Why Physicians Quit Comp: A 60-Second Seminar in Workers’ Compensation Claims Handling

In a previously published blog, entitled “Physicians Who Quit Comp,” we cautioned the claims industry that a campaign was being conducted encouraging medical providers to withdraw from the workers’ compensation system.  Specifically, we said:

“Currently, an educational campaign is being waged within the medical community where physicians are being encouraged to leave workers’ compensation under the theory that the work comp system needs doctors more than doctors need work comp. Afterall, an employer’s MPN cannot function without an appropriate number of physicians enrolled in their network.”

In that blog we suggested a remedy to end the exodus of physicians from MPNs.  Specifically, we recommended that medical providers be paid pursuant to the state’s Official Medical Fee Schedule (OMFS) without applying a PPO discount.  We warned that unless this was done physicians would continue to quit workers’ compensation because of poor reimbursement rates.  Our prophecy apparently was right on target.  Since that initial publication, several major medical organizations have announced their intent to stop treating injured workers.

According to a DaisyBill article dated 10/04/23, Rehab One Medical announced that effective January 1, 2024, all their clinics throughout the state, except one, will no longer accept or treat workers’ compensation patients, ending a 19-year tenure of caring for injured workers.  Rehab One facilities will; however, remain available to conduct medical/legal examinations.Other medical offices have voiced similar complaints about our workers’ compensation system.  Letters from three different medical groups were recently published expressing their intent to no longer treat injured workers.  Below are excerpts of three disturbing comments issued by medical providers as published by DaisyBill:

“Soon, we will cease accepting WC patients because it is so time-consuming and onerous trying to get paid.”

“I hear monthly from doctors I work with that they will not be taking work comp patients any longer because of the ‘low pay for more work’ reason.”

“We just closed our business of 35 years and were unable to sell even the branding of this business as not one surgeon wanted the part of our referral base (about 60%) that was workman’s (sic) compensation.”

It is no secret that insurance companies, employers and third-party administrators throughout the state are experiencing a significant shortage of available physicians in their MPN’s.  This situation is anticipated to only get worse in the months to come.  We, therefore, once again recommend the same solution as previously offered, namely, claims administrators should enter into an agreement with their MPN providers to pay them pursuant to the Official Medical Fee Schedule without applying a PPO discount.  Unless this is done, we anticipate that our workers’ compensation MPN system will begin to suffer within a short period of time.