Moore: Time to First Medical Care

Friday, December 22, 2023 | 0

I received a note that the Workers Compensation Research Institute will host a webinar on Jan. 11 covering the time to first medical care and its effects.

James Moore

The Six Keys to Workers Comp Success (originally four) that I wrote in the 1980s had the timely first reports to the insurance carrier or third-party administrator and having a medical network as the two most critical components. 

Another combo key that I should have included before now is how rapidly the injured employee receives access to medical care. Speed and access to treatment set the tone for the claim.

One of the most popular slides during my presentations on workers' comp savings shows how out-of-control claims cost more and do not provide quick access to the first medical care. See the chart here.  

By the time I became involved in the claim, a biofeedback specialist was the treating medical provider. I have nothing against biofeedback, but the original surgeon was out of the loop and the claim ended up costing more than $1 million.

One of the most popular articles on this website covers how during the pandemic physician networks reached critical mass, as treatment plans were disrupted nationwide. The time to first medical care became a very complicated matter.

When do we refer injured workers to network physicians?

The advice that I give is whenever the employee has to leave work due to an injury, send her to the clinic or physician immediately. Most workers' comp adjusters will tell you that the claim was completely out of control when an employee goes home after a minor injury. I have seen a splinter claim exceed $250,000 due to the employee being sent home after a very minor-looking injury.

And on top of everything else, the injured employee may seek medical treatment on his own over a weekend or even just one night. So much for the workers' comp medical network or control of the time to first medical care.

This blog post is provided by James Moore, AIC, MBA, ChFC, ARM, and is republished with permission from J&L Risk Management Consultants. Visit the full website at www.cutcompcosts.com.