Selection of Workers Compensation Treatment Providers (Physician Selection) © 2006 RCS Services

WC Laws Governing Selection of WC Treatment Providers  Three Basic Types— –The Employee Selects the provider. –(You still need to make a selection – “stay tuned…”) –The Employer selects the provider. –The Employee selects the provider from a list (“panel”) of providers that the Employer has designated.

Why is Proper Selection Important?  The medical treatment provider should be your company’s partner and ally in controlling WC costs.  Medical treatment providers can be indifferent to the interests of your company, or even predators.  If your company ends up with a predator or indifferent provider in a place where you need a cooperative partner, what will happen…?

The Ideal Provider…  Is able to balance effective treatment with efficient delivery.  Understands your company’s policies and procedures.  Communicates openly with your company.  Is accessible for questions and discussions.

The Ideal Provider…  Understands the importance of modified duty for both patient recovery and cost control, and is committed to modified duty concepts.  “Industrial Medicine or Clinic” in the practice’s name is often a good indication they understand the Workers Compensation “arena.”

How Do I Find Good Provider Candidates?  Do the “legwork” yourself.  Ask your insurance agent/broker.  Ask your insurance carrier  Ask associates in local trade or other business/civic organizations.  Other methods…

Questions For Evaluating a Provider Candidate  What is their quality of care?  How do they relate to employees?  How accessible are they?  Are they fair in their treatment plans?  Are they regarded as “employer-friendly” while still providing the best possible treatment for the injured?

Qualifying A Provider Candidate  Identify the candidates.  Conduct a preliminary survey.  Schedule appointments with qualifying candidates.  Interview the candidates.  Check references.  Make the decision.  Notify the selected providers and make necessary arrangements.

Suggested Interview Questions  What is their attitude about modified duty?  Will they share information with you?  What is their attitude about drug testing for Workers Compensation cases?  Are they experienced in handling Workers Compensation cases?  Are they willing to honestly share information about an employee’s prognosis, including suspected malingering or fraud?

“Employee-Selection” States  Although the employee is allowed to select the treatment provider, no state prohibits the employer from suggesting a pre-selected provider, so long as you do not force nor coerce the employee’s decision.  An injured employee may not know of a clinic to use. The employer having “an account” already set up with a physician will ease the employee’s mind about where to go, who will pay the bills, and other concerns.

“Employee-Selection” States  Having a pre-selected clinic will help with the transportation of injured employees to the treatment facility.  Having a pre-selected clinic also helps ensure that a staffing representative will be in attendance with the employee at the facility.  A claimant insisting on using a provider including a family/personal physician may be a red flag – an indication the employee is using and working with a potentially predatory treatment provider.

“Employee-Selection” States  Whether the employee selects a suggested provider or one entirely of his/her own choosing, document their choice using the RCS “Medical Treatment Request Form,” (Form 6-W) or equivalent.

Summary  Know who the law designates to choose the provider in the state(s) in which you operate.  Providers can be predators.  Select providers through a due-diligence process as you would for any other supplier.  Develop a close and cooperative relationship with your provider(s).  Even in “employee-selection” states, select good treatment providers, and suggest that injured employees utilize them.