The Prescription for Keeping WorkComp Costs Down Is in Finding the Right Physician

In many states, employers can make the initial choice of doctors for their injured workers. Yet some employers defer the choice to employees.

Why is that a problem? First, employees are most likely to choose either an emergency room or their family doctor. Emergency rooms are busy places and their primary task is to make sure people are not in imminent danger. Since the job of the ER doctors is to treat the patient, they don't have time for detailed conversations with injured employees about their work duties and how they might be modified so they can get back to the job. More often than not, an injured employee will wind up spending much more time out of work than they should.

The only time an injured employee should go to the emergency room is when there is a 911 emergency or when there are no other treatment options (such as a third shift employee). Even when someone gets hurt on third shift, the initial doctor's visit can be postponed for a few hours until a preferred doctor is available.

The family physician presents other issues. They think of the employee as their client and, most commonly, they will grant their requests. If the employee asks for a week off, the doctor will approve it. Why not? It keeps the client happy. Also, family physician offices are set up to deal with the small number of health insurance companies that operate in their state. The staff knows exactly how to deal with them. It's cumbersome for them to figure out how to file the proper paperwork for a Workers' Compensation insurance company with which they have no experience.

Find the right doctor

Most family physicians have no experience with occupational medicine. On the other hand, occupational physicians understand health in the workplace and the importance of getting employees back to work. You can find doctors who are members of the American College of Occupational and Environmental Medicine.

Don't have a certified occupational physician in your area? You can still make this work. The key to choosing the right doctor, certified in occupational medicine or not, is communication. While it's not possible to train a doctor to be an expert in occupational medicine, you can show them enough about how Workers' Comp works to get better outcomes for injured employees.

First, does the doctor know that you are willing to accept the employee back for modified/alternate duty? If doctors aren't confident that their restrictions will be followed, they will almost always just tell the employee to stay out of work. Once they know that the employer will accept injured employees back, then you can communicate with them about what information you need about the injured employee. The work restrictions, timeline for return to full duty work and so forth. These bits of information can help employers make the best decisions possible about returning the injured employee to the job.

In states where the employer doesn't have first choice of a physician, it can be more difficult. With few exceptions, even when employers can't choose a doctor, they can still recommend one. Telling an employee, "Dr. Doe has treated many of our employees and does a great job" is often enough to convince an employee to seek that physician for initial treatment.

A recent NCCI report highlights the continuing growth of prescription drug costs in Workers' Comp claims. Physicians who understand how to treat injured workers are more effective in getting those employees back to work and healthy. This shortens the duration of an employee's injury and leaves less opportunity to have "long tail" Workers' Compensation claims where prescription drugs take up much of the total cost.

Find out if physicians dispense prescriptions through their practice. The NCCI report highlights the growing share of prescriptions that are being dispensed directly at the practice, and often at a higher cost.

About the author:
Kevin Ring is the Lead Workers’ Compensation Analyst for the Institute of WorkComp Professionals, the Asheville, NC-based organization that trains insurance agents to help employers reduce Workers’ Compensation expenses. A licensed insurance agent, he leads workshops, analyzes Workers’ Comp programs and is the co-developer of CompImpacta Workers’ Comp software suite that helps insurance professionals in working with employers. He can be contacted at 828-274-0959 or kevin@iwcpro.com.

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