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Time To First Medical Care – Workers Comp Fundamentals

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Time To First Medical Care = Program Success

I received a note this morning that WCRI (Workers Comp Research Institute) will host a webinar on January 11, 2024.  The webinar covers the time to first medical care and its effects.

The Six Keys to Workers Comp Success (originally four) that I wrote in the 1980s had the timely first reports to the insurance carrier or TPA and having a medical network as the two most critical components.  Another combo key that I should have included before now is how rapidly the injured employee receives access to medical care.  Speed and access to treatment set the tone for the claim.

pic stopwatch time to first medical care access
Wikimedia Commons – Sandstein

One of the most popular slides during my presentations on workers comp savings shows how out-of-control costs more and does not provide quick access to the first medical care.  See the chart here.  

By the time that I became involved in the claim a biofeedback specialist was the treating medical provider.  I have nothing against biofeedback but the original surgeon was out of the loop and the claim ended up costing over $1 million.

One of the most popular articles on this website covers how during the pandemic physician networks reached a critical mass as treatment plans were disrupted nationwide. The time to first medical care became a very complicated matter.

When Do We Send The Injured Worker to Network Physician?

The advice that I give is whenever the employee has to leave work due to an injury – send them to the clinic or physician immediately.  Most Workers Comp adjusters will tell you that the claim was completely out of control when an employee goes home after a minor injury.  I have seen a splinter claim end up exceeding $250,000 due to the employee being sent home after a very minor-looking injury.

And on top of everything else, the injured employee may seek medical treatment on their own over a weekend or even just one night – so much for the workers comp medical network or control of the time to first medical care.

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2 Responses

  1. Delaney, thank you for your comment. Almost 2,000 articles are available by using the search box on any of the webpages or posts. Getting the injured worker to medical care is the #1 way to reduce workers comp costs. The proper medical care has always guaranteed the best recovery to return to gainful employment. Quick injury reporting, quick medical care, and a return to work program will always save on Workers Comp and make sure the employee is treated well. Quick and appropriate medical care is one of the Six Keys for cutting workers comp costs.

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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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