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The Importance of Choosing Doctors for a Workers’ Compensation Physician Panel

One of the changes to the Tennessee workers’ compensation laws that went into effect on July 1, 2014 affected the rules about physician panels. Under the old law, business owners had to provide three physicians or surgeons, who are not affiliated with the same practice, in the employee’s community from which an employee could choose to treat injuries suffered on the job. If a back injury occurred, employers had to add 1 chiropractor to the panel. If the chosen doctor referred the employee to a specialist, the employer had to provide a new panel of three non-affiliated specialist physicians. Under the new law, employers can now provide a panel of three physicians, surgeons, chiropractors, or specialty practice groups available in the employee’s community. If no providers are available in the community, employers can include doctors within a 100-mile radius of the community. If the chosen physician refers the employee to a specialist, the employer can either accept the referral or provide a panel of three specialists. For business owners, choosing physicians for this panel is a very important process. We at Elite Insurance Solutions would like to help our local business owners with this task by sharing some tips from the American College of Occupational and Environmental Medicine (ACOEM) on how to best choose these physicians.

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To find the best available physicians, the ACOEM recommends following three steps:

1. Identify potential candidates.

It is very important to provide physicians in whom your employees can trust. To best find potential candidates, you can call the healthcare or workers’ compensation departments of large and well-managed employers in your area to ask about their physician panels. Ask your fellow colleagues for recommendations of the best healthcare practices. You can also consult with your state or county’s medical society as well as with state family medicine, orthopedic, and chiropractic groups to ask for a list of members in the occupational health or workers’ compensation committees.

2. Determine which doctors meet the criteria for suitability in terms of proficiency, access, and credentials.

After identifying potential candidates, ask to meet with the staffs and physicians at each facility. Ensure that the facilities are within a reasonable driving distance from your workplace, are accepting new patients, are willing to take workers’ compensation cases, and are open during your business hours. Check the education of each physician as well as the practice history to ensure the basic medical competency and moral fitness of the doctors. You should also look for a physician or practice with a proven background and demonstrated familiarity with workers’ compensation and occupational medicine.

3. Learn about each physician’s practice style.

To find the best high value doctors, you should learn all you can about the practice style of each of your candidates. Look for the following services:

A suitable practice setting and location with reasonable waiting times

Good communication skills within the entire office

Accurate diagnosis, effective treatment, and a focus on functional recovery

Have questions about the Tennessee workers’ compensation laws? Contact Elite Insurance Solutions to ask our agents anything you need to know.

The 2014 Reform of the Tennessee Workers’ Compensation System: What Are the Changes?

In July 2014, the state of Tennessee passed a wide reform of the workers’ compensation system to make improvements for state workers. If you employ five or more full-time or part-time workers, you are required by the state to have workers’ compensation coverage. It is understandable that you may have questions regarding this new reform to the system. What exactly are these changes and what do they mean for local business owners? Our staff at Elite Insurance Solutions would like to explain these changes to you to help you understand the new workers’ comp system in Tennessee.

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The System Has Become More Streamlined and Dedicated.

An autonomous division, the Division of Workers’ Compensation (DWC) is being created to handle all workers’ comp claims and benefits throughout the entire process. Along with this new division, a new court, Court of Workers’ Compensation Claims, is in place to make the decisions. The DWC Administrator will appoint the judges, mediators, and appeals board; however, the Tennessee Supreme Court remains as the highest court of appeals.

The Reform Provides More Fairness.

Before this reform, close decisions usually favored the injured worker. After this reform, the law will be applied impartially with no favoritism towards the employee or employer.

The Definition of “Injury” Has Been Revised.

According to the Nashville Business Journal, the new definition includes a physical injury by accident, a mental injury, an occupational disease, or a cumulative traumatic condition that arose “primarily” in the scope and course of employment after all other causes have been considered. The “primarily” means that the job contributed to over 50% of the injury.

Employers Now Have Greater Access to Medical Information.

The required employee-signed waiver of the past is no longer necessary for employers to be able to communicate directly with the treating physicians. Employers will also be able to review all medical records related to the treatment of the workers’ comp injury.

Permanent Partial Disability Benefits Will Be Determined Differently.

The reform now considers all injuries and impairments as “body as a whole” injuries. Additionally the maximum number of weeks to receive benefits has increased from 400 to 450 weeks.

A Mandated Ombudsman Program Has Been Created.

This new program will educate, assist, and protect the rights of injured workers, their employers, and others looking to resolve workers’ compensation claims disputes. People who do not have legal counsel will be able to take part in this ombudsman program.

Even though the changes included in this reform are viewed as positive by both employees and employers and will significantly reduce costs, medical inflation continues to increase. A Medical Advisory Committee has also been formed to aid in reducing medical expenses. This committee will consult with the DWC Administrator to create the guidelines, which must be adopted by January 1, 2016, for the diagnosis and treatment of the most commonly occurring workers’ compensation injuries.

Want to talk to one of our agents about this workers’ compensation system reform? Contact Elite Insurance Solutions today to find out how these changes affect you.

By Randy Hulett on September 15th, 2014 | Tagged with: Tags: , , , , , | Leave a Comment