Category Archives: Medicaid

Talking points for injured workers who want to see their own doctor

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Talking points for employers looking to undermine rights of injured workers to pick their own doctor

I was sitting in a conference call when I screen captured the email that is the photo for this post.

The email came from an occupational medical clinic in Omaha. It used the occassion of an updated doctor choice form from the Nebraska Workers Compensation court to distribute talking points for management when injured workers balk, rightly, at being sent to an occupational medical clinic.

Injured workers have the right to pick their own doctor in Nebraska. But that doesn’t mean that the insurance industry and self-insured employers aren’t going to try to control medical care to their advantage. Insurance companies spend money on “nurse case managers” and self-insureds usually have in-house nurse case managers, who in my view, try to persuade doctors to write medical records and reports that are favorable to the employer. The use of occupational medicine or “occ, med,” clinics is another tactic used by emplyoers to get favorable outcomes for themselves in workers’ compensation claims.

These talking points overcoming employee objections to going to an occ, med. clinic are an example of how employers/insurers try to work around rules that allow injured workers to see theiir own doctors in Nebraska.

I am going to break down these talking points one by one.

1.“We want the best care for you.” If an employer wants the best care for their employees, it would stand to reason they would let the employee go to a doctor who has treated the employee previously and knows their medical history. Treatment would be more effective and efficient without having to re-invent the wheel with a new doctor.

A lot of injured workers end up at occupational health clinics because they don’t have a family doctor because they don’t have health insurance. If a company doesn’t offer affordable health insurance, I would question whether the company really wants what is best for their employees.

2. See you right away – If the injury is acute, an employee will be sent to the emergency room rather than an occupational medical clinic that is more or less an urgent care clinic. While there can be delays in getting to see a family doctor, many family doctors or general practitioners will hold back appointments for urgent cases like work injuries. Injured workers need to be assertive with medical office staff in insisting that they be seen that day.

Of course, this point is moot if an employee doesn’t have their own doctor. See the previous paragraph. That’s why I support the initiative to expand Medicaid in Nebraska.

3.You don’t have to pay if you go to an occ. med. clinic – Under the Nebraska Workers’ Compensation Act, an employee doesn’t have to pay out of pocket for medical care – period – it doesn’t matter who they see. There is an element of truth that some doctors don’t accept workers’ compensation insurance. But if the case requires a referral to surgeon, that surgeon will almost certainly accept workers’ compensation insurance.

By the way, if an employee does get stuck at an occ, med. clinic and they get a referral for a surgery, they can pick their own surgeon even if the employee agreed to let the employer pick the doctor at first.

4. You have to go to this clinic to get drug tested clinic anyway – This isn’t so much a talking point as it is an assertion of power by an employer. It’s a thinly veiled threat that if the employee doesn’t go to the cliinic the employer wants, then they are going to be in trouble. The use of occupational health clinics to perform mandatory post-injury drug testing is a way from employers to cleverly work around Nebraska law on doctor choice under the cover of state and federal law about drug testing. Employee drug testing is as much about employers asserting control over employees as it as about employee safety.

OSHA regulations have recently been revised to allow employers more clarity — or latitude — to drug test emplyoees after a work injury. I will post on this in the near future, but take a look at this post for now,

In short, some employers are going to do their worst to cajole and coerce injured workers into undermining their workers’ compensation case by not letting employees pick their own doctors. Employees in such a situation ought to call a lawyer to get advice and help with their workers’ compensation case.

The offices of Rehm, Bennett & Moore, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

This entry was posted in Doctor Choice, Medicaid, Nebraska, nurse case managers, Workers' Compensation and tagged , , , , .

Possible Medicaid expansion could impact workers’ compensation, labor markets

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State Sen. Adam Morfeld of Lincoln has helped lead the charge for Medicaid expansion in Nebraska.

Nebraska voters will likely vote on Medicaid expansion in November after Insure the Good Life turned in 135,000 signatures earlier this month. Insure the Good Life estimates 98,000 Nebraskans who aren’t eligible for Medicaid but can’t afford coverage on the ACA exchanges will would get insured if the measure passes in Novmeber.

If Medicaid expands in Nebraska, it could impact the  employee-employer relationship and workers compensation in the state.

Workers Compensation

Expanded health insurance means that more people will have access to medical care and have a relationship with a general practitioner. Oftentimes injures employees don’t have family doctors, so they let their employers pick their doctor by default. Letting an employer pick a doctor in a workers’ compensation claim can be harmful to an injured employee’s workers compensation case.

Access to primary care can also help an injured worker manage chronic conditions such high blood pressure and diabetes that can hinder recovery from a work injury.

An employee who has their workers compensation claim denied and isn’t working is usually unable to afford COBRA coverage — assuming their employer offers health insurance in the foirst place. An injured worker in that situation who is covered by Medicaid can continue to get the medical care they need to recover and develop their workers compensation case.

Employee-Employer relations

Employees often put up with abusive employers solely for the sake of health insurance. The option of enrolling in Medicaid would give more employees to take their job and shove it. This concern is part of the allure of portable benefits for employee that I have written about before. Less reliance on employers for health insurance could improve labor mobility and push up wages.

My opinions about the impact of Medicaid expansion in Nebraska come with some caveats. I have long believed the expansion of health insurance leads to more doctor choice for injured workers. But some studies of the ACA show it has lead to consolidation in the medical industry. This consolidation could gut any formal right employees have to chose their own doctors under workers compensation laws because there is less overall choice of doctors. This issue may have to be addressed by more vigorous anti-trust law enforcement

Also, just because a state expands Medicaid by referendum doesn’t mean the elected branches of government will implement the expansion. That is what is happening in Maine. The whole structure of the Affordable Care Act could be altered through another court challenge to the ACA. Finally the Nebraska Medicaid petition has been challenged by opponents of the expansion

But even with those caveats, I believe Medicaid expansion would be a good thing for injured workers and employees in Nebraska.

 

The offices of Rehm, Bennett & Moore, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

This entry was posted in Medicaid, Nebraska, portable benefits, Workers Compensation and tagged , , , , .

Not Expanding Medicaid: Deadly Consequences

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Today’s post comes from guest author Charlie Domer from The Domer Law Firm in Milwaukee.

As previously discussed in my blog post from last year, Nebraska’s Gov. Heineman has refused to expand Medicaid under the Affordable Care Act. Although the Legislature attempted in 2013 and 2014 to expand Medicaid, it has not passed with a filibuster-proof majority.

Whether it is for politics or short-sightedness, Heineman misses the positive impact an expansion of Medicaid would mean to all of Nebraska, including its working families. The benefits of expanding Medicaid to Nebraska’s workers are outlined here.

As I wrote almost a year ago, and as Mr. Domer’s blog post below suggests, the governor’s response in this 2013 Omaha World-Herald article of essentially “eat an apple a day” and go ask your church for some help just doesn’t cut it anymore. I don’t know of too many churches handing out health coverage for an emergency appendectomy or for melanoma screenings. The coverage gap of when a person isn’t eligible for subsidies but would have been eligible for expanded Medicaid looms large for many families and workers: many of them will go without health insurance altogether.

Because there are definitely Nebraskans who are “too poor for Obamacare and … too rich for Medicaid,”even though they’re working, they can look forward to potential “dire health consequences,” as Mr. Domer writes, without insurance. I hope the 2015 Nebraska legislative session will be the year for more working Nebraskans to improve their health through the Unicameral passing expanded Medicaid coverage.

Please take a moment to ready this story out of Pennsylvania: Study: Many Will Die if Medicaid is Not Expanded.   As part of the Affordable Care Act (“Obamacare”), an expansion of Medicaid was intended.  Medicaid essentially is the joint federal-state program to provide health insurance to low income individuals and families.   The federal government strongly encouraged this expansion by the states, by offering to pay for that expansion for many years.   Unfortunately, the US Supreme Court–in upholding the constitutionality of the bulk of Obamacare–did strike down this Medicaid expansion.  The Supreme Court decision left it up to the state’s themselves to decide whether to expand Medicaid for their residents or not.

In many Republican-led states, the decision was made to not expand Medicaid.  As seen in this article, Pennsylvania was a state that declined to expand.  Wisconsin, with Republican Governor Scott Walker, also decided not to provide this expanded Medicaid coverage to the the state’s low income individiduals.  (Check out the story here and here.) 

Now comes news that failure to expand Medicaid may actually result in increased deaths among the affected population.  The failure to have this expanded coverage, according to the study examining Pennsylvanis, will result in thousands of deaths due to individuals foregoing necessary medication, medical treatment, and preventative screening. Additionally, the expansion failure will result in “catastrophic medical expenses and tens of thousands of cases of untreated depression, diabetes and missed screening tests.”   This is a truly scary scenario–and an avoidable one.

In Wisconsin, Gov. Walker is suggesting that these individuals can now obtain health insurance throught the federal-run exchanges.  The real issue is whether these low-income individuals can truly afford the premiums and whether they actually qualify for the federal subsidies.  These lower-income individuals were the one supposed to be covered by Medicaid expansion–not by the exchanges.    Based on the Pennsylvania study, if these individuals are ineligible for Medicaid and cannot secure health insurance elsewhere, dire health consequences (or even death) loom as possibilities.

The offices of Rehm, Bennett & Moore, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

This entry was posted in Medicaid, Obamacare, Scott Walker and tagged , , .