ReAudio: ReAssess Your Workers Comp Toolbox
ReAudio goes beyond policies and regulations to explore the real impact of workers’ compensation. We break down key industry trends, workplace injury data, and best practices while diving into the human side of recovery. Through expert conversations and powerful stories, we uncover the challenges, emotions, and perspectives that shape the experience for employees and employers alike.
Whether you’re an industry professional or just curious about the system behind workplace injuries, this podcast brings you the facts you need and the stories that matter—because workers’ comp isn’t just about processes, it’s about people.
The award-winning ReAudio podcast is presented by your partners at ReEmployAbility. Thanks for listening!
ReAudio: ReAssess Your Workers Comp Toolbox
Navigating Healthcare Hurdles in Modern Workers' Comp Claims
A healthcare crisis is hitting workers’ compensation: fewer doctors are treating injured workers. Why are physicians leaving, and what can be done?
Woodruff Sawyer, VP | Specialty Claims Consultant, Debbie Hammer, with 35 years of experience, breaks down the complex reasons behind the shortage—from fallout of the Dobbs decision to burdensome paperwork—and its real-world impact on recovery times, disability claims, and costs.
Hammer also shares actionable solutions for employers, insurers, and injured workers to navigate this growing challenge and improve care access and outcomes.
Whether you're in HR, claims, or healthcare, this episode offers crucial insights into one of the industry’s most urgent issues.
Subscribe for more expert discussions on workers’ compensation and return-to-work strategies.
How do you get better at what you do?
Speaker 2:Time management assistance.
Speaker 3:AI.
Speaker 2:Webinars Mentors. Open platforms like Coursera Live and virtual Live training, live course Live training.
Speaker 1:Live course, live training Live training Live training, live training, live training, live training, live training, live training, live training, live training, live training.
Speaker 3:Whoa, tell me a little bit about what you've been up to. You've been a guest with REA Audio a couple times in the past. We've done some webinars together and I just so appreciate your take on things and kind of your position on things. You're able to take some of these work comp issues that we talk about and go really deep on them, and so I'm really glad that you've come back as a guest and really interested in what you're up to now. Debbie at Woodruff Sawyer.
Speaker 2:Great, yeah, thanks, todd. Thanks for having me on again. I love your show and I love being on and talking about all of these important issues and going into deep dives and so yeah, so let's see where can I start. You know, I know you're familiar with my background a little bit. I've been in workers' comp for about 35 years.
Speaker 2:I've been with Woodruff Sawyer for 19 of those years and what I do at Woodruff Sawyer is I'm a claims consultant and advocate for our clients. I'm basically a liaison between our clients and their claims adjusters on the carrier side, and I get involved anywhere from the onboarding process when we have a new client or we have a client who is changing carriers, and I get the team together to make sure that we've got special handling instructions in place and everybody understands them and is comfortable with them to then getting involved in claim oversight and management. I help out with reserve strategy, settlement strategy, return to work strategy. As you know, I have some clients who are involved with re-employability and your not-for-profit programs, and so basically, we have claim reviews with our clients and meetings to discuss statuses and action plans on the open claims. And then we also get involved with, or I get involved with XMOD projections to help our clients with forecasting and budgeting, understanding where their premium might lay on the next year, based on their claims, and so that's basically what I do here.
Speaker 3:There's a lot of things that are involved with what you do. Obviously, do you work in specific industries, or is there a specific type of client that you work with at Woodruff Shore?
Speaker 2:Not really. We have some claims consultants here who are a little bit more specialized in their focus. We have someone who does a lot of construction accounts and then we have people who are involved in tech accounts. I tend to be sort of the multi-practice person here. I have a lot of different areas and I love that. I love being able to handle construction accounts, and then I have a handful of tech risk management very large deductible accounts or accounts that are self-insured, and that's very different from working on smaller accounts who are on, say, a guaranteed cost program and there's different strategies involved. And I love working with the different personalities, with different types of clients small, large and whatever their industry area is. It's it makes it more fun and I think I learn more as well Just seeing how different types of companies and industries handle things differently, and that's, you know, that's really interesting to me. That's really interesting to me. Illuminating.
Speaker 3:And I'm sure you learn, right, that's one of the things I like about being able to travel and talk to our clients that are in very different industries is that you can learn so much just from learning what one organization does and you can then help, kind of be a resource to other people as you talk to, even in different industries, right? A lot of best practices go across industries and I'm sure through your experiences and the time that you've been there.
Speaker 2:You've been able to absorb a lot of things and share that information with your clients, haven't you? Absolutely, Completely agree with you on that?
Speaker 3:So what are you seeing as trends now in workers' comp as you're talking to your clients? Are there specific things that are creeping up that maybe you've seen creep up in years past, or new things happening that are starting to kind of draw your attention to?
Speaker 2:So one of the things our team has been talking about lately is an uptick in physician shortages in workers' comp, and that has got me really interested in why why that's occurring and where is it occurring. Is it geographically specific or is it type of specialty? So there's a lot going on with that and, you know, I think there's a lot of interesting reasons and maybe a convergence of factors that are all causing this.
Speaker 3:So if we step back for a second, can you explain a little bit? And it may seem obvious, but if you could just kind of lay out like how does that negatively impact a claim and from a you know, risk manager standpoint somebody who is trying to keep their X mod as low as possible and trying to move claims to closure as quickly as possible and safely as possible and get their employees back to work and do all the right things how does a physician shortage affect that?
Speaker 2:So I think it affects both injured workers and employers negatively, and the most significant impact is going to be felt by the employees because they need to rely on prompt and effective medical care to recover from their injuries and return to work. Without an adequate number of physicians that are willing to provide treatment, employees are forced to wait longer for appointments, they get inadequate or, in some cases, no care at all. And the other thing I find is the lack of quality care can result in misdiagnosis and inappropriate treatment for the wrong condition. I've seen cases where an injured employee was provided physical therapy for their shoulder and then it turns out much later that the problem was actually not the shoulder at all but a herniated disc in the neck, causing radiating pain down the upper extremity. That could have been caught early on if there had been proper triage, diagnostics and specialty consultation. So that's one area, and I think you know that it's important to note that the delay in treatment is also affecting not just the injured worker's physical recovery but their financial stability and their mental health.
Speaker 2:So many employees are unable to return to work for extended periods. It puts their livelihoods at risk and you know it can lead to long-term disability, prolonged suffering chronic pain and then a feeling of hopelessness and frustration starts to set in. So that's the other thing we've been seeing. Related is and there's many reasons for this not just the physician shortage, but the more complex an injury is and lack of care and all these other factors it can lead into site claims. So we have seen another. You know another problem there. That's probably the subject of another conversation.
Speaker 3:Yeah, yeah, I mean, it is all connected. So are you seeing more people just not get the treatment that they need, or are they getting treatment from you know, like I know myself, I've gone to. I got a new doctor a couple of years ago and I've never seen him. I always see the EA, which is fine, she's wonderful, she's super nice, she seems very knowledgeable. I'm in pretty good health, so that's okay. But it's not just in workers' comp, right? I'm in Florida and there's a lot of people here and I've seen it too.
Speaker 3:Growing up as a kid we went to the local doctor. His office was in the first floor of an old house, right, great guy. His office was in the first floor of an old house, right, great guy. Family doctor. But now it seems like it's all corporately owned, or you're going to an urgent care or something like that. So you know, I've seen it just in my own, in my own life. And so in work comp and for people that might not understand this at this point, in most cases I am asked to go to a specific doctor by my employer. Is that correct?
Speaker 2:Yes In workers' compensation. If you are injured, you would be directed, if it's handled appropriately like it should be, to an occupational physician, not your personal care physician. That is true in, as far as I know, all states across the country. There's varying regulations and differences there across states. But yeah, employees do not see their personal care doctors and workers comp anywhere.
Speaker 3:They're not supposed to. Right, they're not supposed to, but why is that? And why is that? They're not supposed to? Right, they're not supposed to, but why is that?
Speaker 2:That is just the way that the system is set up, so that there is cost containment and there's medical control. I don't know that that means that there isn't medical control and cost containment outside the work comp system, but work comp is just a unique area of specialty, and so the whole reason behind having medical provider networks is to control costs and control the system and be balanced and fair for both employers and their injured workers.
Speaker 3:So do you feel like this lack or the physician shortage is due to physicians just not wanting to get into the workers comp world, or is it an issue of, like, fewer physicians coming out of school now?
Speaker 2:I think it's a lot of different reasons and it's interesting. I mean, I could talk a long time on this and you can feel free to cut me off?
Speaker 3:No, not at all, it's interesting.
Speaker 2:So I think again there's multiple reasons and they are all converging at once. One of the things that people don't talk about much in comp in terms of the physician shortage is how there's a domino effect from the Dobbs decision, which overturned Roe v Wade. So obviously this has decreased student motivation to pursue medical careers in the OBGYN area. But did anybody think this decision would be so far reaching as to extend to workers' comp medical care? And the link is the Dobbs decision decreased student motivation to apply to medical schools in states with severely restrictive abortion rights, for example the Midwestern, central and Southern states that we know of and in turn, this has reduced medical school enrollment and residency training, leading to the lack of availability of practicing physicians in those states. So the most significant impact from my research has been on family medicine and emergency room care, which affects treatment for occupational injuries, especially when severe injuries require an emergency room visit. And then there's other areas of medicine that have been affected by this as well, including occupational and orthopedic specialty care. So, essentially, physician demographics and workforce patterns have shifted as a result of this. But, aside from the Dobbs decision, the physician shortage has already been in the making for decades because of shifting demographics. For other reasons, due to a combination of population growth, we have an aging population. Due to a combination of population growth, we have an aging population. We have an aging, near retirement physician workforce that is experiencing burnout. So there's now a higher percentage of the population being older the baby boomers, including those older working physicians, entering their twilight years and having greater and more varied medical needs.
Speaker 2:And I just want to go back to what you said. You know the physician burnout. Why people are not entering the medical field is because of red tape. So and this is both in occupational and non-occupational medicine there's more medical practice and patient care regulations. There's more insurance and administration regulations. So people enter the medical profession to care for patients, not complete time-consuming reports, right?
Speaker 2:So for many physicians, the administrative hurdles outweigh the financial and professional rewards of providing direct care and advocacy for patients. The other problem is reimbursement rates. Reimbursement rates are less than they used to be and they are less in workers' comp than they are for general, you know, non-occupational practice. There's significantly more physician regulations in workers' comp. And, getting back to what we were talking about earlier, that is because the system's designed to be fair and balanced and protect both injured workers and employers and to contain the costs. But yeah, there's definitely more. There's utilization review guidelines, evidence-based treatment guidelines In workers' comp. Doctors must provide detailed documentation about injury causation and permanent disability A lot of complex factors in workers' comp that we just don't see on the non-occupational side. So there's just a lot of bureaucracy and legalities that don't help attract and retain physicians to the field.
Speaker 3:Yeah, and you know, I feel like just that going to see a doctor now is much different than what it used to be, as I recall the just the whole appointment process and this is outside of the work comp world, right, this is just personal experience, you know, I remember full physicals and you know more of the experience of a doctor was less about what they're seeing in the blood test and more about what you're actually feeling and experiencing. And I feel like it's changed. And again, I'm not a doctor. If I was a doctor, I wouldn't be doing this interview right now, right, but I feel like it's become again. This is just personal experience, less personal and it is, and I would imagine, even so, in a work comp atmosphere, when there is so much more red tape, so much more reporting that has to be done, it is almost like an assembly line and there's not that personal care, right.
Speaker 2:Yeah, that's a good analogy. It's an assembly line.
Speaker 3:Yeah, that's a good analogy. It's an assembly line. Yeah, so what's being done to overcome this in the short term from a work comp perspective?
Speaker 2:Well, I think that there's a lot that needs to be done. I'm not sure what's actually being done but, I think that this is a collective effort.
Speaker 2:It has to be. It can't just be one single group alone. I think that insurers, employers and healthcare providers, as well as policymakers, need to come together to collaborate and find solutions, and starting with employers. I think that many of them are unprepared. When an employee suffers an injury, they don't know where to direct their employees for treatment. Maybe they don't even have the education and the knowledge to know that the treatment can't happen with that employee's personal care physician, that it has to be through a provider network. So I think that employers need to be proactive and work with their carriers up front to obtain provider listings prior to injuries occurring, so that they can educate their workforce. If you get injured, here is where you go, here is where you access medical providers for workers' comp injuries. So that's one thing I think. Long term, I feel I'm really into wellness, that whole field, and I see a connection between wellness and workers' comp, and I know that wellness is hot right now. I wish more employers would consider offering robust wellness programs, because they can reduce the risk of injuries in the first place, they can reduce the severity of injuries when they happen and that is going to reduce the strain on workers' comp. So I think that's one area.
Speaker 2:Nurse triage services is another popular area. I think that can be effective. These nurse triage services are offered through either work comp carriers A lot of them are starting at their own in-house program or third-party vendors, and these nurses can assist in proper diagnosis at the time of injury and help determine the best medical care. A lot of times they can establish that an injury is not severe as initially thought and that the injury really may only require over-the-counter or at-home treatment and avoid the need to find a doctor altogether. Telehealth is another good option, and not in all cases, but sometimes we find that injuries that used to be required to be evaluated by an in-person physician could be addressed by telehealth and or by a physician assistant. You know that can improve the appropriateness of treatment based on accurate diagnostic testing and referrals to specialty consultations.
Speaker 2:I think on the carrier side, what insurers can do and allow greater leniency for adjusters to approve medical treatment and diagnostics and related to that, another possibility is to amend the Request for Treatment Authorization form, the RFA requirements. Now, not all states have this. California is a big one that relies on this designated mandated form. Doctors are required to submit it to the claims adjusters when they make a recommendation for treatment, but some of these doctors aren't even aware of the existence of the form, so part of that solution is to train doctors.
Speaker 2:But, at the same time, why not allow doctors to make a request using their standard medical report form, as long as they provide the rationale for the treatment right?
Speaker 2:And many doctors are doing this already, but adjusters are denying treatment because the request isn't made on a specific form in a specific format. So some of these things like the carriers will push back and say, well, this is our regulation, you know we have to do this, and sometimes that's true. So some of these things may take legislative reform before insurers can make changes. And I would say one more thing for insurers is investing in technology such as electronic medical records and automated claim processing platforms, you know, to help speed up the system, reduce administrative overhead, using integrated platforms that allow physicians to quickly submit claims to check on the status of their reimbursements, communicate with the adjusters. California's Division of Workers' Comp e-form system. This is a state rather than an insurer system, but it's a unique shared online portal which integrates with insurer claim management platforms, so that is something that can help reduce the burden on you know the administrative burden on physicians.
Speaker 3:Yeah, Okay, this is just pulling right out of the thin air. What do you think about a national work comp system rather than 50 individual ones?
Speaker 2:I have not reflected on that before, todd. You know you talk about all the different jurisdictions.
Speaker 3:I mean, I understand how it was set up. I've done I understand, know, 100 years ago, when workers work comp was set up, you know, with all the right intentions, and it was a much different world then, right. But we work in all 50 states here at reemployability and so we have 50 different bona fide job offer letters that we sent out, so that it's everything is jurisdictionally in line with what it's supposed to be. And you talk about the requirements of California versus the requirements of a state like Florida, where we are, and you talk about red tape and just doing what makes sense.
Speaker 3:It seems like sometimes there's so many things that hold us up that could so benefit human beings that we hold up because and I understand we want to make sure that the right thing's being done and people are being taken care of and that there's less fraud than than could be. Right, that this, as you, as you pull back restrictions, the more opportunity there is for human beings to be human beings and fraud to creep up and people take advantage of the system. But but at the end of the day, it seems like what you're saying is it's red tape on the side of the doctors that is prohibiting them from doing what they're supposed to be doing, and it's red tape on the side of the insurance adjusters that are prohibiting them from being able to do. What seems like the right thing to do is if we could come together and just kind of free that up. It seems like we'd be doing a lot of good for a lot of different people.
Speaker 2:I think in theory, that is an awesome idea.
Speaker 3:I'm not sure. Let you and I get together and do it. What do you say? We?
Speaker 2:need to come up with something, todd to help our legislators across the country. Yeah, that would definitely help streamline, for sure.
Speaker 3:So what about tips and tricks? You had mentioned some things that you talked to I'm sure you talked to your clients about, to try to smooth this issue out a little bit. Are those mainly the focuses that you use with your clients when they're trying to overcome these hurdles of the physician shortage?
Speaker 2:Yeah, I would just say, going back to what I said about what employers can do, that's part of my job is to try to educate them barriers claim account manager to discuss what their medical provider network looks like and ask for provider. You know physician panels in each of the employer. You know my client's geographical location so that they can make sure to educate their employees before the renewal date, because you know they're going to have an injury on day one and they're not going to know what to do.
Speaker 2:They're going to be scrambling. So it's about proactive measures and education and yeah, that's basically what I'm trying to educate them on. And we do talk about triage as well and try to find appropriate resources there and help our clients vet the different providers in that space. Whether it is, you know, I always feel it with the nurse triage systems. Start with your carrier, see what they have, because sometimes the carriers aren't going to charge a fee, it's just rolled into the premium package, right, but then maybe that program isn't as robust as the client would like. So maybe that's when we start to look at outside third-party vendors.
Speaker 2:But beyond that, you know, this is something we talk about in claim reviews also, when we have both our client and the claims adjuster present, also, when we have both our client and the claims adjuster present. And if I see a pattern where treatment is being delayed because an adjuster is denying treatment because of the doctor not submitting the right form, the RFA or whatever it is, then I like to take a step back and look at it logically and then discuss should we just, you know, go ahead and honor the doctor's request from the medical report they provided? If the rationale is there? Why do we have to go through all this rigmarole? And you're just, you're prolonging the injured worker's disability and being out of work longer, which is affecting everybody. It's affecting our you know our clients business as well, and so that plays into it.
Speaker 2:But yeah, these are the things again that we like to discuss and claim reviews and try to be really creative in our strategy. You know, there's other times where an adjuster might be really insistent on a claimant treating within the medical provider network. But what if the injured worker is in a remote area and there are no providers within a reasonable geographical distance? So that's when we've got to look at do we want to go outside the provider network? It's not the injured worker's fault that they can't find care within the network. So then sometimes we discuss nurse case managers. You know they can be really helpful if there's a delay in treatment and coordinating care, and they can also help bridge the gap in communication issues between the different parties. So we talk about that strategy as well.
Speaker 3:So one final question I'm curious how would you, what kind of advice would you, give to an injured worker? How would what's the best way for them to advocate for themselves when they're perhaps see themselves in a situation where they're not getting the medical care that they're supposed to be getting?
Speaker 2:The best advice I can give is to really be their own advocate and maybe pretend like they're trying to help their elderly parents. You know we often are better at advocating for our loved ones than we are for ourselves.
Speaker 2:So what would you do if your elderly sick mother or father is not able to get treatment or they're not getting treatment authorized and they're not getting responses from the insurance company or the doctor? You step in for them and you escalate issues. So for injured workers, they can go back to their employer for help. They can go to their adjuster. Really, the adjuster is the first person they can talk to and a lot of times there's miscommunication between adjusters and doctors and it's no one's fault. It's maybe the injured worker just went to a medical appointment and the doctor tells them verbally I want you to have an MRI, and the injured worker expects that MRI to be authorized immediately. Well, what if the adjuster doesn't have that information yet?
Speaker 2:They often don't because the doctor can tell the injured worker verbally what they recommend, but then they have to put it in a report and that takes time for the doctor and that's often delayed. So that's another thing is like if the injured worker can just get on the phone with the adjuster, don't go out and get an attorney. That's not going to help, that's just going to delay everything and make the problem worse. And you know, call the adjuster. If you can't get through to the adjuster, call your employer, escalate it to the next level.
Speaker 3:Yeah, communication is key in all points of this from every direction. It's all about communication, for sure, and Debbie, we were talking. You said that you know having talked about this has kind of prompted you to do some research, to perhaps write an article about the physician shortage. Where are you? Have you been published? Where have your articles been, if people want to look you up and read some more about other things that you've written on?
Speaker 2:So people can go to. They can either look me up on LinkedIn Debbie Hammer, woodruff Sawyer. They can either look me up on LinkedIn, debbie Hammer, woodruff Sawyer, or they can look at our website, woodruffsawyercom and find our insights blog and then do a search by name or by area. Claims is one of those areas and usually people can find my articles there, either on our blog, our insights blog, or on LinkedIn.
Speaker 3:You have incredible insights and I really appreciate you coming on and being with us. It's such a pleasure to talk to you and I hope you come back again in a couple weeks, months, maybe another time over the summer. You may get back with us.
Speaker 2:Thank you so much, Todd.
Speaker 1:Thanks for listening to REA Audio. I hope we opened up your brain a bit and helped you be better at what you do. Please follow us on Spotify, apple Podcasts, stitcher, amazon Music or wherever you get your podcasts. If you have input or suggestions, email Todd at reemployabilitycom. Be grateful and have a fantastic rest of your week.
.png)