The largest portion of any workers’ compensation claim is medical costs associated with a work injury. While these figures vary in each jurisdiction, providing effective medical care and treatment for employees remains a challenge.
Start With Effective Post-Injury Response
Top performing claim management teams know from experience that the best way to reduce and manage the medical costs of any work injury starts with an effective response following an incident. This includes a number of factors that can be implemented by all stakeholders. While on-site medical care is preferable, it is often not realistic. Here are some important pointers to implement within the workplace:
- Proper training for all employees on how to report and respond to a work injury;
- Commitment from employers and management on dealing with injuries;
- Basic first-aid training and equipment that is accessible to all employees; and
- Preparation of an injury response plan.
Develop Local Health Care Facility Relationship
An injured worker does not usually require emergency medical care and treatment. It is important to provide all employees with accessible medical care and treatment at a local health care facility. A proper evaluation of this facility should include the following:
- Competent medical staff that can properly diagnosis and commence medical care and treatment for the most common injuries;
- A strong referral network of specialists who are training to treat a variety of injuries. This includes doctors who have a background in orthopedic medicine, neurology, psychology/psychiatric care and other “sports medicine” specialties;
- Medical facilities that communicate with all interested stakeholders, including the claims management team and employer representatives.
Other Trends in Medical Cost Containment
The use of managed care models in workers’ compensation has proven to be an effective tool in providing quality medical care and treatment, along with cost containment strategies. Under this system of care, the managed care program is charged with the responsibility of developing a network of doctors, surgeons, chiropractors, osteopaths, podiatrists, physical and occupational therapists, and other specialists to provide medical care and treatment to injured workers. This can also include the designation of specifically medical clinics and hospitals were employees are required to receive their care.
Laws and other administrative rules governing managed care programs vary in each jurisdiction that allows these arrangements. Workers’ compensation laws typically allow employees to choose the doctor(s) they see for care. In other instances, they are also allowed to go outside the established network.
There are a number of benefits to a manage care model in a workers’ compensation program:
- Allows for a more holistic approach to care and provides for care coordination and utilization review of treatment;
- The use of case managers allows for better communications between all interested stakeholders in the process. This manager can also help answer questions for parties who lack experience or knowledge of the workers’ compensation process; and
- Coordination with other professionals in the workers’ compensation process. This can include a coordinated effort in return-to-work matters and the evaluation of work restrictions.
Access to quality medical care and treatment is a right every employee has following a workplace injury. This can sometimes be at odds with the interests of other stakeholders. Seeking creative solutions and being proactive is one step every employer should take to consider the interests of their workforce and protect their bottom line.
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: email@example.com.
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.