Following are answers to some of the more commonly asked questions. Should you have additional questions, please feel free to contact your workers’ compensation insurance examiner, or Majoris Health Systems at (800) 525-0394, or your Majoris claim representative directly.
What is Majoris Health Systems?
Majoris is a state-certified managed care organization. We contract with physicians, hospitals, and other health care providers to provide medical services to enrolled employees with work-related injuries or illnesses. Our providers are carefully selected and trained in the treatment of work-related conditions. Majoris, and the health care providers in our network, want to make sure that timely, effective, and convenient medical services are available for our enrolled workers. Majoris will be working closely with your provider(s) and insurer to help you return to gainful employment as soon as possible after an on-the-job injury or illness.
Is Majoris a Workers’ Compensation insurance company?
No. Majoris contracts with insurance companies and self-insured employers to provide managed care services to injured workers. We monitor medical care that is provided to ensure that it is appropriate and necessary, and that it meets our quality standards.
Majoris does not make decisions on acceptance or denial of claims, payment of time loss or medical benefits, or any other workers’ compensation benefits. Decisions concerning these and all other claims issues remain the responsibility of the claims examiner for the insurer or self-insured employer.
Am I required to see one of the Majoris doctors if I am injured on the job and need medical care?
In most cases, yes. However, there are two circumstances in which you may receive treatment from a non-Majoris provider. They are:
1. Prior to claim enrollment
You may receive treatment from a non-Majoris physician prior to your claim being enrolled in the MCO. However, once your work-related claim is enrolled, you are required to seek care from an Majoris authorized treating physician. If your physician does not meet Majoris requirements, you will be required to change physicians at the time your claim is enrolled. So, you may want to use an Majoris provider before your claim is accepted, to avoid interruption in your medical care. Once your claim is enrolled, you may receive care from a non-Majoris physician only in the following situation:
2. You have a private physician who qualifies as a primary care physician.
Your family physician may qualify to treat you under the managed care arrangement, even if they are not on the Majoris list of contracted providers. To qualify:
• Your doctor must be a medical doctor (M.D.), an osteopath (D.O.), or a chiropractor (D.C.), and
• Your doctor must be a family practitioner, general practitioner, or internal medicine specialist,
• You must have a history of being treated by that doctor, or have the doctor as a designated primary care provider under your group plan,
• The doctor must agree to abide by all terms and conditions of Majoris Health Systems, and must refer you to a Majoris provider for any specialized care you may need.
Should you receive care from a provider who does not meet the above criteria for out-of-panel treatment, your Workers’ Compensation insurer or self-insured employer will not be required to pay for medical services. In addition, the provider will not be allowed to authorize your time loss from work.
A list of Majoris providers in your geographical service area will be provided to you at the time you have a work-related injury or illness that is subject to the MCO agreement. You may also obtain a complete panel list for the entire state by contacting Majoris.
To find a network provider, please click here.
What if I live a long distance from Majoris’ service area?
If you live more than one hundred miles from Majoris’ geographic service area (the state of Montana), you will not be subject to the MCO arrangement.
What if I am currently receiving care from a non-Majoris provider for a work-related injury or illness at the time I am enrolled into the Majoris MCO program?
You will be required to treat with a Majoris network provider, with the exceptions noted above. However, if you have not yet been declared medically stationary and Majoris determines it would be medically detrimental for you to change physicians, Majoris will allow you to continue treating with your non-network provider.
If you are not yet medically stationary and think that a change of physicians would be medically detrimental to you, you may request review by Majoris. To request review, please submit your request in writing to Majoris (contact us page link) within 30 days of the date of the action. Failure to request review in writing within 30 days precludes further appeal.
What if I need help finding or scheduling an appointment with a Majoris provider?
If you would like help in scheduling an appointment, or if you have contacted several panel providers and were not able to schedule a timely appointment, please contact Majoris for assistance.
What do I do if there is a medical emergency and I’m not able to see a Majoris provider?
In true emergency cases, Majoris, your employer, and your insurer believe the first priority is to have your medical emergency taken care of. An emergency is defined as a medical condition that creates the risk of death, serious disability, or serious medical consequences if treatment is not rendered immediately.
If your claim is subject to the MCO, and you are far away from, or otherwise unable to receive care from a Majoris provider in an emergency, you should seek care from the nearest appropriate medical facility. After you are out of immediate danger, all follow-up care will be provided within the MCO. If emergency care is needed and an appropriate Majoris facility is available, care should be sought from the Majoris member facility if possible.
If you are in need of emergency care and unsure of where to go, seek medical care from the closest available medical facility. Emergency care should not be used as a substitute for routine, ongoing medical care from a treating physician.
What about medical care I might need for non-work related conditions?
Majoris has no involvement with medical care that you might seek for illnesses or injuries that are not job-related. You will continue to receive group health benefits, if any, as provided by your employer. Contact your Human Resources or Employee Benefits department for information concerning these benefits.
What do I do if I am injured on the job?
Report all injuries to your designated employer representative immediately. They will provide you with necessary forms to complete.
Once your claim is enrolled in Majoris, if you require medical care, you may choose to see any physician on the Majoris Provider list who is listed as a “Treating Physician.” Or, you may treat with a non-Majoris provider as explained previously.
If you have trouble scheduling an appointment or need help in accessing care, Majoris is happy to assist you.
In addition, you should always follow all of your company’s rules for work-related injuries including reporting requirements and modified work schedules.
What can I do if I disagree with an action taken by Majoris or one of its network providers?
Majoris wants to make sure you receive timely, effective, and convenient medical services for your work-related injury. However, should a dispute arise concerning your care within the MCO, you may request review through Majoris’ Dispute Resolution Process.
Such requests must be made in writing within 30 days of the action giving rise to the dispute. You should state the specific issue for which you are requesting review and include any information you think we should consider in our review. All requests should include an explanation of the issue or decision being disputed.
All disputes will be reviewed and responded to within 15 days of receipt of all information necessary to issue a decision.
If a dispute cannot be satisfactorily resolved through Majoris’ internal dispute resolution process, the party requesting review may appeal to the Montana Department of Labor and Industries.
Please note that failure to request a review in writing to Majoris Health Systems within 30 days of the action giving rise to the dispute means you lose your right of further appeal.
Disputes must be made in writing and sent to our mailing address (PO Box 1728, Lake Oswego OR 97035), faxed to 503-601-8437, or emailed to your Majoris claim representative.
