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Workers Compensation Medical Networks – Are You A Drive-by User?


Workers’ Compensation Medical Networks – Discounts Not Being Used By Employers

Workers’ Compensation medical network usage tends to be the drive-by type.   What do I mean by drive-by?

drive thru workers compensation medical network
Wikimedia Public – Digimint

PPO/MPN/Cost-Savings Network

Most employers have an agreement with their carrier or Third Party Administrator (TPA) if your company is self-insured.    Drive-by medical treatment originates with the employer or claims staff just using whomever they find convenient for post-accident treatment.

The discounts used provided by the medical networks never see the light of day.  By luck, the injured employee treats with a provider that is in-network.   The savings can be significant with Workers’ Compensation Medical Networks.   The usual PPO discount pegs at 15% or higher.

Many networks exist in the marketplace.  Some are whitelisted by a carrier, TPA, or other networks as their own group of providers.   The white-listing should not be a cause for concern.   Use the network you have in front of you regardless of the source of the providers.

Emergency Services vs. Workers’ Compensation Medical Networks 

Please note one exception to the networks.  If an injured employee needs emergency medical care or incurs a serious injury, make sure the injured employee receives immediate medical care.  Do not worry about medical networks on this type of claim. 

Attempting to have an employee with severe injuries stay in-network ends up costing insureds more than any network savings.   I designed a walk-in clinic medical network for a very large (now defunct) home builder.   The injured employee had a thumb amputation.  He showed up with his supervisor at a walk-in medical clinic.

The supervisor said he stayed in-network.  I was horrified and told them to go to the nearest hospital emergency room.   The walk-in physician had already made the referral.  The hospital reattached the thumb – Duke University Medical Center – whew!

Adjuster and Claims Department Concerns

Rightfully so, the claims adjuster and departments raise concerns about staying in the Workers’ Compensation medical network while assuring that the injured employee receives treatment from industrial-minded physicians.

Adjusters like to use certain physicians in certain areas for certain types of injuries.  When I adjusted claims and now consult on them, I always carry a list of medical facilities in my head for a certain state or area.    I think the main attribute was a “successful return to work”  with the employee’s capabilities returned to enable them to do their jobs in full.   The other attribute by physicians and medical providers was the bedside manner.

WCRI performed a host of studies on the main attribute that employees possessed with a successful return to work.   The word TRUST of the employer before the injury and the medical care resulted in better returns-to-work.

The Second Key

The second key of my Six Keys To Workers Comp savings was written in the order of the claim.   If I had to rank the Six Keys on savings potential, medical networks would rank the highest.   Creating a network for injured employees seems complicated.   Being prepared ahead of time make the task much easier.

At the time this article was published, approximately 41 states allow the employer to choose the medical network or to provide the injured employee with a panel or list of providers.    Even if the employee retains the right to choose the treating physician (nine states?), the injured employee will treat with a suggested physician.

Preparation and Teamwork for the Workers Comp Medical Network 

The upfront preparation pays off with the proper medical treatment at the lowest cost.

The team members should be:

  • Claims adjuster or staff
  • Providers in the area
  • Medical network access for all involved – should be online with the carrier or TPA
  • Employer representative
  • Rehabilitation nurse – can be the hub to set up the network
  • Original treating physician – in-network referrals for more complicated cases.
  • Trust – see WCRI study referenced in a previous section

The employer representative kicks the medical network into gear by checking with all the above mentioned other parties.   When looking for providers in your area, make sure they know that you use a certain network.   Many medical providers signed up with medical networks once they learned local employers use a certain workers compensation medical network.


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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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