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Fundamentals Series: Medical Benefits in SC

Matthew Riddle

Although we typically use our blog to report news and developments in SC Workers’ Compensation Law, from time to time it helps to get back to basics.  We hope  our “Workers’ Comp Fundamentals” series will be useful as a learning tool for those who are relatively new to the world of workers’ compensation, while providing a good refresher for the more “seasoned” practitioners among us!  Today’s entry summarizes an injured worker’s entitlement to medical treatment under the SC Workers’ Compensation Act.

Medical Treatment

  • Section 42-15-60 of the South Carolina Workers’ Compensation Act governs what medical benefits are provided under the Act.
  • The employer/carrier is required to provide medical care that is causally-related to the work injury.
  • Medical care can continue so long as in the opinion of the Commission it will “tend to lessen the period of disability.”
  • Claimants are entitled to medical treatment after maximum medical improvement if they can establish that the treatment will “tend to lessen their period of disability.”  A claimant must provide a doctor’s opinion stating that the post-MMI treatment will more likely than not be necessary, based upon a reasonable degree of medical certainty.
  • In South Carolina, the employer/carrier directs medical treatment and choose the physicians who treat the claimant.
  • Prosthetic devices are covered for repair or replacement for the lifetime of a claimant, including surgical hardware.

Obtaining Medical Records and Communication with Physicians

  • Section 42-15-95(A) – An employee who seeks treatment for an injury or condition for which compensation is sought CONSENTS to the release of medical records.
  • Send a request and cite Section 42-15-95 as allowing you to obtain the records.

Communication with Physicians

  • Section 42-15-95(B) governs communication with health care providers.
  • Issues that may be discussed:
    • Medical history
    • Diagnosis
    • Causation
    • Course of treatment
    • Prognosis
    • Work Restrictions
    • Impairment
  • Requirements to have such communication:
    • Notify employee/claimant or Claimant’s attorney in timely fashion, In writing or orally prior to communication taking place.
    • “Timely fashion” – Regulation 67-1308 says that 10 days notice Is required.
    • Advise employee of the nature of the discussion or communication prior to the discussion or communication.
    • Allow claimant or claimant’s attorney to attend the meeting or participate in the discussion.
    • If written questions are used, provide a copy of the questions to the employee/claimant or claimant’s attorney at the same time the questions are submitted to the health care provider.
    • Provide copy of response to questions to employee.
    • Any information obtained in violation of these requirements cannot be used at a hearing.