Work Ethic: The Duty of the Physician in Workers’ Comp

If you know a physician who provides workers’ compensation in their clinic, known as a PTP (Primary Treating Physician), then you probably know that they are very busy people. The reason for this is because they are responsible for collecting far more data from a patient who is coming in for a workers’ comp injury, than any other routine doctor’s visit.

The fascinating specifics of this topic bring to light the degree of mettle that it takes to be a physician in workers’ comp. First we’ll take a look at the duties of the PTP when seeing the injured worker.

A closer look at the patient

“When I’m acting as primary care provider and someone comes in with a broken arm, I might ask them about their job and move on,” Says RateFast founder, Dr. John Alchemy, “But in the case of a work comp claim, the report writing has just begun, because I have to detail the permanence. In work comp, what you do for work is of upmost importance.”

Workers’ compensation is a very sophisticated system. Most states have an outline for the countless types of injuries and illnesses that can happen on the job. While no two people are the same, we are similar enough that we can use this outline to determine how much to pay for each injury at the time of impairment. But to know how to pay for the injury, the PTP must take a wide variety of measurements, examinations, ask the patient variety of specific questions, and speak with specialists who see the patient about specific injuries. “There is a huge cascade of report writing and administrative tasks to have these questions answered,” says Dr. Alchemy.

To add to that, the PTP has to be incredibly careful with the data mentioned above, making sure that they are taken and recorded as thoroughly as possible. The data is put into a report which will be sent to the employer’s work comp insurer who will scrutinize the report before determining if it they will provide compensation, or if additional data is needed. In the case of the latter, they object to the report, and the doctor must write the report again. They may or may not have to have an appointment with the patient to take the measurements again in greater detail.

Quarterback of the injury

According to Dr. Alchemy, “The PTP is the quarterback of the injury.” They are constantly analyzing the injury and working with the other stakeholders to arrive at permanent impairment, in order to close the claim.

A stakeholder in a workers’ compensation claim is anybody who touches the case. They all serve a different purpose, but work towards the end goal of compensating the patient fairly for their injury. While the injured worker is the reason that the stakeholders exist in the first place, it is the PTP who is the hub all of them. It is the PTP’s responsibility to communicate with all of the stakeholders to advance the claim.

In the case of California, the Stakeholders who are always involved in a workers’ compensation claim are as follows:

  • PTP: The doctor who oversees the workers’ comp claim for any one injured worker (the topic of this article)
  • Injured worker: The individual who was hurt, suffered a disease, or died at their workplace
  • Injured worker’s employer: The business or company where the injured worker is employed
  • Employer’s insurance company: The company responsible for compensating the injured worker for their injury, time off work, and related costs where applicable

Depending on the scenario, additional stakeholders may join the claim. Usually they join the claim if there is dispute between any of the default stakeholders. These additional stakeholders all serve different purposes from one another. Examples of these stakeholders are:

  • Specialists: Individuals who work in specific fields like orthopedists, and people who work with special equipment like MRI machines.
  • Nurse Case Manager: A nurse who is hired by one of the stakeholders to assist the injured worker with various things associated with the claim. The nurse case manager is an impartial stakeholder whose purpose is to make sure things go smoothly
  • Workers’ Comp Attorney: Any default stakeholder in the claim may hire a workers’ comp attorney. The attorney will consult the stakeholder, give depositions, and handle litigation if needed.
  • QME (Qualified Medical Examiner): A QME is a certified third party physician who reviews the reports in a workers’ comp claim.

On top of this, a physician has an office of administrators who will help out with writing the reports. The physician is not only doctor, but oftentimes a ‘boss’ of their own clinic as well.

Conclusion

There are a great many responsibilities for the PTP when handling with a workers’ compensation claim. Any individual in California who is the subject of a  claim will see one. By simply knowing the responsibilities of PTPs, injured workers’, or any stakeholder for that matter, may in some way be able to help their PTP make the claim go more smoothly.

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