What You Should Know About Handling Workers’ Compensation Claims

Author(s): 
Steven I. Subotnick DPM, DC

Becoming a qualified medical evaluator in workers’ compensation cases may be a significant referral generator for your practice. Accordingly, this author offers a closer look at his experience with these cases, reviews pertinent points in the evaluation of these patients and key steps you can take if you wish to start seeing these patients in your practice.

   Over the years, I have found that assessing and treating patients in workers’ compensation cases allow you to see some pathology you may not normally encounter in the normal day-to-day caseload of a podiatry practice. I have also found that being involved in these cases provides a good source of patient referrals and enables you to forge relationships with other physicians who are involved in the treatment of injured workers.

   I started assessing injured workers for workers’ compensation cases approximately 20 years ago. At first, I treated a few injured workers. Then I was asked to become an independent medical examiner (IME) and was sent patients to evaluate for disability. I eventually became a qualified medical evaluator (QME).

   The state of California decided it wanted to have a pool of QMEs to evaluate for disability as well as other issues in the treatment of injured workers. It therefore created a QME system approximately 15 years ago. In order to become a QME, you had to take a test and be qualified by California’s Department of Workers’ Compensation.

   Some QMEs become agreed medical evaluators, who represent the insurance company, employer and the injured worker. They are expected to follow the worker’s compensation laws of the state of California. Agreed medical evaluators have more responsibility and they also get paid 25 percent more for their medical-legal evaluations.

   When I began treating workers’ compensation patients, referrals came from occupational medicine centers as well as attorneys representing injured workers and attorneys representing insurance companies and the employer (see the sidebar “A Glossary Of Relevant Terms For Workers’ Compensation Cases”).

Understanding The AMA Guide To Workers’ Compensation

   California’s disability evaluation guidelines previously evaluated injured workers. Currently, the state uses the American Medical Association (AMA)’s Guide to the Evaluation of Permanent Impairment, Sixth Edition.

   There is a section in the AMA Guides on the lower extremity. Chapters 1 and 2, which are considered to be the most important chapters, instruct the evaluating physician on how to go about his or her duties. Essentially, the key with this system is determining the level of impairment as opposed to disability.

   Previously, physicians used the term “disability” as per the Guidelines for Work Capacity in order to evaluate patients’ ability to compete on the open job market. The AMA guides use “impairment” to determine whether there is permanent impairment.

   The AMA wrote the guide to permanent impairment. There is no podiatry input. There is input from the American Orthopedic Association but no specific input from the American Orthopedic Foot and Ankle Society.

   Regarding the American College of Occupational and Environmental Medicine (ACOEM) Second Edition Guidelines for Occupational Medicine, membership in ACOEM is primarily for occupational medicine doctors and physical medicine doctors. There is no membership category for podiatrists. Therefore, there has been no podiatry input on the foot and ankle section.

   Needless to say, the lack of podiatry input in both of these books that are the standards for treating and evaluating injured workers in California is a source of frustration for the podiatrist who does this type of work.

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