Workers Compensation

Workman’s compensation is the monetary compensation offered from an employer to an injured employee or to the dependents in cases of death.

Injuries at work place are very common and may be debilitating. Workplace injuries often occur because of high-risk jobs, lack of or scarcity in safety devices, lack of training, higher number of manual workers and repetitive stress.

Repetitive stress injuries are the most common types of work-related injuries with several risk factors, including repetitive, forceful, or prolonged exertion of the hands and prolonged awkward postures.

Common injuries at the work place include:

  • Sprains
  • Fractures
  • Bone dislocations
  • Soft tissue injuries
  • Injuries requiring limb amputations

Depending on the type and severity of injury, treatment will be initiated. Regardless of the type of injury, patients should be provided first aid at the workplace including:

  • ABC: Airway, breathing and circulation
  • Immobilization of the body part affected to avoid further injury
  • Transportation for further evaluation at a hospital or physician’s office

An individual will be eligible to claim workman’s compensation if the individual suffers injuries or illnesses during employment and if caused by the nature of work. However if the injury occurred is because of negligence of an individual to obey safety rules, if the individual was under the influence of alcohol or drugs, or if the disability from the injury lasts for ≤3 days, then the employer will not be liable to pay compensation.

Your doctor plays an important role in treating work related injuries and diseases, helping patients recover from occupational injuries and illnesses.

Workers Comp FAQ’s by Sara

How do I make an appointment using my worker’s compensation claim?

When calling to make an appointment, before being seen every Worker’s Compensation patient must have their insurance name, claim number, adjuster name and phone number, and their job information. In order to get this information a claim must have been filed with their work regarding this injury that occurred. Patients must also supply the date of the injury as well as a detailed description of the injury and what happened on that day. It is important that we are made aware of the specific body parts that were injured and covered under the claim, because worker’s compensation claims are body part specific. Body parts that were not reported in the patient’s initial report to their job will not be covered under their claim. When making an appointment we will do our best to get you in the same day as your call, as long as we have a provider in the office on that day. Patient’s are required to come in with x-rays at the time of their first visit for all body parts except for the back. When you make your appointment, we will send the x-ray script to any local radiology facility of your choice or our referral.

What happens if my claim is not yet processed?

If you were injured on the job and you need to be seen urgently but your claim has not yet been processed, we will take the steps to see you same day regardless. We would take your work information and confirm with a supervisor that there will be a claim open for you.

As a precaution, we will always take a copy of your photo ID and insurance card along with your social security number. If it turns out that your job does not open a worker’s compensation claim for you and we already saw you, you would be responsible for the bill for that visit. This is why it is very important to report the injury to your job immediately, making sure you fill out the proper paperwork.

What happens if my claim gets denied?

If your worker’s compensation gets denied or discontinued at any point, we are able to call your private insurance and try to get authorization through them for your follow-up visits if necessary.

If we receive a notice of denial for your claim, you will be notified immediately. Once you are notified, we will take all the necessary steps with your private insurance for your continuation of care. It is very important that you attend any appointments that are set up for you by worker’s compensation to try and avoid being denied. If you get scheduled for an IME you must attend.

Why would my worker’s compensation claim get denied?

A worker’s compensation claim can be denied for many different reasons. One of the main reasons that claims are denied are for the lack of the patient showing up for their IME visit with the worker’s compensation doctor. If you do not show up, and fail to reschedule immediately your claim will automatically be denied.

Another reason that a claim may be denied is if the patient does show up for the IME and the doctor decides that no further treatment is necessary based on his/her evaluation. Claims may also be denied if the worker’s compensation insurance feels that the body parts being treated are not correlated with the injury that occurred at work.

This is why it is very important that when you file the claim paperwork you are very body party specific and you include everything that was injured on that day in full detail, including whether the injury is on the left or right side. There are also cases when patients reach “Maximum Medical Improvement”. This means that either the IME doctor, treating physician, or worker’s compensation believes that the patient has been treated and healed to the best of their ability.

What if I need physical therapy or an MRI?

If you are referred out for physical therapy or occupational therapy all the proper paperwork is done between our office and your physical therapist. Forms, such as MG2 and C4 auth, are filled out to make sure that your worker’s compensation will pay for the physical therapy visits, and we renew them about every six weeks.

Your physical therapist will continue to send me their visit notes, which our office signs, attaches our office notes and the proper worker’s compensation forms, and forwards to your worker’s compensation adjuster and the worker’s compensation board to assure that you are approved for the treatment that you need. These forms are also filled for MRI authorization as well as injection authorization, or any treatment that you may need beyond a routine office visit.

Please be advised that the turnover time on the authorization of these forms is solely dependent on the speed in which your worker’s compensation insurance returns and approves our requests. Forms for authorization are filled out and sent from our office the same day that they are ordered by the treating physician.

How does my worker’s compensation insurance know about my visits?

When it comes to your routine office visits, your office notes and the proper worker’s compensation paperwork is sent out at the end of the week you were treated. This is the case for every visit that you come into our office.

This will give your worker’s compensation any treatment that was rendered at the time of the visit, your work status, any outward referrals (physical therapy, radiology, chiropractor, etc.), and how long until your next visit. Your adjuster also faxed us any additional paperwork, which is filled out and sent back on the same day that it is received. We do not provide any patient information over the phone, so when your adjusters call, we ask them to send a fax which we answer right away.

What if I need additional information for my job?

If your job has any questions regarding your visits, or if your job gives you any outside paperwork for us to fill out we are happy to do so. Bring any paperwork at the time of the visit and we will do our best to accommodate you same day. We are also happy to fax the paperwork straight to your job if necessary.

What happens if the providers orders for me to be out of work?

If the treating physician orders you to be out of work for a specific period of time, we will fill out the proper work note for your job as well. We can give you a copy of this out of work note, and if you have a proper fax number we can also fax it to your job for you as well.

We do not give extended periods of time out of work. If you are told to be out of work for 2 weeks, you must follow-up with us within that time so that you can be re-evaluated to see if your work status has changed. At the time of the follow-up we can extend the period that you are out of work if the provider deems necessary.

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