Medical Treatment Networks – A Little Work Saves Big Claim Dollars
Works For All Types of Employers And Provides Injured Workers With Top-Notch Treatment
Workers Compensation Medical treatment networks remain the mother of all workers comp savings plans. If an injury occurs, knowing the local industrial minded physicians and other medical providers can save a ton of premiums (voluntary market) and budgetary dollars (self-insureds, large deductibles, etc.)
We received such a large readership rate and buzz on the article from last week on injured employee trust. This led me to extract a piece of my cornerstone manual.
Our article readers will receive a great freebie today – this advice used to cost money – you had to buy the manual on medical treatment networks from me a few years ago. From my 1996 Workers Compensation manual – Keys To Cutting Your Workers Comp Costs – From The End To The Beginning – the verbatim excerpt follows on medical treatment networks: (One Of the Six Keys) –
Network Importance for Industrial Accidents
THIS is the most critical part of any WC claim without question. One very important point to remember is the Industrial Boards and Commissions in each state that oversee Workers Compensation claims consider the medical providers, especially the treating physician, as the only impartial parties/witnesses in the WC claim.
Some states require that a medical panel be available to all employees so that all employees have immediate and proper medical care. All employers in all states should have a panel of physicians.
Some states allow the employer to have the choice of medical providers for the employees, while others allow the employee to choose their own physician. However, studies have shown that employees in states that allow the employee to choose the physician will usually attend the paneled physician appointment.
The treating physician makes the determination of what medical costs will be incurred, the length of time the employee is out of work, and if the employee has any permanent disability. A good industrial-minded physician in the local area is very important to your Workers Compensation program.
I recommend a walk in clinic or an urgent care clinic to initially treat all injuries. A large number of WC urgent care centers are cropping up around the US.
The most important physicians for the more serious injury are the level two physicians. These physicians are usually surgeons (Orthopedic, Neurosurgeon, etc). The level-one physicians should know who your preferred level two physicians are before a referral is made.
If an injury is very serious, the employee should be taken to the emergency room at the nearest hospital. It behooves the employer to know the nearest industrial-minded orthopedists, neurologists, orthopedic surgeons, and neurologists in their general area (within 150 miles). The physician network often has to be expanded beyond the local area due to availability of specialty medical providers.
Win Win Win for Employer Physician and Injured Employees
Earlier I mentioned the win-win-win situation when medical treatment networks are used by employers.
The win-win-win results are:
- First and foremost – the injured employee receives timely and proper care. No treatment delays exist in the medical section of the file. An employee that receives timely and proper treatment usually returns to work more quickly than an employee who is unhappy with their treatment. WCRI (research) performed a very large injured employee study that proves this point.
- Medical control – the employer knows the employee is receiving the best care in the medical network or panel provided to the employee at the time of accident.
- Insurance carrier or TPA – with a medical treatment network, the workers compensation adjuster does not receive the twilight zone phone call,. If the injured employee treats within a familiar network, the adjuster usually calculates that familiarity into the reserves on the file. <<very important. This importance also applies to self insured reserves.
- Return to Work – with the adjuster, employer, and employee all on the same medical treatment network page, the return to work will likely be very smooth. BTW, return to work is another of the Six Keys.
- Cost Savings – Using the TPA or insurance carrier networks usually result in a 15% reduction in medical fees. However, the medical providers in the network need to be researched heavily before coming up with a panel.
Setting up a medical treatment network requires a little work. Speaking with your carrier or TPA about their recommended industrial-minded physicians may be a good place to begin building the panel.
A local rehabilitation nurse (a recommended risk management strategy) may also be able to assist in forming industrial-minded medical treatment networks.
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