If your practice takes Workers’ Compensation patients, there may be a few things here to peak your interest or affirm your current practice. 

If you do not, but have some interest, read on.  I want to address some of the familiar complaints and barriers to your office taking on Comp as part of a practice profile and answer the question: Why Not Workers’ Comp? 

Most Comp patients are fakers and malingerers, right? Of course not. The fakers are out there, but the system has a very heavy handed approach to attack fraud.  And I do mean attack. The fraud section of the Workers’ Compensation Act can be described as the “nuclear” provision obliterating any claim falling under its criteria. 

This part of the Act is devastating to the individual patient who commits to taking or attempting to take benefits by false or misleading statements. If that patient is found by a Judge of Compensation Claims to knowingly make, or cause to be made, any false, fraudulent, or misleading oral or written statement for the purpose of obtaining or denying any benefit or payment under the comp statute, that is it, the claim is over. 

Even if the patient’s claim was compensable, if the judge determines a false or misleading statement was made, verbal or in writing, the claim is over for that patient. Fortunately, you as the doctor do not have to make that call. This finding is subject to a civil standard as opposed to the heightened “beyond a reasonable doubt” criminal standard.  

This provision has been in effect for some time now and very heavily litigated. It has ended many a claim and caused countless withdrawals of questionable benefit requests. Such malfeasance is not relegated to Workers’ Compensation alone. Fraudulent activity may be spurred on for other reasons, attracted by other benefit streams and can be encouraged by a private disability policy, a Social Security Disability effort, desire to get out of work, school, you name it. Nor is it just the injured worker. Employers commit fraud. Nevertheless, good people get hurt on the job every day and need good healthcare providers to get them back on track. To see the figures tracking fraud convictions in Florida go to http://www.myfloridacfo.com/wc/pdf/DIF-DWC-2011-Joint-Annual-Report.pdf. 

How about another concern: the pay and the paper work. Unless you are part of that handful of practitioners who refuse to accept anything other than self-pay clients you are already enmeshed in paper work as it is and wondering when the continued contracting down of compensation for your services will ever end. To that end Comp is no longer at the bottom of the barrel. I cannot go through all or even a decent sampling of CPT codes in this article, but suffice it to say comp can be a viable component to your practice profile. 

When an established relationship comes into the office with an on the job injury the doctor/patient relationship can be maintained. Accepting Workers’ Comp can also be a way to attract more business if you are a specialist relying upon other physician referrals. Primary care physicians need specialists to whom they can refer the patient injured on the job. Even if you are a “paperless” practice, documentation is not going away. To make comp work for you, your office needs to be set up to obtain authorization of care, provide a treatment plan and report the progress of the plan. 

It’s all about getting the patient back to work. In order to be an authorized doctor, Independent Medical Examiner or Expert Medical Advisor for Comp you must be certified. This is done through The Division of Workers’ Compensation under Florida’s Department of Financial Services.  The link to see for certification, billing and reimbursement is www.myfloridacfo.com/WC/provider/index.html. There is more.

Lawyers, adjusters and nurse case managers are all a part of the system. They each have a job to do in this system. Medical drives the system and determines the outcome of each case. As such the nurse case manager seeks out diagnosis, treatment plan and prognosis. This information is relayed to the adjuster who is charged with making a decision on benefit placement.

The attorneys argue for their client’s respective positions in large part based on the medical opinions. You are a pivotal aspect to each comp claim. You can establish boundaries that work for you and still successfully take care of the injured worker. If you take the time to understand and have your staff understand, the experience will be workable and meaningful.

I have practiced in the area of Workers’ Compensation for 24 years and find it fascinating. We need more doctors in Central Florida willing to take these patients. I hope you will consider it for your practice.

Steve Pyle has been a practicing attorney for 24 years. His areas of focus include Workers' Compensation, Personal Injury and Social Security, representing individuals disabled due to illness or accident. He runs a successful practice in Winter Park, Florida and is AV Rated by Martindale Hubbell. Mr. Pyle is a State Certified Instructor who lectures to insurance company adjusters in the area of Workers' Compensation.

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