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Medical Treatment Networks Save Money – Win Win Win On Claim


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.)

graphic of Workers Comp Medical Treatment Networks
Licensed – Wikimedia Creative Commons


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

Doctor and Patient medical treatment networks shaking Hands
by StockUnlimited

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

Nurse medical treatment networks preparing syringe injection
by StockUnlimited

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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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management 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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