Who Chooses the Doctor for Workers' Compensation Claim?
IF I’M INJURED ON THE JOB, DO I GET TO CHOOSE MY DOCTOR?
If you’ve been injured on the job, you’re entitled to file a workers’ compensation claim. Although your employer’s insurance will pay for 100% of your medical bills, the system comes with stringent rules – including a list of approved doctors chosen by the insurance company. The process can be lengthy and confusing, but a skilled South Carolina attorney can help you understand the ins and outs of workplace injuries.
FINDING A DOCTOR
Although you might have a trusted family doctor who you would prefer to see in the event of a workplace injury, those medical bills won’t be paid by your workers’ compensation unless your physician is on the insurance company’s list of approved doctors, and the insurance company chooses to send you to that doctor.
If you would still like to visit your own doctor, you can do that. However, you will likely have to pay for those bills out of pocket, as your personal insurance carrier will not want to pay for injuries which are already covered under workers’ compensation.
Once you’ve visited an approved doctor, it is possible that he or she will refer you to a specialist to receive additional treatment. While this may seem like a simple run-of-the-mill referral, it comes with red tape.
In this case, the doctor forwards his report and medical recommendation to your employer’s workers’ compensation insurance company. An adjuster will review the report and decide whether or not they will approve the recommended treatment. This procedure continues throughout the entire treatment process, with the adjuster needing to approve each and every step.
It’s possible that the adjuster will deny the recommended treatment, in which case you’ll need to attend a hearing in order to enforce the doctor’s orders. If you have an attorney, they will file for the hearing on your behalf, and will know how to effectively negotiate with the insurance company.
You might also encounter a visitor at your doctor’s appointments, known as a nurse case manager. They’re usually registered nurses who are employed by the insurance company to monitor your case. They’ll report information back to the insurance company, such as the general status of your medical condition, any prescriptions you’re taking, your future prognosis, and a possible date of when you might be able to return to your job.
It is extremely important to understand that you do not have to allow a nurse case manager to be present at your doctor’s appointments. Contact your attorney immediately if a nurse case manager has become involved in your case.
TELL YOUR DOCTOR EVERYTHING
When you visit the doctor, it’s often hard to remember everything you need to say. This is why it’s extremely important to make notes before your appointment, as you need to verbalize every complaint you have and let them know about every part of your body that is hurting. It’s a good idea to bring a friend or family member to your appointment who can take notes, ask questions, and provide support.
It is also necessary to make sure that your physician records all of your complaints in your medical report, so there is documentation to reference back to if needed.
You’ll also be asked by your attorney to receive a work status note at all of your doctor’s visits. This will indicate whether you are on light duty, medium duty, or full duty at your job. This might also include a list of restrictions specified by your doctor.
If you’ve hired an attorney to represent you in your workers’ compensation case, it is important to call them or their paralegal after every doctor’s visit, letting them know the status of your injury and whether your treatment is progressing. This information will help them understand how to best fight for you, and which steps they need to take next.
You should also keep track of all of your doctor’s appointments and attend every single one. Missing too many appointments can cause you to lose your workers’ compensation benefits, as it might imply that your injuries are not actually what they are. Allowing big gaps of time to occur between visits can also be problematic.
If it’s absolutely necessary to cancel a doctor’s appointment for a legitimate reason, give your doctor’s office as much notice as possible and be sure to reschedule the appointment. Call your attorney to let them know you’ve cancelled and give them the date of your new appointment.
There are some situations in which you might disagree with the insurance company’s approved doctor and want a second opinion. This is possible, as South Carolina law does not prohibit the claimant from seeking a second or third opinion. The system also allows for decisions to be appealed, such as a doctor’s order for the injured party to return to work, or for a disability rating. A qualified attorney can arrange for a second opinion and any necessary appeals.