One of the greatest benefits provided under South Carolina Workers’ Compensation law is medical treatment for the injured worker. The law that addresses medical benefits related to work accidents is S.C. Code Ann. §42-15-60(Time period medical treatment and supplies furnished; refusal to accept treatment; settled claims; total and permanent disability). This statute tells injury lawyers, claimants and the public at large what the rules are regarding medical benefits after someone is hurt in an accident at work.
The statute reads in part that an employer is to provide hospital, surgical, medical and other treatment as may reasonably be required. Unlike private health insurance, where the employee is responsible for co-payments and the like, workers’ compensation medical is paid at 100 percent of the medical provider’s bill but said bill is subject to the fee schedules as set by the South Carolina Workers’ Compensation Commission. Importantly, future medical benefits are addressed two ways in this law. The first is for workers who are not totally and permanently disabled from work. In order for them to continue receiving medical care for their work injuries, they must have an opinion from their doctor that continuing treatment will “tend to lessen the period of disability.” Translated to English that roughly means that the care will help the employee with their activities of daily living. Workers that are deemed to be total and permanent in their disability are entitled to lifetime medical care.
Importantly, the workers’ compensation insurance company can stop medical benefits and weekly disability benefits if the worker refuses treatment and it is determined that he or she is not justified in doing so. This bar to further compensation and money benefits only lasts as long as the injured employee continues in his refusal of treatment. If the worker stops his refusal and/or the Commission finds that their is “good cause” for his actions then the medical and other disability payments will be restarted.
As of July 1, 2007, any work related accident after that date is subject to some new rules under the this law. Specifically, when a case is settled on an approved form by the Commission the defendant insurance company is not required to provide treatment after one year from the payment of all monies to the Claimant in settlement. Also, any order must now state clearly whether the worker is entitled to continued care and treatment. It is very important to note that no one is entitled to continued medical in the event that they do not seek treatment within one year of their last doctor’s visit unless their is a settlement agreement or Commission order that states otherwise and/or the worker has attempted to get further treatment but is not the cause of his failure to get same.
