Choosing a designated medical provider

In workers’ compensation, the focus is on treating injuries caused at work and getting patients back to work as soon as possible, rather than on the myriad other reasons people typically seek medical care. Workers’ compensation doctors don’t treat ailments such as colds, diabetes, high blood pressure or injuries that happen outside of the workplace. The most common kinds of injuries they treat are sprains, strains, cuts, burns and those resulting from exposure to toxic chemicals.

As a Colorado employer, you must designate at least four medical providers or clinics for your workers to choose from if they are injured. We recommend that you research providers to make sure you like, trust and can work with those who will treat your employees. What’s more, since workers’ compensation is highly regulated, these medical providers must be familiar with Colorado Division of Workers’ Compensation rules, so that should factor into your decision making process.

What is a Designated Medical Provider?

Designated providers are the primary care providers for injured workers.In a typical scenario, they:

1. Establish a diagnosis and determine if an injury is work-related.
2. Order initial tests and make referrals to specialists.
3. Outline any work restrictions and estimate when an employee is able to return to work.
4. Decide whether a worker is permanently impaired.

If you fail to select four medical providers, Pinnacol will make the determination on your behalf.

Before you choose your providers, you may want to consider your needs by asking:

1. Do you require multiple medical provider locations, based on your operations?
2. Do you want your medical provider to do pre-employment exams, physical screenings and drug testing?
3. Do you have special needs as an employer due to the type of work (e.g., Department of Transportation physical examinations?
4. Do you need a medical provider with caregivers who speak Spanish?
5. Are you likely to need after-hours care?
6. What are your expectations for the medical provider and staff?

Once you've answered these questions, start researching medical providers in your area. Pinnacol's online SelectNet provider directory is an excellent resource, providing specific information on how our providers meet many of the criteria listed above.

5 steps for choosing a medical provider or clinic

1. Use Pinnacol resources to find local medical providers or clinics. Pinnacol’s contracted medical providers (SelectNet) offer a discount and have been screened for basic elements of quality (e.g., board certification, no medical license restrictions, no concerning history of malpractice). Find SelectNet providers in your area through the policyholder portal or you may call Pinnacol Customer Service at 303.361.4000 for assistance.
2. Review the clinic website and ask for opinions from local, trusted businesses. Check the hours of operation, including extended hours to match your work shifts. Read the posted material to determine whether the clinic website mentions “workers’
   compensation.” (If not, the clinic may have little experience with workers’ compensation’s unique rules and approach to care.)
3. Call the clinic. Assess whether the telephone staff is pleasant and knowledgeable. Request a conversation with the clinic manager, who should be willing to answer questions if the clinic is interested in forming a partnership. Once connected, ask the following:

• How many workers’ compensation cases has the clinic treated this past year? (A low number could indicate lack of experience.)
• Does the clinic have a contact person for workers’ compensation-related issues? (If so, this can help you and injured workers resolve issues faster.)
• How long do clinic appointments last, and how long does it take to be seen by a provider? (New patient appointments should be at least 30 minutes long, and injured workers should be seen within 24 hours and as frequently as needed thereafter.)
• Does the clinic dispense (hand out) medications in the office or send patients to pharmacies? (If providers dispense prescription drugs from their clinic, overall costs can be much higher.)
• Does the clinic provide other services? (Services such as drug and alcohol testing, pre-employment physicals, medical surveillance evaluations, asbestos exams, audio testing, and immunizations could be important to your business.)

4. Tour the clinic. Evaluate parking and access to the clinic and decide whether the clinic is clean and the waiting area is comfortable. Assess staff friendliness and determine whether a private conversation can be held at the front desk.

5. Interview potential medical providers who work at the clinic. This interview will give you valuable information about whether a provider should care for your injured workers. Equally importantly, it will introduce the medical provider to your business, help the provider understand your expectations and help you and the provider
begin to develop a relationship based on trust and accountability. Refer to the Medical Provider Interview Guide for a list of questions to ask the provider and staff.

Periodic re-evaluations of each clinic's performance

It is important to periodically review whether the clinics you have selected are responsive and provide good care. After an injury, ask your employees who were treated whether they were satisfied. Be willing to give a clinic a second chance and communicate right away with the clinic to resolve problems. If this is unsuccessful, please notify Pinnacol so we can assist. If you are not satisfied with how things are going, Pinnacol will help you change your designated providers.

Questions? Please contact Customer Service at 303.361.4000 for assistance.