In a South Carolina workers’ compensation claim, the employer’s insurance company usually chooses and directs your treating doctor, so you cannot just switch physicians on your own. You can still ask the insurer to approve a second opinion or a change of physician, obtain your own evaluation, and, if the insurer refuses, ask the South Carolina Workers’ Compensation Commission to order one for good cause. Since workers’ comp is no-fault, you don’t have to prove your employer did anything wrong to fight for proper care.
When the doctor handling your work injury seems more focused on getting you back on the clock than getting you better, it’s frustrating and more than a little scary. Maybe you were released to work while you’re still in real pain, you received a low rating that doesn’t match how your body feels, or the treatment your doctor recommended was suddenly denied. You’re not imagining it, and you’re not stuck. If you’re in the Columbia area, our Columbia workers’ compensation attorneys at McCravy, Newlon, & Clardy offer a free consultation to walk through your options for a workers’ comp second opinion.
Here’s what we’ll cover.
– Why the insurance company’s doctor controls your care in South Carolina
– When to consider a second opinion for workers’ compensation
– How to request a second opinion or a change of physician
– How a second opinion differs from an insurance company IME
– How the Workers’ Compensation Commission handles medical disputes
Why Does the Insurance Company’s Doctor Control Your Care in South Carolina?
In South Carolina, the employer and its insurer generally have the right to select and direct your authorized treating physician. During any period of disability resulting from the injury, the employer, at his own option, may continue to furnish, free of charge to the employee, an attending physician and any medical care or treatment that is considered necessary by the attending physician, and the employee shall accept it, unless otherwise ordered by the commission for good cause shown.
That’s exactly why so many injured workers feel the doctor is working for the insurance company. Because the insurer picks the provider and pays the bills, that doctor’s opinions on your treatment, your work restrictions, and when you’ve healed carry enormous weight. The important thing to remember is that the same law lets the Commission order something different for good cause.
When Should You Consider a Second Opinion for Workers’ Compensation?
Consider a second opinion any time the authorized doctor’s conclusions don’t match your condition, especially in three situations:
The first is being released to work too soon. Once your treating physician releases you, the insurer can move to reduce or stop your checks. Under South Carolina law, temporary disability payments may be terminated or suspended when the treating physician releases the employee to work without restriction, or to limited-duty work provided by the employer, and the employer offers comparable employment.
The second is a low impairment rating at maximum medical improvement (MMI), the point at which the doctor decides you’re as recovered as you’re going to get. After the claimant reaches maximum medical improvement, the parties may agree to settle the claim, so that rating drives how much permanent disability compensation you receive. A number that’s too low can cost you dearly.
The third situation is having recommended treatment denied or cut off.
Can I get a Second Opinion on Workers’ Comp in South Carolina?
Yes, but how you obtain one depends on whether the insurer cooperates. You generally have a few paths. You can ask the adjuster in writing to authorize a second opinion or a change of physician. You can obtain your own evaluation, which may come at your own expense, but can still become evidence in your claim. And if the insurer refuses, you can ask the Commission to step in. When circumstances justify it, the commission may order a change in medical or hospital services.
One word of caution: don’t simply walk into an outside doctor’s office and assume the insurer will pay. Without authorization or a Commission order, you could be left holding the bill. This is where having a lawyer early makes a real difference.
How is a Second Opinion Different From an Insurance Company’s IME?
A second opinion is something you seek, while an independent medical examination (IME) is an exam that the employer or the Commission requests. After an injury and so long as he claims compensation, the employee, if so requested by his employer or ordered by the commission, shall submit himself to examination, at reasonable times and places, by a qualified physician or surgeon designated and paid by the employer or the commission.
Insurers often use an IME to dispute your ongoing treatment or to lock in a low impairment rating. Here’s a right many workers don’t know they have: the employee has the right to have any qualified physician or surgeon present at the examination, provided and paid for by him. That can help make sure the exam is fair.
How Does the Workers’ Compensation Commission Handle Medical Disputes?
When you and the insurer cannot agree, you resolve it by asking the South Carolina Workers’ Compensation Commission for a hearing. Injured or affected body parts and conditions shall be set forth with as much specificity as possible on the commission’s Employee’s Notice of Claim and/or Request for Hearing form, hereinafter referred to as Form 50. When a party files a Form 50 or Form 52 with the Commission requesting a hearing, the Form 50 also serves to file the claim if a claim has not been filed before.
A commissioner then hears the dispute and can order a change of physician, additional treatment, or a different rating. And because South Carolina workers’ comp is a no-fault system, you don’t need to prove your employer was negligent. You only need to show you’re entitled to proper care and benefits.
How McCravy, Newlon, & Clardy Can Help
For 30 years, our attorneys have guided injured South Carolina workers through exactly these fights, always with an honest, straightforward approach and a strong commitment to doing right by our clients. We’ll review your records, line up a credible second opinion where it’s warranted, and advocate for treatment and an impairment rating that reflects your actual condition.
With seven offices across South Carolina, including our West Columbia office serving the Columbia area, plus Greenville, Clinton, Greenwood, Anderson, Saluda, and Spartanburg, help is never far away.
Think the insurance company’s doctor got it wrong? Call our experienced attorneys at McCravy, Newlon, & Clardy at 866-MCCRAVY for a free consultation.
Frequently Asked Questions About Workers’ Comp Second Opinions
Can I choose my own doctor for a work injury in South Carolina?
Generally no. The employer and insurer select your authorized treating physician, and you’re expected to treat with that doctor unless the Commission orders otherwise for good cause. You can still request a change or a second opinion.
Who pays for a second opinion on workers’ compensation?
If the insurer authorizes it or the Commission orders it, it should be covered as part of your medical treatment. If you arrange an evaluation on your own without approval, you may have to pay upfront, though that report can still support your claim.
What if the insurance doctor releases me to work, but I’m still hurt?
Tell the doctor and the adjuster in writing, then talk to a lawyer quickly. A release can allow the insurer to cut your checks, so a second opinion or a request for a hearing may be needed to protect your benefits.
How much does it cost to hire a workers’ comp lawyer?
Your consultation is free. We handle workers’ compensation claims with no upfront cost to you, so you can receive answers without adding to your financial stress. Call 866-MCCRAVY today to talk with an experienced member of our team.