The Court of Appeals recently addressed a claimant’s right to medical treatment pursuant to S.C. Code §42-15-60(A) after remand by the South Carolina Supreme Court.
The claimant was a 50-year-old auto body paint technician who claimed he injured his back while cleaning his employer’s shop. The claimant testified that he began experiencing low back pain the afternoon after completing the work and felt very sore in his lower back the following day. The claimant testified he told the employer’s owner the day after the alleged injury that he was “pretty sore” and that he “must have hurt himself.” The claimant did not seek medical treatment at that time and left his employment soon after the alleged accident.
§42-15-60(A) now provides “the employer shall provide medical, surgical, hospital, and other treatment, including medical and surgical supplies as reasonably may be required, for a period not exceeding 10 weeks from the date of an injury, to effect a cure or give relief and for an additional time as in the judgment of the Commission will tend to lessen the period of disability as evidenced by expert medical evidence stated to a reasonable degree of medical certainty.
In this case, the Court of Appeals noted that in 2007, the South Carolina legislature added a requirement for expert medical evidence to support an award of additional treatment and limited the Appellate Panel’s broad discretion to order such treatment in a case or controversy between the employer and the employee. The Court of Appeals stated that an employer’s responsibility for providing medical treatment to covered employees under the Act is limited to 10 weeks following an injury. To hold an employer liable for medical expenses beyond this time period, the Appellate Panel must decide that, based upon a heightened standard of medical evidence, additional treatment would tend to lessen the claimant’s period of disability.
In the subject case, it was undisputed that the claimant never requested medical treatment or reimbursement of expenses from the employer. Because more than 10 weeks had elapsed since the claimant’s alleged injury and the Appellate Panel did not support its decision ordering additional medical treatment with expert medical evidence, the Court of Appeals found the Appellate Panel erred when it awarded medical benefits, and therefore reversed the Appellate Panel on that issue.
Obviously, in most accepted claims, medical treatment is provided by an authorized treating physician until the authorized treating physician places the claimant at MMI regardless of the 10 week limitation in §42-15-60(A). It is somewhat implicit when additional treatment is recommended and a follow-up evaluation is scheduled or noted in a medical report even without language specifically stating the additional recommended medical treatment is “to effect a cure or give relief” and “will tend to lessen the period of disability.” This opinion should not affect the way admitted claims with authorized treating physicians are handled. However, in denied claims with some specific factual scenarios, a claimant may not automatically be entitled to additional medical treatment. However, most claimants’ attorneys have physicians who will perform IMEs of their clients and provide a report stating his or her expert medical opinion to a reasonable degree of medical certainty that the claimant needs additional medical treatment to effect a cure or give relief and tend to lessen the period of disability. So, while this opinion looks at first blush to be of some benefit to employers and carriers, it may not have a noticeable effect on how claims for additional medical treatment are handled.
As always, please do not hesitate to contact any of the attorneys at Clement Rivers, LLP to discuss this opinion or any other workers’ compensation issues.