In the insurance profession, claims adjusters will see the same physicians over and over again. But instead of working with them for a common goal, they tend to view the treating doctor as the enemy.
To medically defend a claim you have to obtain a medical opinion from another physician that goes against the diagnosis and causal relation statement of the treating physician. Adjusters know the IME doctors that they like to use in certain scenarios, depending on the injury and whatever goal they are attempting to attain.
Catch More Bees With Honey – Work To Develop Relationship With Treating Doctor
But oftentimes they fail to create a good relationship with the treating doctors that they see nearly every day. These could be occupational clinic doctors, specialty doctors, and surgeons. Even when a claim is compensable, the adjuster is going to spend a lot of time dealing with the office of the treating doctor, but fail to really talk to the doctor over the phone.
Every treating doctor has their own style of treatment, and some are more thorough than others. Adjusters will send faxed letters over to the treating doctor asking them to address certain questions. If they do not get the outcome they expected, they spend the rest of the file with a chip on their shoulder.
This situation can be avoided by picking up the phone, or better yet, going to the office. Ask to speak with the office manager and see if that person will give you a tour of the office and to introduce you to the treating doctors. Explain your role and the common patients you have had. I would be surprised if they refused to show you around.
If the tour is successful, later on try to schedule a time to meet with a few of the doctors before or after their clinic hours. You may be surprised to find out that they know who you are as well!
The goal of this is to open the lines of communication. Talk to them about what your role is. Some treating docs have not had the best experiences with work comp adjusters, and they come in guarded with their own attitudes. Once you get the defense wall down, you may find out how willing they can be to help you in cases you have in common.
You may also find out that you have more information than what was shared with the doctor from the patient directly. You can help the doctor connect the dots between job descriptions, injury descriptions, return to work light duty programs, and so on. If the doctors knows that you are open and approachable, you may be able to better handle the file rather than jumping to an IME and incurring the additional costs.
If Having Trouble, Get A Referral From Nurse Case Manager
If you are striking out in getting access to a treating doctor’s office, try to use a nurse case manager. The Nurse Case Manager has a lot of face to face time with the treating doctor. If the Nurse Case Manager has a good relationship with the treating and they help refer you in, you have a good chance at being able to sit down and discuss your difficult case as a team.
The goal is to work with the treating doctors, so the battle lines are not drawn in the sand from the start. You will be seeing this doctor’s name many times throughout the course of a year.
The claimant has a certain amount of trust placed in to their treating doctors. Once you order and Independent Medical Evaluation, the claimant only sees that IME appointment as “The work comp doctor”. When the IME differs from the treater’s perspective, the claimant is quick to file a lawsuit.
Personal Relations Skills Can Go A Long Way
So try to go to the treating doctor first and clarify the opinion if there is a question or issue. Make sure they have all of the details and that they know as much about the injury as you do. You always have the IME in your back pocket if you need to use it, but you can save some litigation headaches if you can get that treater on your side to help the defense of your file. Also, it never hurts to bring them a coffee when you go for your discussion.
Even if you cannot visit the clinic in-person, a phone call can go a long way to show them that the file has your attention. Plus you want to be sure that they have all of the information regarding the injury that you do. One little detail can change the compensability of the case, even from the treating doctor’s view.
Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.
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