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Who’s Afraid of the Big, Bad Change of Condition for the Worse

J. Steven Rodenberg

The Appellate Panel of the South Carolina Workers’ Compensation Commission recently issued an opinion regarding the specifics of how a claim for a change of condition for the worse is filed within the one-year statute of limitations.

In this particular case, claimant sustained an admitted compensable injury to her left shoulder on January 28, 2015. Treatment of the left shoulder was authorized and provided. The authorized treating physician ultimately completed a Form 14B indicating claimant had sustained a 12% permanent impairment to her left shoulder with no need for future medical treatment. That claim was settled on a Form 16A on June 14, 2016 with the date of last compensation occurring on July 14, 2016. The claimant filed a Form 50 request for hearing on September 8, 2017 wherein she alleged to have sustained a change of condition for the worse to her left shoulder. Claimant contended that she satisfied the one-year statute of limitations requirement upon notifying her employer of her desire to return to the treating physician within one year of last receipt of compensation, and that by authorizing and paying for a return evaluation by the authorized treating physician, the one-year time frame was tolled. Defendants asserted that the change of condition claim was barred by the statute of limitations since the claimant did not file a Form 50 within one year of the date of last compensation and presented no medical evidence establishing a change of condition for the worse within the one-year period. After a hearing, the Single Commissioner ordered that claimant’s claim for additional indemnity benefits was denied on statute of limitations grounds, but also ordered defendants to provide additional causally related medical treatment as recommended by the authorized treating physician.

The Appellate Panel found that the claimant settled her workers’ compensation claim via Form 16A on June 14, 2016. Claimant received her lump sum settlement payment on July 14, 2016. Claimant was re-evaluated by her authorized treating physician on June 26, 2017 at the request of the workers’ compensation insurance carrier and additional treatment was recommended. When claimant returned to the authorized treating physician for additional treatment, additional treatment was then denied by the carrier. On October 4, 2017, at another follow up appointment with the authorized treating physician, additional treatment was again recommended. On January 23, 2018, the authorized treating physician completed a questionnaire wherein he opined that claimant’s left shoulder had worsened since he originally released her on April 13, 2016.

The Appellate Panel further found that pursuant to the original Form 16A settlement, claimant received the last payment of compensation on July 14, 2016. The Appellate Panel also found that claimant did not file her Form 50 for a change of condition for the worse until September 8, 2017, outside the one-year statute of limitations as prescribed by S.C. Code § 42-17-90 and that claimant therefore did not timely file her Form 50 for change of condition for the worse.

Finally, the Appellate Panel concluded that pursuant to S.C. Code § 42-17-90 and the language of the South Carolina Workers’ Compensation Commission Form 16A, claimant’s claim for additional indemnity benefits was denied; however, the Appellate Panel further concluded that pursuant to S.C. Code § 42-15-60(B)(3)(b), claimant is entitled to all additional, causally-related medical treatment recommended by the authorized treating physician.

This opinion suggests that the Commission is going to strictly follow the requirement that an actual Form 50 claim for additional indemnity benefits as a result of a change of condition for the worse be filed within one year of the claimant’s last received compensation. However, the opinion also suggests that even if an authorized treating physician does not indicate claimant is going to need future medical treatment on a Form 14B, if claimant returns to the authorized treating physician within one year of settlement of the claim on a Form 16A and additional medical treatment is then recommended by the authorized treating physician, claimant is entitled to receive that recommended medical treatment.