It’s Your Money: is it really a reasonable and necessary medical cost?

By | November 4, 2011

Written by Bob Hollingsworth of The Buckner Company


Workers’ Compensation laws vary from state to state.  The goal is to help your employee return to work at full productively if possible.  If returning to work at full productivity is not an option, the second goal is  to help the employee get to what is known as maximum medical improvement (MMI).  The Workers’ Compensation system obligates the employer to be responsible for all medical costs for work-related injuries.  This can include: doctor visits, surgical care, hospital care, nursing services, medicine, and durable medical equipment.  The only limit is that these costs be reasonable and necessary.


As the responsible party, the employer has the right to question whether something is reasonable and necessary, but few employers take advantage of this right.


You, the employer, should question these areas.  Remember, it is your money:


  1. Diagnostic Testing: Watch out for duplicate testing.  Sometimes a repeat MRI is unnecessary, because if the MRI is for a different part of the body than what was injured, you might be paying for something unrelated to a workers’ compensation injury.
  2. Yoga, Massage and Aqua Therapy: These sound more like spa treatments than medically necessary procedures.  I would strongly advise that you request a second opinion regarding these treatments.
  3. Special Devices: When employees suffer serious injury they often need specialized equipment, when a wheelchair is needed there are huge cost  variables such as motorized vs non-motorized. If the employee is permanently confined to the chair, motorized might be reasonable. These situations should be reviewed on a case by case basis.
  4. Home Improvements: When ramps are put in because of a wheelchair we can understand this.  But when a doctor is prescribing a new pillow top mattress, a hot tub, or home gym equipment . . . you should express some concern to the adjuster and insurance company. Physical therapy should be offered at a reputable physical therapy facility.
  5. Attendant Care at Home: Sometimes a seriously injured employee needs assistance at home.  The nurse case manager needs to work closely with the primary medical care provider to establish what is needed in the way of home assistance.  When the injured employee needs bandage changes or toilet assistance this may be done by a non-medical person approved by the work comp adjuster.  Cooking and laundry, etc. may not be medically necessary.


The key to remember is workers’ compensation dollars are your dollars, you ultimately are the one paying the claims.  Your premiums are a reflection of the cost of your claims.

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