Tag Archives: medical treatment

Limits on Medical Treatment Options for Injured Workers?

Doctor choice.  And choice of treatment.  The Wisconsin way.

Unlike systems in other states, an injured worker in Wisconsin has access to their own doctor and what that doctor recommends for medical care.  Wisconsin does not have specific directed care or a panel of worker’s compensation doctors. The choice of medical care and experienced practitioners produces some of the fastest return to work rates in the country, along with low costs per claim.

The only “limit” is the “two doctor rule,” where a Wisconsin injured worker has the right to see their own doctor or to get a second opinion from another doctor.  While any doctor beyond the “two doctor” limit would be excluded from coverage (unless mutually agreed to by the work comp carrier), a worker has the right to see any doctor that is part of the referral chain from the two doctors–making doctor choice virtually unlimited if the worker obtains an appropriate referral!

The recommended medical care should be covered by the work comp carrier is reasonable and necessary to cure from the effects of an injury.  Unless the insurance company has a contrary medical opinion (through an adverse, or “independent” medical evaluator), they generally are responsible for the medical treatment recommended, whether that is therapy, office visits, prescriptions, injections, surgery, etc. 

Other states place limits on the type of treatment a worker can receive.  A recent article revealed that Ohio legislators are limiting when injured workers can have certain prescription medications or surgery (Ohio Imposes Strict Rule on Workers’ Back Surgery, Opioids).  Ohio is required a worker undergo 60 days of “alternative care”, potentially without opiate use, before having a work-related back surgery.

To date, Wisconsin’s legislature preferred the medical expertise of its physicians and their treatment recommendations.  Relying on experienced, quality medical practitioners allows workers swift access to the necessary medical care and recommendations–and puts them back in the workplace fast!

 

Medical Outcome Based Compensation – Essentially a Workers’ Compensation Concept Already

Outcome Based Medicine Being Adopted by NYC

Today’s post comes from guest author Jon Gelman, from Jon L Gelman LLC.

The idea of compensation medical providers for the end result, or benefits of medical care provided, is not a new concept as it is already embraced theoretically by the workers’ compensation system. Employers, who usually control the delivery of medical benenfits, not only pay for medical benenfits, but also compensate the injured worker for the outcome through permanent disability awrds.

In actuality the workets’ compensation system rewards the employer for the most favorable outcomes by theoretically awarding lower permanent disabillity benenfits to those with the most favorable outcomes.

Adopting this concept to the nation’s entire medical care system, is a wise step and one that is being advanced in the New York City Hospital system. 

“In a bold experiment in performance pay, complaints from patients at New York City’s public hospitals and other measures of their care — like how long before they are discharged and how they fare afterward — will be reflected in doctors’ paychecks under a plan being negotiated by the physicians and their hospitals.”

Click here to read New York Ties Doctors’ Pay to Quality of Care (NY Times)

 

If You’re Going Out To Eat Check Out “Behind The Kitchen Door”

Today’s post comes from guest author from Jon Gelman, LLC – Attorney at Law.

For many celebrating the holiday season is going out to eat for an enjoyable experience. Unknown to many restaurant patrons are the problems of restaurant workers and include:  low wages, occupational stress and lack of medical benefits that requires restaurant workers to go to work sick.

Behind The Kitchen Door exposes the working conditions in the restaurant industry.

“How do restaurant workers live on some of the lowest wages in America? And how do poor working conditions—discriminatory labor practices, exploitation, and unsanitary kitchens—affect the meals that arrive at our restaurant tables? Saru Jayaraman, who launched a national restaurant workers organization after 9/11, sets out to answer these questions by following the lives of ten restaurant workers in cities across the country – New York City, Washington DC, Philadelphia, Houston, Los Angeles, Houston, Miami, Detroit, and New Orleans. Blending personal and investigative journalism, Jayaraman shows us that the quality of the food that arrives at our restaurant tables is not just a product of raw ingredients: it’s the product of the hands that chop, grill, sauté, and serve it, and the bodies to whom those hands belong.

“Behind the Kitchen Door “ is a groundbreaking exploration of the political, economic, and moral implications of eating out. What’s at stake when we choose a restaurant is not only our own health or “foodie” experience, but the health and well-being of the second-largest private sector workforce—the lives of 10 million people, many immigrants, many people of color, who bring passion, tenacity, and important insight into the American dining experience.

Download the 2012 National Diners Guide – See how your favorite restaurant ranks