Worker Compensation Claims in a Nut Shell

Confused about how Worker Compensation Claims Work? Hopefully this article will dispel myths and confusion.

You aren't alone, as many physicians don't understand the nuances either. When I first started my orthopedic practice, I hardly knew Worker Compensation claims, and the process that it involved.

Here is the website for Hawaii's Worker Compensation process: https://labor.hawaii.gov/dcd/home/aboutwc/

Here are the steps involved for a Worker's Compensation claim:

1. Tell your employer immediately.

2. Get a claim number immediately as this will help establish medical care sooner. Knowing your claim's adjuster contact information is important too.

3. Contact a clinic that takes Worker Compensation claims. The attending physician on record is the one that will manage your case, and you can only change the attending physician once.

4. Get appropriate treatment. Treatment means referrals, consultations, imaging studies, and medications. All treatments require the approval from your claims adjuster before it can start. Make sure you contact your claims adjuster about time loss and wages during time off of work.

5. When your treating physician says "MMI" or maximal medical improvement, this is the estimated time where no further treatment will change your outcomes.

6. After all treatments are finished, then there may or may not be permanent impairment, and you will be referred for an independent medical examination for rating purposes. This will benefit you, as the Worker Compensation insurance carrier provides a financial sum for the lost in function of that injured body part.

7. If your insurance carrier feels a diagnosis is not work injury related, or if there is confusion on the treatment course to get you to maximal medical improvement, an independent medical examination will be requested.

8. The goal is to return to the job of injury, however, if work conditioning fails this, then a functional capacity evaluation is performed. A functional capacity evaluation determines what permanent work restrictions are required.

9. With the functional capacity evaluation results, we as treating physicians ask your employer to accommodate such permanent work restrictions without changing your job title, or to provide a new job position. If your work cannot accommodate, then you may have to find a new job with a new company or undergo vocational rehabilitation.

Lastly, to dispel a myth, as treating physicians, we are not hired by the Insurance Company to be a Worker Compensation physician. Rather, we accept the insurance carrier, similar to accepting Medicare or Medicaid. Many physicians don't want to deal with the extra paperwork involved with Worker Compensation cases, and refuse Worker Compensation claims.

Please let us know if you have any other questions! Please email at westoahuorthopedic@gmail.com