Doctors Not Taking Workers’ Comp Cases

 

• Who can I go to?
• Why does this happen?
• What are my options if I encounter this situation?

 

It’s gotten to the point, in many circumstances in Eastern North Carolina, the doctor options are down to one and maybe two – Kevin Jones

 

Why am I being denied treatment? 

We help people injured on the job site or in the workplace.

While injuries may differ on how they happened, how things are handled at a hospital or doctor’s office or rehab center or treatment facility can be surprisingly similar.

And that “way” is not always fair.

We’re not talking about the fairness of the injury itself.  Instead, it can come down to the Employer, the Insurance Company, and the ability to find a doctor who is more concerned about the patient than anything else.

From our perspective, getting healthy is the first and most important consideration.  It’s about getting our client, the Employee, the person whom received a physical injury, back to work as quickly as possible.

You may not realize that the laws meant to protect Injured Workers in North Carolina are the same if you are a construction worker or a nurse who fell on the hospital wing or the laborer who got hurt while working on a production-line in a factory.

Obviously the extent of the injury may be different, but when you are in a smaller town like Morehead or Beaufort in Eastern North Carolina, there are pretty much only so many doctors available and they tend to help injured people, focusing less on the cause of the accident, and more on the treatment.

When you think of what doctors do, and how they may focus or limit or “specialize” in their individual practices, it quickly becomes apparent that there may not be many choices, especially when even driving to the doctor’s office, or even worse, being stuck in a hospital, literally limits your ability to seek treatment alternatives.

From the outset then, even in larger cities like Greenville North Carolina or Jacksonville, it can be hard to find a good doctor.

Then come the insurance companies whom represent the employer, not you.

When it comes to the quality of care for Injured Workers, and how Insurance Adjustors actively seek to limit coverage and treatment, things have frankly gotten pretty bad over the years.

 

It has gotten so bad that some doctors just do not want to mess with the carriers, the process, or anything that has to do with a Workmans Compensation Claim.  That stinks – Kevin Jones  

 

The end result is that fewer and fewer options (doctors) become available to help the person hurt on the job.

To make things worse, some insurance companies now flat-out refuse to pay for treatment for “out of policy” or “out of plan” doctors or even deny certain types of treatment. . .even if they are common and despite how important it is to the longterm prognosis.

Under the law, there really is no such thing as “out of policy.”

But, the end result is that Employers and Insurance Companies regularly refuse to make payment to c

ertain doctors, any doctor or doctors, unless they get to choose the doctor.

Instead, insurance companies want you to go to their doctor.  The doctor they pay.  The doctor they send a LOT of work to.

It doesn’t take a rocket scientist to figure out what happens and what that means.

Even if unintentional, a bias most certainly starts to develop.

Common, standard, and medically approved treatments for the rest of the world are suddenly deemed, “unnecessary” or “overly expensive” or “nonstandard” or even “excessive.”

Good, experienced, well-trained doctors, after years of dealing with carriers rejecting their bills or questioning their medical opinions or commonly applied medical techniques or denying payment or coverage, eventually just give up.

“Life is just too short,” is what we hear from doctors.

The end result is fewer and fewer doctors and treatment options.  That hurts people injured on the job.

What is left are Company Doctors and in some instances, that results in substandard care and even the failure to treat someone at all.

That’s just not fair.  It certainly is not legal.

As Workers’ Compensation Lawyers, we are seeing this more-and-more often.

So instead of focusing on issues involving back-pay, lost wages, and disability ratings due to a workplace injury in North Caroilna, we are forced to protect our clients, just to make sure they get the treatment necessary to get them back on their feet.

 

Does that make sense?  People work hard.  If they get hurt at work, they’re not trying to win the lottery.  They just want them to get back to work – Kevin Jones 

 

As a Greenville Work Comp Lawyer, I spend my day helping people get through things like this.

I look at a lot of medical records.  I am not a doctor, yet, after a while, you start to see certain trends.

You see things, common injuries, over-and-over again.

You see how the human body reacts to certain stresses or pressures.  You start to anticipate the type of injuries seen on a construction site, versus a factory.

It often comes down to a matter of simple physics.

And after twenty-five years of helping people with Work Comp cases in Eastern North Carolina, you understand what is fair and what isn’t.

When bones break, there are some general, standard ways to treat them and how they heal.

Some bones heal more quickly than others.  That’s true too for muscles, tendons, and ligaments when they result in sprains, strains, and even detachments.

It may depend on whether there is something like a stress-fracture versus the bone breaking through-and-through, or what doctors may refer to as a “compound fracture.”

MORE INFO: Hurt on the Job: What Should You Do?

 

Obviously, because of how often they are used, it can seem like it takes forever for certain bones to heal.

It’s one thing to break a finger or an arm.  Maybe you can use your other hand or learn how to do things another way.

But what happens when you break your back from a fall at a construction site? There really isn’t a way to stay off your back, except not to move around too much and maybe stay in bed.

The point of all this is that when our clients are often at their lowest, when they’re hurt, when they literally are doing their best to get better, someone with an interest focused on saving money, denying, or closing-out claims quickly, can have a tremendous advantage in the situation.

That’s where we come in.  We help.  We battle with the carriers.

When they assert something that is factually or legally incorrect, and in some instances, downright untrue, we call them on it.

We hold employers and insurance companies accountable.

We demand proper treatment.

And when that doesn’t happen, sometimes we are required to challenge things at a hearing with the Industrial Commission.

If you or someone you love has been hurt in Jacksonville, Greenville, New Bern, Morehead City, or Beaufort NC, please give us a ring.

We’re here to help!

 

 

 

Modified Transcript of “Doctors Not Taking Workers’ Comp Cases” for the Hearing Impaired

Hello. My name is Kevin Jones. I’m a workers’ comp specialist in eastern North Carolina. I’m going to talk to you today about trends in workers’ comp claims in the fall of 2017.

One of the biggest concerns that I have, and that a lot of us have, is the lack of access to good-quality specialists: surgeons, neurologists, orthopedists, neurosurgeons, any type of specialty that would be involved in these kinds of claims.

The options are becoming more and more limited.

More of these doctors, good doctors trying to help their patients, are being pushed out of the system because they can’t get the treatment that they’re recommending approved. They finally throw up their hands and they say, “I can’t do this anymore,” and they stop taking workers’ comp.

I understand why they do it. I understand their frustration. I wish that it did not have to be this way, but this is what I am seeing.

I am seeing a concerted effort by many insurance carriers, many self-insured employers, to basically limit the options of the injured worker, to so frustrate these doctors, these very good doctors that used to take workers’ comp that they just won’t anymore.

Then all we have left in many situations are hand-picked, under contract

sometimes, company doctors whose opinions we can’t trust. The injured worker can’t trust that doctor’s opinion, I can’t trust that doctor’s opinion, because we know that that doctor is the doctor that they’re getting sent to by the insurance company on a regular basis. All the injured workers at a particular company go to this doctor. Well, why is that?

When there’s that potential for bias, there is always that potential for that doctor not giving an honest opinion. That’s what we really want to know. What is wrong and what really needs to be done to fix it? If that’s going to be an expensive surgery, so be it.

That’s the problem. That’s what we’re seeing: surgeries being denied, treatment sometimes, just testing, sometimes physical therapy, sometimes just a prescription because it happens to be a little too expensive in the eyes’ of the adjuster. These doctors just say, “That’s it. Enough. I’m done. I’m not taking these cases anymore.”

It’s gotten to the point where in many circumstances, especially in eastern North Carolina, the option is down to one or maybe two.

One of them is a doctor that we know is a regular expert hired by insurance companies, hired by the defense in these kinds of claims. We know that’s a doctor’s opinion who we can’t trust for that very reason.

If you’re in that situation, if you’re being told things like, “Well, that doctor’s not in-network,” there is no such thing as in-network or out-of-network in a workers’ comp claim.

There’s no contractual in-network kind of situation like you might have with health insurance. If you’re being told that, that’s not really the case. There’s no such thing as in-network or out-of-network.

The problem is getting the physicians to be willing to see an injured worker in a workers’ comp setting, in a workers’ comp claim. It needs to be a situation where you trust the opinion of the doctor that you are seeing. Period. End of story.

It needs to be an unbiased opinion by a qualified physician, specialist, depending on your circumstances. Whatever it is that you need, that’s what needs to happen. It’s not happening nearly enough in a workers’ comp case in North Carolina.

It often becomes the focal point of the fight between myself and their lawyers over who the treating physician is going to be.

That, to me, is probably the biggest trend. That was not really the case many years ago. It would happen every once in a while, but for the most part, it was going to be a local doctor, who was a well-respected doctor, who was going to see the patient, who had the expertise, and that was it. Not so much anymore.

If you find yourself in that situation, give us a call. I’m happy to sit down and talk with you about what your options are as far as treatment to try to get you the care that you need.