How On-Site Medical Clinics Curb Fast-Rising Costs of Medical Care in Workers Comp

On-Site Clinics Decrease Costs

Many medium and large employers in their never-ending battle to reduce cost and to provide benefits to their employees are opting for on-site medical clinics. On-site medical clinics can decrease the cost of general health benefits programs and decrease the cost of medical care associated with workers' compensation claims. On-site medical clinics have proven they can curb the fast-rising cost of medical care for both personal and work-related injuries and illnesses.

Some employers are hiring clinicians themselves, and others are using contracted providers who also provide software, protocols and other tools to support the clinicians.

Medical Care Provided at Work Site, Convenient & Effective Treatment

With the on-site clinic, the medical care is provided at the work site, which is convenient for employees who otherwise would have to leave work for care. Injuries and illnesses are evaluated by the clinic staff; many cases can be treated on site. Employees are referred to off-site medical facilities only if the injury or illness is beyond the scope of the medical professionals in the on-site clinic.

On-site clinics often use a variety of staffing models, including RNs, nurse practitioners, and physician assistants - with physician collaboration and direction as needed. Depending on the employer's needs, on-site clinics can be staffed with a doctor. When properly managed, on-site medical practitioners can provide high quality medical care while reducing overall costs. They can also provide other health services such as wellness, and regulatory exams, etc. On-site clinics can include x-ray machines and pharmacy services, though costs and state regulations affect the feasibility of those services. Good providers of on-site medical clinics will tailor the services provided to the employer's needs.

Benefits to Employees

The benefits to the employee injured on the job include:

· Medical services available when the typical doctor's office is closed - evenings, weekends and holidays

· No appointment is necessary

· Immediate medical care following an injury

In addition to the workers' compensation benefits, the employee also enjoys easy access to medical care, assistance with chronic medical problems and healthy living guidance.

Benefits to Employers

The benefits to the employer of the injured worker include:

· Evaluate and treat employee injuries immediately

· Avoids unnecessary and off-site medical treatment

· Referral to appropriate and screened preferred medical providers when off-site care is needed

· Improved outcomes and faster return to work, increasing productivity

· Assist in keeping all workers healthy and productive

· Reduces absenteeism

· Significantly lower cost for medical services for workers' compensation claims

· Can provide physicals

· Drug screening

· Improved general health of employees

· Improved employee morale

· Increases employee retention

· Can coordinate pharmacy usage with your Pharmacy Benefits Manager

· Timely reporting of the injury and medical information to relevant parties.

· The First Report of Injury form is completed and filed with both the state and claims office.

Treat Workers Comp and Health Care

On the workers' compensation side, the on-site clinics can treat lacerations, strains, sprains, other minor orthopedic injuries, abscess drainage, minor skin infections and other routine acute medical conditions. On the health care side, the on-site clinics can treat the whole gamut of minor medical conditions that causes employees to lose time from work including strep throats, colds, ear and eye infections, skin lesion removal and vaccinations.

Clinics Used For Any Site with 1,000+ Employees

On-site clinics are not just for industrial sites like factories, and mines or large office centers. On-site clinics can be operated for just about any industry where there are 1,000 or more employees in one location. Mobile and temporary clinics are used for large construction projects such as skyscrapers, power plants, and highways. All clinics need to be equipped with the necessary furniture, supplies, equipment, and medications.

The cost of drug testing for both employee applicants and existing employees can be significantly reduced by using an on-site clinic. Drug testing due to reasonable suspicion, random testing and post-accident screening can be completed by the on-site clinic. In many states the timely completion of a post-accident drug testing can be used to deny workers' compensation benefits to employees under the influence of a drug at the time of their injury. A positive drug test result can be sent to a certified lab for further confirmation.

Be Sure to Select Quality On-Site Medical Provider

When an employer is selecting the on-site medical provider, select a medical provider who provides an on-going review of the quality of service they are providing. The service quality can be evaluated by patient reviews and comments, by clinic audits and by staff performance evaluations.

On-site clinics do carry costs and risks as well. To be successful, the staff needs to be trained for on-site work, and be supported with appropriate software, operating systems, supplies, medical direction, protocols, QA, and other infrastructure. The medical practice needs to carry malpractice insurance coverings the employer and be compliant with HIPAA, GINA, HITECH and other privacy regulations. In addition, some on-site providers may introduce conflicts of interest if they are financially tied to the off-site hospitals, clinics and pharmacies that they refer to.

For further information about on-site clinics, please contact us.

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Workers Comp Benefits You May Be Entitled to After a Work Related Accident

The United States Congress passed the Occupational Safety and Health Act (OSHA) in 1970 as a means of preventing work-related illnesses and injuries. OSHA is a federal agency that is part of the Department of Labor. Their primary job is to issue and enforce safety standards and guidelines to keep employees from being harmed in the workplace. Before OSHA was formed, it was common for employees to work in dangerous and noisy conditions or be exposed to hazardous chemicals. The primary mission of OSHA is to make sure the health and safety of all workers in America are kept to the federal standard. It is the job of OSHA to investigate complaints by inspecting the workplace when there is a possible hazard or danger, which could lead to serious injury or death.

Benefits You Are Entitled to Receive

When an employee becomes injured or disabled while on the job, they have the right to file a claim for workers compensation benefits. Each state has their own specific workers compensation laws that regulate benefits. However, in general any employee who is injured through no fault of their own is entitled to receive the following benefits:

• Reimbursement for all medical treatment needed. • Travel-related expenses going to and from medical appointments, including the cost of hiring transportation when they are unable to drive due to the injury. • Temporary or permanent disability benefits, which are usually based upon a percentage of the employee's hourly wage. • Lost wages if the employee is unable to work for a period of time. • Vocational rehabilitation costs to retrain the employee for a different job when necessary. • Survivor benefits for the family members if the employee was killed on the job. This includes a specific amount for burial expenses. • Attorney's fees for workers to hire legal help when their claim is denied. The actual amounts vary in each state.

Some states allow the compensation benefits to be retroactive if the disability continues for a period of time. The maximum weekly payment and the length of benefits vary in each state. For example, in the State of Louisiana, the maximum weekly benefits cannot exceed $577 and benefits only continue for 520 weeks. Employees who are out of work for over one year can apply for Social Security Disability Insurance (SSDI) benefits.

Who Chooses the Physician?

Some states allow the employee to choose the physician that will be providing care and treatment for their injuries. Employers in other states may make the initial selection of the physician or the insurer may have established a medical provider network that the employee can choose from after a certain period of time. In the State of California, an employee who has notified the employer prior to becoming injured that they have their own personal physician has the right to be treated by their doctor.

Before Filing Your Claim

Most employers have a certain protocol that employees must follow when they become ill or get injured on the job. These are some things to remember before filing your claim:

• Immediately seek medical treatment for the injury. Start by obtaining help from the employer's medical personnel. • Go to the local hospital, clinic or emergency room for treatment. • Report the accident immediately to a supervisor or manager. • Make a report that details exactly what caused the accident. • Find other employees that may have witnessed the accident who can give an account about what happened. • Collect evidence that can prove the accident was not the employee's fault. • Take pictures of the dangerous conditions that existed when the injury occurred.

The employer's insurance may require the employee to file a claim within a short period of time after the incident occurred. Therefore, it is imperative to take action right away by documenting the claim immediately.

Why You Need a Workers Compensation Lawyer

Workplace accidents can have a severe impact on the employee's life when they are left with serious and debilitating injuries. They may end up being hospitalized for months after surgery or require long periods of rehabilitation. When an individual has been denied workers compensation benefits, they have the legal right to appeal the decision. Many insurance companies will appoint a Claims Resolution Specialist whose goal is to resolve the issues. Sometimes a claim may be resolved through arbitration and an Administrative Law Judge (ALJ) will be appointed to oversee the hearing. If the claim is still denied after this hearing, an attorney can file a lawsuit in the state's Circuit or District court.

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Getting Income Insurance: What Options to Consider?

Most income protection policies are flexible and can be tailored to suit your personal circumstances. There is a wide range of individual options available offered by different companies. Some might be unique; however, there are some common options that are worth considering and these are:

Types of Cover: Agreed Value Policy or Indemnity Policy

1. Agreed Value Income Protection Policy

This is the most expensive option as the policies' premiums are approximately 20 per cent higher than for indemnity policies. It pays out a monthly payment in the amount that is agreed upon or stipulated in your policy that reflects your income at the start of your policy.

Any fluctuations in income do not affect the cover so there is the advantage that you know the amount you will receive, regardless of changes in your income. Moreover, this type of policy will cover you regardless of employment status, so this is particularly useful for self-employed people.

2. Indemnity Policy

This is the more common and less expensive income insurance policy. The monthly payment will be assessed through verification of your income at the time when you make a claim and may cause adjustment to your benefit accordingly which could be an issue if your salary fluctuates in instances when you have taken maternity leave, worked part time or became unemployed.

Superannuation funds can be used to provide for these indemnity policies. Premiums can be deducted straight from the member account. Superannuation funded policies are the cheapest option and indemnity value-based. However, this type of policy offers fewer features and less flexibility. Moreover, this type of policy is sufficient for those who have a reliable, regular income.

There are some superannuation funds that offer income protection insurance as default cover. This type of superannuation funded policy automatically accepts applications without medical checks - and provides an option for those who would otherwise not be covered.

Understanding Benefit and Waiting Period

Benefit Period

This is the period where, in the event of a claim, you will receive your income protection benefit payments. This could be from 1 to two or five years or to a specific age. For instance, this could be up to age 60 or 65.

You will be the one to determine the benefit period that suits you, so you must consider these:

The length of the benefit period depends on the amount of cover you are willing to pay for. The longer the Benefit Period the higher the premium. However, there is the potential for a long term claim. Choose a longer benefit period as much possible so that you can protect yourself in the event of long term disablement.

Waiting Period

This the time between a valid claim is made (when you are incapacitate and unable to work) and the time when you start receiving your first income protection payment. A waiting period from 14, 30, 60, 90, 180, 360 and 720 days are usually chosen. This means that if you chose a 30 day waiting period, then you will start receiving payments after 31 days from the day you made a valid claim.

In choosing a waiting period, you must also take into account these other considerations:

The waiting period chosen has a significant influence on the cost of a policy or the premium. You must remember that income insurance are undertaken for the express purpose of protecting you for the long term so choose a longer waiting period for a lower the premium, i.e. changing a waiting period from 14 days to 30 days can sometimes half the premiums. The longer the waiting period chosen, the lower the premiums. There are sick leave and accumulated annual leave and potentially long service leave that you can use before income protection would need to kick in. Accident Benefit - which will waive the waiting periods in the event of an accident offered by many companies will attract an additional premium. Insurance For Early Retirees   

Work-Related Back Pain: How to Pay Your Medical Bills

Suffering an injury is stressful: Will my work suffer? Will my quality of life suffer? When you are hurt on the job, one question should be answered for you: that of how to pay for treatment.

Many workers develop work-related back pain that progresses into a chronic pain condition. A European Union conference was told by the Fit to Work coalition in October of 2011 that more than 25% of the European working population suffers back pain due to the demands of their jobs. Given the fact that many instances of back pain worsen if not addressed, it is important to know how to pay for treatments.

Back pain can be caused by jobs that require repetitive motions, heavy lifting, stress and staying in one position for prolonged period of time. Some of our most important positions leave the people who work them prone to back pain: nursing, construction, firefighting, policing, cleaning, truck driving and office work are professions with high instances of back pain.

In the U.S., workers compensation exists to protect: 1) workers from being left with no money if a job-related health problem limits or destroys their ability to work and 2) employers from being sued by employees hurt on the job. Workers compensation is best known for paying disability benefits to those who can no longer work due to an injury or illness acquired on the job, but these benefits can also go toward medical treatments while you remain at work or take a brief hiatus to facilitate recovery. WorkCover is a similar program based in Australia. Many other countries have socialized medicine to ensure care is received by every citizen.

To receive workers compensation benefits, you must file a claim. Visit your doctor to determine the cause of your injury; if it is work-related and your treatment will require more than simple behavioral changes, you should file a claim. Also inform your doctor before making an appointment that you plan to receive workers compensation benefits, as some doctors do not accept these cases. Many private insurance companies refuse to cover the cost of injuries or illnesses acquired at work, so if workers compensation denies your claim, it will be necessary to seek the help of a lawyer. It is not easy for everyone to receive benefits. Back pain is a very widespread condition with many causes. You can expect some bumps in the road.

If your doctor confirms that your back pain is work-related, your employer may request that you receive a second opinion by a different doctor. Although this may seem like a way for your employer to back out of insuring you, it is still important to go for this second assessment, since benefits can be denied if you refuse.

Exact workers compensation regulations vary by state, but generally, benefits do not apply to alternative or experimental treatments. Massage, chiropractic and physical therapy sessions may be granted, but with a limit on the number of sessions covered. If a doctor informs the claims representative that more treatments are needed, he or she may grant them.

Prompt back pain treatment greatly increases your chance of recovery. Since back conditions can develop slowly, the pain may go unnoticed before the damage has escalated to a point of serious pain. Pay attention to your pain from the start, and keep track of the duration and severity of symptoms. Any back pain that persists longer than 2 days is not caused by simple muscle strain and demands your full attention.

If your job is causing your pain, work with your doctor and employer to identify behavioral changes that may help. If diagnostic imaging, chiropractic care, massage therapy, physical therapy or repeated doctor's visits are required, workers compensation should be footing the bill. Don't be fooled into thinking you can't afford to take care of yourself. For information on workers compensation laws by state, see http://www.workerscompensation.com/workers_comp_by_state.php.

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Smoothing the Way to a Successful Workers' Compensation Claim

Filing for workers' compensation, or long-term disability benefits through Social Security can be a daunting process. The following tips can help you avoid, or at least better deal with, common pitfalls such as lack of documentation, lost paperwork and slow response times.

Complete a "Benefit Review" as soon as you are injured or have received a diagnosis or other indication that you may not be able to work at some point in the future. The review helps you to understand what benefits are available to you, how you qualify for those benefits, and what your income will look like when you are no longer working. Completing your benefit review right away will greatly help your chances of being allowed to make changes to enhance your benefits in the future should you need to.

All employers that offer benefits are required to provide a Summary Plan Description to all employees. If you do receive benefits from your employer check with your personnel department and request a copy.

Beware of switching to a part-time employee as this can be a mistake. An employer must make "reasonable accommodation" for your condition to help you continue working under the Americans with Disabilities Act (ADA). Reduced hours and reduced pay are part of the accommodations in most cases. (LTD) long-term disability programs through work often tie benefits to what you were earning at the time you stopped work. If you reduce your hours at work this will also reduce your income and the benefits you're eligible for later on, and if your hours drop too dramatically, you may even lose eligibility for the benefits all together since they are usually only offered to full-time employees.

Make sure you are following up with every step of the claim process. Contact the examiner and analyst and make sure all the necessary forms were received, also follow-up with doctors to who have yet to submit their records. This will help you personalize your claim to the examiner and also reduce the time it will take to process the paperwork.

Maintaining a phone log can be a useful step. When you talk to the insurance company or Social Security or your employer be sure to keep a record of the call. Keeping written records is the best way to keep things in order. When people are asked to submit things to you in writing they are much more likely to be careful about what they say, and to be sure that what they are saying is accurate and will be done in a timely fashion. Anyone can say anything over the phone, by asking for things in writing you can feel a little more at ease.

It is easy to get frustrated with a process like this, but be careful not to threaten or get upset with the people you speak to. It will get you a lot farther a lot faster to be complimentary and ask as many questions as possible. Make sure to double-check what you are told; when it comes to your income and your continued health insurance, you can never be too careful.

Moving from work to disability due to an on the job injury or other medical condition is not an easy process. By using these tips you can make the workers compensation or long-term disability claim process a little easier and less daunting.

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Who Is Not Covered by Workers Compensation?

There are many examples of what is covered and what isn't covered by it; it is very important that you understand what will be covered and what won't so that if you have to make a claim, you know what to do. There are examples of people who will be covered by the workers compensation policy and that is important to know because you don't want to even waste your time gathering documents to file a claim if it will get denied.

People Who Are Not Employees

If you aren't employed by the company, you aren't going to be able to file a claim. Let us say that you are hurt on the job site, but you don't work there, you aren't going to be covered under what they have to offer to their employees. Know that this would go for visitors, family members, and other people who are not paid directly by the company. Their coverage would fall under other insurances the business may have.

People Who Are Subcontracted Employees

It is important to understand that if you are a subcontracted employer you are not covered under that particular employer's compensation plan. You may be covered under one that is offered through the company that hired you, but the company that you are working for is not responsible for you. Make sure that you know who has your workers compensation insurance policy if you are a subcontracted or a temporary employee.

People Who Are Not Performing Job Duties

If you take a company truck home and you get in an accident when you are off of the clock, your workers compensation policy will not cover it. In order to be covered by workers compensation, you must be working, you can't be off the clock and just hanging out, they aren't going to cover it. Understand this so that you are aware of when you should make a claim through this insurance.

People Who Are Under the Influence of Alcohol or Drugs

If you get hurt on the job and you are under the influence of alcohol and drugs, they aren't going to cover you with a workers compensation policy. The one thing that is specifically excluded on a workers compensation policy, and something that in most cases will almost guarantee that your claim gets rejected, is being affected by drugs or alcohol.

Knowing who is covered under a policy is very important. You want to make sure that you are well aware of the rules that go into a workers compensation policy so that you are familiar with it. You need to know what is covered and what isn't and who is going to be covered so that you are set in case you need to make a claim and know what you should make a claim for.

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