L&I workers’ compensation claims in Washington State and the quality of medical opinions

L-and-I claim medical opinion

Being an Attending Provider in an L&I claim or a workers’ compensation claim in Washington State can be burdensome. In fact, the Attending Provider (or Attending Physician) has a big job to do.

 

Attending provider duties in an L&I workers compensation claim

More explicitly, there are several important responsibilities that come with being an attending physician:
1. The provider must see the work injury claimant approximately every 30 days;
2. Make referrals to specialty doctors;
3. Submit the appropriate treatment requests for authorization through Comagine;
4. Provide opinions to the Department of Labor and Industries (L&I);
5. Answer vocational questions from vocational counselors;
6. Fill out volumes of paperwork;
and more. When you add these tasks to a busy clinical practice, L&I claims can become a nuisance.

 

It seems to me that rather than trying to legitimately ease the burden on Attending Providers, L&I fosters initiatives that limit injured workers’ access to unbiased and quality medical care. For example, L&I spent a lot of time and money developing the Centers for Occupational Health & Education (COHE). L&I says COHEs coordinate injured worker care for the first year of treatment and engage with employers about return to work options. In addition, a COHE is supposed to train providers in best practices and help providers implement those best practices in their offices.

 

Centers for Occupational Health & Education (COHE) in L&I claims

From my perspective, the COHE is merely another way for L&I to exert its influence over medical opinions and to control claim outcomes. L&I makes COHE appealing to Attending Providers by offering them access to Health Services Coordinators (HSC). HSCs coordinate and track referrals, assess barriers to recovery, and make referrals to community services. Also, they assist with medical issues, coordinate return to work, support transitions of care, monitor recovery, and coordinate surgical care.

 

Certainly, when done by the right people with the right motives, this type of service can greatly benefit both attending providers and injured workers. Sadly, based on my observations, the right personnel and motives are not in place. Once again, there is an undue focus on benefiting “shareholder” or “stakeholder” interests. Consequently, those people that suffered a work injury are left behind.

 

Trying to control medical opinions in L&I claims

Who are “shareholders” or “stakeholders”? It is an ever-expanding group that includes employers, medical providers (including healthcare facilities, doctors, counselors, physical therapists, occupational therapists, etc.) vocational providers, retraining facilities, retrospective ratings groups and more. When coordination of care assumes the role of protecting all of the stakeholders in the system, it invariably comes at the expense of work injury claimants.

 

With these various stakeholders being given a voice in L&I claims, the injured workers’ voice is drowned out. Because of this, now more than ever, I believe that in order to achieve the goals of the Industrial Insurance Act, people with work injury claims must aggressively advocate for themselves (or hire a representative to do it for them). Additionally, they must have a supportive attending provider on their side.

 

Some final comments

The problem is, L&I has made the role of attending provider so burdensome and nearly impossible. It is getting increasingly difficult for work injury victims to access supportive medical care within claims. By controlling medical opinions and access to unbiased and supportive medical care, L&I is doing the opposite of what it should. In my opinion, L&I is protecting stakeholders and placing their interests ahead of the injured workers it was designed to protect.

 

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