After working 17 years as a stock clerk in a warehouse on Dillingham Boulevard, Keoni felt a sharp, shooting pain in his back as he lifted a 50-pound box. Not wanting to let down his co-workers, he kept working. The next morning, he could barely get out of bed. He called to make an appointment with his primary care clinic of 11 years but was told that it does not take workers’ comp. The receptionist gave him three numbers, but on the first pass he could not get through. He lay there, staring at the ceiling, feeling helpless.
Injured workers like Keoni are not only in pain. They also worry about leaving extra work to their co-workers. They wonder how they will pay their bills when disabled, even temporarily. Many are concerned that the injury will result in termination. They are unsure what care is available or where to find it. For these reasons, work injuries are sometimes not reported until days or weeks after the accident, and needed care is often delayed.
Few primary care doctors accept workers’ compensation insurance. Reimbursement is low, detailed treatment plans must be submitted before sending patients to specialists for MRIs or other procedures, and all care after 60 days must be pre-approved. None of the local workers’ compensation carriers can interface with electronic medical records, yet they all require medical records to be submitted with every bill. Carriers often contest compensability, at times motivated by a contentious employer. Because the compensation to personal injury attorneys is limited and usually a long time in coming, it is only a minority who accept these cases. Carriers often hire physicians to perform independent medical evaluations. However, most opinions are rendered by physicians who are not primarily in clinical practice. Those who work for the defense know that if their opinions are too "patient friendly," it can affect job security.
An employee must report any work injury at the time it occurs. The incident report must include an accurate disclosure of what happened and fully describe the bodily injury. At that point the employer is obligated to file a report with its carrier within a very short period of time. The carrier will then assign a claim number and an adjustor who may take a statement from the injured person.
Upon the initial visit with a physician trained in occupational health, a medical report will be generated and forwarded to the carrier. During that visit the provider will work to make a responsible diagnosis, provide treatment recommendations and advise on the ability to work. When placed on temporary disability, workers are entitled to wage-loss benefits.
Any treatment provided to an injured worker must be appropriate, necessary and related to the accident. The cost for care is not subject to co-pays or deductibles. During the first 60 days following an injury, workers are entitled to a maximum of 15 medical visits, medication, X-rays and 20 visits for physical therapy. They are also entitled to a maximum of 15 visits for each of the following services: acupuncture, massage therapy and chiropractic.
Protocols for injured workers in Hawaii are meant to care for employees who become hurt as they fulfill their usual and customary duties. The system is far from perfect both in principle and in practice, but basic knowledge of a worker’s rights and responsibilities can go a long way in navigating toward recovery during a time of need.
Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center as well as CEO of Global Advisory Services Inc. Please submit your questions to firstname.lastname@example.org.