A caller to my office had a really good question about a very frustrating scenario he was in.
He is an industrial painter and does a lot of overhead lifting and work in general. One day, he felt a sharp pain in his shoulder while bringing down some items from a scaffold. This was witnessed, and nobody disputes that he was hurt at work. All of his time off has been paid, as have his medical bills, so far.
His orthopedic doctor has ordered a MRI to confirm his suspicion that he has a torn rotator cuff. The insurance company agrees that he needs a MRI. Even though there is a facility in his doctor’s office, as well as three others within ten minutes of where he lives, the workers’ comp insurance company is saying they will only pay for the MRI if he goes to their chosen provider, who happens to be more than an hour away.
Why would they do this?
This is a great example of how the insurance company doesn’t care about your health, they care about the money they have to spend by law to get you better. What is happening here, is that the insurance company has cut a deal with a MRI provider for reduced rates for this exam. If they save $300 here, and on 100 other MRI’s throughout the year, that’s a $30k savings for them on the year. What do they care that this worker has to drive over an hour or that doing so may put him at risk of an accident or that the facility they are sending him to uses sub-standard equipment? They know he has a torn muscle and just want to save money.
The good news on this is that nothing under the Illinois Workers’ Compensation Act requires him to travel this ridiculous distance for a procedure that can be done in a much simpler manner. This isn’t like an IME exam where they can pay you to travel to see a doctor for a one time visit. This is you choosing your own treating doctor and following what that doctor recommends.
This is understandably frustrating, but it’s because the worker looks at this case and thinks of their health while the insurance company looks at this and every other case and thinks about it as a business deal.