Wednesday, November 23, 2005

WCRI Report on Provider Choice

The Workers' Compensation Research Institute (WCRI) issued a report entitled The Impact of Provider Choice on Workers' Compensation Costs and Outcomes. The report states panel physicians produce objectively better results, which WCRI attributes to an employer and carrier's superior resources in choosing physicians (Liberty Mutual is touting their system to put an even finer point on this).

WCRI's report admits employees report greater satisfaction with physicians they choose. The authors state this response is inconsistent with the poorer return to work outcomes and higher costs of employee chosen providers.

The rub of course is how the provider balances the conflicting interests of the employer and employee. A procedure that makes excessive medical and disability costs apparent to the employee would control costs without the dissatisfaction of restriction of choice.

Insurance Journal Article

Update: A similar study by the Public Policy Institute of California (using Pennsylvania among others as representative states) made similar findings, but with a twist. If the Claimant chose a physician not on the panel, but who the Claimant had seen before, outcomes vs. a panel doctor were not significantly different. The obvious inference would be that the pre-defined preexisting condition could not become part of the work injury in these cases. Article

Thursday, November 10, 2005

Supreme Court Holds Section 301(c)(1) Amendment Is Not Bar To Contract Exception To Coming and Going Rule

In Wachs v. WCAB (American Office Systems & Donegal Mutual Ins. Co.) the decedent had a fixed place of business. He worked in his home office and the employer's home office as a technician supervisor. Earlier, the decedent was a technician. When his employer recruited him back from a competitor, the decedent had demanded and was provided with a company car.

On the date of injury, the decedent was called in to the home office to work on two fax machines a client dropped off to be serviced. He drove his company car. The decedent was killed in an automobile accident.

The Court recognized an injury arising in the course and scope of employment does not include "injuries sustained while the employe is operating a motor vehicle provided by the employer if the employe is not otherwise in the course and scope of employment at the time of injury;..." Because the decedent had a fixed place of employment, the coming and going rule applied.

The Court stated however that all common law exceptions to the coming and going rule remain in effect. These are consistent with the language "if the employe is not otherwise in the course and scope of employment at the time of injury." The exceptions are: 1) claimant's employment contract includes transportation to and from work; 2) claimant has no fixed place of work; 3) claimant is on a special mission for employer; or 4) special circumstances are such that claimant was furthering the business of the employer.

In this case, the fact the decedent demanded and was given a company car made his transportation to and from work a part of the Claimant's negotiated employment contract. Accordingly, the accident was within the course and scope of employment by operation of the contract exception to the coming and going rule.

Article further analyzing case.