Yes, as long they follow very specific rules. When you have an admitted claim, the carrier is covering your medical expenses. https://www.kphippslaw.com/medical-treatment-in-a-wc-claim-in-sc/ In these circumstances, 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); S.C. Code Ann. Section 42-15-95(B) https://wcc.sc.gov/sites/wcc/files/Documents/Main/Insurance_and_Medical_Services/SECTION%2042.15.95.pdf
“Ex Parte” Communication with a doctor:
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 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 about 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 today.
