MEDICAL TREATMENT AND NEUTRAL OPINIONS
The Trustees have provided for two unique components to the Program: an Exclusive Provider Organization (EPO) as the sole source of treatment of the work injury; and a Neutral Examiners Panel for examinations and opinions on medical issues that are in dispute.
EXCLUSIVE PROVIDER ORGANIZATION
It is the intent of the Board that injured union workers of participating contractors will have the very best medical care available within reasonable driving distance of their homes and worksites. The Board believes this customized network of health care providers will improve treatment outcomes through: using more qualified primary care providers (occupational medicine specialists); quicker approval and appointments for specialty exams; fewer treatment and treating doctor disputes; credible and consistent light-duty work restrictions; monitoring of pain medication prescriptions; and, possibly, an overall reduction in the cost of medical treatment.
Injured workers must seek treatment from a physician who is a member of the EPO, with few exceptions. The EPO has physicians from a variety of medical specialties. Doctors are available in most of the geographic areas of Minnesota where participating contractors are located, and more will be added as the Program grows. Every doctor in the EPO must meet criteria established by the Board of Trustees. Any doctor not continuing to meet these criteria will be removed from the EPO. In areas where there are insufficient providers in the EPO, we ask employers and unions to help us identify candidates for consideration. The EPO list will be updated monthly. Therefore, we recommend that you visit the website each time a referral is needed rather than printing off a list.
A call center, administered by CorVel Corporation, is available to employees, employers, and insurers as a source of information, guidance, and assistance when an injury occurs. CorVel staff can arrange a referral to an appropriate and convenient health care provider. The CorVel Call Center can be reached during regular office hours at 877-838-6841 and press 1 at the prompt.
The Board realizes that occasionally there will be a good reason to treat with a doctor who is not in the EPO. For details as to when an employee may opt out of the EPO, see Section 10 of the Program rules which can be found on our website in the Documents section.
This new program does not apply to those union members who were injured prior to July 1, 2004 and already have an established relationship with a health care provider. However, when an injury occurs after July 1, employers should direct employees to an approved provider in the EPO for immediate as well as ongoing care. When there is a serious injury which requires emergency care, the employee should be seen at a nearby emergency room, whether that facility is associated with the EPO or not. If the injury requires urgent care, the employee may be seen at any Occupational Medicine clinic during regular business hours or at any Urgent Care clinic after hours.
FOR ANY QUESTIONS REGARDING THE EPO PROCEDURES, PARTICIPATING PROVIDERS, or EPO RULES, PLEASE CALL THE DISPUTE RESOLUTION FACILITATOR AT 952-851-3501.
NEUTRAL EXAMINATIONS AND REVIEWS
The Union Construction Workers' Compensation Program does not allow the insurer or the injured employee to arrange for and use independent medical examinations (IME). Instead, upon request of either party, the dispute facilitator arranges for an opinion from one of the neutral examiners approved by the Board of Trustees for this purpose. These examiners have been selected based upon several criteria, such as timeliness of reports, thoroughness of examinations, opinions based upon sound medical reasoning and an accurate review of all records. All parties are allowed input to the neutral examiner, but only through the facilitator. Copies of correspondence to the neutral examiner as well as their examination report are provided to all parties. As a result, the majority of the opinions from these neutral examiners are not disputed by either party.
The neutral examiners can offer an opinion on any of the following topics:
- Reasonableness and necessity of past or proposed medical care;
- Ability to return to the occupation held on the date of injury;
- Ability to return to transitional work being offered by the employer;
- Perspectives on any disputes regarding a claim for benefits;
- Theories regarding causation of an alleged injury;
- Permanent partial disability ratings;
- Attainment of maximum medical improvement; or
- Necessity for surgery.
NOTE: Both the employer and injured employee are limited to the examiners on the Program's list. Please go to the Documents page to see the approved Neutral Examiners list.
Please contact the Facilitator's office to request a neutral examination.
