• Medical “Management” in Indiana

    Indiana is an employer choice of medical state.  Over time, many employers or their worker’s compensation administrators have come to believe that they are entitled to completely manage the employees’ medical care.  Such management has taken many forms, including nurse case managers, “independent” medical evaluations, unilateral “redirection” of medical care, peer review, utilization review, authorization procedures and other “cost containment” techniques. Yet, the language of the Worker’s Compensation Act rather clearly and simply mandates that the nature of the care which the employer is to provide is that which “…the attending physician or Worker’s Compensation Board may deem necessary” (Indiana Code 22-3-3-4(a)).

    Indiana case law makes it clear that while the employer has the right to select the medical provider the employer does not have the right to select the medical treatment to be provided.  As to the use of a nurse case manager (NCM), the Worker’s Compensation Board of Indiana has recently posted a “Notice” on its website which states:

    “A NCM may be involved in a claim to schedule appointments, help facilitate care suggested by the medical provider and to report back to the employer and/or carrier.  However, a NCM should not express opinions, to either the injured worker or the medical provider, regarding an injured worker’s course of medical care or otherwise to influence the process. Additionally, a claims adjuster should not attempt to direct the care provided to an injured worker by the authorized treating doctor.”

    As an Indiana self-insured employer you must be sure that your self/third party administrator makes the best possible medical provider selections and then promptly facilitates and supports the medical treatment recommended by the medical providers so selected.  Any cost control or other process which delays the provision of such treatment by such medical providers must be avoided.

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