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Impact of COVID-19 on Workers’ Comp

Since starting the Out Front Ideas COVID-19 Briefing Webinar Series just a couple of weeks ago, we have been receiving questions from our listeners regarding COVID-19 and how it is changing the landscape of workers’ compensation. With daily changes in regulations occurring across the country, we wanted to answer the most pertinent questions affecting how we handle claims moving forward. 

Three industry experts joined us for our special edition Out Front Ideas COVID-19 Briefing Webinar Series to answer audience questions regarding the impact of COVID-19 on workers’ compensation:

  • Max Koonce – chief claims officer, Sedgwick
  • Nina McIlree, MD – vice president, medical management, Zurich North America
  • Thomas Robinson – co-author, Larson’s Workers’ Compensation Law

What does the term “presumption” refer to in workers’ compensation law?

Presumptions are mechanisms in workers’ compensation law used to switch the burden of proof in claims. Instead of the injured worker needing to prove the injury occurred in the course and scope of their employment, these presumptions state that the illness or injury is presumed to have occurred while on the job. Some presumption laws were already in place, but mainly applied to firefighters and first responders who filed claims related to heart and lung diseases, and sometimes cancer where exposure could have occurred on the job.

In the instance of COVID-19, presumptions are changing on a state-by-state basis. Several states, through either legislation or executive orders, have enacted presumptions relating to COVID-19 occurring in first responders and healthcare workers. Illinois has embraced a presumption that covers all essential business employees who could be at risk of exposure, and other states are looking at similar legislation. 

How do these presumptions define healthcare workers?

A big problem with these presumption orders is that they are often vague. Some define healthcare workers as those on the front lines treating infected patients. Other orders simply refer to “healthcare workers” and could apply to a wide variety of people employed in the healthcare system who may have no exposures to patients. Unfortunately, this lack of definition in new statutes is confusing.

See also: Sustainability in the Time of Coronavirus?  

Are presumptions rebuttable? Is it difficult for an employer to prove that an employee contracted COVID-19 somewhere other than the workplace?

While not impossible, it will be challenging, especially because the goal of presumption laws is to shift the burden of proof to the employer. However, if a fact finder can prove that exposure to the virus came from someone else (e.g., someone was showing symptoms in their household), the employer may be able to file a rebuttal. 

How does the industry handle new COVID-19 claims?

At the foundation of workers’ compensation, we determine each claim based on the merit of each case. That said, are legislative changes in presumptions necessary for cases like healthcare employees who have faced exposure to multiple patients with the virus? Healthcare workers are typically at higher risk anyway, so we already see a higher frequency of claims from their industry.

The current crisis also changes the investigative process for claims examiners. Their process has become much more detailed for COVID-19 claims, including contact tracing and testing to prove positives. In all presumptions, there is more entitlement for specific groups of employees, which creates inequity in claims, when other employees may be just at as much at risk. 

Are the testing and quarantining periods covered within a workers’ compensation claim?

This coverage varies by jurisdiction, but some have required this to be covered under workers’ compensation. Some jurisdictions require the testing and quarantine to be covered under workers’ compensation, even if the employee ultimately is shown not to have COVID-19.

What industries are filing COVID-19 claims?

Healthcare represents the highest percentage of claims, including food service within the healthcare industry. Public entities are also seeing a large number of claims due to first responders. Combined, these industries cover about 65% to 70% of COVID-19 claims. The rest of the claims are coming from essential industries, like grocery stores, where employees cannot practice shelter in place or social distancing. There were also a few early exposure claims from the transportation industry, like airlines, but, with travel regulations in place, those have now almost entirely dropped off.

What is an employer’s liability claim?

When workers’ compensation was initially crafted, employees gave up their right to civil litigation for workplace injuries in exchange for guaranteed no-fault benefits. Under this agreement, workers’ compensation is the “exclusive remedy” for employees who suffer a workplace injury. Employer’s liability is the potential exception to this exclusive remedy. Under very narrow circumstances, certain states allow an injured employee to pursue civil litigation, alleging that the actions of the employer created a situation where the injury was “substantially certain” to occur. In regards to COVID-19, there has been some litigation filed alleging the employer did not provide proper protective equipment and knew employees risked exposure.

If we release an injured worker for modified work, but work isn’t available because of current conditions, do examiners continue temporary transitional employment (TTE)?

Because every state has its own workers’ compensation laws, the answer varies. Some states will insist that benefits be continued for a light-duty release even when an employer has no control over whether a business is currently operating due to current regulations. With a full-duty release, when many businesses are closed currently, the employee would collect unemployment in lieu of workers’ compensation benefits. Continuation of healthcare benefits for injured employees is the most crucial consideration currently, so we can encourage a return to work when businesses do reopen. 

Is workers’ compensation litigation continuing given the current crisis?

State agencies are trying to manage litigation in a few different ways. Some states are using virtual or telephonic processes to work through settlement hearings. Others are using an alternative notarization process, where you can see all members signing necessary documents. The remaining states are using limited staff to process documents needed for litigation to work through the process. There are state agency matrices designed to inform clients and examiners what methods they are using and whether they are currently operating. There is a prioritization of resolutions currently because the public is facing so many uncertainties in their daily lives.

See also: What Comes After the Coronavirus  

When does an employer need to report a claim involving COVID-19 to its carrier or claims administrator?

The best practice is always to report it as you would with any other work-related illness. If an employee says he has been exposed to the virus on the job and wants to file a claim, file it. Consider the future of not filing a COVID-19 claim. For example, does it leave you responsible if you did not take the necessary steps to file a claim, and OSHA gets involved, or an employee decides to file a suit? What if the employee can prove she made a clear statement about being exposed to the virus while on the job?

To listen to the full Out Front Ideas with Kimberly and Mark webinar on this topic, click here. Stay tuned for more from the Out Front Ideas COVID-19 Briefing Webinar Series, every Tuesday in April. View the full list of coming topics here.

Zero Injury: A Cultural Imperative for the Construction Industry

If there is a silver lining in the protracted downturn and delayed recovery in the construction economy, it is that “fatal construction injuries are down nearly 42% since 2006,” according to the BLS National Census of Fatal Occupational Injuries in 2011.

That same report observed that “fatal work injuries in the private construction sector declined to 721 in 2011 from 774 in 2010, a decline of 7% and the fifth consecutive year of lower fatality counts.”

However, as the general economy stabilizes and construction spending and project volumes increase, it will not be long before hiring pressures mount throughout the industry.

With an increase in hiring comes an opportunity to institute increased emphasis on safety through employee selection standards, substance abuse testing, new employee orientation and training processes, as well as job safety analyses and daily “huddles” to address project safety requirements.

There is no better time than now for construction company owners and construction financial managers to focus on systematic injury prevention by adopting a zero injury vision and strategy and begin a transformation into a zero injury culture.

Reality Check: Stop Rationalizing Construction Injuries & Fatalities As A Cost Of Doing Business

Stop for a moment and reflect on the hard fact that many construction workers are injured, disabled, and killed at work each year. It is widely recognized (or rationalized) that construction is a hazardous industry, accidents happen, and jobsite conditions are constantly changing and difficult to control.

The reality is that the overwhelming majority of injuries and fatalities are preventable. A common trait we’ve observed among companies that have adopted a zero injury culture is an underlying philosophy and belief that all injuries and fatalities can be eliminated.

What is required to make this philosophy a reality? Leadership resolve to change the prevailing attitude that rationalizes fatalities and injuries as an unfortunate aspect of the construction industry and a cost of doing business and a culture shift that changes the attitudes, beliefs, and behaviors of all industry stakeholders.

This shift to a zero injury culture instills a true belief that injuries and fatalities are not acceptable, should not be condoned, and cannot only be reduced, but actually prevented. This culture shift is necessary at the project, company, and industry levels, as well as in the thoughts and actions of each construction employee.

Zero Injury Culture Is For All Companies

Culture shapes the performance expectations of such key workplace attitudes as the importance of punctuality, wearing proper attire, and how hard to work (or not to work). It directly influences safety attitudes and behaviors, including whether employees wear protective equipment, ignore training instructions, and/or take safety shortcuts to finish work faster.

Therefore, culture determines if a company or work crew will act with a safety-conscious and risk-averse set of values or accept “at-risk” attitudes and behaviors as the prevailing norm.

With the emphasis on zero injury or zero incident culture by large contractors, many small- and medium-sized contractors are wondering if this is a suitable strategy for them as well. We believe all companies can benefit from adopting a zero injury vision and strategy.

The success of a company’s drive to attain a zero injury culture hinges on a company’s owners and senior leaders who must instill, reinforce, and sustain the core building blocks of a zero injury safety culture shown in Exhibit 1 below.

Exhibit 1: Zero Injury Safety Culture Building Blocks
Representative Examples
Attitudes

Zero Injury is attainable on every shift and every project.

Zero injury culture needs to permeate all company activities and not be viewed as a separate process.

Beliefs

All levels of the organization believe that zero injury is achievable — from company executives to all craft/trade employees.

 

All employees accept personal responsibility and accountability for zero injury.

 

Values

The company values the health and safety of all employees.

The company is committed to employees going home safe at the end of every work day.

Assumptions

Employees are not taking unnecessary risk.

New employees accept safe work practices as the expectation.

Norms

Employee behavior on projects rejects shortcuts and recognizes that unnecessary risk-taking is not acceptable.

Zero injury is ingrained in the way the company builds every construction project — regardless of size, location, company division, manager/supervisor, and/or schedule.

How To Institute A Zero Injury Culture

Companies that have adopted a zero injury culture generally have instituted the measurement of leading indicators in addition to traditional lagging indicators (which are discussed in Risk Performance Metrics). Leading indicators focus on the prevention-based activities that drive improved safety expectations and performance outcomes.

Exhibit 2 outlines a life cycle process for the development of a zero injury safety culture. We have high-lighted five distinct phases and delineated key steps and milestones for each phase. The five-phase model is presented to provide a useful framework for monitoring the progress of the evolving process.

For simplicity, Exhibit 2 summarizes key challenges, major milestones, and process outcomes in each of the five phases of the zero injury culture development life cycle. Similar to safety culture development, rarely is a one-size-fits-all approach appropriate for any organizational process or practice. Company culture is unique and will grow and change in its own way.

Building an organizational safety culture can be a slow and messy process, and it does not necessarily follow a linear progression. Sometimes the adage of “one step backward to go two steps forward” is necessary advice.

A model of organizational transformation that we found relevant and realistic to instituting zero injury culture is “Journey of Transformation: The CFO’s Perspective” (by Renee Beaulieu, Skip Perley, Dr. Perry Daneshgari, and Heather Moore in the May/June 2012 issue of CFMA Building Profits), which describes the Strategic Breakthrough Process Improvement.

Many of the companies adopting a zero incident or zero injury culture often describe their process of doing so as a journey.

Safety Culture Development Challenges

The 10-question Safety Culture Health Check in Exhibit 3 can provide your company’s leadership with an assessment of their personal and organizational readiness for instituting a zero injury culture.

Exhibit 3: Safety Culture Health Check

The following 10 questions are designed to provide a quick assessment of your company’s current safety culture. Even though this health check cannot provide insight as deep as a comprehensive, systematic safety perception survey, it is a useful tool for gauging the need to expand safety awareness and accountability.

  1. Does your company’s senior management team operationalize safety commitment and show demonstrable involvement in managing the process by addressing safety as a core strategic discipline that positively impacts the execution of company and project performance?
  2. Do your company’s supervisors and employees fundamentally believe that all accidents and injuries are preventable, or do they believe that accidents and injuries are part of working in the hazardous construction industry?
  3. Is your company known for having a robust safety program with rigorous attention to safety, or is safety known to take a backseat to production pressures?
  4. Does your company’s prevailing attitude toward safety regard it as a necessary evil that decreases productivity or as a vital process that positively impacts productivity and profitability by maintaining a healthy workforce?
  5. Is safety performance viewed as the responsibility of a corporate safety officer, or is adhering to safe work practices the responsibility of every employee?
  6. Does your company have a culture that condones or eliminates safety shortcuts?
  7. Does your company engage all employees in safety processes, including conducting safety observations to identify and correct unsafe conditions and “at-risk” behaviors?
  8. What is your company’s reputation for safety among peer group companies and among the recognized industry leaders?
  9. Is safety an important aspect of your company’s brand image and reputation?
  10. Is your senior management team willing to go “all-in” for the safety and welfare of its employees by making it a core value of the company?

It is crucial that the zero injury culture process be well conceived with thoughtful consideration of how to communicate the company’s commitment, secure employee engagement, and implement functional support structures to reinforce and sustain the process.

It is important to recognize that employees will intuitively know if the company leadership sincerely wants to adopt a zero injury culture. Employee skepticism will run high if the company has a history of initiating and quickly abandoning “fad of the month” safety programs.

A final “gut-check” question is necessary to determine your company’s readiness and resolve for adopting a zero injury culture: Is your company ready and willing to commit to adopting, instituting, and sustaining a zero injury culture? In honestly evaluating this question and its implications, it is natural to consider the challenges in doing so and identify the obstacles to overcome for your company to be successful.

Benefits & Outcomes

Once implemented, the benefits of a zero injury safety culture will be realized through reduced claim severity and frequency, increased productivity, and improved profitability. Once a zero injury safety culture is achieved, your company will:

  • Become an employer of choice, reduce voluntary attrition, and improve morale among existing employees
  • Increase productivity by decreasing time spent investigating employee injuries and reducing idle equipment, thereby increasing potential for improved margins
  • Decrease direct and indirect costs associated with employee injuries, thereby reducing your company’s total cost of risk
  • Demonstrate improvement in project owners’ prequalification metrics (e.g., total recordable cases (TRC); days away from work, job restriction, or transfer (DART); Workers’ Compensation Experience Modification Rate (EMR), etc.), thereby remaining on eligible bidder lists and increasing opportunities to bid desirable projects
  • Align zero injury culture with other strategic zerobased risk management objectives: zero defects, zero crashes, zero equipment breakdowns, zero defaults, zero IT downtime, and zero disruptions (For more information, read “Zero Disruptions: Preparing for Unexpected Business Interruptions & Protecting Your Assets” by Calvin E. Beyer and Brian J. Cooney in the May/June 2011 issue.)
  • Attain respect among peer competitors and establish a positive reputation in the industry

Management Safety Culture Assessment

Various survey instruments have been developed to measure perceptions of safety management culture. The Management of Safety Culture Assessment is based on the Determinants of Safety Culture Model, which assesses the measurable capacity and performance ability of companies to minimize accidents, injuries, and related costs.

According to Dr. Christopher Garrabrant, the Management Safety Culture Assessment and Determinants of Safety Culture model are founded on Charles Perrow’s 1994 discussion of Normal Accident Theory and High Reliability Theory, both of which correlate to reducing losses.

Garrabrant asserts this Management Safety Culture Assessment identifies and measures 15 factors within five broad categories that contribute to the success of a company’s safety culture, as shown in Exhibit 4.

Exhibit 4: Management Safety Culture Assessment
  Assessment Category Assessment Factors
1. Organizational Leaders Operationalize Commitment

Demonstrable senior leadership participation and involvement

Resource allocation

Core processes and results measured

Accountability system for safety at all levels of the organization

2. Identify Safety and Reliability as Goals

Safety as a goal is consistently and clearly articulated

Multiple and independent channels of communication

Decentralized decision-making authority

3. High Levels of Redundancy in Personnel and Technical Safety Measures

Continuous operations and training

Job hazard analyses are owned, continuously reviewed, and updated

4. Organization Strives for a “High Reliability Culture”

Presents optimism toward a desired future state

Consistent communications

Adaptability to change

5. Sophisticated Forms of Trial and Error Organizational Learning

Capacity to learn and act

Accident investigations are blame-free and pursue systemic improvements

Hazard analysis occurs before accidents

A company demonstrates the necessary values within its culture to promote the health and well-being of its employees. The culture demonstrates behaviors that can be expected to result in fewer workplace accidents and achieve a more rapid return to work should an accident occur. The assessment is intended to validate a company’s ability to exceed industry expectations of safety performance.

Importance Of A Zero Injury Mind Shift In The Construction Industry

We recognize that for a true zero injury culture to occur, the mindset of zero injury needs to reach beyond the individual company culture and become the norm for the construction industry as a whole, since many contractors use the same subcontractors, vendors, and workforce. Therefore, until the industry – including all owners, contractors, and employees – takes a unified stance against unsafe behaviors and acts, each individual company will obtain limited success as a zero injury culture.

We envision a construction industry with the shared culture where workers have the same positive experience at every project where they are asked to put in an honest day’s work without taking any unnecessary risk and where they safely complete their work each day.

In order to do that, we are encouraged to see general contractors and subcontractors band together with insurers to start working as an industry to change the norm for all workers to complete each work day safely.

Please take a moment to think about whether you are willing to do what is necessary to help make zero incidents, injuries, and fatalities a reality in your company and the construction industry.

Challenge the conventional thinking about the construction industry being hazardous and help make the vision of a zero injury culture within this industry a reality.

We appeal to every stakeholder of the construction industry to join the cause of making zero injuries a reality. There really is no higher calling for the construction industry – the time is now for zero injuries to be the expectation, the norm, and reality.

Web Resources

1. BLS Economic News Release: Census of Fatal Occupational Injuries Summary, 2011.

2. Zero Injury Techniques, University of Texas at Austin, Construction Industry Institute.

3. Safety Plus: Making Zero Accidents a Reality. University of Texas at Austin, Construction Industry Institute.

A Brief History of Zero Injury Culture in Construction

The concept of zero injury in construction has existed at least since 1993 with the publication of the Construction Industry Institute’s (CII) Zero Injury Techniques. The 1993 study highlighted 170 techniques that construction companies used for injury prevention. The CII’s follow-up study in 2003, Safety Plus: Making Zero Accidents a Reality, further popularized the term and increased awareness of the benefits of a zero injury culture.

The 2003 study quantified a significant demonstrable improvement in safety performance of companies adopting nine high-impact, zero injury techniques:

  1. Demonstrated management commitment
  2. Staffing for safety
  3. Planning (pre-project and pre-task)
  4. Safety education: orientation and specialized training
  5. Worker involvement
  6. Evaluation and recognition/reward
  7. Subcontractor management
  8. Accident/incident investigations
  9. Drug and alcohol testing

Since the two CII studies, a growing number of construction companies, many of which have more than $250 million in annual revenues, have adopted the vision of creating a zero injury culture. In the past couple of years, a cadre of such companies (known as The Incident & Injury Free CEO Forum) emerged to provide leadership by example on the benefits of zero injury culture.

Members of this group include American Infrastructure; Baker Concrete Construction; BMW Constructors, Inc.; Cal Dive International; Gilbane Company; Great Lakes Dredge & Dock; Hunter Roberts Construction Group; Jacobs; JMJ Associates; Lend Lease; Limbach Facility Services, LLC; Manson Construction Co.; Nicholson Construction Company; Skanska; Terracon; and Weeks Marine.

These companies are collaborating to expand awareness of zero injury techniques and have been engaging with representatives from major construction insurance carriers and brokers to foster greater adoption of zero injury culture throughout the construction industry.

Zero Incident
Many large companies have adopted programs with a more stringent focus of attaining zero incidents instead of merely zero accidents. The rationale is that incidents are “near hits” that could have resulted in injuries or fatalities and near hits are early warning signals of an underlying hazard that warrants attention and correction.

One of these companies distributed Safety 24/7: Building an Incident Free Culture to all its subcontractors. This book is recommended for any owner or strategic leader seriously interested in instituting a safety cultural change.

Authors
Cal Beyer collaborated with Eric Lambert in the writing of this article. Eric Lambert, CRIS, ARM, CHST, is National Director of Construction Quality and Safety for Zurich North America Commercial in its Boston, MA office. Eric has worked in the construction industry for the past 20 years to save lives, reduce loss, and make companies better. For the past 11 years, Eric has worked to make a zero injury culture a reality. Eric has participated in many construction industry roundtables and committees to learn from and provide input to improve the industry’s safety culture and practices.

© 2013 by the Construction Financial Management Association. All right reserved. This article first appeared in CFMA Building Profits. Used with permission.

Medical Provider Networks – Valdez v. Zurich North America

The Second District Court of Appeal recently issued their decision on this case which involves in part, the admissibility of non-Medical Provider Network doctor’s reports. This is an unpublished decision and therefore has no precedential value. In other words, it cannot be cited in other cases with the same or similar issues. In summary, it says in part that employee-requested visits to his/her own physician under L/C 4605, i.e. non-Medical Provider Network diagnosis, treatment and attendant reports which are paid for by the employee are admissible.

While the applicant’s attorney will ask the court to publish it, the probability seems very low in that the case was remanded to the trial court to deal with the admissibility issue as well as other issues left unsettled by the Workers Compensation Judge at the time of trial.

Background
Labor Code (L/C) 4605 was first enacted in 1917 under the Insurance and Safety Act. Sec. 9(a) is most interesting in that it reads:

“Such medical, surgical and hospital treatment, including nursing, medicines, medical and surgical supplies, crutches and apparatus, including artificial members, as may reasonably be required to cure and relieve from the effects of the injury, the same to be provided by the employer, and in case of his neglect or refusal seasonably to do so, the employer to be liable for the reasonable expense incurred by or on behalf of the employee in providing the same: provided, that if the employee so requests, the employer shall tender him one change of physicians and shall nominate at least three additional practicing physicians competent to treat the particular case, or as many as may be available if three cannot reasonably be named, from whom the employee may choose: the employee shall also be entitled, in any serious case, upon request, to the services of a consulting physician to be provided by the employer: all of said treatment to be at the expense of the employer. If the employee so requests, the employer must procure certification by the commission or the commissioner of the competency for the particular case of the consulting or additional physicians; provided, further, that the foregoing provisions regarding a change of physicians shall not apply to those cases where the employer maintains, for his own employees, a hospital and hospital staff, the adequacy and competency of which have been approved by the commission. Nothing contained in this section shall be construed to limit the right of the employee to provide, in any case, at his own expense, a consulting physician or any attending physicians whom he may desire (my emphasis). The same general language as to responsibilities will now be found in L/C 4600(a); 4601 and 4605.

The reason this section is important is that Section 9(a) pre-dates L/C 4616, the Medical Provider Network statute. As such, any attempt to harmonize the rights of the employee to seek their own doctor at their own expense against the later enacted Medical Provider Network statute will have to give precedent to the later enacted labor code section. I therefore offer the following as one strategy to retain medical control under the Medical Provider Network while at the same time avoiding lengthy litigation over the admissibility of the employee’s non-Medical Provider Network doctor’s report.

Strategy for Medical Provider Networks Going Forward
On all new claims, employers and their claims administrators (carrier or TPA) should continue to assert medical control under their Medical Provider Network. Employers will need to make sure that the notice process to the employee is complete and well documented. That is one of the issues currently facing the trial judge on remand, i.e. was there a valid Medical Provider Network in place. Had there been better documentation on the employer’s notification process presented at trial, the issue of applicant attorneys’ attempt to seize medical control may have been avoided.

However, the real question deals with the use by applicant attorney of L/C 4605 as a means to get his non-Medical Provider Network doctors reports admitted and relied upon. What is most interesting is the caption for that section:

“Consulting or attending physicians provided at employee’s expense.”

“Nothing contained in this chapter shall limit the right of the employee to provide, at his own expense, a consulting or any attending physicians whom he desires.”

It must again be noted that this language was in the Labor Code long before L/C 4616, i.e. the Medical Provider Network enabling statute which became effective in 2004. As noted above, under the rules of statutory construction, the later enacted takes precedent over the former when seeking to harmonize the two as to current legislative intent.

Recommended Procedure
I therefore recommend that the injured employee be informed, as part of the employer’s or carrier’s acknowledgment of the claim, that a valid Medical Provider Network is in place and that the employee’s cooperation is expected. Next, it should state “that they are free under L/C 4605 to seek their own consulting or attending physician, at their own expense. They will be told at that time that if they do avail themselves of this option under L/C 4605, their consulting or attending physicians medical reports will be tendered to the Primary Treating Physician for this injury who, under the Medical Provider Network statute is the controlling doctor (L/C 4061.5) This way, the consulting physician’s report will have been admitted for use by the Primary Treating Physician as he/she deems appropriate.

At the same time, the normal Medical Provider Network process will be enforced as is current policy. Demand will be made that the employee continues to be seen for diagnosis and treatment by a Medical Provider Network doctor. If there is a dispute as to diagnosis or treatment by either the applicant’s attorney or the L/C 4605 obtained consulting report, that dispute over the diagnosis and/or treatment will be handled under the Medical Provider Network’s 2nd, 3rd and if necessary, the Independent Medical Review process.

We will also be requesting from the employee an acknowledgement, under penalty of perjury that the employee has already paid or understands that he/she is the ultimate responsible party for paying their L/C 4605 obtained physicians as well as any other related bills for testing and other costs. We will object to the fronting of said costs by the applicant’s attorney or any liens from the consulting physician unless it is clear that they understand the applicant’s obligation to pay their costs.

Under this scenario, employers and their carriers or Third Party Administrators will be able to use the full weight of the Medical Provider Network process while at the same time, dealing with non-Medical Provider Network procured medical diagnosis and treatment. This will help keep the employee within the Medical Provider Network and, if handled in a swift and judicious manner, help hasten a timely closure of the claim.