When you are injured in the course and scope of your employment in the
State of Indiana, your employer or their insurance carrier typically has
the right to direct your medical treatment.
In most cases, the employer is required to provide a physician, free of
charge, for the treatment of injuries an employee sustains. This employer/insurance
carrier control, however, can create conflict when large employers and/or
their insurance carriers use the same providers repeatedly.
This issue is not one of quality of care; rather, this conflict is raised
when clients are released at MMI (Medical Maximum Improvement) and provided
their PPI (Permanent Partial Impairment) ratings. Under the current law,
workers compensation injury victims are not awarded pain and suffering.
Rather, a permanent injury is typically denoted via a PPI rating. These
ratings are then applied to a Statutory schedule which pays based on the
severity of injury (i.e. the higher the rating, the higher the settlement
or judgment). PPI ratings are by their very nature subjective. While most
treating physicians attempt to utilize the
AMA Guidelines as an objective application to individual injuries, these impairment
ratings historically vary greatly depending upon the subjective analysis
of the provider tendering them.
The lower the PPI rating, the less employers and their insurance carriers
are obligated to pay in settlement or judgments. Thus, we are forced to
consider whether there is an innate conflict of interest created when
providers are being repeatedly hired by the same employers and insurance
carriers. In such circumstances, the providers are obviously being paid
for their services and retain an interest in getting more patients from
those employers and carriers. Thus, when dealing with the release of a
patient or tendering a PPI rating, those same providers are being asked
to tender a rating which could be contrary to the hiring parties’
interests. In other words, the higher the PPI rating the physician tenders,
the more the employer or their insurance carrier must pay. In essence,
this places the providers in a very difficult position of “biting
the hand that feeds them”.
Whether a provider consciously evaluates this issue or not, human nature
(and good business sense) would force them to consider the possibility
that a severe rating against an employer or their insurer could cost them
additional business in the future. This is not to suggest that providers
change their approach because of this conflict or that employers or their
carriers are putting forth such an attitude; rather, the environment created
by this structure forces one to contemplate the foundation of a physician’s
actions when an untimely release or disconnected PPI rating is put forth.
Again, this is not to suggest malintent on the part of the drafting provider;
rather, this is simply a product of the Indiana Statutes controlling the
current Worker’s Compensation system. By placing the physician selection
in the hands of the employers, it forces medical providers seeking repeat
work from these entities to at least consider catering to the interests
of the employers or their insurers. After all, they’re the ones
choosing and paying them.
Other States, such as our sister State of Illinois, have remedied this
conflict by placing the provider selection into the hands of the employee.
While such a system certainly requires a more careful eye towards provider
charges, it does serve the purpose of directing the providers intention
and interests back to the patient-employee. Thus, a providers interest
is the patient in front of them, and not the source of additional patients
or the fees that follow.