Why You Need a Designated Occupational Clinic

Are you familiar with this scenario? One of your employees has a seemingly minor injury while working. After hitting her hand on the corner of her desk, she decides to visit her primary care doctor through her private medical plan rather than going to her Human Resources manager to check on her workers’ compensation plan.

The employee has been visiting this doctor for a long time for various health conditions, including wrist pain and neck pain. The doctor submits a report, indicating that all the patient’s pain issues are work-related. Furthermore, the doctor discourages the employee from further work without distinguishing between any industrial and non-industrial conditions.

Employers that don’t have medical treatment protocols in place, including a designated occupational clinic for employees who suffer an injury, risk ending up in this situation. When employees don’t know where to go for a workers’ compensation injury, they often default to their personal care physician. When a patient has an existing relationship with a personal physician, it is more likely the physician will be sympathetic to them rather than the employer’s business interests.

Also, when injured employees seek treatment from their private physician for both work-related and non-work-related conditions, it’s challenging for HR managers to separate billing for the various issues, which may result in overpayments on claim files. Additionally, many physicians in the private health sector don’t know the differences between workers’ compensation and the private health care system when it comes to guidelines for treatment, disability, billing, and reporting.

This lack of information complicates billing when the claim gets to the workers’ compensation insurance carrier, often triggering bill denials and processing delays, and prompting medical providers to file liens. This situation increases the potential for litigation on both the injured worker and care provider side.

However, there is a solution. In this article, we discuss how you can avoid these challenges, gain control, and mitigate workers’ compensation medical and disability costs by establishing an occupational clinic for your employees.

What Is an Occupational Clinic?

An occupational clinic is a medical facility that provides comprehensive medical care for employees who experience work-related injuries or illnesses. An occupational clinic, either on or off premises, specializes in working with people who are filing workers' compensation claims. Some of the services include:

• Lab work
• Injury care
• Health screening
• Drug and alcohol screening
• Post-accident screening and testing
• EKGs
• X-rays

Some occupational clinics are stand-alone facilities, and others are located within a larger clinic or a hospital. Some large businesses even have occupational clinics or doctors specializing in occupational medicine within their offices.

What Are the Advantages of Occupational Clinics?

An employee getting sick or injured on the job is a serious issue. There are many advantages to establishing medical provider relationships for employers in states where they can direct care.

First, it is critical to know that you are sending your employee to an occupational health provider with an excellent reputation and who provides next-step care (treatment plan).

Have you had an injured worker inform you they didn’t feel heard when being seen or had their treatment plan significantly delayed? The longer the injured worker feels injured, the bigger your exposure.

Second, a good relationship with several providers in your area will expedite the return-to-work process in a more proactive fashion. The medical providers will issue work statuses based on their knowledge of your business and understanding your modified duty availability—not based on the injured worker incorrectly informing the provider that their employer has no modified duty available.

From a cost and care standpoint, if you inform the provider that you would like conservative care such as physical therapy or chiropractic services expedited within the first several visits, they will act accordingly. This early communication helps prevent the significant delays caused by urgent care treatment referrals.

Additionally, many urgent care facilities charge a claimant a co-pay based on their personal insurance waiting to get approval from an adjuster. However, if your business has a relationship with a provider, a quick phone call often can resolve all questions and eliminate potential billing to the injured worker’s private health care insurance.

Lastly, experienced occupational health providers understand the workers’ compensation fee billing schedule and the state jurisdictional rules for medical treatment. Understanding both structures is critical to managing both the claim cost and the injured worker’s care.

How to Select a Medical Provider for Your Occupational Clinic

How do you determine which providers will be a good fit for your employees? First, if you can direct care in your state, your workers’ compensation carrier may send you to a medical provider network (MPN) that your injured workers must choose from.

Also, your workers’ compensation carrier has a liaison who can make a list of providers within your geographical area to help narrow down your options.

Your Woodruff Sawyer broker is a great resource. They have connections with multiple clients and carriers and can assist you with the entire selection process. If you have a relationship with your workers’ compensation carrier adjusters, they can give you the good, bad, and ugly on local providers as well. Once you have the list finalized, it’s time to vet your top choices.

Collaboration is an important feature in workers’ compensation claims. Here are some questions to ask:

• Is occupational health their specialty?
• Do they have a wide range of providers and staffing within their location and referral physicians outside their location?
• Does their clinic feature flexible hours?
• Do they offer telemedicine for follow-up visits?
• How much time do they spend with injured workers?
• What is their process for establishing a return-to-work status?
• Are they amenable to working with the employer in returning the injured worker back to work?
• What is their stance on nurse case manager (NCM) attendance at appointments?

Language barriers are a huge impediment to a workers’ compensation claim. If most of your staff is fluent in other languages than English, ensure the clinic has staff interpreters or an online solution for real-time interpretation for your injured workers.

As mentioned previously, it’s a good idea to run your final list by your broker or your carrier to be sure your list contains solid candidates.

What Are the Next Steps?

If you are researching medical providers and only have a handful of claims a year, this process will not be as involved or detailed-oriented as if you had a manufacturing facility operating three shifts per day with more injuries per year. Once you have had the first-line conversation and would like to move forward, ask if you can meet with the providers directly at their medical facility.

If you are a manufacturer with physically demanding jobs, consider inviting the medical provider team or office administrator to tour your facility. This visit allows the team to see the jobs in action and understand your commitment to safety.

Once you have chosen your medical provider, continue building the relationship. This process may include the following:

• Call or email your contact person to let them know you are sending over an employee.
• Equip the physician with detailed job descriptions to ensure they provide work restrictions that correlate with the employee's job functions—not a generic status that requires further conversation.
• Conduct ongoing check-ins with providers about injured workers whose injuries are more severe than a sprain/strain.
• Determine if the clinic can provide your employees with health and safety training via meetings or seminars.

Remember to maintain good communication with the injured employee as well. Injured workers are less likely to retain an attorney when they feel heard and cared for, both from the provider and employer standpoint.

Medical treatment for injured workers does not have to be painful. A designated occupational clinic and the solutions and resources it provides can help control your workers’ compensation costs and accelerate your injured workers’ recovery times.

If you have further questions about occupational clinics, contact your Woodruff Sawyer representative and let us know how we can help you.