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Worker's Compensation

In Dr. Hain's medical practice, we have learned to fear worker's compensation patients. We are not alone, in Illinois it is very common for physicians to refuse to see worker's compensation patients. There are several logical reasons for this:

1. "Take backs" -- when one treats a patient whose symptoms are eventually attributed to a work injury, should the individual come in using their health insurance, it is common for the insurance company to "take back" all payments for work already done. After this is done, the worker's compensation carrier will say that they did not authorize any of the medical services. The medical practice ends up doing work, with no payment. For this reason, it is dangerous to accept regular health insurance, for a patient who has had a work injury. Sometimes neither the patient nor the practice knows.

2. Case managers. This means that there are two (or more) people there for the appointment, the patient themselves, and a "manager". Frequently, this doubles the time required for the appointment. First one sees the patient, then one sees the case manager. The case manger then asks a series of quasi-legal questions -- for example, "when will Mr. X be at MMI" ? This is very disruptive to other patients who have to wait for a double-length clinic visit.

3. Legal activity. It is common for workman's compensation patients to not only have a case-manager, but also have an attorney. The attorney, interested in winning the case, will often send multipage forms, asking questions concerning ability to work, concentrate, etc. These are actually legal forms, and have nothing to do with caring for the patient. The attorney then is asking the physician to work for them, again without pay.

4. Worker's compensation patients are often shunned by other doctors -- meaning that there is nobody left to manage their non-work compensation related illnesses. Diabetes, hypertension, heart disease.

We think the root of the problem is the fiscal risk -- and the "take backs" outlined in item 1. This is a hole that should be closed.

 

 

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