will have to report the illness and your doctor’s diagnosis to your employer. Once you report the illness, though, you may have to see an employer-approved doctor who determines whether your illness qualifies for workers’ comp benefits.
Can I Request a Different Doctor for My Workers’ Comp Treatment?
If you’re unsatisfied with the doctor or nurse case manager (NCM) assigned to your workers’ comp case, then you may ask your employer’s representative if you can go to a different doctor. However, they aren’t required to permit this. If they deny your request, you can appeal it with the state’s Workers Compensation Commission.
You can hire a lawyer at any point in this process. If you wish to file an appeal, an attorney familiar with South Carolina workers’ comp statutes can help you correctly fill out the form, submit it on time, and include the appropriate information and documentation. A lawyer can also argue your appeal before the WCC Board.
Can I Pay Out of My Pocket for a Second Opinion?
If your employer denies coverage for a second medical opinion, you may see if your own health insurance can cover it, or you can pay for the appointment yourself out of pocket.
If you’re paying for the entire appointment yourself, then the answer to “Can you see your own doctor on workers’ comp?” is yes.
Or, you may have a pre-existing medical condition that’s aggravated by your workplace injury or occupational illness and wish to see your own doctor or a specialist familiar with your condition. If your doctor isn’t on your employer’s list, your treatment won’t be covered. You may benefit from having your attorney step in at this point.
How Can a Lawyer Help with a Dispute Over My Treating Physician?
South Carolina workers’ compensation statutes are complex. A lawyer who focuses on workers’ comp laws and injured workers’ rights can evaluate your case, your injury, and your current condition and determine your legal recourse based on the situation.
You may request a hearing by filling out Form 50. Any errors or omissions on this form could cause your appeal to be delayed or denied, so you should have an attorney fill out and file the form for you.
You are entitled to adequate medical care, and an attorney may be able to help you have the costs of a second medical opinion or specialist care approved by the WCC Commissioner. If you need care beyond what your workers’ comp treating physician can provide, for example, an attorney may be able to build a case proving that you need additional medical care and that care should be covered by your workers’ comp benefits.
If you were diagnosed with a workplace-related illness, need ongoing treatment, and aren’t getting it, a lawyer could file an appeal and make a case to justify the longer treatment period.
Each workers’ comp case is unique, but if you aren’t getting the benefits you believe you should or you are dissatisfied with the treatment you’re receiving, an attorney can advise you about your rights under the workers’ compensation system and explain the options available to you.
Talk to Our South Carolina Workers’ Compensation Attorneys Today
Do you need help pursuing a workers’ compensation claim, or have you had a claim denied? Are you having problems with your assigned treating physician or want to get a second medical opinion about your condition?
Our South Carolina workers’ compensation attorneys offer a free consultation about your case. Contact Jebaily Law Firm today, and let us get to work for you.