1. Establishing a Medical Protocol
Presented By: Scott Hunter and Kelly Marino
don’t just insure. BE SURE.

2. Establishing a Medical Protocol
What is a medical protocol
Steps to Implementing a Medical Protocol
How to choose a doctor
Talking to Physician
Showing your job duties
Setting up pharmacy protocol/programs
Referrals
Examples
How Work comp is calculated
How it helps both the company and AlaCOMP

3. What is a Medical Protocol?
Medical protocol is a program that is setup by the employer to include:
specific physician/doctor that is used in the case of an employee getting injured at work
Pharmacy programs
After hours physician or ER information
You as an Employer have the right in Alabama to choose your doctor – sometimes this is forgotten
Beneficial to the employee and the company

4. STEPS to Implement a Medical Protocol
Picking a Doctor
AlaCOMP can provide a list of recommended physicians
Well-known in the community
Trusted practice
Established
Similar hours

5. STEPS to Implement a Medical Protocol
Visiting Physicians Office
Set up a day and time to visit the office and the doctor(s)
Tour the facility
Meet and converse with doctor(s)
Ask Questions:
Patient protocol
Drug Testing
Meet Staff (specifically who you may be dealing with)
Discuss prescription protocols
Discuss Pharmacy Programs (i.e. Carlisle Medical)
Discuss referrals/specialist

6. STEPS to Implement a Medical Protocol
Visit to your facility
Set up a day and time for the doctor(s) to visit your facility
Give them a tour the facility
Show them job duties
Discuss possible injuries, past injuries, etc.

7. STEPS to Implement a Medical Protocol
ABC, LLC
MEDICAL PROTOCOL FOR WORKERS COMPENSATION INJURIES
REPORT INJURY TO:
Company: ABC, LLC
Phone: (123)
Contact Person: John Doe
TREATING PHYSICIAN:
Doctors Office
Dr. Greene
123 Apple Street
Any city, AL 12345
(444)
EMERGENCY ROOM:
Weekends or night shift (where treating physician’s office is closed)
ABC Hospital
5555 Office Way
No City, AL 67890
(098)
ER personnel are authorized to treat emergencies regarding the above referenced cases.
In the event further treatment is necessary, the ER physician shall refer the employee back to the designated treating physician.
The ER Personnel has the authority to issue enough prescription drugs to last until the next business day. Then, the emergency room physicians should instruct the employee to go back to the designated treating physician for any further prescriptions. The intent is to have all prescription management handled by one doctor.
PRESCRIPTIONS
The authorized treating physician shall prescribe generic drugs on prescriptions when available. Prescription cards are available through your adjuster.
AlaCOMP RX Program:
Once the authorized treating physician writes the prescription, the injured worker may take the prescription to the pharmacy of choice. Have the pharmacy call AlaCOMP/Business Insurance Group at (888) to obtain authorization from the assigned claims adjuster. The injured worker can pay for the initial prescription(s) and can be reimbursed after a copy of the pharmacy receipt is submitted (to include name of medication, quantity, and prescribing physician).
Medical Protocol in place
Discuss the medical protocol with employees
RX Pharmacy Program
Discuss the Medical Treatment Declination Form
Post Medical protocol information for Employees

8. STEPS to Implement a Medical Protocol
(COMPANY NAME) MEMORANDUM
TO: (Employee)
FROM: Human Resource Department
DATE: (Date)
RE: Workers’ Compensation Medical Protocol
Dear Employee:
The following is the established medical protocol for workers’ compensation injuries that occur during the day and night shifts or on the weekends that are not life threatening or do not involve serious bodily injuries.
Mandatory Notice: You must report all incidences of injury to your supervisor immediately.
Daytime workers’ compensation accidents: Report to treating physician’s office.
**Physician Name & Address**
**Physician Telephone Number**
Nighttime/Weekend workers’ compensation accidents: Report to treating physician. If their office is closed, then report to Emergency Room
**ER Facility Name & Address**
**ER Phone Number**
Emergency Needs during any shift: First report to treating physician’s office unless closed. If closed, report to ER Facility.
Failure to report to the above listed medical providers may jeopardize your workers’ compensation benefits. Prior authorization must be received whenever possible.
If you have any questions please contact your HR Department.
Thanks,
Bob Smith
ABC, LLC
Medical Protocol in place
Letter to all Employees implementing the medical protocol

9. Comparison of Companies
Company A
(No Medical Protocol)
Company B
(medical Protocol in place)
Worker was injured during normal business hours.
Company had no medical protocol setup for employees to follow.
Employee choose to use the ER and a family physician.
4 Visits for injury
Time lost at work
Worker was injured during normal business hours.
Company setup a protocol for employees when injured on the job.
Employee followed the medical protocol and went to the doctor that the company chose.
4 Visits for injury
Had the option of light duty work
No time lost at work
These are all approximate cost and are to show the difference in having a medical protocol versus not

10. Comparison of Companies: difference between claim cost
Company A
(No Medical Protocol)
Company B
(medical Protocol in place)
1st Visit: ER: $3,836.19
2nd Visit: Family Doctor: $160.96
3rd Visit: ER: $352.06
4th Visit: Family Doctor: $179.38
Indemnity payment: $231.27
TOTAL: $4,759.86
1st Visit: Doctor’s Office: $152.71
2nd Visit: Doctor’s Office: $60.00
3rd Visit: Doctor’s Office: $68.52
4th Visit: Doctor’s Office: $68.52
TOTAL: $349.75
These are all approximate cost and are to show the difference in having a medical protocl versus not

11. How work comp is calculated
Frequent losses often result in the occurrence in several loss
Experience Mod:
Calculated from the most 3 recent years
More occurrences of losses is typically worse than one large loss
Work Comp:
Based on payroll, rates, losses and experience mod
These are all approximate cost and are to show the difference in having a medical protocl versus not

12. Comparison of Companies How Losses Effect Experience Mod
Company A
(No Medical Protocol)
Company B
(medical Protocol in place)
2015 Losses: $10,000
2016 Losses: $9,000
2017 Losses: $9,000
Experience Mod: 1.17
2015 Losses: $7,000
2016 Losses: $6,000
2017 Losses: $6,000
Experience Mod: 1.09
Company A has an 8% increase over Company B
These are all approximate cost and are to show the difference in having a medical protocl versus not

13. Why A Medical Protocol Helps everyone
How it helps the insured
Saves time and money
One point of contact for injured employees
Someone looking out for the employers and employees best interest
Helps get injured employee back to work (even light duty)
Provides RX programs to help injured employee getting prescriptions
Reduce workers’ comp cost
Helps keep a lower experience mod
How it helps the workers comp company
Reduces medical cost
Reduces doctors offices to deal with
Overall helps reduce workers’ comp to insured

14. RECAP
What is a Medical Protocol
What’s the first step to set up a Medical Protocol
Why set up a Medical Protocol
Taking the time in the beginning to set up a Medical Protocol can save you money in the end and overtime!

15. QUESTIONS & ANSWERS
If you have any questions or need help setting up a MEDICAL PROTCOL please contact:
Scott:
Jim: