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Treatment issues
This page talks about how to handle a few treatment issues. It also has
answers to questions about L&I reviewing your records.
What should a PT/OT/MT provider do if the injured worker is not progressing in treatment?
Document their assessment of the injured worker's progress (or lack thereof) in chart notes and progress reports. If the care being provided is neither curative nor rehabilitative, providers should plan for discharge and clearly indicate progress is not being made.
Providing palliative care may prolong the claim and contribute to the possibility of long-term disability for the injured worker. Research shows that it is in the best interest of the injured worker to stop medical treatment once functional improvement has ceased.
If provider continues to receive referrals for therapy despite a recommendation to discharge the patient, please contact the claim manager for assistance.
What should a PT/OT/MT provider do if the injured worker is not participating in treatment?
Document cancellations and missed appointments. In addition, if the worker is not participating as expected, contact the claim manager for assistance.
L&I's authority to review health services providers
Why does L&I review provider records?
We review providers' patient and billing related records to make sure workers are receiving proper and necessary medical care. Also to make sure providers comply with L&I's Medical Aid Rules, fee schedules and policies.
Can L&I request records from a provider?
Yes. We have the authority to request copies of provider's patient and billing related records. When L&I request records, they must be received within 30 days of receipt of the request and should be legible.
Can L&I discipline a provider?
Yes. If a provider fails to comply with any order, rule or policy, we can:
- Ask for a refund of payments,
- Assess penalties, or
- Take other disciplinary action.
