Broadspire Medigram: Revisiting Some Controversial Topics

dr. jake headshotBy Jacob Lazarovic, MD, FAAFP Senior Vice President and Chief Medical Officer, Broadspire

 

REVISITING SOME CONTROVERSIAL TOPICS

 

TAKING OUR PULSE

 

Practicing medicine, or making decisions about the appropriateness of treatment, and the presence and extent of disability, is not always a straightforward issue. How many times have you heard the “experts” change their minds about whether a certain vitamin is useful, or whether eggs and coffee are good or bad for you?

 

In our world, we also must confront controversial issues and ensure that we are adopting “best practices” based on the most current evidence-based medical research.

 

So today we will revisit a few ongoing issues, see what the prevailing wisdom is, and review our current approaches.

 

JUST WHAT THE DOCTOR ORDERED

 

  1. Fibromyalgia

 

Fibromyalgia is not quite a disease, but rather a syndrome of various complaints involving fatigue, pains in muscles and other soft-tissues, and sleep disturbances. It doesn’t qualify as a disease because, to this point, there is really no firm evidence of any objective physical findings (that can be seen in lab tests, x- rays, tissue biopsies, etc.). It remains a largely subjective phenomenon.

 

There is debate about its cause, with proponents disputing whether it is a “brain” condition or a musculoskeletal one. Some scientists claim to have noted abnormalities on central nervous testing, such as MRIs. Others feel that is a psychological state akin to depression, which is why anti-depressants are often successfully used to treat it.

 

In 2013, one laboratory claimed to have discovered a blood test that can diagnose fibromyalgia, which would be a breakthrough. However, even though some insurance carriers now reimburse the test, many others consider it to be of unproven value, as do many researchers.

 

From our perspective the most important fact is that, regardless of what stance one takes on the above, there is certainly no evidence of an occupational causation. Consequently, our policy remains as follows, per our medical advisory on the subject:

 

FIBROMYALGIA MEDICAL ADVISORY

 

Medical Advisory:

Based on the above considerations, fibromyalgia, chronic fatigue syndrome (FM/CFS) and other related conditions, and treatments for such conditions, cannot be considered work-related. There is no evidence at all to substantiate any occupational factors or injuries as causative. The current best hypothesis is that FM/CFS, to the extent that it has “legitimacy as a discrete entity” represents a genetic pain sensitization phenomenon due to dysregulation of pain pathways related to atypical neurotransmitter levels. 

 

With respect to disability (functional impairment), this needs to be carefully evaluated based on objective evidence of physical and cognitive deficits. 

 

 

B)  Viscosupplementation (hyaluronic acid, HA) injections to the knee

 

These injections have been used for a long time to reduce the pain and stiffness of arthritic knees. They can be thought of as a “lubricant” that cushions the knee as the joint is in motion. However, there have always been skeptics questioning the effectiveness of this therapy.

 

Several recent studies, one of which is excerpted below, now validate this skepticism, demonstrating that there is no, or minimal, benefit from HA injections.

 

However, the Official Disability Guidelines (ODG) continue to recommend this therapy, although a very long list of utilization criteria must be met prior to approval. As further evidence is published, ODG may reconsider its stance on viscosupplementation.

 

Of course causality is also an important consideration. Knee osteoarthritis is a degenerative condition which, unfortunately, many of us will get, and not necessarily related to occupational activities. It typically affects multiple joints in the body and is thought to have a genetic predisposition as well. A careful analysis to determine whether the condition is genuinely causally related to an individual’s occupation is recommended.

 

ODG:

Recommended as an option for severe knee osteoarthritis (OA) for patients who have not responded adequately to conservative treatment (exercise, NSAIDs, corticosteroid injections), in order to potentially delay total joint replacement. Higher quality studies have shown the magnitude of improvement to be modest at best. While medial and/or lateral compartment OA is a recommended indication, there is insufficient evidence for other conditions including patella-femoral arthritis, chondromalacia patella, patella-femoral syndrome (kneecap pain), or osteochondritis dissecans. 

 


C)  Platelet Rich Plasma (PRP)

 

PRP is one of several blood products that can be extracted from a patient’s own blood, and then injected into a painful body part. In the case of PRP, the blood is concentrated to achieve a high number of platelets, which contain growth factors that, theoretically, when injected into damaged tissue, can help to heal and strengthen the involved area. It is commonly used for soft tissue injuries, although you may have noticed local newspaper ads in which medical entrepreneurs advertise its use for myriad conditions. Similar claims are being made for stem cell therapy.

 

Despite all the fuss, there remains no consensus that PRP or related therapies have meaningful benefit. Broadspire’s medical advisory, as well as the ODG, reinforce this view. The prevailing recommendation is that this therapy should be confined to rigorous clinical studies, and not used in the general population.

 

Medical advisory:

Blood product injection therapies are not recommended for certification/ authorization due to an absence of high-grade medical evidence permitting an evaluation or confirmation of the efficacy of this modality. There is currently insufficient evidence to support the use of these injection therapies.  Rigorous studies of sufficient sample size, using validated clinical, radiological and biomechanical measures and tissue injury healing response biomarkers are needed to determine long-term effectiveness and safety. 


BLOOD PRODUCT INJECTIONS MEDICAL ADVISORY
 

 

 

ODG:  Platelet-rich plasma (PRP)

Not recommended for chronic pain except in a research setting. PRP therapies are more complicated than previously acknowledged, and an understanding of the fundamental processes and pivotal molecules involved will need to be elucidated. PRP therapies in clinical trials await assessment. Platelet-rich plasma (PRP) therapy is a recently developed technique that uses a concentrated portion of autologous blood to try to improve and accelerate the healing of various tissues. There is considerable interest in using PRP for the treatment of musculoskeletal disorders, particularly athletic injuries. Because PRP products are safe and easy to prepare and administer, there has been increased attention toward using PRP in numerous clinical settings. Platelet-rich plasma has been used to treat conditions such as lateral epicondylitis, ligament and muscle strains, and tears of the rotator cuff, anterior cruciate ligament, Achilles tendon, plastic surgery and other conditions. Platelet-rich plasma can be applied at the site of injury either during surgery or through an injection performed in the physician’s office. However, there is little published clinical evidence that proves its efficacy in treating the multitude of injuries/disorders that are thought to benefit from PRP. 

 
CIRCULATING IN THE PRESS 

 

More Insurance Companies Now Paying for Fibromyalgia Blood Test

 

“In 2013, Los Angeles-based biomedical company EpicGenetics made international headlines when it introduced FM/a, the first ever fibromyalgia blood test.

 

While FM/a hasn’t caught on in most doctors’ offices, more insurance companies are now paying for the test.

 

Dr. Bruce Gillis, EpicGenetics’ CEO, says the No. 1 reason patients get the test is to prove to family members and others that they are really sick.

 

He believes physician bias is the main reason why the test is not more widely used.

 

The legitimacy of fibromyalgia has been complicated for decades because of the lack of a diagnostic test to prove its existence. It’s typically a diagnosis of exclusion – meaning illnesses with similar symptoms have been ruled out through extensive (i.e. often expensive) medical testing.

 

We believe [the term] fibromyalgia is a misnomer, he says. These people aren’t suffering with anything that’s affecting the muscles, per say. What they are suffering with is their immune system cannot produce normal quantities of protective proteins. There are cells in the immune system called peripheral blood mononuclear cells. They are not producing normal quantities of the protective proteins called chemokines and cytokines.

 

EpicGenetics’ research and the FM/a test aren’t without critics. Fibromyalgia expert Dr. Daniel Clauw has said EpicGenetics’ studies contradict other research, which has shown normal or elevated cytokine levels in fibromyalgia sufferers.

 

Researcher and rheumatologist Dr. Fred Wolfe called one of EpicGenetics’ studies “junk science”, saying it didn’t meet minimal scientific standards.”

 

 

Viscosupplementation for Osteoarthritis of the Knee

 

“Knee osteoarthritis is responsible for a large burden of care and cost within health care. Osteoarthritis results from an imbalance between the breakdown and repair of articular cartilage in any joint and occurs as a result of multiple risk factors including mechanical overload (obesity, heavy lifting), trauma, overuse (repetitive knee bending), and genetic predisposition.

 

The CDC (U.S. Centers for Disease control and Prevention) reports that one in two individuals may develop symptoms of osteoarthritis in at least one knee by eighty five years of age.

 

In conclusion, this best-evidence systematic review assessing the clinical significance of outcomes involving pain relief and functional improvement does not support the routine use of intra-articular HA. In contrast to previous reviews, we found no significant evidence of publication bias in the studies that we selected for analysis. The patient benefit of intra-articular HA was not clinically important when compared with intra-articular saline solution injections used as a placebo. Subdividing HA preparations by molecular weight did not change the results of the analyses. Selecting the best evidence resulted in significantly reduced heterogeneity but did not change the outcome; no clinically important improvement in pain and other outcomes from a patient’s perspective was found.”

 

 

How effective are platelet rich plasma injections in treating musculoskeletal soft tissue injuries?

 

“Platelet-rich plasma (PRP) has become increasingly popular in sports medicine and orthopaedic practice as treatment for muscle, tendon, and ligament injuries, and has received media attention because of its promise as a regenerative therapy.

 

We argue that patients should only be offered PRP for musculoskeletal soft tissue injuries within the context of well-designed clinical trials, with informed consent, high quality verbal explanations, and supporting written information. Advise patients that there is currently insufficient evidence to show that it is effective treatment for musculoskeletal soft tissue injuries. Clinicians offering PRP should ask manufacturers for the evidence of the platelet and growth factor concentrations, the constitution, and the viability of their PRP product (platelet activation levels).”

 

 

Efficacy of Autologous Platelet-Rich Plasma Use for Orthopaedic Indications: A Meta-Analysis4

 

“The recent emergence of autologous blood concentrates, such as platelet-rich plasma, as a treatment option for patients with orthopaedic injuries has led to an extensive debate about their clinical benefit. We conducted a systematic review and meta-analysis to determine the efficacy of autologous blood concentrates in decreasing pain and improving healing and function in patients with orthopaedic bone and soft-tissue injuries.

 

The current literature is complicated by a lack of standardization of study protocols, platelet- separation techniques, and outcome measures. As a result, there is uncertainty about the evidence to support the increasing clinical use of platelet-rich plasma and autologous blood concentrates as a treatment modality for orthopaedic bone and soft-tissue injuries.”

 

 

****************

REFERENCES:

  

  1. “More Insurance Companies Now Paying for Fibromyalgia Blood Test”, Donna Gregory Burch, http://nationalpainreport.com.
  2. “Viscosupplementation for Osteoarthritis of the Knee”, David Jevsevar, MD, MBA, et al, J Bone Joint Surg Am. 2015;97:2057-60.
  3. “How effective are platelet rich plasma injections in treating musculoskeletal soft tissue injuries?”, David Keene, et al, BMJ 2016;352:i517 doi: 10.1136/bmj.i517 (Published 17 February 2016).
  4. “Efficacy of Autologous Platelet-Rich Plasma Use for Orthopaedic Indications: A Meta-Analysis”, Ujash Sheth, et al, J Bone Joint Surg Am. 2012;94:298-307.

 


 

About Broadspire®

 

Broadspire (www.choosebroadspire.com), a global third party administrator, offers casualty claim, medical management, disability and absence management solutions, and risk management information services, helping increase employee productivity and reducing the cost of risk through early  intervention, professional expertise and data analytics. As a Crawford Company, Broadspire is based in Atlanta; Ga. Services are offered by Crawford & Company under the Broadspire brand in countries outside the U.S.

 


 

Leverage Physical Therapy Checklist To Return Employees To Work

When an employee suffers an injury to musculoskeletal system, the medical provider will frequently recommend a course of physical therapy for the employee. Self-insured employers who self handled their workers’ compensation claims need to know how to manage the physical therapy (PT). All employers can benefit from knowing how to manage PT.

 

 

Adjuster Physical Therapy Checklist

 

When the medical provider determines there is a need for physical therapy, the medical provider will advise the adjuster of the diagnosis, the modalities needed and the time frame. The adjuster, in the states where the employer/insurer controls the selection of medical providers, in turn assigns the physical therapy to a therapist provider. In states where the employee selects the medical provider, the medical provider will refer the employee to a therapy clinic of the medical provider’s choice.

 

Regardless who selects the therapy clinic, the adjuster for the employer needs to do the following:

 

  • Confirm the therapy clinic has the medical provider’s diagnosis and the amount of therapy recommended by the medical provider

 

  • Require the therapy clinic to do an initial physical therapy evaluation during the first visit by the employee and to provide a physical therapy evaluation and treatment plan following the first visit and prior to the second physical therapy visit

 

  • Provide the therapy clinic with billing information and obtain an agreement on whether each individual physical therapy session will be billed or if physical therapy sessions will be billed weekly or monthly

 

  • Discuss with the therapist the estimated time frame until the employee will increase his/her functionality

 

  • Obtain the therapist’s opinion on the possibility of the employee returning to work either full duty or modified duty

 

  • Provide the therapist with a copy of the employee’s job description

 

  • Set up with the therapist a timetable for the adjuster to follow up with the therapist

 

  • The therapy clinic should be instructed to advise the adjuster immediately if the employee cancels a physical therapy session for any reason, or is a no-show

 

 

 

Categories That Should Be Included in Physical Therapy Treatment Plan

 

When the adjuster receives the physical therapy evaluation and treatment plan following the first visit by the employee, the evaluation and treatment plan should be carefully reviewed. The following information categories should be in the treatment plan:

 

  • The diagnosis of the therapist – it should match the diagnosis of the medical provider. If not, this needs to be addressed right away.

 

  • The employee’s current physical limitations due to the injury

 

  • The employee’s prior medical history and if it will impact the physical therapy, how so?

 

  • The type of modalities the employee will receive

 

  • The frequency of the physical therapy visits per week, and the number of weeks the PT is projected to continue

 

  • The treatment goals and what is expected

 

  • The frequency the therapy clinic will report the employee’s progress to the medical provider

 

  • The self-care guidelines provided to the employee

 

 

If any of these categories are missing from the evaluation and treatment plan, the adjuster should discuss with the therapist the need for an addendum to the evaluation and treatment plan that discusses the missed categories.

 

The initial projections by the medical provider as to how long the employee will need physical therapy are not set in stone. Occasionally the employee will recover faster than expected from the injury and the physical therapy will be discontinued early.

 

 

If Additional Treatment is Requested, Consider Utilization Review

 

Sometimes the employee will recover slower than average resulting in the medical provider extending the requested physical therapy. When extended PT is requested, the adjuster needs to consider the effectiveness of the treatment. If the adjuster has any doubts about the need to continue the physical therapy treatments, the adjuster should arrange for a Utilization Review (UR). If the UR nurse rejects the need for additional physical therapy, the adjuster should ask the Utilization Review nurse to discuss the physical therapy request with the medical provider. If the UR nurse and the medical provider do not reach an agreement on the physical therapy requested, an Independent Medical Examination can assist the adjuster in determining whether to approve additional physical therapy or not.

 

Managing physical therapy is not difficult. It does take time, however when properly managed the employee’s recovery time is minimized. The PT clinic is an excellent source of information to assist the employer in returning the employee to work on modified duty, or full duty. By working with the therapist, the amount of time the employee is off work is limited to what is necessary.

 

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Humanize Work Comp To Realize Medical Savings

Medical costs continue to account for a significant portion of every workers’ compensation claims.  In order to address this matter, innovative teams are seeking improvements in the way they direct medical care and treatment in their claims.

 

 

Barriers in Directing Medical Care

 

All workers’ compensation programs are subject to a rigid statutory and regulatory framework that impacts the medical portion of every claim.  Notwithstanding the use of treatment parameters and fee schedules, the medical component in every jurisdiction can create challenges.  Some common barriers faced by the claim management team include:

 

  • Choice of medical providers and the ability of the employee to switch providers during the course of medical treatment;
  • Failure to use correctly an independent medical examination (IME) to mitigate exposure on a claim. This can often include selecting a doctor who lacks the correct credentials or familiarity with the injury in the claim; and
  • Problems dealing with medical care that enables the injured worker to malinger.

 

 

Dealing with Common Pitfalls in Medical Care

 

The claim handler in charge of the claim is on the front lines when it comes to dealing with injured workers and making sure they receive the benefits, care and treatment they are entitled to post-injury.  This requires that member of the claim management team to take a proactive approach to dealing with these issues and reducing future exposures.

 

Here are some important things to consider:

 

  • Educate the employer/clients regarding injury prevention;
  • Be proactive when it comes to reporting claims. Time is of the essence.  A promote injury response can also buy good will from the employee and their attorney;
  • Have good lines of communication with the medical representatives of the employer. This should include having a coordinated response immediately post-injury and continue throughout the course of care; and
  • Gain the trust of all medical providers outside the scope of the preferred employer medical team’s network. This includes conducting yourself in a professional manner at all times.  By gaining their trust, you will more likely than not gain their cooperation.

 

 

The Human Element of Workers’ Compensation

 

To the injured workers, members of the claim management team are often faceless individuals that are guardians of the insurance carrier’s financial interests.  This perception leads to the false conclusion by injured parties and their family members that the claim handler does not consider the interests of the injured employee.  Personalizing the services you provide can pay dividends during the course of managing the claim.

 

Various steps can be taken to gain the trust and cooperation and “humanize” the workers’ compensation process:

 

  • Provide accurate information whenever dealing with the injured party or their legal representatives;
  • Be responsive to their communications. Set realistic and reasonable expectations from the outset of the claim.  Develop the relationship as you would any other professional interaction.  Personalizing the response is helpful; and
  • Empathize with the position of the injured party. Although workers’ compensation wage loss benefits are tax free, they are being paid at a reduced rate.  When the injured person is off work, it is important to remember their bills do not have a similar reduction.

 

 

Conclusions

 

Reducing the medical costs in workers’ compensation claims requires an active role by all members of the claim management team.  Part of this requires individual claim handlers to make the extra effort in their file load.  It is also necessary for the claim handlers to bring a sense of humanity to their claims when dealing with injured employees.

 

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

7 Considerations For Selecting Your Work Comp Doctor

Hello. Michael Stack. Principal of Amaxx, founder for COMPClub and co-author of Your Ultimate Guide to Mastering Workers’ Comp Cost. I want to give you a success tip that actually comes out of the 2016 version of Your Ultimate Guide to Mastering Workers’ Comp Cost, it is the fifth step of the five-step system to reduce your cost by 20 to 50%. That step is in regards to medical and pharmacy cost containment.

 

 

7 Considerations To Use in Doctor Selection:

 

When we talk about managing workers’ comp claims and reducing workers’ comp cost, one of the things that we often forget is that these are medical injuries, and they need the expertise of medical providers for the healing and recovery of those injuries. I want to give you seven considerations to use as a reference point for the selection criteria of the medical providers that you work with at your organization.

 

Now, when it comes to doctor selection the laws are going to vary by states. You’re going to want to definitely check with your jurisdiction. It’s either going to be an employee-directed state, an employer-directed state, or often times a blend of those two. There are some states where the employer can have zero input whatsoever, so be sure to check with your state laws. Often times even in an employee-directed state, you can do what’s called soft channeling by setting up relationships with high quality providers and giving a recommendation to your employees to go to see them if they chose.

 

 

Care & Credentials

 

Let’s talk about these considerations and some of these criteria that you should use. Of these seven considerations, there’s really two main categories that they’re going to fall under. The first is care and the second is credentials. The first category is care, how much those providers care, and the second is what are their credentials. Let’s talk about some specifics here.

 

 

Be responsive to employees’ needs and willing to return them to work

 

The first thing that you want to look at in regards to care is you want to talk about how much responsiveness do they have to your employees? Responsive to your employees’ needs and a willingness to return them to work. Responsive to your employees’ needs and a willingness to return those employees to work.

 

 

Visit your organization

 

Second criteria here is that they visit your company. They actually go to your job site to visit your employees and find out what type of work they’re doing on a regular basis, get to know your organization, and at the same time be willing to use your forms in your return-to-work program in order to get the medical restrictions and get them back to work to work within your system. Their responsiveness, their willingness to return them to work, and then also visiting and understanding what those job descriptions are understanding what type of work your employees are doing, and using your forms to feed right into your system.

 

 

Be available to schedule employee’s appointments without delay

 

Selection criteria number three is scheduling appointments. You want to make sure that your employees can get in to see these providers easily. One of the studies that WCRI just recently came out with was in regards to worker outcomes, and the ability for the employees to get the care that they needed was one of the biggest factors in determining whether they would ever come back to work. The ability to get the care that they needed was one of the biggest factors in determining whether they would ever come back to work, so being able to get in to see those providers is a key selection criteria.

 

 

Spend extra time with your employees as needed

 

The last criteria here is time. How much time are those providers able and willing to spend with your employees? If you’ve ever studied human relations, you know that one of those principles is people don’t care how much you know, until they know how much you care. People don’t care how much you know, until they know how much you care. That’s what this first set of criteria (is about), this first selection criteria, is making sure those providers care to work with your organization and they care about your employees and what’s best for them, which is getting them back to work.

 

 

Possess outstanding medical credentials and an excellent reputation

 

Let’s talk about these credentials, because if you have this down, then of course, the quality of those providers is an extremely important piece as well. The first thing you want to look at is their credentials, their actual medical credentials and their reputation in the community. What is their background? What is their expertise? What is their specialty, and then what is their reputation in the community? You obviously want to work with a very high quality provider to provide your employees with the highest level of medical service that’s available.

 

 

Provide medical records and reports timely, be available for consultation with claims team

 

Number two then. In regards to working with your claims management team, you need to be able to get the reports and any records and any communications and conversations that need to be had with your adjuster, with your nurse case manager, and with your claims management team, providing reports, providing records, and having conversations. Their ability to provide that information to ensure your employee is getting the best medical treatment, to get the best medical outcome, getting them back to work, and by the way, that will lead to the lowest amount of workers’ compensation cost.

 

 

Provide detailed medical restrictions for return to work

 

A final point then, and probably most important from an employer standpoint, is be able to get restrictions for return to work. To be able to get restrictions, the medical restrictions, to understand what that employee can do safely and productively at your organization in a return-to-work program. You need to have them sign off that they’re able to go back to work and understand what those restrictions are. For example, they have a 10-pound, a 20-pound, a 30-pound weight-lifting limitation, they can only stand for a certain number of time, etc, so understand what those restrictions are, have it written out in your form, and get those employees back to work as soon as possible.

 

 

That’s the selection criteria for your medical providers. Remember, your success in workers’ compensation will be determined and defined by your integrity, so be great.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

How Much Time Are Doctors Spending On Your IME?

doctor tabletThe independent medical examination is one of the most important components of a successful workers’ compensation claim.  This is because in most jurisdictions, the defense gets one opportunity to see and examine the injured employee by a medical expert of their choice.  One of the most important factors to consider in selecting the correct service provider is seeking out only those that add value to your claim.

 

 

Selecting the Right Medical Expert

 

An important component when selecting an IME service provider is the panel of medical experts they offer.  In the modern workers’ compensation system, there are a whole host of injuries.  This gives rise to the need to work with a service provider that has a wide variety of medical experts.  This also includes connections with specialists in a number of fields.  Some of these areas include orthopedics, neurosurgery, psychology, and psychiatry.

 

Before selecting the right IME doctor, it is also important to know the background of the expert.  Part of this investigation includes and understanding of the doctors medical training, professional experience and other specialties.  It is also important to consider an expert who has written peer-reviewed articles for medical publications and/or hold distinguished lecturing credentials.

 

 

How Much Time Are Doctors Spending On Your IME?

 

It is also important to understand the physician’s perspective performing an IME. The demands on a physician’s day are well documented, and increasing administrative requirements and changes in health care have only made the job more difficult.  An important question to ask is how much time are doctors spending on your IME?  In many instances, providers will fill the doctor’s schedule with appointments, which does not allow the doctor adequate time to complete a thorough exam and determine a thoughtful conclusion.  This detracts from the final and most important product when defending a case—the IME report.

 

Best practice dictates the physician to be fairly compensated, and allowed additional time to complete the exam and IME report.  The end result is a thoughtful report in which the medical opinion becomes a material element in your claim.

 

A second necessity for adequate time from the IME doctor is providing and receiving additional information as required by the adjuster and/or nurse case manager.  A high quality physician that will render a high quality opinion needs to be fairly compensated for this additional time. However, the investment can often lead to a significant return as the opinion is based on adequate information and all parties are able to agree on the proper course of action on the claim.

 

 

Preparation and Turn-Around Time

 

The final element to consider in the relevance of time to your IME is in preparation and turn-around of the report.  There must be the ability for the IME providers to access medical records and reports for review by attorneys and claim handlers prior to the examination. It is also important to have a reliable point of contact to handle issues as they arise throughout the process.

 

Important matters to consider include:

 

  • Turnaround times for the completion of reports; quick turnaround time is important, however, not at the expense of report quality. Waiting a day or two extra for more a comprehensive report that substantiates all requested issues would most likely impact the potential exposure of a case then getting a report back a day sooner;

 

  • Quality assurance measures that include a review of the report for typographical errors; and

 

  • Superior customer service.

 

 

Conclusions

 

The independent medical examination is one of the most important parts of defending a workers’ compensation claim. The main question asked at the deposition or hearing is whether the medical expert has adequate foundation to issue their findings and opinions within a reasonable degree of medical certainty. Increasing demands on physician’s time, along with increased pressures on lower fees often creates a low quality IME report. Ensure your IME physicians are fairly compensated and have adequate time to complete a high-quality, meaningful report.

 

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

MRSA: Infectious Diseases in Work Comp

Dealing with MRSA infections in workers’ compensation claims presents a number of challenges to the claims management team.  Given the rise of these infections, it is important for the claim handlers to understand the basics of managing such claims.  Dealing with these issues in an effective manner can help the employee return to work in a timely manner and reduce the cost to a workers’ compensation program

 

 

What is MRSA?

 

MRSA is known in the medical community as “Methicillin-resistant Staphylococcus aureus” infection.  It is a strain of bacteria found the in the “staph family” that is dangerous and in some instances deadly.  A main area of concern is that this family of staph-type bacterium is resistant to common antibiotics. This complicates the management of a workers’ compensation claim and can damage key vital organs such as the heart and lungs.

 

 

Compensability of MRSA Infections

 

Issues concerning compensability from infections are different in each jurisdiction.  There are various factors, which come into place when analyzing these cases.  Matters are also complicated based on the fact a person not working in a healthcare position could contract such a condition and make a claim for workers’ compensation benefits.  Larson’s Workers’ Compensation Law touches to some extent on this issue when discussing contagious diseases that may be “ordinary.” Larson’s categorizes a MRSA infection in the same classification of claims involving heat, cold and elements exposure.

 

It is important to consider the following scenarios that could result in program exposure:

 

  • Direct workplace exposure: Most jurisdictions allow an infection to be compensable if it arises from direct workplace exposure; the nature of one’s work is a factor to consider.  In all likelihood, healthcare professionals who are exposed to infectious diseases would have an easier time proving their claim when compared to someone in a typical office or factory setting.
  • Exposure during medical care and treatment: Issues concerning compensability in this setting vary.  The general rule is that employers/insurers are responsible for medical care and treatment (and disability) resulting from the injury, as well as injuries that occur during such care.  The injured worker still carries the burden of proof, but could argue that such infection was contracted during the course of medical care, especially if the treatment required an invasive surgical procedure.  Claims of this nature must be handled with care and include exploring potential subrogation claims for medical malpractice.

 

 

Practice Pointers for Handling MRSA and Infection-Related Cases

 

Questions of compensability in workers’ compensation are fact dependent.  Complex issues require the assistance of an attorney.  An experienced claim handler should come to understand areas of inquiry that can assist on primary liability determinations prior to legal involvement.

 

When reviewing a claim for benefits involving MRSA, one should examine the following areas:

 

  • A sudden onset of MRSA, or other staph-related symptoms and/or infections. These types of infections usually develop within a few days of exposure and contraction of the infection.  Areas of investigation include where the claimant has been and persons they have had contact with prior to contracting a condition;

 

  • Development of a MRSA related infection immediately following hospitalization or surgical intervention. Medical facilities and other areas that stress cleanliness are often a breeding ground for bacterial infections.  Exposure to these conditions often occur during or after a hospitalization or surgery.  It should be an area of investigation as to whether the claimant visited a medical facility to visit a family member or individual; and

 

  • An established medical history on staph-related symptoms and/or infections.

 

 

Conclusions

 

Defending MRSA and other staph-related poses a series of difficult questions for the claim management team.  Given the nature of these conditions, it is important that team members investigate fully all possible sources of contraction and defend the claim as appropriate.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

6 Factors that Slow Recovery from a Workers Comp Injury

An injury is an injury.  Structurally something occurs within the body that leads to being uncomfortable and in pain. The goal is always to get back to pain-free as quickly as possible.

 

But this goal is harder to attain for some people than others.  Adjusters can handle thousands of claims within the timeframe of their career.  And it is within the handling of these claims that the adjuster becomes familiar with the non-work related comorbidities and how they affect the duration of a claim.  Below we discuss 6 of the more commonly seen issues and how they can affect the duration of an injury claim.  

 

  • Smoking or other tobacco use

 

It is not a new revelation that tobacco use can prolong healing. Many occupational studies have been performed that prove that tobacco users can take longer to heal than those who do not use tobacco. One of the first questions the adjuster asks when taking a statement is if the claimant smokes or not.  This is done because tobacco users will take longer to heal, which means the claim will last longer create a need for a higher reserve on the file.

 

 

  • Diabetes

 

Another question asked during the claimant statement process will be if the injured worker has diabetes.  The positive diagnosis of diabetes will prolong healing, which means a higher reserve will have to be placed in the file.  Maybe not so much with a minor strain, but especially true with a bone fracture.  Severe injuries with a positive diabetes finding will require the adjuster to keep a close eye on the progress on the file.

 

Complex fractures with diabetes will often be transferred to a more advanced adjuster familiar with how the treatment process will flow.  These claims often are around for a period of months to years and require more complex therapies and costing a lot more than the normal.  Onsite nurse case managers will be used to be involved in the recovery process, and to talk to the doctor about how the patient is doing and what roadblocks may be ahead. This is all done in an effort to remain proactive on the claim, and to expect the unexpected should it happen to occur.

 

 

  • Obesity

 

The finding of obesity is usually not viewed as complex as diabetes, but it can lead to prolonged healing depending on the type of injury and the overall body habitus of the injured worker.  Moderate to severe lumbar strain claims can hang around longer with obesity than without.  However, just because a person is labeled obese does not mean that they are out of shape or generally weak.  Sure their back may be weakened due to conditioning issues, but that may or may not have a tangible impact on the claim.  More importantly, if the claimant fails to heal within a certain timeframe, the adjuster may ask the treating doctor if the nagging continued pain is due to the obesity rather than an acute injury.

 

This can be hard to prove.  The adjuster has to figure out if the claimant has pre-existing back pain, especially is past medical records show evidence of this pain.  The doctor will be called on to separate these two issues and make a determination of what is work related and what is pre-existing.

 

 

  • Pre-Existing injury

 

Using the back as an example, if a person is performing a task and feels back pain, they could have a work comp injury.   If this worker was off of work for non-work related back pain, then comes to work and feels back pain, how does the adjuster know what is work related and what is not?  The only person that will know is the claimant, since they are the ones feeling the pain before and after the injury.

 

Adjusters have to reinforce the fact that just because someone is at work and has pain, this doesn’t 100% guarantee that an injury or pain is work related.  There has to be an isolated event, with a mechanism of injury present to produce the pain.  This is where claims can get messy, because the worker feels that whatever they did at work is what caused or worsened their pain.  On the other hand, if the adjuster finds out that this worker has had a lot of back pain issues or prior comp claims for back injuries, then the adjuster will deem that this worker has a bad back probably from some non-work related issue, and that work is merely exacerbating those issues.  Depending on the jurisdiction, this may or may not affect the compensability of the claim.  If you as the employer know that your worker has a storied history of back issues, be sure to tell your adjuster.  It is usually a safe bet that the claimant may not be so forthcoming with their prior back issues when asked by their adjuster.

 

 

  • Medication side effects

 

A lot of research has been done to show that some medications may not be very helpful with chronic injury.  These meds were used for acute pain in the early stages of a claim.  Injured workers placed on strong levels of medications for months and months build a tolerance to the med, and their complaint will be that they feel no relief from the medication after a few months.  So they take more, which can open the door to potential addiction issues.  Adjusters have been warned that injured workers taking strong opiate meds need to be monitored very closely, both with dosage and with urine tests, to make sure they are not taking more than prescribed or obtaining other types of opiate medications from other treating physicians.

 

 

  • Depression

 

The diagnosis of depression can mean several things, with varying severity.  When an injury occurs adjusters will send a medical release over to the claimant to sign, so they can obtain medical records from their primary care doctor.  When receiving these records adjusters will review the medical notes looking for anything that can contribute to a claim, be it occupational in nature or not.  Insurance carriers have started to notice that a lot of functional workers also have a diagnosis of depression, usually treated with medication.

 

Comparisons are starting to show that those with underlying depression issues can also have delayed healing times, for a multitude of reasons. This is somewhat of a new issue in the world of work comp, and it is one to keep an eye on.  On the surface, if you make a blanket assumption, one would think if a person has depression that this could delay their healing, but again it is not always the case.  It could be safe to assume that it can impact the file negatively, and it should be noted in the file, but I have seen cases both ways.  The important thing is that it is noted properly in the file, in case it does come in down the road as a barrier to healing, whether physical or psychological in nature.

 

 

Summary

 

Every day there are workers injured on the job.  It is difficult enough as an injured worker to deal with getting the medical help you need to get better, combined with income loss and the stress of dealing with being in pain.  When you add the factors in above along with the injury, you can see how the injured worker can become frustrated and have increased anxiety with the whole claims process.

 

It is important as adjusters to properly note the issues above, and how they can negatively impact a claim, especially on the reserving aspect.  It is not to say that if a worker has one or more of the above that they are doomed and will never get better and never return to work.  Chances are they will return to gainful employment, It just may not be as quickly as either party had anticipated.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

WCRI Recap: Impact of Fee Schedules On Case Shifting in Work Comp

 

Hello, Michael Stack here, Principal of Amaxx and Founder of COMPClub.  The dust has settled on the WCRI conference which occurred about a week and a half ago.  I’d had a chance to look through my notes and I want to share some of my top take-aways from the sessions.

 

 

Do Higher Fee Schedules Affect The Number Of Workers’ Comp Cases?

 

Please note the results of this WCRI study are preliminary and subject to change.

 

The first session was called the Impact of Fee Schedules on Case Shifting in Workers’ Compensation.  And what they did in this session was ask the question “Do higher fee schedules end up having an impact on the number of cases that are considered workers’ compensation”. What they did was they took a look over a number of states, and the fee schedule in those states.   This is going to be a very rough draft outline of what that graph looked like.  But, essentially there were a number of states that were in the middle that had very similar fee schedules, and there were some outliers that were high and low.   It was ultimately the comparison of those outlier states that lead to the data in this study.

 

Basically they looked at the two different types of injuries, the two different classifications or main classifications of injuries.  And we all know there are some injuries in workers’ comp that are very clearly defined, they are clear as the causation of that injury.  And there are some that are unclear, or much more gray as far as that causation and much more up the doctor’s discretion to classify that particular injury.

 

Now these clear cases are typically trauma cases, these are physical injuries that require immediate medical attention right after the injury.  The unclear or gray-area claims, these are more the back injuries, stains, shoulder or knee injuries.  Again the causation is much more gray or unclear, and it’s very much up to the discretion of the doctor to define whether or not that injury would be considered workers’ compensation.

 

 

No Change When Causation Clearly Defined

 

So, the next thing they did was they looked at these fee schedules, the impact the fee schedule had on the number of claims.  The number of claims that were considered workers comp for that particular type of injury.  Here is what was interesting and really was the conclusion of this study. In these clear cases, the clearly defined cases, that the causation was very much known and undisputed, there was no change in the number of cases that were considered workers’ compensation.  When the causation was clearly defined, there was no change in the number of workers’ compensation cases.

 

In the unclear, or gray area cases, when it was up to the discretion of the doctor to define whether or not it was a workers’ compensation case; what they found was that a 20% increase in the fee schedule lead to a 6% greater odds that case was considered workers compensation.  So, a 20% increase in the fee schedule for the provider, for that back injury, a 6% greater odds that case would be considered workers’ compensation.  And they equated this down to a 1.5% increase in costs.

 

Now 1.5% might now sound like a large percentage, but from a state level, from a policymaker level, that can equate to millions and millions of dollars.  So, what does this mean for you, what sort of an impact do these numbers and the results of this study have on your organization?

 

 

Understand Tendency Exists To Shift Gray-Area Claims

 

My take-away from this is really the understanding this tendency exists, the understand that this incentive exists at the provider level.  From a work comp management standpoint, the action step that I would recommend is to have a medical review become a standard part of your company compensability investigation.  I’ll say that one more time, so from a work comp management standpoint, have a medical review become a standard part of your company compensability investigation.

 

Because of this tendency, particularly on these unclear, or gray area claims, bringing that exertise to the table on your side can ensure that you are not accepting claims that you should not be, and thereby paying costs that you shouldn’t be paying.

 

So, again, in workers’ compensation, your success if defined by your integrity.  So, be great!

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Is A Cheaper Doctor Better For Your IME?

The independent medical examination (IME) is one of the most important parts of defending a workers’ compensation claim.  Part of the IME process includes selecting the correct doctor.  There are a number of other factors to include in this decision making process.  Part of this important decision includes the cost of the examination.  However, picking the doctor based solely on cost can have an adverse impact on your claim.

 

 

What is an IME?

 

An IME is an examination conducted by a medical doctors selected by the defense in a workers’ compensation case.  This is something recognized in all workers’ compensation systems and is one of the few instances where the employee and their attorney have limited grounds to object.

 

There are some constraints to this examination which members of the claim management team should be aware.  While these limitations vary in each jurisdiction, some common themes include:

 

  • The timing of the examination and when it needs to take place;

 

  • When the report following the IME needs to be served and filed with the state industrial commission and/or the claimant;

 

  • The distance in which the claimant needs to drive in order to attend an IME;

 

  • Reimbursement of reasonable costs for the claimant to attend the examination; and

 

  • What documents are discoverable following the IME. This can include correspondence between the defense attorney/claim management team and the IME doctor.

 

Statues and regulations typically define the parameters of the IME process.

 

 

Factors to Consider When Selecting an IME Expert

 

There are numerous factors to consider when scheduling an IME.  Failure to consider these factors can impact your case.  A main example that will be questioned at deposition or hearing is whether the medical expert has adequate foundation to issue their findings and opinions within a reasonable degree of medical certainty. The quality and relevancy of the doctor issuing the report is a significant factor during litigation.

 

Before selecting a doctor, it is important to review the following items concerning your expert:

 

  • Medical training and board certifications;

 

  • The nature of their practice and degree of experiences with injuries at question in your claim;

 

  • Professional accomplishments, including scholarly publications and professional lecturing;

 

  • Credibility of the expert within the local medical and legal community; and

 

  • Bedside manner and the professionalism they exhibit should the case become a “battle of experts.”

 

 

Should the Cost be a Consideration?

 

The cost of litigation has become a significant focus within the claims management industry over the past decade.  This has required teams to analyze the services they receive, which includes the use of medical experts.  While the cost of an IME is fair game, attempting to ‘save’ in this category will often have adverse claim affects as one will get what they pay for.

 

The higher-end doctor whose opinion will carry the most weight in court, is also the doctor whose time is most in demand.  Attempting to pay a discounted fee for an IME report will more likely gain interest from discount doctors.

 

Instead of focusing on the cost of an IME, claims management teams should look at the big picture of the claim and evaluate the experience of an IME service provider and the composition of their doctor panels.  They should also evaluate the other services a company can provide that give them a competitive advantage by offering a holistic approach to IME services.  These additional services should include:

 

  • Medical Peer Review & Record Review;

 

  • Expert Witness Evaluation / Review;

 

  • Diagnostic Review; and

 

  • Other medical evaluative claims services.

 

 

Conclusions

 

The IME is an important component for properly defending a workers’ compensation claim.  While the cost of the IME doctor can be looked at as an expense, it should not be an area to look for discount pricing.  Making a slightly higher investment in a higher quality doctor can be the difference between winning and losing your case.  Companies should look for service providers who offer a variety of additional services to complement a high quality doctor panel.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Write a Great Workers’ Compensation IME Letter

Members of the claim management team are often called upon to write a cover letter to a doctor for purposes of an independent medical examination.  This is sometimes an overlooked part of a claim handler’s job.  Care should be taken to writing an effective letter as it will help at later points of the claim, including future litigation.

 

 

Important Points of Consideration

 

The cover letter for an independent medical examination is an important part of a claim.  The person drafting the letter should consider the following matters:

 

  • The cover letter sent to a medical expert is subject to discovery protocols. Make sure the letter is free from bias, written in a manner respectful of the injured worker and completely factual;

 

  • Letters to medical experts should be clear and concise. Avoid adding unnecessary information and your personal opinions; and

 

  • Make it clear as to the procedural posture of the case and let the medical expert know what findings and opinions are seeking.

 

 

Laying Proper Foundation

 

In order for expert testimony to be accepted, the examining doctor needs to have the requisite medical background.  They also need to demonstrate they have seen and examined the injured worker and have a complete set of facts.  A great IME cover letter will help the expert do this.

 

  • Provide the doctor with a complete background of the case on the body of the letter; and

 

  • Provide the expert with a complete set of medical records. List the records you are sending to the doctor in the body of the record.  It is also important to request the doctor re-state the records they reviewed in the final report.

 

 

Issues of Causation and Need for Medical Care

 

Remember that workers’ compensation cases typically have a lower threshold of compensability when compared to other personal injury cases.  Consider asking the expert the following questions:

 

  • What is your diagnosis and prognosis of the Employee’s complaint(s)?

 

  • What is the substantial contributing cause of any diagnosis you make? Further, what is the etiology of any diagnosis you make?

 

  • In your opinion, did the claimed events of DATE OF INJURY HERE, aggravate, accelerate or otherwise substantially contribute to the onset and progression of the Employee’s diagnosed condition?

 

 

Always Ask About Maximum Medical Improvement/End of Healing Period

 

Maximum Medical Improvement (MMI), or “end of healing period” is an important threshold in workers’ compensation cases.  In most jurisdictions, it can signal the end of a claimant’s temporary total disability (TTD) benefits.  It can also serve as a basis for rating any permanency.

 

Here are some suggested questions to consider:

 

  • In your opinion, has the Employee reached Maximum Medical Improvement for all diagnosed conditions? If so, when did the Employee reach Maximum Medical Improvement?  If not, when would you expect the Employee to reach Maximum Medical Improvement for all diagnosed conditions?

 

  • Do you agree or disagree with Dr. NAME HERE’s opinion, found in the medical records from PROVIDER NAME, dated DATE HERE, which the Employee reached Maximum Medical Improvement on DATE HERE? Why or why not?

 

 

Be Careful When Asking About Permanency Rating

 

Asking about a permanency rating can be detrimental to a case when asked in the early phases of litigation.  Be sure to consult with your attorney or others on your team when asking the following:

 

  • Did the Employee sustain any ratable permanent partial disability, pursuant to the STATE NAME Workers’ Compensation Permanency Guidelines as a result of the work injury of DATE HERE? If so, please state what would you attribute any permanent partial disability, citing the specific section in the STATE NAME Workers’ Compensation Permanency Guidelines?

 

When in doubt, simply ask the examining doctor to evaluate for this issue, but defer stating these opinions in writing.

 

 

Other Questions to Consider

 

There are also other matters to consider when obtaining an independent medical examination.

 

  • The reasonableness/necessity of prior medical care and treatment;

 

  • Whether all prior medical care was in conformance with any applicable treatment guideline;

 

  • Any future medical care and treatment that maybe related to the work-injury;

 

  • Issues regarding appropriate medical restrictions on the employee’s activity;

 

  • Matters concerning future employability and permanent total disability issues.

 

Before asking these questions, consider your case and the purpose of the examination.  Asking non-germane questions may open matters for additional claims.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Professional Development Resource

Learn How to Reduce Workers Comp Costs 20% to 50%"Workers Compensation Management Program: Reduce Costs 20% to 50%"
Lower your workers compensation expense by using the
guidebook from Advisen and the Workers Comp Resource Center.
Perfect for promotional distribution by brokers and agents!
Learn More

Please don't print this Website

Unnecessary printing not only means unnecessary cost of paper and inks, but also avoidable environmental impact on producing and shipping these supplies. Reducing printing can make a small but a significant impact.

Instead use the PDF download option, provided on the page you tried to print.

Powered by "Unprintable Blog" for Wordpress - www.greencp.de