How to: Chiropractic Workers Compensation New Patients

How to: Chiropractic Workers Compensation Cases

State Workers Compensation programs are exempt from HIPAA mandates and some may use obsolete CPT Codes or make up their own.  Contact the state Worker’s Compensation office for a list of their valid local codes.

  • Proper verification of coverage is important
  • Employer name, address, phone/fax number, and contact person.
  • Payer
  • Date & time of injury or illness
  • Description of how the accident or illness occurred

#1 Contact the Employer to Verify the Accident!

  • Verify that the employer is familiar with the accident and the patients injury, and they do not anticipate any fraud or problems with the claim, i.e., the patient lying or embellishing
  • The employers report of the accident/injury has been filed with the insurance carrier.
  • The name of the Industrial Insurance carrier
  • The employers Workers’ Compensation policy number.

#2  Contact the Workers’ Compensation Carrier and ask the following:

  • Is the employer’s Workers’ Compensation policy still in force?
  • Since many companies are divisions of other companies, what company name should appear on the claim form submitted for processing adjudication?

New Workers Compensation Patients

Photo used under Creative Commons from Kheel Center, Cornell University

According to Chirocode, every state requires the physician to complete a first Report of Injury.  The information that is required on that form can be found on page A90 of the 2011 version.

Loss of Work Time – If the patient is off 3 days or less the patient is not compensated.  If the patient is off less than 14 days, days 4-14 are compensated.  If the patient is off more than 14 days, all days are compensated.

Communication with the employer and insurance company is of utmost importance.  After the examination is completed, the estimated time off work, treatment plan, and necessity for outside testing must be shared.

This is not intended to be legal advice and is only provided as an example of what our office policies and procedures are like.  Please check the laws in your state before implementing any changes to your policies and procedures.

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