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ELI5: Worker's Compensation visits

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Can someone explain what these visits entail? I'm about to start a new job and my SP states the practice is starting to increase their Worker's Comp visits because "they pay well and they pay on time". What exactly is Worker's Comp? How is it different than insurance that a company provides for its employees? What does it mean for a practice (i.e.- is it way more work for them to do the visit, more paperwork?)

I drive by some practices in my local area that "specialize" in Worker's Comp visits.

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Worker's Comp is just what the name implies....people who claim to have a work related illness or injury who are getting some kind of benefits (money) because of said illness or injury. WC visits are about determining if the patients problem is work related, what their limitations are, and when or if they can return to work.

This is one man's opinion but it is based on some experience. WC is a giant PIA. The employer is paying the bill and they want them back at work ASAP. The employee wants his due for his work related injury and doesn't want to return to full duty until he is back to pre-injury baseline. It becomes a giant push/pull between employer and employee with often neither party being happy. Declaring someone MMI (maximum medical improvement) is sometimes a declaration of war and often triggers a slew of appeals and paperwork requests.

There is a better than small amount of employee manipulation and malingering to try to get something for nothing. Personally I'd rather sit on the street corner and panhandle.....or maybe do street medicine.


Your mileage may vary....

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Because of the things Scott mentions above, it's a field desperately in need of principled, compassionate providers--that is, those with strong empathy, strong ethics, and a strong BS detector.  The REAL workplace injured are lumped in with the fakes and frauds, and they end up losing everything over the course of a multi-year claim.

I never would have picked it, but dealing with complex worker's comp cases has made me a much, much better provider and a better human being to boot.

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8 hours ago, IMGtoPA said:

[...] because "they pay well and they pay on time".

In Washington state, this is certainly true, with the exception of Sedgwick or other third-party administrators.  Their tactics are to make sure that injured workers are forced to return to the job because their payment delays are so insufferable that no provider will see patients covered by that insurance.

I get paid for doing paperwork.  From one day per week of workers' comp claims, I typically net the practice $600-800/month in PAPERWORK revenue (above and beyond the E&M charges): Activity prescription forms, phone calls, emails, filling out a form anyone sends you... I don't "pad" what I do (e.g., useless APFs where nothing has changed since last visit) and still bring in very good revenue for my practice, much better than the family med reimbursement.

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Worker's Comp can be like Urgent Care in some settings - foreign body in the eye, laceration, sprained ankle, burns, etc. I could treat and street about 70% in one clinic. Tdap, suture, wound instructions, limited work if applicable for 7-10 days depending on laceration and case closed in 21 days max.

Those cases come to fruition usually without much issue and someone gets better and goes back to work.

Back pain is the most difficult to work with - real, malingering, surgical, do they ever get better?

I dealt with some weird stuff too - chemical exposures, TBIs from unsafe work sites, faked injuries where an investigator brings me video of actual "injury" that is sooooo fake. Human bites from folks who work with troubled youth and our local state mental hospital where the criminally mentally ill are housed - one guy with permanent brain damage from being picked up and slammed into metal doors - he was only 32.  Nails through digits was a also a favorite.

I am in Washington like Rev. In our state, patients have a right to pick their provider. In Texas - it was employer driven. They could legally contract with a specific site where workers HAD to go to get care. In WA- patients can pick their provider but there are benefits to using a real Occ Med provider - something called COHE in WA where a provider is trained a bit and gets better reimbursement.

As Rev says - there is a billing code for everything - phone calls, forms, paperwork - you really do bill for everything you do. So, not too bad on that note.

Learn your forms, learn your state rules. Remember common sense - someone with a 2.5 cm laceration on their forearm does not need 6 weeks off and a bunch of hydrocodone.....

Good Luck

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As mentioned it's a pain in the butt.

You are expected to treat the presenting problem and ONLY the presenting problem.  if they come for workers comp backache and they happen to have a nail sticking out of their head, you will get on your bosses nerves, as well as piss off the WC patient's boss off, if you dare to address it.   Furthermore, often lots of annoying paperwork to fill out.  Then, you have to start making up rules...the WC forms often ask detailed nonsense about "Mr. ____ may lift no more than ___ lbs to chest height, ___ lbs to shoulder height, may be on his/her feet for ___ hours continuously..."  There is no clear guidance or rule I have ever seen on these, and most docs just make up the numbers as they fill out the form.   

In shorts, it's a pain in the butt, unless there are VERY clear guidelines of EXACT limitations per presenting problem, and the MA or front desk takes care of most of the paperwork for you.

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