How To Get The Doctor To Respond To Your Questions

Physician interaction is part of the job in claims management. With time, adjusters become more and more familiar with medical terminology, mechanism of injury, and causal relation. Oftentimes no matter whom the adjuster may be, certain physician offices are harder to interact with than others. This is due to the fact that there is no standard of interaction that is uniform for every clinic or specialty office.

 

The goal with any claim is for the injured worker to recover and get back to their normal full time job without medical restrictions. The rules are different in a work comp claim than in group heath. Certain criteria have to be met, questions have to be answered, and some of the questions are harder there others. Many times the questions can be confrontational, such as when a doctor must call a patient out for a lack of disability. Doctors will avoid this issue at times, and this is when the adjuster and the nurse case manager have to get involved in order to get the tough questions addressed.

 

One of the best things you can do for your work comp management program is to develop physician relationships in advance. However, if you haven’t done this step, or are having trouble getting information, here are some tips on how to get the doctor to respond to your questions:

 

1. Get a field nurse case manager on the file. Many doctors have awful telephone habits, also known as the doctor not returning your calls. This can be due to many reasons, but frankly I think most just do not have the time. Occupational physicians often float between clinics in several locations, and also have a private practice of their own. This is where a field nurse case manager is a great asset. The on-site nurse is at the clinic the time of the appointment, and can start asking the doctor questions right after the exam while it is fresh in the mind of the treating physician.

 

2. Avoid asking open-ended questions. The more a doctor has to dictate an answer to your question, the less likely they are going to respond at all. Again, it comes down to time management. Instead of asking a question such as “What degenerative issues does the patient have in their spine and why are they there?” you may want to phrase it as “Considering the MRI evidence of multilevel disc degeneration in the spine is it safe to say that there is no acute, traumatic injury and this is merely an exacerbation of their pre-existing condition?”

 

3. Make your question as concise as possible. If the doctor sees your nicely written fax, but your points are multiple questions and sub-questions per item, you are not going to get a response that is helpful. Keep in mind the doctor is familiar with the medical portion of the case, and you can talk “shop” without having to explain your basis. Get right to the point. Instead of outlining every single item of a light duty job, you can start off by asking “Can the worker perform sedentary duty with an option to stand when needed?” The doctor need only respond with a “Yes” and then you are good to go for light duty.

 

4. Be persistent. The squeaky adjuster will get the answers. This is when it is important to have a relationship with your local clinic, and to get to know the doctors and their support staff. Maybe this doctor responds quicker when you give the questions to their physician assistant, or to their nurse, instead of going right to the doctor.

 

5. Go to the office in person if you can. When all else fails, I recommend going to the clinic and talking to the doctor directly face to face. You could even go when your injured worker has an appointment. After all, you are going to show the injured worker and the doctor that you care about their claim, their well-being, and their injury as a whole. You want to get them back to work, and you want to make sure that you are accommodating the worker correctly. It is hard for the doctor to ignore you when you are sitting right there next to the patient. This also prevents the patient from fabricating some mistruths about lack of light duty, or leaving out certain key details to the injury itself.

 

They key is to be involved, be concise, and be known. Show that you have a genuine interest and care for your injured worker, or your claimant, and that you are trying to move this claim along as efficiently as you can. Use outside vendors when needed to accomplish your goals. Your local physicians and clinics should be your assets, and not your adversaries.

 

 

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: mstack@reduceyourworkerscomp.com.

 

 

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