When employers select worker’s compensation insurance for their organizations, it’s important that they consider a commonly overlooked but critical factor: the experience and credentials of the physicians who handle the claims.
That’s because the treating doctors play a significant role in areas that impact both the injured worker and the employer, such as quality of care, cost control and return-to-work decisions. In the end, they are the ones who are driving the claim and dictating the treatment, so it’s important to choose them wisely.
Understanding the workers’ compensation process
If a worker is injured, there’s a process in place to ensure they get the immediate and continued care they need. Directly following an injury, either the worker or their employer will report the claim to the insurer.
“On the Nationwide side, we engage with the claims adjustor who reaches out to the injured worker to find out what happened,” explains Nicole Cabreriza, Workers’ Compensation Consultant.
The claims adjustor reaches out to the treating physician to learn more about their evaluation and findings to ensure the worker is receiving all the care they need for maximum improvement of their work-related injury. They also speak with the employer to find out if modified duties are available so the worker can return to the job as safely and quickly as possible.
The key role of treating doctors
The treating doctor plays a critical part in the resolution of workers’ compensation claims. Most importantly, they help care for the worker to help them get the best possible outcome, both physically and professionally.
They also play a pivotal role in ensuring that the claim is resolved in accordance with the workers’ compensation rules and regulations specific to the state in which the injury occurs.
“If a physician is unaware of the workers’ compensation process, it can create significant problems,” notes Cabreriza.
When an injured workers sees a doctor for a workers’ compensation-related injury, it’s not the same as seeing a doctor they have known and trusted for years.
“These providers are not their personal physicians,” says Jennifer Anderson, Workers’ Compensation Consultant.
That means they don’t have insight into the patient’s complete medical history and have to rely on information the employee relays to them and what they can find in the medical records they are allowed to access.
It can also be challenging to discern which complaints are due to the work injury and which are not, as well as make a distinction between the subjective complaints of the patient and the doctor’s objective findings.
“The treating physician has to be able to separate those out,” Anderson adds.
Some workers are eager to return to work as quickly as possible, even if they are not ready.
“There is a delicate balance, and the challenge is to have the provider navigate patient care while following the regulations around workers’ compensation claims,” she says. “At the same time, they have to ensure they are treating the patient in a holistic manner.”
Selecting the right treating physician can help mitigate some of these challenges and ensure the best outcomes within a reasonable timeframe. Each state decides how physician selection is done. Some allow the employee to choose their treating doctor, and other states leave it up to the employer or workers’ compensation carrier.
When Nationwide is able to select the treating physicians, they lean on some best practices to ensure they are choosing the most experienced and qualified doctors for workers’ compensation care. “We rely on our experience with physicians in different states who have good patient outcomes and who understand the workers’ compensation process,” explains Ryan McCombs, Workers’ Compensation Consultant. “We also have relationships with urgent care facilities that have experience with work-related injuries and can help expedite initial treatment and the claims process.”
Ultimately, it’s important to work with trusted providers with specific expertise in workers’ compensation cases, which can provide the best possible outcome for the injured worker, their employer and the insurance carrier.
Supporting our insureds along the way
Nationwide supports its partners with a suite of resources designed to help them through the workers’ compensation process and ensure they have the most positive experience with their treating physician.
For example, Nationwide turns to its team of nurse case managers who can keep track of a patient’s treatment and help guide them to the right specialty if there is any gray area.
“Sometimes it can be ambiguous,” notes McCombs. “For example, it’s important to know if a foot injury should go to an orthopedist or a podiatrist.”
Nationwide also offers insureds a claims toolkit so they know exactly what steps to take in the event a worker is injured. This helps ensure the workers gets the care they need right away while streamlining the workers’ compensation process in alignment with state regulations.
“We also have a physician website, which helps injured workers select an in-network doctor near them who has been fully vetted to handle workers’ compensation cases,” he adds.
And, of course, Nationwide’s loss control experts can offer guidance to employers on how to maintain a safe workplace so they can reduce risk of work injuries before they happen.
“We understand that an on-the-job injury can be a devastating event that changes everything in the worker’s life,” says Cabreriza. “At Nationwide, our goal is to help them navigate worker’s compensation injuries so they can return to wholeness and get back to work as soon as possible, which is the best outcome possible for all parties.”