Everyone prefers his or her own doctor. You chose your doctor, and your doctor knows you. That trusting relationship is vitally important and a great comfort, especially when you’re badly hurt.
But South Carolina workers’ compensation medical care doesn’t work that way.
Worker’s Comp Doctors: The Insurance Company’s Choice
To get your medical treatment paid for by your job’s workers’ compensation insurance, you must go to the doctor chosen by the insurance company. It’s the law. And usually, it works out okay.
Generally, you must also do what those providers say, meaning you attend appointments and undergo all treatment as ordered. If you strongly disagree with your treatment or the doctor’s assessment of your injury, you may be able to get a second opinion.
A word to the wise if you're considering a second opinion. Two things to remember here:
- Just because you disagree with the comp doctor doesn't mean you can refuse treatment. If you unjustifiably refuse treatment, your benefits will stop.There are very limited exceptions to this rule, like when the insurance company forces you into multiple visits with different doctors to “doctor shop” for an opinion that you’re not hurt. Of course, there’s also an exception for emergency treatment where you have no time to get a referral from the insurance company.
- Getting a second opinion can be tricky, so you should discuss that option with an experienced workers' comp attorney before taking any action. The main reason is this: you need to be sure the second opinion comes from a doctor who’s experienced in comp cases, and who’s got a good reputation with the insurance company's attorneys and the commission, so you get a reliable second opinion that can actually help your case. A skilled comp attorney can help you find one. Plus, experienced attorneys know how to get a second opinion the right way.
Medical Disputes Can Force You to Take Your Case to a Worker’s Compensation Lawyer
In our experience, the most common legitimate battles over medical care in workers’ compensation are fought over the insurance company’s refusal to pay for treatment you need, releasing you from care too early, or unjustifiably low impairment ratings. A second opinion can shed some light on these issues. How you get one depends on the case. If the insurance company or its doctor is already resistant to helping you, you need someone on your side: an experienced workers’ compensation lawyer.
Denied Treatment Means Prolonging Your Suffering
Sometimes the insurance company denies treatment, especially if the treatment would be expensive—surgery, for example. Sometimes all other treatment has failed, but the insurance company refuses to pay for the surgery that might help. We’ve even had cases where the doctor recommended surgery but the insurance company denied it anyway. We’ve seen insurance companies go to heartbreaking lengths to save a dollar at your expense, like sending medical records to an out-of-state bone doctor to refuse a local neurosurgeon’s recommending spinal surgery for a hurt worker the neurosurgeon had treated for months.
Sometimes the doctor wants to release you from care too early. If you're still having severe symptoms, a second opinion might result in treatment that could provide relief.
Medical Shortchanging: Unjustifiably Low Impairment Ratings
One of the most important factors in valuing your workers’ compensation settlement is the permanent impairment rating the doctor gives when you reach maximum medical improvement. The impairment rating is the basis for many settlements. Sometimes doctors give impairment ratings that don’t truly reflect the permanent damage to you. They’re human—anyone can be a little too proud of his work, or underestimate things, or just have a bad day; any combination of these can contribute to an unjustifiably low rating. In this situation, a second opinion might help to more accurately assess the basic level of permanent damage to you from your injury. In a recent article, we described a rare case where we felt the rating was so unjustifiably low it forced us to send our client for a second opinion for a more accurate rating.
Who’s on Your Side, Keeping the Insurance Company Honest?
If you’ve been seriously hurt on the job in Spartanburg, Greenville, or nearby, we hope your employer’s workers’ compensation insurance company will do right by you. But there’s always the risk it won’t, and your treatment can be delayed or even denied.
If you are facing serious medical treatment—especially surgery—you need someone to look over your shoulder to protect your rights and make sure you get the treatment you need without being shortchanged. It’s bad enough you got hurt that bad. Feel free to call us at 864.582.0416 or toll-free at 888.230.1841. If you’re hurt too bad to come to us, we can come to you. You can also start a live chat right where you are or send us an email. It won’t cost you anything to discuss your options with us and see if we can help you get the maximum medical care and compensation you need so you can just get back to work.