Occupational Health Clinics: Maximizing Compensation Claims

By Brianne Mooney / Claims Specialist

A relationship with an Occupational Health clinic should be part of your Workers Compensation program. Employers frequently inquire about the benefits of this topic. Our claims advocacy expertise is available to provide you with insight and tips to initiate or improve your relationship.

Getting Started

Occupational health clinics are everywhere and usually provide services for minor injuries such as sprains, strains, lacerations, etc.  Selecting the right clinic can be most effective when you interview a representative.  Interviewing points should include questions about their treatment processes and how this can be tailored to your needs. What are the qualifications of the medical staff making recommendations?  Are medical services limited to examinations or can the facility execute drug testing, diagnostic testing, physical therapy and services of medical specialists?  How does the staff become familiar with your employee job duties and modified work programs?

We at Horton have available a sample list of questions you may find helpful, if you would like a copy – please send the request to claims@thehortongroup.com.

Communication

Delays in employee return to work can be a huge frustration for employers.  Clinics will have a relationship developed with you in order to ensure return to work recommendations are provided immediately.  Thus, allowing you to provide expectations to your employee.  We have seen many situations when an employee’s own treating physician doesn’t provide work status directly to the employer making for extra steps.  Clinic work status slips should also include diagnosis, treatment plan and the next scheduled appointments providing you with tools plan for possible adjustments to your workforce.

The communication not only benefits in the manner of treatment and return to work, but also with medical billing.  When your clinic has direct billing information, your employees don’t have to worry about providing the correct contact or receiving charges at home.  We have seen the frustrations of an employee who is sent to collections because they were under the assumption the charges paid under their claim. The miscommunication of medical payment is one of the biggest reasons employees turn to attorney representation.

Cost Effective

When employers do not have the option of occupational health, the cost of medical treatment can be extraordinary.  Most of the time, the only other option for treatment is an emergency room of which can result in medical charges 10x the cost of a clinic examination.  We have seen employers attain overall medical savings of 40% with the use of occupational clinics when compared to those claims without.   The lower cost of the occupational health is further discounted through insurance carrier preferred provider billing networks or Workers Compensation state fee schedules.

Claim costs are not only affected in medical charges, but also with lost time.  Remember, your clinic will have details regarding specific job duties and light duty programs providing the best opportunity for restrictions or even full duty.  Challenges arise when an employer is unable to communicate their light duty program with a physician outside of the occupational clinic due to employee protections under state Workers Compensation laws.  The outcomes of these challenges can result in the requirement to pay temporary total disability for lost time.  You can imagine how this impacts your insurance premiums.

The Horton Group can assist achieving your occupational health goals.  Contact us today to get started.