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Workers Comp Emergency Room Visits – Bad Risk Management?

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Workers Comp Emergency Room Visits – Very Touchy Subject

This is my angle on workers comp emergency rooms as initial medical treatment providers.  I am not discouraging anyone to not go to an emergency room. What I am covering in this article is minor injury treatment through emergency rooms.  Read on to see how I discovered a massive cost-cutting method for workers comp claims.

I have been admonished over the years for recommending a risk management technique that put injured employees’ lives in danger.   Bottom Line – if the injury needs emergency treatment, then go to the nearest hospital emergency room.

pic workers comp emergency room UNC hospital
Wikimedia Commons – Bbfd

My Own Emergency Room Visit = Idea

More than a few years ago, I was working a claims adjuster’s desk when I realized something amazing   A huge homebuilder (now defunct) was trying to figure out how to cut workers comp costs to a minimum while providing proper care for their injured workers.  I had just visited an emergency room the week before due to massive cuts to multiple fingers from a canned ham accident.

When the bill arrived and then the health insurance carrier’s EOB (Explanation of Benefits) I was astounded at the charges.  I was covered by an HMO, so the final amount I paid was much less than the original bill – whew!

I did not have a primary care provider (PCP) or a family physician.  The only place to go that I could get in for an appointment was the emergency room at the nearest hospital.  There were no urgent care providers/walk-in clinics in the area.

I then reviewed  a loss run for the huge home builder to see what factors would help them reduce their costs.  I noticed that all the injured employees, even with a splinter, went to the nearest hospital emergency room.  The light bulb came on that minor claims could be handled by the nearest walk-in clinic as a much reduced cost.  This was before the advent of Workers Comp medical networks.   Workers Comp emergency room visits were reduced by the home builder.  Their premiums for Workers Comp dropped 30%.

The light bulb was the beginning of the Six Keys to Workers Comp savings.

Workers Comp Emergency Room Visits – 1999 Study

I was the Director of Risk Management for the NC School Boards Association when I noticed the cost for certain school districts was much higher per claim than some of the others.   I decided to pen and paper analyze over 7,000 claims to see if the four Keys that I had discovered 10 years earlier would cut workers comp costs.  (quick injury reporting, medical treatment network in place, return to work program, treatment of an injured employee by the school district post-injury).

The most significant cost factor was not having a medical treatment network in place or just telling the injured employee to go to the emergency room or their family physician.  Even more extreme costs were generated by a minor injury being treated by an emergency room.

WCRI – New Study On Workers Comp Emergency Room Use

A new study was  performed by WCRI’s Dr. Fomenko that carries on the same question.  According to the study and report:

Oftentimes workers resort to emergency departments (EDs) to receive their initial medical services after a work-related injury. For some injuries, workers may be more likely to use ED services rather than going to physician offices or urgent care clinics—which are less costly alternatives to ED services.

I have not read the report yet, only an abstract summary.  I rarely make purchase recommendations, but in this instance, the $35 may be worth it.  The other variable that I did not cover in this article is how COVID-19 affected medical treatment.

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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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