South Carolina Workers’ Compensation law requires the insurance company to provide payment for the costs of future medical treatment arising from your on the job injury. When your treating doctor concludes that you are not getting any better or any worse, but have reached maximum medical improvement (MMI), he/she will give an opinion as to whether or not you need additional treatment. Oftentimes, the doctor’s opinion as to future medical care is listed on his/her progress note or release to work form. In other instances, the treating doctor will complete what is known as a Form 14-B, on which the doctor will state whether you have additional medical needs. For example, your doctor may say you need further injections, anti-inflammatories, physical therapy, or even surgery.
Your employer’s workers’ compensation carrier then has a decision to make. They can “leave the medicals open” and pay for your future treatment as needed, or they can “clincher” your claim. A clincher agreement means that instead of paying for future doctors’ visits and treatment, the insurance carrier pays you more money up front. In return for paying you more money on the front end, they get to close (i.e. clincher) the case.
Injured workers with health insurance, and whose medical needs are relatively limited, often choose to clincher their claim and get more money on the front end. Conversely, injured workers who do not have health insurance, and may require significant future care, probably benefit from leaving the medicals open and allowing the workers’ compensation carrier to pay for their treatment.
If you have questions about the workers' compensation benefits you should receive for future medical costs arising from a South Carolina workers’ compensation claim, I am here to help. Call us today at (803) 790-2800 or use the live chat box below to contact us now.