Week 16/Chapter 17 Realty Check Billing and Reimbursement

In order to qualify for workman’s compensation benefits, an employee must be injured on the job. When an employee collects workman’s compensation benefits, he or she is eligible for medical treatment, temporary disability, permanent disability, and vocational rehabilitation and survivor benefits.

Medical treatment is the easiest to process because they are filed for minor illnesses or injuries normally treated by a health care provider. Claims that involve temporary and permanent disability, as well as vocational rehabilitation and survivor benefits, take longer to process and are much more convoluted due to the nature of the injury and, in some cases, the ability for the worker to retrain for a new career.

Managed care is incorporated into workman’s compensation programs, which improve the quality of medical benefits and services. The benefits for employees include:

• More comprehensive coverage
• Provision of appropriate medical treatment to facilitate healing and promote return to work
• Internal grievance and dispute resolution procedures involving the care and treatment provided by the workers’ compensation agency

Do you think the Workers’ compensation program would work without the managed care aspect of the program? Why or why not?

Write 1 to 2 paragraphs explaining your answer.