Magazine article Clinical Psychiatry News

Integrity Is Key to Victory in Workers' Comp. (Clear Layman's Language Gets Results)

Magazine article Clinical Psychiatry News

Integrity Is Key to Victory in Workers' Comp. (Clear Layman's Language Gets Results)

Article excerpt

To win workers' compensation coverage for a patient who has suffered a psychological injury on the job, write reports that make it easy for the claims manager to say yes, said Dr. Lee S. Glass, assistant medical director of the Washington State Department of Labor and Industries.

"Honesty, integrity, and independence are absolutely key factors," said Dr. Glass. "A doctor who's thought by a claims manager to be trustworthy can do more in 5 minutes on the telephone than another doctor can do in 5 years of litigation."

He offered the following suggestions for psychiatrists writing workers' compensation reports:

* Remember that claims managers often find themselves in an unpleasant position: No matter what claims managers do, someone's going to think their decisions are wrong. If they say yes to a claim, then they're going to have to deal with an employer who's angry about potential increases in insurance rates. If they say no, there will soon be a lawyer on the phone threatening litigation.

* Write the report in very clear lay language. Practically no one in the system, including the claims manager and his or her supervisor, has the benefit of medical training.

* Provide the claims manager ammunition that will help him or her approve the claim. Don't merely assert that providing coverage is the right thing to do for a patient.

* List a specific diagnosis using the terminology and numerical identification of the current version of the Diagnostic and Statistical Manual, addressing all five axes.

* Use nationally recognized measuring tools, such as the Beck and Hamilton scales, when appropriate. …

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