Building Trust Through Transparency: The Importance of Physician-Adjuster Communication in Workers’ Compensation

Workers’ Compensation Claims can be difficult for everyone:

We get it, the workers’ compensation claim process can be daunting. There are often delays, disputes over treatment plans, and misunderstandings among all parties involved in the claims process. It’s difficult to create a balance between protecting employees while safeguarding employers from lawsuits and additional costs and still manage to get your claim paid for by insurance companies.

One of the most important aspects of a worker’s compensation claim is establishing transparency and collaboration between physicians and claims adjusters.

Why is transparency important during the worker’s compensation claims process?

Transparency during the worker’s compensation claims process is not only important, but also vital for a successful claim. Open, effective communication between physicians and adjusters builds trust, reduces misunderstandings, and leads to better outcomes for all parties involved—injured workers, employers, and insurers.

What does transparency in a workers’ compensation claim look like?

Transparency in a workers’ compensation claim allows all parties involved: employee, employer, insurance company and physician, to be on the same page. All-inclusive communication fosters trust and creates a smoother claims procedure. Transparency is an open and honest process including:

• Full details of the incident
• The extent of injury to the employee
• Any pre-existing medical conditions
• Relevant documentation
• Expert evaluation of the employee’s injury
• Treatment plan
• Timeline for returning to work

Miscommunication in Healthcare claims:

During any healthcare claim, and especially a workers’ compensation claim, there needs to be clear communication between all parties. Otherwise, confusion about the diagnosis, treatment and when the employee can return to work occurs. This can lead to delays in processing the claim, confusion about benefits, potential for claim denial, and increased frustration for the injured worker.

Physicians and claims adjusters do not always “speak” the same language:

Imagine that you in a foreign country, and do not speak the language. You want to understand what someone from this country is saying to you, so you hire an interpreter. It sounds like a very basic idea, but when it comes to workman’s compensation claims, the physician and the claims adjuster speak two entirely different languages. The physician speaks in medical terms, scans, images and diagnoses. The insurance adjuster speaks in numbers, ICD codes, computer schematics, and “usual and customary” concepts.

This is why a physician/claims adjuster relationship with clear communication is important. When the two parties understand each other, the claims process is much easier for everyone.

At BICMD, we are interpreters:

We can open a line of clear communication by helping each party in the claims process understand the patient, their diagnosis and an accurate timeline for recovery. Each of the entities can continue to do what they do well:

• The physician provides an accurate diagnosis, recommends treatment, and monitors recovery progress.
• The claims adjustor manages claims, ensures appropriate benefits, and coordinate care within policy guidelines.
• The employer knows what to expect, is assured their employee is being taken care of and manages their related costs.
• The employee receives appropriate, timely treatment and knows what to expect.

What happens without effective communication in a workers’ compensation claim?

The most common problem that can occur without appropriate communication in a worker’s compensation claim is frustration! Other problems include:

• Delay of approval for treatment or diagnostic tests
• Delay of care
• Inappropriate care or procedures
• Distrust between employer and employee
• Misalignment of return-to-work plans
• Conflicting messages
• Denial of coverage

How can BICMD help open the communication between worker’s compensation parties?

At BICMD we offer a very simple process for open communication called the MD Roundtable. In this virtual meeting we can:

• Improve the understanding of medical necessity
• Give clarity the specific injury
• Explain diagnostic tests and findings
• Offer expert diagnosis and prognosis
• Suggest an appropriate treatment and timeline for returning to work
• Assist with faster approvals for care
• Open a collaborative discussion to ensure realistic expectations

How can BICMD facilitate effective Physician-Adjuster communication?

Our MD Roundtable service provides a virtual environment where physicians have completed a comprehensive review of medical records and/or imaging and then explains the findings. This meeting is conducted in a 30 minute session with discussion between the BICMD physician and the claims adjustor. Other parties may attend the virtual conference as necessary. A written follow-up can be done upon request. This establishes a clear channel of communication between the adjuster and the physician.

Evidence-based recommendations:

At BICMD we offer a collaborative case review. We encourage mutual respect and understanding; physicians and adjusters should recognize each other’s expertise and work collaboratively toward the injured worker’s best interests.

What is the impact of transparency between claims adjusters and physicians?

The broader impact of transparency between claims adjusters and physicians is the trust it builds. Transparency benefits all stakeholders:

• Injured workers receive timely care and consistent messaging which gives them confidence in the claims process.
• Employers experience reduced claim costs and faster return-to-work times.
• Insurers improve the claims management efficiency and reduce the likelihood of disputes or litigation.

BICMD creates transparency in the workman’s compensation claims process:

The importance of transparency and collaboration between physicians and adjusters creates a fair, efficient, and effective workers’ compensation system. When the stakeholders prioritize open communication as a key strategy for building trust and improving outcomes in workers’ compensation claims, everyone benefits.

Choose BICMD to make claims processing easier, more transparent and with better communication. Check out our Best In Class MD Roundtable where we offer expert, unbiased opinions backed by experience and research. We can help make your medical claims process easier!