Do I need to tell the insurance adjuster about new treatment and possible surgery right away? – South Carolina

Short Answer

In South Carolina, a claimant generally has no fixed statutory deadline to notify a liability insurance adjuster about each new treatment before a lawsuit begins. However, the claimant should tell the attorney handling the claim promptly. The attorney can accurately update the adjuster without describing surgery as certain before the MRI and medical recommendation confirm it.

Understanding the Problem

The question is whether a person with an ongoing South Carolina injury claim must immediately report resumed physical therapy, an upcoming MRI, and the possibility of neck surgery while an attorney continues settlement negotiations with an insurance adjuster.

Apply the Law

South Carolina law generally does not impose a specific pre-suit deadline for reporting every change in treatment to a liability adjuster. Still, new treatment can affect the nature and value of an injury claim. The adjuster will usually need updated medical records, bills, diagnostic results, and a treating provider’s recommendations before evaluating additional medical expenses or future care. Because an attorney represents the claimant, communications should normally go through that attorney.

Key Requirements

• Prompt and accurate communication: The claimant should promptly report new treatment to the attorney. Any update to the adjuster should distinguish confirmed treatment from care that remains only a possibility.
• Medical support: Physical therapy records, MRI results, bills, and written treatment recommendations help establish what care occurred and whether it relates to the claimed neck injury.
• Deadline protection: Ongoing negotiations do not ordinarily pause the deadline for filing a lawsuit. The attorney must preserve the claim even if treatment remains incomplete.

What the Statutes Say

• S.C. Code Ann. § 38-59-20 (Claim Settlement Practices) – Requires insurers to use reasonable standards for investigating claims and addresses prompt, fair settlement when liability becomes reasonably clear.
• S.C. Code Ann. § 15-3-530 (Three-Year Limitations Period) – Generally gives a claimant three years to file an action for injury to the person, although different rules may apply to particular defendants or claims.
• S.C. Code Ann. § 15-3-535 (Discovery Rule) – Generally measures the three-year period from when the person knew or reasonably should have known of the cause of action.

Analysis

Apply the Rule to the Facts: Returning to physical therapy is a confirmed change and should be reported to the attorney now. The upcoming MRI is also a concrete development, but surgery remains uncertain until the MRI is completed and a treating provider recommends it. Counsel can give the adjuster a limited status update now and provide the diagnostic results, records, bills, and treatment plan when available.

Accurate wording matters. An update may state that the claimant resumed physical therapy, has an MRI scheduled, and will receive further recommendations after review of the results. Presenting surgery as definite before a provider recommends it could create credibility problems and may cause the adjuster to request clarification.

Process & Timing

1. Who sends the update: The claimant’s attorney. Where: The update goes to the assigned adjuster or insurer’s claim department. What: A written treatment-status update, followed by relevant records and bills. When: Promptly after counsel learns of the resumed therapy and scheduled MRI.
2. After the MRI, counsel can obtain the report and confirm whether the treating provider recommends surgery, continued therapy, injections, or another course of care. The timing depends on the medical facility and provider.
3. Once the treatment plan and prognosis become clearer, counsel can submit a supplemental demand or supporting materials. If the filing deadline approaches first, counsel may need to file the lawsuit in the appropriate South Carolina Circuit Court rather than wait for treatment to end.

Exceptions & Pitfalls

• Pending litigation: If a lawsuit has already been filed, discovery requests or court rules may require timely supplementation of information about treatment, medical providers, and claimed damages.
• Different defendants: Claims involving a government entity, workers’ compensation, medical negligence, or another specialized claim may have different notice requirements and deadlines.
• Premature settlement: Signing a full release before the MRI and treatment recommendation may end the ability to seek additional compensation if surgery later becomes necessary.
• Direct adjuster contact: When counsel is involved, the claimant should avoid independently discussing symptoms, prognosis, or settlement value with the adjuster. Incomplete or casual statements may be misunderstood.
• Treatment gaps: Records should accurately explain why therapy resumed. An unexplained gap may lead the insurer to dispute whether later care relates to the original injury.

Conclusion

South Carolina law generally does not require immediate personal notice to the adjuster every time treatment changes. Still, resumed physical therapy, a scheduled MRI, and any confirmed surgical recommendation can materially affect the claim and should be documented accurately. The usual filing period is three years, and negotiations generally do not extend it. Send the attorney handling the claim the new treatment information promptly so counsel can update the adjuster and protect the filing deadline.

Talk to a Wrongful Death Attorney

If an ongoing insurance claim involves new treatment or possible surgery, our firm has experienced attorneys who can help explain how to document the medical developments, communicate with the adjuster, and protect important timelines.

Disclaimer: This article provides general information about South Carolina law based on the single question stated above. It is not legal advice for your specific situation and does not create an attorney-client relationship. Laws, procedures, and local practice can change and may vary by county. If you have a deadline, act promptly and speak with a licensed South Carolina attorney.