2nd QUARTER 2014
41
Y
ou decide that it’s quicker to take the
stairs, rather than wait for the elevator,
as you race tomake a meeting for which
you are already late. You are moving at
record pace down three flights, when you trip.
You break the fall with your right hand, ending
up with a broken hand and elbow.
What next? Would you log on to your
workers’ compensation carrier’s website and
pick any orthopedist on the list? No, you
would find the most qualified orthopedist — a
doctor whom a close friend or family mem-
ber recommends, who is Board certified and
will be on the cutting edge of his specialty.
Yet, when it comes to our employees, most
of us rely entirely on our insurance carrier to
pick the most qualified doc. We assume that our
insurance carrier or third-party administrator
(TPA) has picked the best-qualified docs for all
employee injuries. After all, they are in the
business of effecting the best care for your in-
jured employees, at the most competitive price.
Look, carriers and TPAs are not nefari-
ous people, but they may have misaligned
incentives with regard to treating your injured
workers. Are you seeing positive results on
your P&L from your TPA’s negotiations, or
are there flaws in this practice? Flaws may take
the shape of medical providers’ bringing your
injured worker back for numerous exams and
tests, as a way to recoup the loss the doctor
experiences from the carrier’s fee schedule.
Injury Management
the Right Way
If you protect your biggest asset, your
human capital, that act in turn will optimize
your working capital.
Employers need to find clinics with
Board-certified occupational health physi-
cians, nurse practitioners, or physician
assistants with two or more years’ experience
in occupational health or workers’ compensa-
tion injuries. A bilingual staff and written
follow-up instructions available in the injured
employee’s language are important. Is the
clinic in close proximity to your business?
Nothing will blow up your financial
forecasts and balance sheet like an employee
who sits at home collecting lost wages paid
for by your workers’ comp carrier. That turns
your risk-transfer mechanism into a loss-
financing instrument. In certain situations
employers end up paying back two or three
times what the carrier has paid, in lost
wages, because of increases in experience
modification factors or negative loss trends.
Early-Return Work Programs must be
everyone’s focus. To that end, is your physician
aware of your light-duty job descriptions?
The number-one reason why workers
retain attorneys is a feeling that their employ-
er doesn’t care. Circumvent that by providing
convenient, local, and qualified care. Don’t
make your injured worker bounce from
facility to facility or endure long waits. Make
sure the clinic you select has electronic wait
times and treatment-time verification. Are
imaging services and Xrays available on site,
along with EKG, pulmonary function, vision,
and audiometric testing?
Loss prevention is critical; however, when
an injury occurs, make sure your employees
are getting treatment at a facility with occu-
pational health as its only focus.
C
Magical Thinking
Most of us assume well-qualified doctors will be treating our injured employees
MARK TORIELLO, PWCA
Principal & Co-Founder, The Alliance Group
Learn more about the author
Mark Toriello has continuously developed his technical knowledge and brings a consultative approach and value to his clients. Since 2008, he has concentrated on workers’
compensation cost management. A Professional Workers Compensation Advisor (PWCA), he launched the Workers Compensation Cost Management and Recovery Process (WCCMR™) for
clients of The Alliance Group. For additional information on this topic please visit his blog at
+
