Several years ago, we noticed a distinct pattern. When workers were injured and sought treatment from a particular doctor, the claims tended to become more involved: the workers’ treatments were more extended, their time off was greatly prolonged, and the costs of their claims ballooned.
We informed L&I of our concern that this doctor was abusing the L&I system for financial gain, and learned that employees had the right to see whichever medical provider they chose, and that L&I had virtually no way to oversee it. It’s one of those times when, as an employer, you realize your hands are really tied.
Fortunately, that’s about to change!
L&I will require injured workers to see approved health care providers in 2013:
In 2011, Washington’s Legislature took a step towards improving this system. As of the January 1st, 2013, injured workers will be required to see an approved health care provider in L&I’s medical provider network.
As of the end of October, there were approximately 6,000 providers in the L&I network — everything from optometrists and podiatrists, to chiropractors and physicians — and the number is growing daily.
The goal is to create a network of providers experienced in treating injured workers, with the aim of returning employees to good health and to their jobs as quickly as possible.
L&I estimates it will save the state $218 million over the next 4 years, which should translate to savings for us, the employers!
How will L&I’s change work for your employees?
When a worker is injured, they may seek immediate medical attention wherever they choose. Obviously, we don’t want someone who is bleeding and in pain to have to do an online search to determine which provider is approved by L&I!
But after that, any additional treatment must be provided by an approved medical practitioner in order to be covered by L&I. This applies to all companies in Washington, even those that are self-insured.
If you have an employee already being treated by an out-of-network provider, alert them now to this change: They either need to talk to their provider about applying to be in the network, or seek a new provider prior to the end of the year. A list of approved providers can be found at FindADoc.lni.wa.gov.
L&I’s Top Tier Providers:
L&I will be creating a program for what they are calling Top Tier Providers.
These providers will be a select group who agree to use certain best practices and who meet performance measures identified by L&I. For doing so, they will be eligible to receive financial and other incentives.
The benefits to the injured worker and to the employer is that the patients often get back to work quicker, reducing the cost of the claim.
In 2011, there were 2,871 workers comp claims in Kitsap County, and 10,361 in Pierce County. That’s an impressive number!
No employer wants to see an employee get injured. But when it happens, for everyone’s sake, we want to see the employee heal quickly and return to productive work as soon as possible.
And when we, as employers, recognize that a medical provider is abusing the system for their own financial gain, we now have an avenue to make our concerns known, and L&I has the ability to terminate their services from the network. This is a step forward on the path of workers comp reform for our state.