# Workmans compensation



## camilleb (Feb 6, 2013)

I am usually confused when it comes to workman's compensation.  I think I have a simple question:  When a patient comes to see the specialist, shouldn't he have some paperwork or contact information from his employer's WC case worker, that states they are accepting responsibility that the patient _can _claim WC?  Often times, patients come to see us, but do not have anything that tells us that the employer is aware of a claim and has instructed the patient to file with their WC carrier.  They can't just say "it's WC" and here it is a year later.  Thanks!


----------



## airart (Feb 8, 2013)

*WC Insurance Info before seeing a patient for the first time.*

**Every state has different rules/guidelines.  Just head over to your state's department of insurance and you will be able to find information similar to what is below.  This is for Texas.

The employee's responsibility is: 
•You must report your injury to your employer within 30 days from the date of the injury, or from the date you knew your injury or illness was related to your job.  If you do not notify your employer within these 30 days, your right to obtain benefits could be lost. 
•You must send a completed Employee's Claim for Compensation for a Work-Related Injury or Occupational Disease (DWC Form-041) to the Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) within one (1) year of the date of injury to protect your rights. 
•For more information please see the Injured Worker Rights and Responsibilities or call Customer Assistance at 1-800-252-7031

What information do I (patient/employee) need to provide TDI-DWC/the carrier/the doctor/my employer?

TDI-DWC:
•Completed DWC Form-041, within one year 
•Any change of address and/or phone number as soon as possible 
•Any information regarding a change to your employment status or wages

The insurance carrier:
•Date of injury 
•Copy of Form DWC Form-041 filed with TDI-DWC 
•Any information regarding your work-related injury or illness 
•Any medical information, regarding your work-related injury or illness, past or present 
•Change of address and/or phone number, as soon as possible 
•Any information regarding a change to your employment status or wages

Your doctor:
•Information regarding how, where and when the injury occurred 
•Medical insurance information, regarding your work-related injury or illness, past or present

Your employer:
•Information regarding how, where and when the injury occurred 
•Any pertinent information regarding work status

**Some physicians place these common â€œrules/policiesâ€� in their office guidelines for patients.

Important information for Worker's Compensation Patients:

•You must be "verified" with the insurance carrier prior to treatment being provided.
•We must know if you are seeking a â€œsecond opinionâ€� with one of our physicians. Worker's Compensation requires special forms to be filled out under these circumstances.
•We must know if you are switching from another doctor to one of our doctors. Worker's Compensation requires special forms to be filled out under these circumstances.
•Worker's Compensation patients will not be allowed to have more than two rescheduled or canceled appointments without jeopardizing their off-work status.

**I found this one site online that has great suggestions before seeing that injured employee for the first time.  This is similar to your verification of insurance prior to initial visit for services for all new patients.

State Workers Compensation programs are exempt from HIPAA mandates and some may use obsolete CPT Codes or make up their own.  Contact the state Worker's Compensation office for a list of their valid local codes.

•Proper verification of coverage is important
•Employer name, address, phone/fax number, and contact person.
•Payer (Workers Compensation Administrator)
•Date & time of injury or illness
•Description of how the accident or illness occurred

Step #1 Contact the Employer to Verify the Accident!
•Verify that the employer is familiar with the accident and the patients injury, and they do not anticipate any fraud or problems with the claim, i.e., the patient lying or embellishing
•The employer's report of the accident/injury has been filed with the insurance carrier.
•The name of the Industrial Insurance carrier and the patient's assigned case worker/adjuster.
•The employer's Workers' Compensation policy number.

Step #2  Contact the Workers' Compensation Carrier and ask the following:
•Is the employer's Workers' Compensation policy still in force?
•Since many companies are divisions of other companies, what company name should appear on the claim form submitted for processing adjudication?

Almost every state requires the physician to complete a first Report of Injury.  Loss of Work Time (varies by state) â€“ If the patient is off 3 days or less the patient is not compensated.  If the patient is off less than 14 days, days 4-14 are compensated.  If the patient is off more than 14 days, all days are compensated.

Communication with the employer and insurance company is of utmost importance!  After the examination is completed, the estimated time off work, treatment plan, and necessity for outside testing must be shared.


----------

