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The Curse Of Employer Controlled Medical Care

Blackwell Law FirmIf you have suffered a serious work-related injury, you may know the frustration. You report the accident. You ask for medical care. Then, your employer sends you to its “occupational” doctor. In Huntsville and many other communities, we have an “occupational” health clinic that typically serves this purpose.

You arrive at the occupational health clinic thinking you will get care. Does the occupational doctor ignore your pain or problems? Does the occupational doctor seem more concerned with the drug test than your injury? Does the occupational doctor misconstrue your history to claim the injury was a pre-existing problem? Or, does the occupational doctor simply neglect your care as long as possible? I’ve heard all the common frustrations. Trust me, they call that physician the “company doctor” for a very good reason.

If you continue to hurt, the occupational doctor may eventually refer you to a specialist. Now, you have a whole new set of frustrations. It takes forever to get an appointment. Afterwards, the insurance company (falsely) claims it never received the specialist’s reports or recommendations for treatment. You sit. You wait. You cannot get the treatment needed to heal. The insurance company uses “paperwork” and “approval” tactics to delay your treatment.

In Alabama, our workers’ compensation system allows your employer (typically through its insurance carrier) to pick the doctor. You want medical care under workers’ compensation? You must go to the physician authorized by the employer. Why? Well, the “theory” is that the employer and its insurance carrier can keep costs from skyrocketing by picking the authorized physician. In reality, it’s the delays, denials and outright refusals of needed care keeping medical costs low. And, the employer sometimes uses its physician selection process to pick the doctor who will promote its goals. While actual medical costs may be lowered, the overall costs created by a failure of medical care are much larger.

I understand the current system. I work within that system to help my injured clients. Yet, I’ve long-argued the system of employer control does NOT keep overall costs low. While initial medical costs may be reduced, this misses the larger picture. In years past, just the very mention of my position would drive insurance people crazy. Yet, their position is short-sighted.

A new study in the Journal of Occupational and Environmental Medicine asks the question, “Is Employer-Directed Medical Care Associated With Decreased Workers’ Compensation Claim Costs?” After studying the issue, the article’s author notes that “while employer-mandated physician choice may reduce medical care costs themselves, the practice may also wipe away any such savings by increasing other claims expenses.” I agree with that conclusion. Yet, it is still incomplete and short-sided.

Yes, I agree employer-mandated doctor choice increases other claims costs for the insurance company. Why? I can tell you from my experience handling workers’ compensation cases over the last two decades, one of the biggest reasons injured employees call me is the frustration of a medical system that does not listen to their needs. That frustration is largely a result of the insurance company using its authority both to choose the physician and then slow the process through administrative maneuvers.

But, the research article is still short-sighted. Why? It is short-sighted because it only considers “claims” costs. That is, it only considers the costs to the insurance company. The article focuses on the increase in legal expenses to the insurance carrier due to employer-directed care problems.

Serious injuries, chronic pain and long-term disability produce huge societal costs. Human costs. Many of these human costs are not reflected in the simple costs of administering an insurance claim. Yet, they are the real costs of injuries. If injured workers received good medical care from a good doctor at the outset, many of these terrible costs would be avoided. Throughout northern Alabama, we have many excellent physicians who could help injured workers recover. What we don’t need are insurance companies picking an “occupational” doctor who will try to ignore the injury. What we don’t need are insurance companies sending case workers or adjusters to pressure physicians into following a short-term course of action. What we don’t need are insurance adjusters artificially delaying care by wrongly claiming treatment recommendations or prescriptions were never received by them for approval.

The current system of employer-chosen physicians may save short-term claims costs for the insurance carrier. Yet, too often the system leads to much larger costs for the injured worker, his/her family and the impacted communities. We need a better solution for the medical care we provide our injured workers.