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Work & Personal Injuries

What is a personal injury?

Personal injuries are those that result from motor vehicle accidents (MVA) or other accidents such as a slip-and-fall episode in a store.

Are personal injuries covered under my managed care plan?

Personal injuries represent special circumstances under most Health Maintenance Organization (HMO) plans. While they may not specifically be excluded from policy coverage, they are not considered as part of the monthly capitated fee paid to your primary care physician under the HMO agreement. Because of this, your primary care physician is not reimbursed for the significant time and expenses incurred while providing medical care for these injuries.

How can I receive care for these injuries in this office?

We are willing to provide care to our patients for these injuries, but cannot do so for free. Therefore, if you would like to pursue care for a personal injury through our office, appropriate payment arrangements must be made for at the time of the initial visit. Otherwise, payment is expected at the time of each visit. 

For motor vehicle injuries, your automobile insurance would be the first line of coverage.  In the event that there are no (or insufficient) injury benefits under the automobile plan, only then will the bills be submitted to your personal PPO or HMO plan.

If you require treatment under a medical lien, we'd be happy to refer you to local providers who might be able to help you out.

What is so special about work injuries?

Injuries or illnesses that occur as a result of one’s employment are covered by the state Workers’ Compensation (WC) insurance that is paid for by your employer. Physicians are obligated by state law to report any work injuries within 5 days of presentation. Unless your private insurance is a special combined plan that includes WC benefits, you must therefore treat your occupational condition through the WC system. We have a great deal of experience in the treatment of industrial injuries and illness, hence we can help you to navigate through the system in order to receive prompt and appropriate medical care.

Per Workers' Compensation guidelines, one's employer is responsible for providing prompt medical attention for any occupationally-related injury or illness. Most employers have contracted out their medical services with a local clinic of their choice (usually, this is the same clinic that your employer uses for post-job offering examinations and urine drug screens). The treating physician selected by your employer has control of your care for the first 30 days after you report your injury.

If you are satisfied with the care being provided by your employer's clinic physicians, then you should continue treating with them.  On the other hand, if you are not satisfied with a particular physician's care, you may select another from a panel of physicians provided by the WC insurance carrier. [We regret that we have stopped accepting new work injuries, but Dr. Pearson can offer advice regarding local specialists, if requested.]

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