I have no greater concern than when I witness willful obstruction of care in our management of injured workers.
We all have jobs to do. Mine is to determine why/how an injury occurred, what treatment has been rendered, what is the current status and whether I, or someone else, can be of assistance to the patient.
Part of determining the patient’s current status is the determination of those actions that have neither furthered our understanding of this injured worker and, in many cases, have made the patient worse.
Among the many duties of a nurse case manager is to insure that the patient complies with care and to determine whether the patient is improving because of that care.
Among the many duties of an insurance claims adjustor is to be certain that the patient is referred to competent individuals in a timely fashion, that quality of care is delivered, and that there is tracking of the appropriateness of the care to the specific injury.
The latter job description can be quite complex. In the absence of a personal relationship with an injured worker, a seasoned adjustor can become distrustful of patients in general and very protective of insurance resources. They feel justified in this response, having been _fooled_ by patients in the past, and if this happens often enough, they distrust all patients until proven otherwise.
They may delay sending checks, including mileage, but more importantly, deny authorization of needed care. This delay or denial will vary from questioning why a physician ordered a medication or a diagnostic procedure, to questioning the relevance of a requested referral.
As control by the adjustor tightens, the resistance and resentment felt by the patient increases, and often, subjective complaints worsen due to the anger and frustration due to feeling obstructed and victimized.
The task then becomes: “How do you remedy a situation in which a newly injured worker is inadvertently punished for the misdeeds of patients who have gone before?”