Think back to one of your earliest experiences with an injury in a public place—elementary school. Remember the school nurse evaluating our scraped knee, banged up elbow, or even that broken bone? There was a comforting sense of urgency and thorough care. If the injury was serious enough, our parents would drop what they were doing at work, come get us and take us to the doctor, or even the emergency room. We learned that whatever it took, everyone would work together to make sure we got the care we needed. There was never any doubt in our minds that we would get the medical attention required.
WHAT ABOUT MEDICAL CARE IN THE WORKPLACE?
While we carry these expectations with us as we enter the workforce, many people are shocked to learn that the dynamic is very different when an injury happens at work. Unfortunately, getting the necessary treatment is often a serious struggle that injured workers never imagined they would have to endure.
A report of a work injury or condition may prompt an “investigation” by the employers’ claims administrator that can take up to 90 days. While the law requires that the claims administrator provide treatment during the investigation, few do. Can you imagine being told as a child that you will have to wait for treatment while the school “investigates the injury” to ensure it is a valid one?
If the claims administrator denies responsibility for the work injury, no treatment will be provided until the worker proves the injury or condition is work-related, which can take months, or even years. No one would expect a child to wait that long for an identical injury!
MEDICAL PROVIDER NETWORKS – YOU AREN’T IN SCHOOL ANY MORE
Even when the work injury is finally accepted as work-related, a claims administrator may insist that the worker only see a handpicked doctor within their “Medical Provider Network.” A doctor who has signed special contracts with the claims administrator that you don’t get to see. Many injured workers are shocked to learn that the doctors can be thrown out of the network at the claims administrator’s whim. No reason needs to be given!
Maybe that explains why many injured workers feel the network doctor often does not meet their treatment needs—the doctor probably doesn’t want to be kicked out of the network for recommending “too much” treatment. Would anyone let a child be caught up in such a conflicted dynamic? No way! It gets worse. Even when a network doctor recommends treatment to heal the injured worker, the claims administrator can have the request denied by another doctor who never even examined the patient! This so-called “Utilization Review” is also conducted by the claims administrator’s handpicked company.
Parents would be at a school board meeting holding a protest if a school was putting their kids through all this over an injury at school—and you better believe these standards would get changed. Fast.
The horrible tragedy is that the identical injury should be treated no differently depending on whether it was suffered at work or school. There is no good reason for this, which explains why so many people ask for help when they are injured on the job—they only want the treatment everyone knows is necessary so they can heal and get back to work.
Everyone deserves effective treatment after an injury, whether it happened at school, or at work. If you or a loved one suffered an injury on the job and aren’t getting the medical support you need, it’s time to call Thomas F. Martin, PLC.