INDIANA'S WORKER COMPENSATION STATUTES FOSTER AN ENVIRONMENT WHICH COULD CREATE CONFLICT BETWEEN HEALTHCARE PROVIDERS AND THEIR EMPLOYEE PATIENTS
When you are injured in the course and scope of your employment in the State of Indiana, your employer or their insurance carrier typically has the right to direct your medical treatment. 
In most cases, the employer is required to provide a physician, free of charge, for the treatment of injuries an employee sustains. This employer/insurance carrier control, however, can create conflict when large employers and/or their insurance carriers use the same providers repeatedly.
This issue is not one of quality of care; rather, this conflict is raised when clients are released at MMI (Medical Maximum Improvement) and provided their PPI (Permanent Partial Impairment) ratings. Under the current law, workers compensation injury victims are not awarded pain and suffering. Rather, a permanent injury is typically denoted via a PPI rating. These ratings are then applied to a Statutory schedule which pays based on the severity of injury (i.e. the higher the rating, the higher the settlement or judgment). PPI ratings are by their very nature subjective. While most treating physicians attempt to utilize the AMA Guidelines as an objective application to individual injuries, these impairment ratings historically vary greatly depending upon the subjective analysis of the provider tendering them.
The lower the PPI rating, the less employers and their insurance carriers are obligated to pay in settlement or judgments. Thus, we are forced to consider whether there is an innate conflict of interest created when providers are being repeatedly hired by the same employers and insurance carriers. In such circumstances, the providers are obviously being paid for their services and retain an interest in getting more patients from those employers and carriers. Thus, when dealing with the release of a patient or tendering a PPI rating, those same providers are being asked to tender a rating which could be contrary to the hiring parties' interests. In other words, the higher the PPI rating the physician tenders, the more the employer or their insurance carrier must pay. In essence, this places the providers in a very difficult position of "biting the hand that feeds them".
Whether a provider consciously evaluates this issue or not, human nature (and good business sense) would force them to consider the possibility that a severe rating against an employer or their insurer could cost them additional business in the future. This is not to suggest that providers change their approach because of this conflict or that employers or their carriers are putting forth such an attitude; rather, the environment created by this structure forces one to contemplate the foundation of a physician's actions when an untimely release or disconnected PPI rating is put forth. Again, this is not to suggest malintent on the part of the drafting provider; rather, this is simply a product of the Indiana Statutes controlling the current Worker's Compensation system. By placing the physician selection in the hands of the employers, it forces medical providers seeking repeat work from these entities to at least consider catering to the interests of the employers or their insurers. After all, they're the ones choosing and paying them.
Other States, such as our sister State of Illinois, have remedied this conflict by placing the provider selection into the hands of the employee. While such a system certainly requires a more careful eye towards provider charges, it does serve the purpose of directing the providers intention and interests back to the patient-employee. Thus, a providers interest is the patient in front of them, and not the source of additional patients or the fees that follow.
INDIANA WORKER'S COMPENSATION WEBSITE
Kooi Law Firm is dedicated to providing strong counsel and aggressive legal representation to clients throughout the States of Illinois and Indiana. Our Firm represents individuals who have been hurt on the job, have worker's compensation claims, or injured or killed at construction site accidents. We represent individuals and their loved ones, and never work for or defend insurance companies.
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