Access to Medical Care for Individuals with Workers' Compensation Claims

Abstract

Experience at a publically funded occupational health clinical center in New York State suggests that patients with work-related illnesses often have great difficulty accessing diagnostic and treatment services. A study was designed to more quantitatively investigate the extent and nature of barriers to medical services for patients with Workers' Compensation claims. Medical practices from 13 selected medical specialties were identified from telephone directories. The directories covered six areas encompassing almost all of a 15-county region. All practices from each selected specialty were contacted by phone and asked a set of standardized questions regarding patient acceptance policies. A number of barriers were identified by the survey including practices closed to new patients and practices closed specifically to patients with Workers' Compensation claims. Barriers also were found to be widespread among practices that did accept Workers' Compensation claims, primarily related to requiring a guarantee of payment prior to seeing the patient. The results were compared by medical specialty and geographic area. While the study showed some of the difficulties patients with occupational illnesses face attempting to access medical services, it most likely underestimated the extent of the problem. Attitudes and practices that impede access, but were not measurable, create additional barriers. Our study strongly suggests that policies that improve access to medical care for individuals with Workers' Compensation claims are necessary to better serve the needs of workers with occupational illnesses.

Barriers to Use of Workers' Compensation for Patient Care at Massachusetts Community Health Centers

“…Barriers to WC from the provider perspective include providers' lack of familiarity with the system, delays, denials, “overwhelming” paperwork (Lax and Manetti ; Woodcock and Neely ; Lax ), administrative hassles (Weber ; Ortolon ), and concerns about litigation, confidentiality, conflicts, and lack of time and resources for obtaining WC reimbursement (Himmelstein and Rest ; Himmelstein et al. ; Lippel ; Lax and Manetti ; McGrail et al. ; Pransky et al.…”

“…Barriers to WC from the patient perspective have been characterized, with vulnerable and minority workers most affected (Brown, Domenzain, and Villoria-Siegert 2002;Azaroff, Levenstein, and Wegman 2004;Fan et al 2006;Lashuay and Harrison 2006 Barriers to WC from the provider perspective include providers' lack of familiarity with the system, delays, denials, "overwhelming" paperwork (Lax and Manetti 2001;Woodcock and Neely 2005;Lax 2010), administrative hassles (Weber 2007;Ortolon 2008), and concerns about litigation, confidentiality, conflicts, and lack of time and resources for obtaining WC reimbursement (Himmelstein and Rest 1996;Himmelstein et al 1999;Lippel 1999;Lax and Manetti 2001;McGrail et al 2002;Pransky et al 2002;Atlas et al 2004;Beardwood, Kirsh, and Clark 2005;Lashuay and Harrison 2006). "Insuranceinduced limbo" (Himmelstein and Rest 1996), in which WC denies claims and other insurers refuse payment because a condition was identified as work related, can leave patients without care or responsible for the bills (Lipscomb et al 2009).…”

Preserving workers' dignity in workers' compensation systems: An international perspective

“…Studies in Canada [Ison, 1986;Lippel, 1999;Beardwood et al, 2005;Eakin, 2005;Lippel, 2007;MacEachen et al, 2007aMacEachen et al, , 2010, Australia [Roberts-Yates, 2003;Sager and James, 2005], and the United States [Lax and Manetti, 2001;Strunin and Boden, 2004] have shown that many workers' compensation claimants report feeling stigmatized by the process, blamed for being an injured worker, and shunned by the community and healthcare professionals because of their status as an injured worker.…”

“…Access to health care for injured workers is sometimes difficult because physicians are loath to deal with the system [Lax and Manetti, 2001;MacEachen et al, 2007b;Kosny et al, 2011] and because other physicians, working for employers or the insurance companies, may behave in a way that discourages treating physicians from participating in the process [LaDou, 2006;Philips, 2010a]. Physicians' roles affect access to coverage, determination of benefits, and the return to work process.…”

Impact of Occupational Injuries on Nonworkers’ Compensation Medical Costs of Patient-Care Workers

“…Workers may feel that it is too difficult to get the care they need through workers’ compensation and may look elsewhere to pay for it, particularly if they are not missing sufficient work (5 days in MA) to be eligible for wage replacement payments. Also, physicians may prefer payment by group health insurance to avoid low reimbursement rates, difficulty getting paid, or uncompensated time spent completing forms reporting on disability or assessing ability to return to work (11). Additionally, a work-related injury may increase the risk of other conditions that are difficult to tie directly to the initial injury and therefore are not paid for by workers’ compensation (12–15).…”