Editor’s note: John Valente is one of the leading experts in Vermont on workers’ compensation. His column, Understanding Workers’ Comp, will appear here each month.
A common subject matter in the news lately has been health care. Articles have focused on what has happened in the past, what is happening now and what may happen in the next few years. Every commentary on the subject seems to mention the high cost of health care. The high cost is no different when the health care is provided to someone who is injured at work. Getting an injured worker on the road to recovery can be expensive.
According to the National Council on Compensation Insurance, the costs associated with medical treatment for injured workers in Vermont continued to increase in 2011, and medical costs account for 54 percent of the total amount of benefits paid on a claim. The rising cost of medical care for employees injured at work should be a concern not only for employers but for employees as well. As system costs, such as medical costs, increase so does the premium paid by the employer, adding a further increase to the expense side of the company balance sheet.
Different stakeholders have different abilities to keep medical costs under control. The Vermont Department of Labor updates the medical fee schedule used to pay providers in workers’ compensation cases. Other groups, representing labor and business, suggest legislative and different remedies. However, there are steps that any employer can take to assist getting injured employees fast, quality medical care that keeps them at work or returns them safely to work as quickly as possible.
Under Vermont’s laws, the employer is entitled to direct the care of the injured worker. If the employee wishes to be treated by someone else, he or she can, but the employer has the first choice. Having a medical provider chosen by the employer is beneficial to both the employee and the employer for a number of reasons.
The provider should be generally available during hours the business is open. In the case of businesses with multiple shifts or in case of emergency, the provider should have a procedure through which the injured worker is to get immediate treatment. There should also be a plan in place that gets the provider the information from that visit quickly and a follow-up scheduled.
The provider should have credibility with the employee. The employee has the option to change providers if he or she chooses. However, a doctor who treats a business’s employees with empathy and respect and does a thorough evaluation will usually be appreciated by the employee. If a doctor is disrespectful, does not listen or talks down to an injured employee, the employee will exercise his or her right to replace that doctor with a doctor of his or her choosing. More importantly, the employee will tell fellow employees about the experience, good or bad.
The provider should be invited to the workplace to review the physical plant, job stations and the job description for each station. The provider should observe the job functions actually being performed and should have the opportunity to ask questions of the employees performing the job.
The provider should also have a meeting with key personnel to discuss the availability of light duty tasks in the workplace and what options are available to keep workers at work and not have them miss time from the plant. This can be an important tool in getting an accurate diagnosis for the injury, determining causation and assessing disability. Using a medical provider who is familiar with the workplace, work stations and physical makeup of the plant gives the provider vital information for opinions on: whether the mechanism of injury is consistent with the provider’s understanding of the job; whether the injured worker is capable of going back to his or her old job without missing any time from work; and any time-limited light duty that may be available on site.
If an employee opts to not continue treatment with the employer’s preferred provider, or there is no preferred provider, then the employer shall have the right to require other medical examinations. After an injury and during the period of disability, if so requested by the employer, or ordered by the commissioner, the employee must submit to examination, at reasonable times and places, by a duly licensed physician or surgeon designated and paid by the employer.
The employee has the right to have a physician or surgeon designated and paid by the employee present at the examination. This right, however, does not deny the employer’s physician the right to visit the injured employee at all reasonable times and under all reasonable conditions during total disability.
Employers can have an effect on rising health care costs in the workers’ compensation system by choosing credible medical providers to be the first stop on their employee’s road to recovery when injured in the workplace.
John W. Valente is an attorney with Ryan Smith & Carbine in Rutland. He is the author of “Understanding Workers’ Compensation: Managing Workplace Injuries and Lowering Costs.” These materials are for general information only and are not intended as legal advice.MORE IN Central Vermont
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