A doctor holding an injured worker “hostage” and not releasing them to light duty work when applicable is a challenge that will never go away. Over time I think many doctors have gotten better with this issue, but sadly many have not. For those that have not, the end result is a claim that costs more dollars due to increased claim expense in the way of work comp wage loss payments. These payments can go on for months, and it is 100% unnecessary and can be avoided.
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So how do you handle a doctor that is holding your worker hostage?
- Get a field nurse case manager on the file. The main culprit to a worker not being given light duty work restrictions is due to a lack of communication. The doctor asks the worker if there is light duty available, and the worker answers “No.” So, the doctor takes their word for it, and leaves it at that. Despite you faxing over questions and leaving messages to talk to the doctor, those requests fall on deaf ears. They are taking the patient’s word, and leaving it at that. This is not acceptable, and you should utilize a field nurse case manager to interject the fact that you can accommodate light duty with any restriction. Use the nurse case manager as your voice, and see what result you get.
- Explain that you want to focus on what the employee CAN do. If you make your stance more about what the injured worker CAN do, rather than what they CAN’T do, you are going to get some results. Asking questions such as “Can the worker drive? Can they get groceries for themselves? Can they sit/stand as needed? Can they climb the stairs on their deck to get in to their house?” If the answer to all of these questions is yes, then you have created your own restrictions. If the worker can drive a car, walk around a grocery store, climb stairs, clean their house, mow their lawn, etc, then they can certainly perform a sedentary job at work. After all if they can drive to the store they can drive to their job, walk in the door, and complete a sedentary job that is just the same as sitting home on their couch. In all of my years I have never heard of a doctor saying a worker can drive to the grocery store but should not be driving to work.
- Provide a detailed light duty job description the doctor can keep in their file. Many times a doctor will not release a worker to light duty because they were burned by it in the past. The doctor released a worker back to light duty, and then the worker was “forced” to complete job tasks outside of their restrictions and then further injured themselves. I imagine this is rare, but all it takes is for that to happen one time and the doctor is hesitant to release another worker on a light duty work program. You can explain to the doctor that you have a formal program, a job description, enforcement of the duties, and monitoring of the position as a whole. If this is explained to the doctor, they are going to feel a lot better about releasing this worker to light duty rather than just saying “Yes, we have light duty.”
- Use an IME if you have to. Sometimes all of your efforts are going to fall short with the treating doctor. Actually, if you threaten an IME to the treating doctor all this is going to do is make the treater pass the buck to the IME doctor. If that is the case, so be it. One IME bill is certainly worth getting a worker back to light duty versus allowing the worker to sit at home collecting a wage loss check .
- As a last resort, use the legal tactic. This last tactic is not my favorite, but it is effective when needed. When a doctor holds a worker off of work and refuses to allow light duty or even to address activities of daily living as a basis for light duty work, use your legal maneuvers.
Doctors that hold their patients hostage are never going to go away. But when you confront them with some of the tricks outlined above, you are going to have a greater success rate for getting your injured workers back to work. Every job within your light duty work program is an important one, and this should be explained to the doctor every time.
Remember, your local physicians and clinics are supposed to be your assets, and not your adversaries. Remind them of the common goal to get your worker whole again, and how psychologically a worker that stays working recovers quicker than one sitting at home watching attorney commercials on TV.
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 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 monthly basis 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: [email protected].
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