The wrong doctor treating the employee for a workers compensation injury is one of the biggest mistakes an employer can make. It is a very fast way to incur higher than necessary medical expenses and higher than necessary indemnity cost. The proper selection of the medical provider is crucial to the overall outcome and cost of the workers compensation claim.
While most employers are blissfully unaware of the importance of the medical provider selection, it is a fact very well known by the plaintiff’s bar association. When the concept of workers compensation was being adopted by the states nearly a hundred years ago, the employer always provided the medical provider. Over the years in approximately half of the states, the plaintiff’s bar has wrestled control of the medical provider selection away from employers and put it in the hands of the employee (who normally allows the attorney to make the medical provider selection).
Why is the selection of the medical provider is important to the plaintiff’s bar association? The answer is simple: money. The television attorney holding a fistful of money while soliciting the injured employee got most of that money by controlling the selection of the medical provider.
The plaintiff attorney representing the employee works for a percentage of the indemnity benefits paid to the employee. The more indemnity benefits paid to the employee, the more money the employee’s attorney makes. Hence it is in the best interest of the employee’s attorney to keep the employee off work as long as possible and for the employee to get the highest possible disability rating (regardless of whether or not it is accurate).
The large majority of medical providers are honest in the assessment of the employee’s ability to return to work light duty or full duty and are honest in the assessment of the employee’s permanent partial disability rating. Some of the doctors in this large majority are more liberal and some are more conservative, but even within those parameters they remain honest.
Unfortunately, there is a small minority of doctors, concentrating primarily in the chiropractic field and the orthopedic field, that sold off souls to the plaintiff’s bar. Whether it is by collusion with the plaintiff attorney or a silent agreement, the plaintiff attorney sends as many of his clients as possible to the “doctor” who in return keeps the employee off of work as long as possible. The employee remains off work until the employee wants to go back to work, or the doctor can no longer justify keeping him off work. The doctor then consults the disability rating guide used in that state, and gives the employee the highest possible disability rating out of the possible range of disability ratings.
This is a win-win situation for the attorney and the doctor. The doctor increases the attorney’s income, and the attorney increases the doctor’s income. The employer loses. The higher the amount paid to the employee in temporary total disability and permanent partial disability, the higher the eventual workers comp insurance premium will be for the employer.
What should the self-insured employer or insurance company do? The employer cannot conspire with a doctor to put the employee back to work before he is physically able to return to work and will not conspire with a doctor to falsify the disability rating. The answer is to consult with the workers compensation defense attorneys in the area where the employer is located. The defense counsels who have had extensive experience dealing with the various doctors in the areas can advise who are conservative, moderate or liberal in disability ratings. They can tell you which doctors get the employees back to work timely. They can also warn of doctors who work solely for the plaintiff’s bar.
We would recommend consulting with defense counsel and learn the precise requirements of the state. In some states, the employer only has to post one medical provider, while in other states the employer must post a list of medical providers (also referred to as a panel in some states). The list of medical providers should include both general practice doctors for the minor injuries, the orthopedic specialists, the emergency care facility and/or hospital and, any other specialties required by the state.
Not only should the employer ask defense counsel what the posting requirements are for the particular state but should also ask the names of conservative, reputable doctors. Employers need doctors who will provide the employee with all necessary medical care, but will also work to get the employee back to work on modified duty or full duty as soon as practical. Also doctors who will give the employee a fair, objective disability rating, if one is needed, are ideal.
Occasionally there will be a plaintiff attorney who will ignore the employer’s posted list of doctors and send the employee to a favorite doctor. The claims adjuster should immediately object and advise the attorney that any medical care the employee receives at the non-approved doctor will be at the employee’s own expense, plus if the employee does not attend the medical appointments with the employer selected doctor, the indemnity benefits will be suspended.
In the states where the employee has the right to select the medical provider, we suggest for the employer to post the “recommended” (not required) doctors suggested by defense counsel. While this will not stop the plaintiff attorneys from sending the injured employee to their favorite doctor, it will eliminate some of the claims that end up in the hands of plaintiff attorneys as the employee will be receiving the medical care they need timely.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20-50% www.WCManual.com. Contact: RShafer@ReduceYourWorkersComp.com.
Our WORKERS COMP BOOK: www.WCManual.com
VIEW SAMPLE PAGES of Chapter 12
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact