Emergency Treatment
Even in states where the employer has the sole right to choose medical care providers under workers’ compensation, there is an exception for emergency care. If a patient presents to an emergency room or a doctor’s office with an injury or illness that may threaten life or limb, that person should be treated appropriately. Most hospitals and emergency room personnel are well aware of the penalties under federal law for turning away such a case. However, this is not an excuse for ignoring the state’s laws on choosing workers’ compensation care providers.
It is common practice for the hospital to contact the insurance company to get permission to treat a patient, so that the insurance will cover the bill. In real emergencies this is done after the treatment is started. For the patients with an earache or a cough, it is usually done first. Particularly in managed care plans, the insurer may direct the patient to another hospital or to an office the next day. If there is no medical reason why the patient cannot wait, this is legal and acceptable practice. The patient may choose to pay cash and receive treatment there or they may go where their insurance will pay the bill.
Work-related injuries should be treated the same way in an emergency room. Federal law requires medical triage. If the illness or injury is a true emergency, treatment should be rendered immediately and the employer contacted later. If the hospital has a formal or informal agreement with the specific employer to provide workers’ compensation care, then this should be adequate. If the patient does not have a life- or limb-threatening emergency and the hospital does not have an agreement with the employer, then the employer should be contacted before care is given, subject to the requirements of EMTALA. In any state, the patient may choose to pay cash for the visit and argue it out with the workers’ compensation insurance system later. And, in some states, it is unwise to ignore the requirement to notify the employer unless you are thoroughly familiar with the state and federal laws.
In a doctor’s office when providing routine care, there is no justification for ignoring the employer. If the employee is claiming a work-related injury and he or she wants workers’ compensation to pay for it, the employer has a legal right to the employee’s relevant medical information. The doctor should be prepared to work with both the patient and the employer or should not be practicing occupational medicine.