{"id":1019,"date":"2017-06-01T01:00:15","date_gmt":"2017-06-01T01:00:15","guid":{"rendered":"http:\/\/www.mtmic.com\/?p=1019"},"modified":"2017-06-10T18:25:40","modified_gmt":"2017-06-10T18:25:40","slug":"behind-the-scenes","status":"publish","type":"post","link":"https:\/\/www.mtmic.com\/blog\/2017\/06\/behind-the-scenes\/","title":{"rendered":"Behind the Scenes"},"content":{"rendered":"

By Donna Motley, Vice President of Claims<\/em><\/p>\n

What is entailed in processing a Workers\u2019 Compensation injury claim? Once the claim form is submitted and set up in our system, it is more than just processing and paying the medical bills. In most cases the injured worker is treating with the employer\u2019s Occupational Clinic. It is the Claims Adjusters\u2019 responsibility to assure the employee is receiving proper treatment, with the appropriate medical personnel; and if necessary, have treatment of the injured worker transferred to a physician specializing in said injury. Orthopedic physicians specialize \u2013 back, shoulder, knee, foot, elbow, hands, etc. A mucular condition would be referred to a Physiatrist.
\nWe monitor each and every doctor appointment the employee attends. If an appointment is missed or rescheduled, we want to know why. We follow up for the necessary disability slip the injured is required to submit to their employer.<\/p>\n

<\/p>\n

We verify prescriptions that are written and filled to assure they are related to the claimed injury. A prescription for an anti-biotic should not be filled for an alleged back injury. We monitor the amount and duration of opioids that are prescribed. Current Michigan Workers\u2019 Compensation law is written that allows us to request a letter of \u201cMedical Necessity\u201d if an opioid is being prescribed after 90 days. If the doctor does not comply with our request, we can refuse treatment and payment.<\/p>\n

If medical equipment is ordered, we make sure it is necessary and applicable to the claimed injury under the Workers\u2019 Compensation Act. Workers\u2019 Compensation is different than Automobile Insurance in that Workers\u2019 Compensation does not pay for \u201cReplacement Services\u201d. If necessary, we contract to have a ramp installed at someone\u2019s home, order wheelchairs, roll-abouts, a hospital bed, tub transfers, etc., and make sure equipment is picked up when no longer required by the injured worker.<\/p>\n

If physical therapy is ordered, we monitor the number of visits, questioning if a visit is missed or rescheduled, and verify through medical notes that progress is being attained.
\nWhen an employee submits a request for mileage reimbursement, we have to verify the employee did attend an appointment on the day indicated and also verify the distance traveled to and from the appointment. Mileage to pick up a prescription is not allowed under Workers\u2019 Compensation.<\/p>\n

We review all medical reports submitted by the treating physicians. We look to see if the diagnosis has changed or a diagnosis been added? Did the employee provide an accurate description of \u201chow\u201d the injury occurred? Is the current condition for which the employee is treating still related to the claimed injury? Are there co-morbidities? Is the employee making excuses to the physician why they can\u2019t return to work, missing appointments, or not going to physical therapy? Is the employee painting an unrealistic picture of their job duties? Is it time to find a different doctor because there has been no advancement in treatment and recovery?<\/p>\n

We monitor our Medical Bill Review vendor, our Investigators and our Attorneys.<\/p>\n

The end result is to have a successful recovery for the employee, have the employee return to work, and save the employer money!<\/p>\n","protected":false},"excerpt":{"rendered":"

By Donna Motley, Vice President of Claims What is entailed in processing a Workers\u2019 Compensation injury claim? Once the claim form is submitted and set up in our system, it is more than just processing and paying the medical bills. In most cases the injured worker is treating with the employer\u2019s Occupational Clinic. It is…<\/p>\n","protected":false},"author":1,"featured_media":1020,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,4],"tags":[],"class_list":["post-1019","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-claims","category-compliance"],"jetpack_featured_media_url":"https:\/\/www.mtmic.com\/blog\/wp-content\/uploads\/2017\/06\/workers-comp.jpg","_links":{"self":[{"href":"https:\/\/www.mtmic.com\/blog\/wp-json\/wp\/v2\/posts\/1019","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.mtmic.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.mtmic.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.mtmic.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.mtmic.com\/blog\/wp-json\/wp\/v2\/comments?post=1019"}],"version-history":[{"count":1,"href":"https:\/\/www.mtmic.com\/blog\/wp-json\/wp\/v2\/posts\/1019\/revisions"}],"predecessor-version":[{"id":1021,"href":"https:\/\/www.mtmic.com\/blog\/wp-json\/wp\/v2\/posts\/1019\/revisions\/1021"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.mtmic.com\/blog\/wp-json\/wp\/v2\/media\/1020"}],"wp:attachment":[{"href":"https:\/\/www.mtmic.com\/blog\/wp-json\/wp\/v2\/media?parent=1019"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.mtmic.com\/blog\/wp-json\/wp\/v2\/categories?post=1019"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.mtmic.com\/blog\/wp-json\/wp\/v2\/tags?post=1019"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}