There are specific rules that govern how injured workers are to be treated and who can treat them. Although most healthcare workers make a sincere effort to follow the laws that govern treating injured workers, sometimes mistakes are made.
A physician’s diligence doesn’t always prevent injured workers from being treated by the wrong physician. Sometimes the communication between patient and physician doesn’t reveal that the injury took place on the job until the patient has begun treatment.
This doesn’t seem like a big deal, but when there’s a workers’ compensation claim involved, the insurance company wants to eliminate every potential for fraud. They want injured workers to obtain an objective examination and diagnosis.
In most states, an injured worker with a claim needs their official diagnosis to come from a workers’ compensation doctor provided by their employer’s insurance company.
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Healthcare workers may not get in legal trouble for treating an injured worker, but a worker who doesn’t seek treatment from an approved physician probably won’t win their claim.
Each state has its own rules for how claims must be dealt with. These rules also come with state mandated fee schedules that don’t allow a medical service provider to bill patients beyond the established fee.
Here’s what you can do to mitigate the risk of physicians unknowingly treating injured workers, and what to do if they’ve already started treatment:
Have physicians give helpful information to patients
You won’t necessarily be able to refer each patient to the right group of physicians without knowing who their employer’s insurance carrier is, but you can provide helpful information when they’re unaware of the rules.
Many patients who haven’t started filing a claim don’t know they need to seek treatment from a specifically selected physician. This is especially common when the injury requires a visit to the emergency room for immediate treatment.
Healthcare workers need to be ready to educate patients on how workplace injuries are handled when a claim is filed. It’s possible that a patient won’t want to file a claim; not everyone does. Sometimes they’re scared, they’ve been threatened, or the injury is so minor that they don’t think it’s worth it. However, they should still be educated so they can make the best possible decision.
If a patient says they don’t want to file a workers’ compensation claim because their employer is making it difficult, they might want to consider hiring an attorney. Some patients don’t even know this is an option. Other patients have already been to the employer’s chosen doctor and have been incorrectly diagnosed. An incorrect diagnosis can lead to the injured worker not recovering enough compensation to cover long-term medical needs.
“The doctor chosen by [an injured worker’s] employer may have incorrectly diagnosed the seriousness of [their] injury or released [them] to return to work before [they were] really ready,” say lawyers in Wilmington, NC. An accurate diagnosis is important in winning a workers’ compensation claim.
While physicians can’t provide legal advice, they can make the suggestion to consult with legal counsel. Unlike a workers’ compensation claim, property damage, pain and suffering, emotional distress, and wrongful death damages can be recovered in addition to medical expenses and lost wages.
Encourage physicians to ask if the injury took place at work
Some injuries are easy to notice as potential workplace injuries once the details of the injury are revealed. For example, when a patient says they were hit by shrapnel in a machine shop, it makes sense to ask if it was their own machine shop or at their job.
Other injuries aren’t so obvious. For example, when a patient reveals they slipped and fell at a convention center event, it might not appear work related. If they attended the event as part of their job, however, the injury is considered work related.
Physicians need to pay close attention to what their patients are telling them (and not telling them) by reading between the lines and asking clarifying questions. Directly asking patients if their injury took place at work can help.