Public Health Law Map - Beta 5 - Medical and Public Health Law Site

turning away such a case. However, this is not an excuse for ignoring the state’s laws
on choosing workers’ compensation care providers.
It is common practice for the hospital to contact the insurance company to get
permission to treat a patient, so that the insurance will cover the bill. In real
emergencies this is done after the treatment is started. For the patients with an
earache or a cough, it is usually done first. Particularly in managed care plans, the
insurer may direct the patient to another hospital or to an office the next day. If there
is no medical reason why the patient cannot wait, this is legal and acceptable
practice. The patient may choose to pay cash and receive treatment there or they may
go where their insurance will pay the bill.
Work-related injuries should be treated the same way in an emergency room. Federal
law requires medical triage. If the illness or injury is a true emergency, treatment
should be rendered immediately and the employer contacted later. If the hospital has
a formal or informal agreement with the specific employer to provide workers’
compensation care, then this should be adequate. If the patient does not have a life-
or limb-threatening emergency and the hospital does not have an agreement with the
employer, then the employer should be contacted before care is given, subject to the
requirements of EMTALA. In any state, the patient may choose to pay cash for the
visit and argue it out with the workers’ compensation insurance system later. And, in
some states, it is unwise to ignore the requirement to notify the employer unless you
are thoroughly familiar with the state and federal laws.
In a doctor’s office when providing routine care, there is no justification for ignoring
the employer. If the employee is claiming a work-related injury and he or she wants
workers’ compensation to pay for it, the employer has a legal right to the employee’s
relevant medical information. The doctor should be prepared to work with both the
patient and the employer or should not be practicing occupational medicine.
4. Reporting
Many states require reporting of certain types of occupational illnesses and injuries
to the health department just like communicable diseases. As with other public health
reports, the medical care provider has a personal duty to make the report regardless
of who else may be reporting. Generally, OSHA reporting by a physician or hospital
is optional. However, OSHA may be the best source of information for patient care
and they may be the most appropriate agency to do an investigation.
C. Records
Providers who care for work-related injuries must know the laws on recordkeeping in
their state. These records are not always confidential like personal medical records.
There is a long list of people who have statutory access to workers’ compensation or
OSHA records. At a minimum, the patient, the employer, and the workers’
compensation insurance company have access to the records on the specific injury. In
some states, the health department or other state agency also has statutory access.
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