While most companies fear false workman's comp claims, those fears have been debunked for years.
However, at the start of a claim, a medical exam is customary and lots of doctors have to deal with a tough situation. If you find that the person you're looking at is actually healthy, you have to make sure you take the next steps carefully.
Follow these four tips to understand your position better so that you know what to do if you find out a client is healthy.
1. Know Your Role
While you have the role of working for the company you're contracted by, you're also beholden to the Hippocratic Oath. You should aim to maintain your own integrity above all else and stay true to your clients, patients, and yourself. There are some obvious implications if you're not honest that you don't want to engage with.
Workers comp clients often agree to work with a company doctor for a lot of reasons. If they don't have quality health insurance, they might want to get a doctor paid for. Some companies agree to speed up the processing of workers comp payments if employees deal with the doctor that the company knows and trusts.
However, as a doctor under the company's employ, there are a lot of mixed loyalties. Some doctors release patients before they're ready to go back to work, which puts them and other employees at risk. It also minimizes their injuries, which causes patients to act irresponsibly with their injuries.
A good doctor needs to remain independent, no matter who is signing the checks. They shouldn't be pressured by a company to give an inaccurate estimate to a patient. However, patients who have nothing wrong with them shouldn't be allowed to make false claims about their state of health.
2. Balance Interests Fairly
As a company's doctor, you might get patients that only come from one of a handful of companies. However, regardless of who is signing your checks, you need to be agnostic toward patients. All patients should be treated fairly and honestly, no matter who they work for.
During treatment, you might think of a financial interest in finding that the patient is okay and not as injured as they might seem. You're within your rights to seek out previous health records and compare scans and x-rays to what you're seeing in your office. However, you shouldn't push the limits of your responsibilities as a medical professional.
If a workers comp insurance company pays you and you don't find anything wrong with a patient, you need to be sure. If you find nothing wrong, the patient might seek to prove otherwise with the help of their own independent doctor and lawyer. You could end up in the middle of a legal battle, having to defend your own decision, so make sure you're comfortable with it.
On the other hand, the company might think that you have a financial interest in providing further medical care, so make sure that you're confident there too. Every decision you make should have some justification behind it to ensure that you don't get pinned behind the eight ball having to answer questions later.
3. Be Prepared for Disagreements
Most legal experts tell people who find out they have no injuries according to a company doctor to seek a second opinion. Your opinion is going to turn into a source of controversy no matter what. However, if you've built up a reputation, you should stand tall behind it.
If you're the company's chief IME doctor and you disagree with the treating doctor that's seen a patient, you need to confer with one another. There could be a difference in method that's the source of the discrepancy. You'll avoid drawn-out legal battles if you can find out why you disagree with the other doctor.
If the patient seeks out the opinion of a specialist who you know and respect, you may choose to defer to their opinion. Even if you've found a disagreement, let the company know that you believe the veracity of your college.
While the company might seek to find a "tiebreaker" to look at the patient, stay out the legal struggle. Keep steadfast on your opinion and the results as you interpret them and don't let anything come between you and your integrity. These battles can get ugly, but that doesn't mean you have to engage.
4. Make Sure You've Got Your Own Protection
Any doctor who works on workers compensation claims should have their own legal protection to ensure that they don't get into trouble. There are going to be people from all sides trying to ensure that get what they're owed. If you know your rights and have someone on board to protect them, you don't have to worry about the diagnosis.
If the patient you're dealing with has nothing wrong with them, you should be able to say that with confidence. However, if you don't have someone in your corner, you might struggle to feel okay about the diagnosis.
Ultimately, you need to protect your position as the company doctor. The company wants to save money, but they don't want a doctor that ends up in legal trouble. If you know that the claim is false or that the company wants you to give a diagnosis detrimental to the worker, stay true to yourself.
If you struggle with delivering the news one way or another, you can learn more here on how to communicate with patients and companies.
Workman's Comp Fraud Is Your Enemy
If you think the person applying for workman's comp is healthy, don't keep that a secret. Be honest with your patient and don't be offended if they seek a second opinion. They're well within their rights if they decide they want a specialist to double check your work.
If you decide maybe health and wellness is the route for you, check out our guide to what else you could be doing.