Selection of Workers Compensation Treatment

Providers

(Physician Selection)

© 2006 RCS Services

WC Laws Governing Selection of WC Treatment Providers

Three Basic Types—

– The Employee Selects the provider.

– (You still need to make a selection – “stay tuned…”)

– The Employer selects the provider.

– The Employee selects the provider from a list (“panel”) of providers that the Employer has designated.

Why is Proper Selection Important?

The medical treatment provider should be your company’s partner and ally in controlling WC costs.

Medical treatment providers can be indifferent to the interests of your company, or even predators.

If your company ends up with a predator or indifferent provider in a place where you need a cooperative partner, what will happen…?

The Ideal Provider…

Is able to balance effective treatment with efficient delivery.

Understands your company’s policies and procedures.

Communicates openly with your company.

Is accessible for questions and discussions.

The Ideal Provider…

Understands the importance of modified duty for both patient recovery and cost control, and is committed to modified duty concepts.

“Industrial Medicine or Clinic” in the practice’s name is often a good indication they understand the Workers Compensation “arena.”

How Do I Find Good Provider Candidates?

Do the “legwork” yourself.

Ask your insurance agent/broker.

Ask your insurance carrier

Ask associates in local trade or other business/civic organizations.

Other methods…

Questions For Evaluating a Provider Candidate

What is their quality of care?

How do they relate to employees?

How accessible are they?

Are they fair in their treatment plans?

Are they regarded as “employer-friendly” while still providing the best possible treatment for the injured?

Qualifying A Provider Candidate

Identify the candidates.

Conduct a preliminary survey.

Schedule appointments with qualifying candidates.

Interview the candidates.

Check references.

Make the decision.

Notify the selected providers and make necessary arrangements.

Suggested Interview Questions

What is their attitude about modified duty?

Will they share information with you?

What is their attitude about drug testing for Workers Compensation cases?

Are they experienced in handling Workers Compensation cases?

Are they willing to honestly share information about an employee’s prognosis, including suspected malingering or fraud?

“Employee-Selection” States

Although the employee is allowed to select the treatment provider, no state prohibits the employer from suggesting a pre-selected provider, so long as you do not force nor coerce the employee’s decision.

An injured employee may not know of a clinic to use. The employer having “an account” already set up with a physician will ease the employee’s mind about where to go, who will pay the bills, and other concerns.

“Employee-Selection” States

Having a pre-selected clinic will help with the transportation of injured employees to the treatment facility.

Having a pre-selected clinic also helps ensure that a staffing representative will be in attendance with the employee at the facility.

A claimant insisting on using a provider including a family/personal physician may be a red flag – an indication the employee is using and working with a potentially predatory treatment provider.

“Employee-Selection” States

Whether the employee selects a suggested provider or one entirely of his/her own choosing, document their choice using the RCS “Medical Treatment Request Form,” (Form 6-W) or equivalent.

Summary

Know who the law designates to choose the provider in the state(s) in which you operate.

Providers can be predators.

Select providers through a due-diligence process as you would for any other supplier.

Develop a close and cooperative relationship with your provider(s).

Even in “employee-selection” states, select good treatment providers, and suggest that injured employees utilize them.