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Workers Compensation Medical Networks Save Bundle – Used Properly

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Proper Use Of Workers Compensation Medical Networks Key To Employee Health And Savings

Workers Compensation Medical Networks have always provided a large return on investment.  Injured employees receive the best medical treatment and the employer cuts their workers comp costs.  The insurance carrier or TPA claims staff being able to work with the treating physicians to obtain work statuses and medical information will always lower your workers comp reserves.

Picture Anesthesiologist Draws Workers Compensation Medical Networks Fluid
US Navy Public License

This is the first area in Workers Comp that I realized benefits all parties.  In fact, in the old days, as an adjuster, I had built informal medical treatment networks for:

  1. The largest homebuilder in the nation
  2. Two different huge fast food restaurant chains on the east coast
  3.  Many manufacturing plants

There were many other companies that benefited from my informal workers compensation medical networks.   I did this while adjusting claims, not as a special project.

I began the Six Keys List soon after that.

doctors doing workers compensation medical networks Treatment
Wikimedia Commons By Gracefairchildsfisher

This Key comes with a caveat.   The medical networks built by me were not necessarily from a TPA or insurance carrier provider list.  The providers on those lists usually provide a 15% reduction in services – but are they the proper industrial-minded physicians that you wish to treat your injured employees?   We have to remember that one of the goals is to keep the injured employees as healthy as possible while they recover and return to work.

The win-win-win of great informal workers comp medical networks come from four different aspects:

  1. The information flow between provider, an injured employee, and the carrier has no logjams.
  2. The provider is listed on the carrier/TPA’s medical provider list – usually resulting in a 15% discount.
  3. Managing one of my other Six Keys – Return to Work becomes much easier
  4. The injured employee receives the best treatment possible in their area.

This key actually links to more of the other Six Keys than all the other keys combined.   Having a great workers comp medical network aids another key Treatment of Employee (not medical).   The great research organization, WCRI studied this area heavily.   And yes, how an employee is treated by their employer has a large effect on the outcome of the file.

Employee workers compensation medical networks check up
Wikimedia Commons – Josie Kemp, U.S. Air Force

As a side note, I had a very severe case of the flu last week and this week.  It was awful.   I ambled to my GP (General Practitioner).  As I take blood thinners, that complicated the issue.   Having the Dr. run test and then tell me I was going to be 100% fine meant quite a bit to me.   Bedside manner goes a long one when treating Workers Comp patients.

One question is often asked in this area – What if the state is employee-directed care?  A study was conducted on this point which showed most employees will go to the physician recommended by their employer regardless of who directs the medical control in the state.  Unfortunately, I cannot locate the source article as I write this passage.

This Key is one of the more difficult to immediately install in your Workers Comp program.   However, once that you do, the benefits of a workers compensation medical network become quickly apparent.

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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