Medical Benefits

Q. What medical benefits am I entitled to under workers' compensation insurance?

A. Workers' compensation insurance will pay 100% of the hospital, surgical and treatment expenses directly related to your injuries. There are no copayments or deductibles. There is no maximum limit on the amount of these covered expenses. Amounts that physicians or hospitals can charge are set by the SC Workers' Compensation Commission. The difference between what the physician or hospital charges and the amount set by the WCC is not the responsibility of the injured worker and you are not responsible for paying that difference.

Q. Will my workers' compensation insurance pay for me to be treated by my own physician?

A. SC workers' compensation law allows each employer to select an authorized treating physician to whom an employee must go for treatment in the event of a job-related accident, disease or condition. You should check with your employer or SAF before attempting to schedule an appointment with a physician.

Q. What if I want to change physicians?

A. In order to change physicians, you must be referred by the original treating physician and obtain authorization from SAF to ensure coverage for additional treatment. This authorization must be obtained prior to changing physicians. If you change physicians without obtaining authorization, you are responsible for paying those bills. If SAF does not authorize a change of physician, you may, as in other cases of disagreement with the SAF, appeal to the Director.

Q. Will I be reimbursed for prescription drugs associated with my authorized medical care?

A. Yes. But in order to be reimbursed for prescriptions, your receipt must contain the date, drug name, quantity, name of the authorized prescribing physician, and the amount you paid for the prescription. For quicker processing and reimbursement, always include your SAF claim number. If your pharmacy allows for direct billing of charges for prescriptions, ask them to contact SAF to establish an account.

Q. Will my workers' compensation insurance reimburse me for travel costs associated with my medical care?

A. Yes. SC law allows you to receive reimbursement for travel costs associated with medical care if you must travel more than ten (10) miles (round trip) from home in order to receive such treatment. If you travel by personal vehicle you may claim the same reimbursement allowed state employees for business travel. Travel reimbursements for bus, train, or other modes of public transportation, food, and lodging are reimbursed for the actual costs as shown on your receipts, which must be submitted. In addition, travel reimbursement requests must include treatment date and destination, as well as, your SAF claim number. You must sign all requests for reimbursement.

Q. Are nursing services associated with authorized medical care covered?

A. Yes. Nursing services will be paid for if ordered by the treating physician.

Q. Will workers' compensation insurance pay for chiropractic treatments?

A. SC workers' compensation law allows for a maximum ten (10) week period of treatment provided by chiropractors. However, chiropractic treatment must be authorized by SAF just like other forms of medical treatment.

Q. Are artificial limbs or other prosthetic devices covered?

A. Yes. At the end of the healing period, artificial limbs and prosthetic devices needed as a result of a job-related accident, disease, or condition are furnished for life.

Q. I am receiving bills from medical providers. What should I do?

A. Contact SAF immediately. Authorized medical providers should not bill you directly for medical charges covered as part of your claim.

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