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Can the carrier talk to or communicate with my doctor?

Posted by Katie Phipps | Nov 15, 2021 | 0 Comments

Yes, as long they follow very specific rules. When you have a claim and the carrier is covering your medical expenses, the adjuster or Nurse Case Manager can communicate with your doctors in person, via phone or in writing, as long as they copy you on their correspondence and/or notify you a conversation about your injury is going to occur. Brown v. Bi-Lo, 354 S.C. 436 (2003); Section 42-15-95(B) Essentially, carriers cannot have "ex parte" communications with your doctor; discussions without you being notified and being offered the opportunity to participate. They must notify you of the communication. How does this work? For example, if a carrier sends a questionnaire to a doctor about your treatment; they must simultaneously send it to you or your attorney. If the adjuster wants to talk to the doctor; they must let you know they have scheduled on call so that you can be present. Most adjusters know that once you are treating with a certain doctor, they cannot unilaterally contact the provider.

So, what is the rule before you are sent to a doctor by the carrier? Can the carrier send correspondence to a doctor about your accident and then send you to that doctor for treatment? Recent case law would suggest they cannot. In Barr v. Darlington County School District, the Court of Appeals found the employer violated the applicable statute when they “failed to communicate with the employee pursuant to Section 42-15-95(B)…” by communicating with a doctor whom the claimant had not yet seen prior to his visit. Barr, Appellate Case No 2018-0001237 (2021) However, the court allowed the doctor's report into evidence, finding the claimant was “not prejudiced…by Employer's actions” when he had ample time to review the report and depose the doctor prior to the hearing. Id. 

It is important to know you and your doctor control your treatment-not the insurance carrier.  If you have questions about your rights, contact an attorney. 

About the Author

Katie Phipps

For more than 17 years, Katie had a successful practice at two of South Carolina's largest workers' compensation defense firms. During that time, she realized her favorite part of the job was helping Pro Se claimants navigate the settlement process. As a lawyer for the insurance carrier, she ofte...


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