Litigation Problem:

1.  An employer   should not need to pay workers comp medical bills directly due to a slow claim processing unit. Adjusters needs to set up a claim file and verify accidents before authorizing treatment or paying initial medical bills.

2.  Problem:  a failure to pay the initial medical bills promptly may force a claimant directly into the hands of an attorney.

The Defense Attorney Problem

1.  Defense attorneys  cannot  and do not coach their employers to take actions inconsistent with their policy reporting requirements  but, that said,  direct payment of minor medical claims,  can be an extremely effective method of lowering an employer’s experience rating if the minor medical claims go unreported. 

The Reality 

1.  The practice  of paying minor medical claims occurs on a nationwide basis throughout the work comp industry because of the driving goal to lower experience ratings. What difference does it actually make if the employer pays the salary of the plant nurse or pays the company clinic for a visit for the minor scrapes and cuts?  In Illinois, an employer is only required to report to the Commission all claims involving 3 days or more of lost time.  Minor medical claims need not be reported to the Commission.

2.  Both the employer  and TPAs need to be aware of the practical goal of lowering claim histories and allowing the prompt payment of medical bills on any new claims, if for no other reason than to prevent an injured employee from feeling forced into seeking legal help.

3.  Larger employers  can and do have an on site company nurse for exactly this purpose of providing minor emergency medical care. These minor incidents are not necessarily reported to the carrier or the TPA as a formal claim.  A company nurse or plant medical personnel can certainly pay for themselves over time if these minor injuries are all too common a problem at a particular facility.

Suggested Solution:

1.  Employers can  and do pay initial medical visits as a way to prevent injured workers from immediately seeking an attorney and litigation. If the initial medical bills are paid promptly, many of the claimants will never pursue filing a formal claim for benefits.  If these minor medical claims are not turned into the carrier as an actual claim, the employer then enjoys the benefit of a lowered experience rating, a lowered accident  history, a lowered mod rate and ultimately by lowering next year’s insurance premiums. But, the employers need to do this in cooperation with their carrier or TPA.

2.  TPAs and carriers  need to adopt or accommodate a policy of instructions for employer direct payment of minor medical expense like setting a dollar figure of say under $500, $750 or even $1,000 for that matter as defined as “minor medical” only claims like a trip to the company nurse or company clinic which does not involve any further medical care nor require any mandatory claim reporting.

3.  Keep in mind,  a visit to any modern day emergency room  easily costs over $1,000 and would with no doubt be serious enough to report to the carrier. (workersxzcompxzkit)

4.  An employer/TPA accommodation  would require the employer to keep accurate records of even minor medical events handled or paid internally so that later, if there are more serious developments, the employer does not prejudice the insurance carrier or the TPA in their defense or in investigation of the claim.

Brad Bleakney of Bleakney & Troiani in Chicago, IL practices in the areas of work-related injury claims third party litigation for accidental work injuries. He has a background in industry where he helped a Fortune 500 company reduce their workers’ compensation losses significantly. Brad can be reached at: Brad Bleakney, Bleakney & Troiani, 1 North Franklin (2625) Chicago, IL 60606 312-541-0045 or fax 312-541-0041 info@WorkComp-Chicago.com

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