Who Picks the Physician in Tennessee? Part 4 of 4

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Education of employees and supervisors on what to do if an injury occurs is a vital step to a successful Work Comp program. When everyone understands what to do after an accident occurs, then costly mistakes for both employer and employees can be avoided.

Teach your employees the importance of reporting an injury. The earlier an injury is reported, the faster a claim can be handled for both employee and employer.

If immediate emergency care is needed, the employee should be treated at the nearest hospital. After an injury is stabilized then the employee can select from the Panel of Physicians for their remaining medical care.

For accidents that happen on the job, the injured EMPLOYEE selects from the Panel of Physicians (in The State of Tennessee it is form C-42) who will be their treating physician. They have an option to switch to another physician ON THE PANEL. An employee may obtain a second opinion (at the employee’s own expense) from a doctor outside the Panel.

Employees should never disregard filing an injury report. Minor injuries can snowball into major injuries. Never “tough it out.” When in doubt, let the treating physician determine if “it’s no big deal”.

Remember, the employer determines who is on the Panel but the EMPLOYEE selects their treating physician from the Panel. You can learn more about Panel of Physicians through the CWCE program. Do you have a question or an experience regarding the Panel of Physicians process to share with the CWCE community? We will continue this discussions in to the future.

Who Picks the Physician in Tennessee? Part 3 of 4

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3. When necessary, the treating physician selected shall make referrals to a specialist physician, surgeon, or chiropractor and immediately notify the employer. The employer shall be deemed to have accepted the referral, unless the employer, within three business days, provides the employee a panel of three or more independent physicians, surgeons, chiropractors or specialty practice groups. The employee may choose a specialist physician, surgeon, chiropractor or specialty practice group to provide treatment only from the panel.
4. When the treating physician or chiropractor refers the injured employee, the employee shall be entitled to have a second opinion on the issue of surgery and diagnosis from a physician or chiropractor specified in the initial panel of physicians provided by the employer. The employee’s decision to obtain a second opinion shall not alter the previous selection of the treating physician or chiropractor.

The two major differences from the rules prior to July 1, 2014 are:

1. A chiropractor is no longer required on a back injury.
2. The 3 day referral notice.

Our next posting, we are going to explore the specifics for educating employees on the State of Tennessee Panel of Physicians.

Who Picks the Physician in Tennessee? Part 2 of 4

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For injuries on or after July 1, 2014, the injured employee shall accept the medical benefits from a physician listed on the employer’s panel when the employee has suffered an injury, the:
1. Employer shall designate a group of three or more independent reputable physicians or surgeons, chiropractors or specialty practice groups if available in the injured employee’s community, from which the injured employee shall select one to be the treating physician.
2. If three or more independent reputable physicians, surgeons, chiropractors or specialty practice groups are not available in the employee’s community, the employer shall provide a list of three independent reputable physicians, surgeons, chiropractors or specialty practice groups, within a 100 mile radius of the employee’s community.

Next posting, we are going to explore two other specifics for injuries occurring after July 1, 2014.

Who Picks the Physician in Tennessee? Part 1 of 4

Employers who have Workers Compensation are required to have a Panel of Physicians. The employer determines what physicians are on the panel. The Panel of Physicians should be filled out completely and updated regularly. This is a very important step that is often overlooked. ALL employees should know what a Panel of Physicians is and who to contact if an injury occurs. Supervisors should never decide if someone is hurt or not. All supervisors need to report ALL injuries to the person who manages the company’s Work Comp program. A treating physician from the Panel of Physicians must make the determination whether an injury is a compensable work-related injury or not.

Next post, we are going to explore specifics of the State of Tennessee Physician Panel for injuries occurring after July 1, 2014.

Who gives the Tennessee Dept. of Labor and Workforce Development the authority to set up the Court of Workers Compensation?

WORKERS’ COMPENSATION LEGISLATIVE CHANGES

Read Legislation Here

Public Chapter 289 (SB0200/HB0194) separates the Division of Workers’ Compensation from the Department of Labor and Workforce Development, except for administrative matters only.

Comments:

The Court of Workers Compensation was set up by the legislature under the above public chapter. This takes all Workers Compensation Claims occurring after July 1, 2014 at 12:01 am to this venue. Only claims occurring before this date can be heard in Circuit or Chancery Court. Governor Bill Haslem signed this bill which is a crowning achievement that streamlines Workers Compensation matters to the Court of Workers Compensation with quicker processing of issues. The Court of Workers Compensation takes the place of the Circuit and Chancery Court venue. Cases can be appealed to The Court of Workers Compensation Appeal Board and then to the Supreme Court Special Workers Compensation panel. In some instances cases the full Supreme Court of Tennessee may elect to hear a case.

When do you provide a Panel of Physicians in Tennessee to an injured worker? Answer: ALWAYS!

When do you provide a Panel of Physicians in Tennessee?

Sources:

1. TCA § 50-6-204 (a)(3)(A) The injured employee shall accept the medical benefits afforded under this section; provided that in any case when the employee has suffered an injury and expressed a need for medical care, the employer shall designate a group of three (3) or more independent reputable physicians, surgeons, chiropractors or specialty practice groups if available in the injured employee’s community or, if not so available, in accordance with subdivision (a)(3)(B), from which the injured employee shall select one (1) to be the treating physician.

2. TCA § 50-6-204 (a)(3)(A)(i) When necessary, the treating physician selected in accordance with this subdivision (a)(3)(A) shall make referrals to a specialist physician, surgeon, or chiropractor and immediately notify the employer. The employer shall be deemed to have accepted the referral, unless the employer, within three (3) business days, provides the employee a panel of three (3) or more independent reputable physicians, surgeons, chiropractors or specialty practice groups. In this case, the employee may choose a specialist physician, surgeon, chiropractor or specialty practice group to provide treatment only from the panel provided by the employer.

Comments:

1. An employer is required to provide a panel when an employee “has suffered an injury and expressed a need for medical care “ This can be immediately after the injury or several days later. The key is when the employee has expressed a need for medical care.

2. When the selected Authorized Treating Physician (ATP) makes a referral. The employer/insurer must provide a panel within three (3) business days IF the employer/insurer is not in agreement with the referral. If no panel is provided the employer automatically accepts the referral. CWCE recommends working with the panel physicians to make sure referrals are to agreeable specialist physicians, surgeons, and chiropractors.

3. If the authorized treating physician makes a referral to a specific doctor and a panel is provided. The employee’s choice is then limited to the three “independent reputable physicians, surgeons, chiropractors or specialty practice groups.” CWCE would recommend that specific doctors be listed on the panel in that listing a group or hospital could dilute the control of the medical.

What happened to Chiropractors in the New Tennessee Workers Compensation Reform?

Sources: 

  1. TCA § 50-6-204  (a)(4)(B) If the injury is a back injury, then the group of three (3) or more physicians or surgeons required to be designated pursuant to subdivision (a)(4)(A) shall be expanded to four (4), one (1) of whom must be a doctor of chiropractic; provided, that no more than twelve (12) visits to the doctor of chiropractic shall be approved per back injury, except upon the approval of the employer. The provisions of this subdivision (a)(4)(B) shall not apply to state or local government employees and shall not apply to workers’ compensation self-insurer pools established pursuant to § 50-6-405(c)(1). (Effective until July 1, 2014.)
  1. TCA § 50-6-204.  Medical treatment, attendance and hospitalization — Release of medical records — Reports — Disputes — Reimbursement or payment of expenses — Burial expenses — Physical examinations — Pain management.  [Effective on July 1, 2014. See the version effective until July 1, 2014.]

Chiropractors for injuries after July 1, 2014 are no longer required to be on a panel for an injury to a back. An employer may include a chiropractor on a panel.  If selected they will have the same authority and duties as any other Authorized Treating Physician.  (Including Referrals)

Treatments by a Chiropractor for injuries occurring after July 1, 2014 are no longer limited to twelve (12) visits. Chiropractic treatment is very valuable in established ongoing treatment for injuries, however caution should be used on initial treatment immediately after an injury. Most reputable Chiropractors will recognize these situations and defer treatment to a Medical Doctor.

Independence Day and the Independent Medical Evaluation!

Chatting With Chris Easy as 1, 2, 3: 1 topic, 2 sources, and 3 comments

Topic:

Independent Medical Exams

Sources:

1. TCA § 50-6-204 (d) (1) The injured employee must submit to examination by the employer’s physician at all reasonable times if requested to do so by the employer, but the employee shall have the right to have the employee’s own physician present at the examination, in which case the employee shall be liable to the employee’s physician for that physician’s services

2. IN THE SUPREME COURT OF TENNESSEE
SPECIAL WORKERS’ COMPENSATION APPEALS PANEL
AT NASHVILLE
January 24, 2011 Session
JEFFERY IRONS v. K & K TRUCKING, INC. ET AL.
Appeal from the Chancery Court for Macon County
No. 3932 C.K. Smith, Chancellor
No. M2010-01280-WC-R3-WC – Mailed – April 25, 2011
Filed – July 14, 2011

Comments:

1. As we honor and celebrate the birth of our country we reflect on the fact that our forefathers wanted to be independent from England having control over every aspect of our country.

Just is the same in workers compensation when a doctor recommends treatment that is unrelated to the claim. Under the above statute and confirmed by the Irons vs. K&K trucking case an employee must submit to an Independent Medical Exam (IME). In the trial court case the Judge did not allow for the IME that was reversed and remanded back to the trial court to comply with the law.

2. The employee must submit to the Independent Medical Exam at a reasonable time. The cost for the IME is the responsibility of the employer/insurance carrier.

3. The employee has the right under the statute to bring his own physician to the exam. However, the cost for this additional physician attending shall be the employee’s cost.

The Tennessee Workers Compensation Reform; The First Few Months

Chatting With Chris Easy as 1, 2, 3: 1 topic, 2 sources, and 3 comments

Topic:

The Tennessee Workers Compensation Reform; The First Week.

Sources: 

  1. 2014 WORKERS’ COMPENSATION LEGISLATIVE CHANGES  http://www.tn.gov/labor-wfd/wcomp/wc_2014legislation.pdf
  2. Public Chapter 837 (SB2088/HB1786) OMBUDSMAN PROGRAM

Comments:

1.  The benefit rate for injuries occurring July 1, 2014 through June 30, 2015

Temporary Disability Max Weekly Benefit = $932.80

Permanent Disability Max Weekly Benefit = $848.00

Minimum Weekly Benefit = $127.20

2. Ombudsman is the title of an official with the TNDLWFD that is charged to assist with the authority to communicate with all parties or providers involved with a claim for benefits, facilitate exchange of medical records, and assist with completion of forms for unrepresented employees.

3. All injuries occurring on or after July 1, 2014 fall under the jurisdiction of the Court of Workers Compensation.

Who picks the pharmacy for Workers Compensation prescriptions?

An issue that employers can face is the decision of where workers compensation prescriptions are filled. Let’s take a closer look at who has the authority to decide, and what is the best solution to fit everyone’s needs.

The Employee
It’s understandable that an employee can be overwhelmed experiencing a work-place injury. Although the employer has the authority to decide the management of prescriptions, it is natural that the employee will wish to select a pharmacy that is convenient or familiar to them. However, this can become costly.

pharmacy

The Employer
An employer has a responsibility to their business and to the insurance company to keep costs under control. One cost saving idea is a preset arrangement with the treating physician’s office to prescribe generic brand prescriptions. This practice is used by many employers, favored by the insurance companies, and affords the same prescription benefits to the employee.

Pharmacy Benefit Manager
Most companies have Pharmacy Benefit Manager access through their existing workers compensation policy. An employer should check with their carrier or insurance agent to see if a PBM is available through the policy should an injury occur.

A PBM is very useful in keeping costs under control while the employee has the freedom of deciding on the pharmacy of their choice. The assistance of a PBM can help the employer in controlling pharmacy expenses, and is highly recommended in a large claim situation.

You can learn more about Pharmacy Benefit Managers and workers compensation prescriptions through the CWCE program. Do you have a pharmacy prescription question or experience to share with the CWCE community?