WCMC uses one word to encompass our process: ACCOUNTABILITY. To be accountable is to be required and expected to justify our actions and decisions. With the approval of our client, WCMC becomes an “AGENT” for the employer as defined through Agency Law.* (See insert on side). This allows WCMC to work directly with the insurance company, defense attorneys, medical providers, QRC’s, employees, and all other parties involved with whom the employer has the right to work. While WCMC is an “AGENT” of the employer, we also maintain the title of “Workers Compensation Consultant,” meaning the employer still has the final say in all decisions that need to be made.
WCMC is first and foremost accountable to our clients. In order to serve our clients’ best interest, we must recognize the responsibilities of all other parties involved when a work-related injury occurs. It is WCMC’s responsibility to help hold all parties accountable, including ourselves.
Injured workers are expected to report their claimed injuries on a timely basis and to strive to achieve a speedy recovery, allowing for a quick return to work and less disruption for the employer. WCMC keeps injured employees accountable with routine communication after doctor visits, making sure employees are working within their limitations and treatment plans are kept.
Health Care Providers are held accountable for providing only medical treatment that is prudent and necessary to the work-related injury. It is WCMC’s belief that any employee capable of light duty should not be taken out of work completely. WCMC keeps health care providers accountable by informing them of light-duty options that the employer has available so more appropriate restrictions can be addressed.
Insurers and Third-Party Administrators (TPA) are accountable for appropriately accepting or denying claims. In order to make such a decision, insurers must perform a thorough review and investigation of each claim. WCMC works with the insurer by aiding in the early investigation of how the injury occurred, reviewing medical records, and securing a legal opinion on compensability when applicable. All investigation performed by WCMC is shared with the adjuster to aid in their decision-making process. On accepted claims, the insurer is expected to see that only prudent and necessary medical treatment is approved. WCMC continues to hold each party accountable by sharing information with the adjuster throughout the claim life to keep the claim moving towards closure. Additionally, the insurer is accountable for the amount of money set in reserves. Since the reserves are what drive the modifier rate, WCMC is in constant review of these numbers with the adjuster.
Employers are held accountable to follow the work comp laws and statutes governing their state. WCMC guides the employer in dealing with issues that might arise while there is an open work comp claim to ensure that no rights of the injured employee are violated. When an injured employee has work limitations as a result of an occupational injury, the employer is expected to provide work within those limitations whenever possible. WCMC also guides the employer in providing temporary transitional light duty job offers.