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Is Employer-Directed Medical Care Associated With Decreased Workers’ Compensation Claim Costs?

Tao, Xuguang, (Grant), MD, PhD; Leung, Nina, PhD, MPH; Kalia, Nimisha, MD, MPH, MBA; Lavin, Robert, A., MD, MS; Yuspeh, Larry, BA; Bernacki, Edward, J., MD, MPH

Journal of Occupational and Environmental Medicine: May 2018 - Volume 60 - Issue 5 - p e232–e237
doi: 10.1097/JOM.0000000000001247

Background: The financial impact regarding choice of physician within the workers’ compensation domain has not been well studied.

Objective: The aim of this study was to assess the difference in claim cost between employee- and employer-directed choice of treating physician after injury.

Methods: Thirty-five thousand six hundred forty indemnity lost time claims from a 13-year period at a nationwide company were analyzed with multivariate logistic regression to determine the association of medical direction with risk of high-cost claims.

Results: States that have employer-directed physician choice were associated with a lower risk of having high-cost claims (≥$50,000) but higher attorney involvement than employee direction. The net effect of this enhanced presence of attorneys offsets the benefits of employer choice of treating physician.

Conclusion: States that permit employer selection of treating physician have slightly higher cost due to the higher prevalence of attorney involvement in the claims process.

Division of Occupational and Environmental Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland (Drs Tao, Kalia); Dell Medical School – The University of Texas at Austin, Department of Medicine, Johns Hopkins School of Medicine, Austin, Texas (Drs Leung, Bernacki); Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland (Dr Lavin); and Strategic Risk and Strategy Management, Louisiana Workers’ Compensation Corporation, Johns Hopkins University School of Medicine – Department of Medicine, Baltimore, Maryland (Mr Yuspeh).

Address correspondence to: Xuguang (Grant) Tao, MD, PhD, Johns Hopkins University, 2024 E. Monument St, Suite 1-300, Baltimore, MD 21205 (

This work is part of general maintenance of worker compensation management and not supported by a particular fund.

The authors have no financial or other relationships that might lead to a conflict of interest related to the findings in this article.

Copyright © 2018 by the American College of Occupational and Environmental Medicine