Yet another...ASAP

MsLady · March 2003

I have an EE who feels he was not properly treated for his WC. He feels that the doctor is a "quack" for saying that he can come back to work. (he said he was given restriction on driving and sitting up, however the report I got from the doctor says that he is limited to lifting 15 lbs and limit repitive bending, twisting of the back) Should I send him to get a second opinion? Or should I stand by what the doctors said, and tell him he is required to come to work and if he would like to get a second opinion, on is own, he can. (He was suppose to be back to work on Mon. he hasn't reported back as of yet.) He left me a message yesterday, however I did not get it until this morning. As always...THANKS!

Kari Swenson

Balloonman · March 2003

You do not want to lose control of the treatment by sending him to his own doctor. He may not want to work, hence the doctor is a "quack". I would call the clinic and ask if there are issues with symptom magnification.
I would then call the employee and explain, that you have some issues. If he no called no showed for 3 days and did not call to yesterday I would terminate him. I would let him know that you had work available withing the restirictions (assuming you did) and explain he will not be paid by WC or you.
THen I would ask the clinic coordinator do they have another clinic within their system and or a doctor they would recommend for a second opinion. They often know which doctors will not take any crap from malingerers and can guide you their.
If you identify one I would let the employee know (assuming you do not terminate, give thought to this as it may be a golden opportunity) that you have an appointment set, if they miss it, they are termed, if they don't come in and bring you the work activity report following the docotor's visit they are termed, and if they don't show up for restricted duty, they will be termed.
My $0.02 worth.
DJ The Balloonman

Safety Witch · March 2003

Employees in WA state sometimes "doctor shop" to find the diagnosis they are hoping for (one that allows time off work). Injured ee's have the right to choose their own physician from the outset of a claim. If a doctor releases an ee to restricted duty and they don't show up (and we have work available), we make them take sick days. It is their own decision not to work. If they don't have sick days left, they don't get paid.

If the doctor is one you have dealt with previously and you trust him, I wouldn't allow a second opinion on the claim. If the employee goes for a second opinion on his own and it differs from the attending physician's diagnosis, then get a nurse case manager and have him/her dialogue with the docs.

LindaS · March 2003

Was this a doctor he chose or one you sent him to? We do not force an employee to go to a specific physician and allow them to choose who they want to be seen by. You will always find doctors that will give the employee what they want regarding restrictions, time off, etc. but as with any WC injury, the insurance company always has the right to send the employee for an IME. As an employer who has been in this situation before, we have always gone with the IME report regarding return to work and restrictions.

If he wants a second opinion, I don't think there is any way to stop him but I would address his not showing up for work. I would also notify the WC carrier as they will stop any TPD payments as of the date he was to return to work.

If this second physician changes his restrictions or keeps him off work, talk to your WC carrier about an IME, especially if the information from the second physician significantly changes.

ssims · July 2003

What we have in Missouri is the right to pick the treating doctor. We always retain that right, we do not let the insurance company pick the doctor or control the treatment, we do. We track and control all treatment, including working with the attorney if it goes to setttlement. I attend all conferences and trials (if it gets that far) and insist on being copied on all correspondence between adjuster and attorney. I know the work comp judge by name and he always acknowledges me when I come in. He says he wishes other employers would take the time to attend. He know our company reputation for always using only the best doctor's and treating our employees well and it goes a long way. Yes, it takes a lot of timeand record keeping but it is worth it. We provide total light duty, if they are totally restricted, we will put them in room and have them watch safety videos or read safety training material. You don't want to put them off if you can avoid it. You can control what they are doing if they are at your facility and they hate just detting. It also helps because you have fewer lost time days. Insurance companies love us once they get used to us because we do most of their work for them. If you want more info, be happy to share.
e-mail is [email]lwchr@clasicnet.net[/email]

Hunter1 · July 2003

Do you understand how fortunate you are to be in Missouri? In WI, the employee gets to choose their own doctor (two as a matter of fact) and all the referrals they can stand from the first two. The employer is, many times, relegated to the sidelines to see what's going to happen, although we, too, provide light duty and have a pretty good carrier to work with. We'd be overjoyed to be able to 'manage' WC cases.

NicoleLee · July 2003

OH also allows employees to see whichever doctor the employee chooses. We have no control over anything. Of course, we are allowed to suggest where we would like employees to go, but in no way can we force an employee to go to our preferred dr. We recently got slammed due to this from an employee who has now been milking a carpal tunnell surgery for almost 4 months. We have done everything to accomodate them; however, her dr. basically does what she asks, and ultimatly, her treatment plan goes. this has been very frustrating and we have not gotten a lot of support from BWC. I WISH we could have the advantage of picking the doc.

Yet another...ASAP

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