It is often stated that one of the most difficult and challenging jobs to have is that of an insurance claims adjuster.  As a claims adjuster, you are responsible for authorization and non-authorization of claims being made in your specific department.  Specific for this work, we would be speaking of workers compensation injury claims.

Since we specialize in this field, we are sensitive to the needs of the insurance adjuster and their role and attempt to not only mitigate cost and expense with our work, we try to achieve the highest rating of detail and professionalism on our reports.  Our reports will spell out the patients complaints, our exam findings, diagnosis and what is recommended for care or treatment and what, if any, other medical expenses may be incurred during the patients stay with us.  We also discuss disability status if necessary for the patients care.  Since we can’t predict the outcome of the patients injury, we cannot give a date of MMI, but every attempt is made to acquire MMI status as quickly as possible without compromising the patient’s care. *( Please see sample reports )

Our facility services first the patient and their needs and not the insurance companies wishes.  We of course always try to make every attempt to establish a friendly working relationship right up front with the claims adjuster on the case and NCM with request of authorization.  If authorization is not received, by law, the patient has rights to receive care and we will make that choice whether or not we desire to follow through with care to the patient.  If we believe the patients injury to be a legitimate injury, we may choose to follow through with care.

Our services provided are consistent with other similar facilities in the area and in the surrounding region; ie...  Physical Therapy, Rehabilitation and Occupational Medicine facilities, where services are provided for such injuries such as slip and falls at work, extremity injuries such as finger, hand and wrist, elbow or forearm injuries, shoulders on down to lower extremity foot, ankle, leg and knee; of course our specialty is the Spine.

We have multiple MD’s that we have hand selected for our extended staff of Physician’s, who specialize in certain regions of the body such as Knee Orthopedics’, or Foot and Ankle Specialists, etc... *(Please see Physician’s), who we utilize as adjuncts to our treatment protocol. Often times, the patients injuries spells out for a second opinion or even a third or tertiary intervention from a professional physician as we’ve discussed. The patient will be referred to the appropriate Physician for second opinion and/or assistance with care with any recommendations they can offer.  Once they have completed their evaluation, surgery or other, the patient is referred back to our facility to engage once more in their Rehabilitation and Physical Therapy.  Depending on what recommendations we receive from the other Physician will depend on how we pursue continued care management. This information allows us as the “NON-SURGICAL TEAM” to rehabilitate the patient back to Health and get them back to work.  Unfortunately, patience is not a virtue with most claims adjuster’s supervisors but must be in order to progress in a positive manner.  Most insurance company’s adjusters expect miracles in 4-6 weeks, some in the 1st week and this is just not practical, often requiring an IME almost immediately.  We encourage IME’s only if we too suspect fraud on the patient’s side or need a true “unbiased” 2nd opinion.  Unfortunately, most IME’s we see, cater to the insurance companies side and give them a story of perfect health when the patient is still struggling and suffering with their injury.  This only hurts the patient, not us.  It is unethical and simply not right!  We hope that your company does not promote such acts.