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Thursday, April 24, 2014

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Treating an Injured Worker

Topics ICD-9 Forms & Publications Medical Provider's Guide
Treating An Injured Worker Treatment Guidelines First Report of Injury (FROI) Form  
Claim Information Claim Number Lookup Capability Assessment form (C3)  
Medical Treatment Medical Provider Appeal Process Medical Services Dispute Resolution Request (M2)  
Subsequent Treatment   Provider Request for Adjustment (M6) form  

Treating An Injured Worker

A medical provider, is a vital member of the Claims Management Team. When the Claims Management Team works together, everyone benefits. A productive work force contributes to the economic health of a company, shortens the injured workers’ recovery period, and establishes common goals to strengthen ties between the employer, injured worker, medical provider, and WSI. When stay-at-work and return-to-work options are utilized, the injured worker is more likely to be happier and healthier by staying an active worker and employee.

The medical provider plays an important role to integrate medical and injury management services as soon as possible after a work-related injury occurs. This approach results in lower premiums, reduced medical, disability, and litigation costs, which contributes to the economic health of employers and injured workers.

The Medical Provider Role

  • Provide prompt and appropriate care to the injured worker.
  • Obtain prior authorization for treatment, when necessary.
  • Evaluate the injury and develop a treatment plan, using the job as part of the recovery process. Establish work restrictions which focus on the injured workers’ abilities rather than disabilities. Help injured workers focus on returning to normal activities.
  • Provide completed medical reports promptly, to include diagnosis code(s). Note: For each medical appointment a Capability Assessment form (C3) should be completed.
  • Maintain primary responsibility for the direction of the medical management on the claim, including referrals to specialists.
  • Share in the employer’s goal of keeping the injured worker at work (using transitional work, when necessary), and share in the understanding that the injured worker’s work abilities must meet the job functions.
  • Establish and maintain communication with the injured employee, employer, and WSI.
  • Accept selection from an employer as their designated medical provider (DMP). In this role, you will acquire knowledge about the employer’s business operations and the employee’s job functions – assisting in making decisions on return-to-work issues.
  • Attend educational seminars provided by WSI to learn about new programs and processes, as well as exchange ideas.

During treatment of the injured worker, if any concerns arise (such as the injured worker not attending physical therapy, symptoms not consistent with the injury, cancellation of medical appointments, or noncompliance with treatment plan), please contact us promptly at (701) 328-3800 or 1-800-777-5033. This information is critical in the management of a claim.

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