Imagine this scenario … you started working for your company about six years ago. One day you’re walking into work in the parking lot … you slip and fall and you hurt your back. There’s a question of whether or not that injury is work-related. You go in to get medical treatment. You’ve get a great health insurance plan but they won’t cover your medical expenses, because you have a work comp claim that’s in dispute. Also, because your work comp claim hasn’t been accepted you can’t get medical expenses covered under that plan either, so, now you’re left to have your injury continue to get worse.
Delayed Or Denied Medical Treatment Is Big Problem
This scenario that I’ve described is a problem in our industry. I’ll say it again. This scenario that I’ve just described is a problem in our industry. I’m Michael Stack, with Amaxx, and, today I’m going to be talking about a solution to that problem. It’s called, Pay without Prejudice, and, in Maine, it’s Statute Number 222, called Provisional Payments of Certain Disability Benefits.
I want to graph this out for you and show you what this looks like. It’s very common and a big problem, as I said, in our industry. Let’s talk about this. You have your back injury … here’s the time of injury. I’m going to graph this out in blue and in red. In blue’s going to be the cost of the injury, and in red is going to be the severity.
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“How Do I Get My Adjusters To Follow My Account Handling Instructions?”
You have what might be a very simple injury. It might be something that just needs a little bit of treatment and you can get back to work right away, but because you can’t get your medical expenses covered, there’s a delay in treatment. Your injury gets worse and worse and worse. The cost is going to follow, of course, in a very similar timeline when it becomes more and more expensive.
The longer the delay in treatment the worse your injury becomes, the more expensive the injury becomes, the more of an impact it has on that individual’s life, the less likely they’re going to be coming back to work. The more likely they’re going to be out on a lifetime disability claim, the longer that injury goes untreated. This is a problem in our industry.
Pay Without Prejudice & Maine Statute 222
Here’s the solution. It’s called, Pay without Prejudice.” In Maine, again, it’s Statute number 222, Provisional Payment of Certain Disability Benefits. This is a concept we talked about in The National Work Comp Conversation, and, this Maine Statute really came into the conversation during those discussions. Basically, what it says is that there’s no delay in benefits. Even though a work comp claim is in dispute, you cannot delay or deny the benefits to get that medical treatment. It’s written right into the statute in Maine.
If you’re not in the State of Maine, you can write this right into your account handling instructions … your account service instructions. If you’re a self-insured employer, or, if you have a high-deductible plan this is a concept that should be in your policy, because this back injury can get addressed right away. This person can get right back to work and these costs remain contained. It creates a better outcome for the injured worker and significantly controls your work comp costs.
If it’s determined that your claim either was or was not compensable the appropriate carrier … either the health insurance carrier or the work comp carrier, can be reimbursed for those expenses appropriately. Pay without Prejudice, and, in Maine … Statute Number 222 … Provisional Payment of Certain Disability Benefits. If this is not in your state talk to your legislators. If this is not in your account handling instructions this is a concept that should be. Remember your success in worker’s compensation’s defined by your integrity … so, be great.
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 protected].
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