Q: What is Majoris Health Systems?
A: Majoris is a state-certified certified workers’ compensation health care network. We contract with physicians, hospitals, and other health care providers to provide medical services to covered employees with work-related injuries or illnesses. Our providers are carefully selected for their expertise 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 covered workers. Majoris will also be working closely with your doctor and insurer to help you return to gainful employment as soon as possible after an on-the-job injury or illness.
Q: Is Majoris a Workers’ Compensation insurance company?
A: 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.
Q: Am I required to see one of the Majoris doctors if I am injured on the job and need medical care?
A: In most cases, yes. Once your claim is enrolled by your workers’ compensation insurance carrier (which means that you have been given written notice of your requirement to treat within the HCN) you will be required to treat with an HCN provider unless one of the circumstances explained below applies:
- You select your current health maintenance organization (HMO) primary care physician as the treating doctor for your workers’ compensation claim. In order for your HMO doctor to be approved as your treating doctor, he/she must agree to the terms of the network contract, and to agree to abide by applicable laws and regulations. If your HMO doctor is not approved, then you must see a network treating doctor.
- Emergency care if needed. If you are hurt at work and it is a life threatening emergency, you should go to the nearest emergency room. After you receive emergency care, you may need ongoing care. You will need to select a treating doctor from the network’s provider list.
- You do not live within the Majoris service area.
- Your treating doctor refers you to an out of network provider or facility. This referral must be approved by Majoris.
If you believe you qualify for any of the above exceptions and would like consideration for treatment, please contact Majoris Health Systems.
Should you receive care from a provider who does not meet the above criteria, your Workers’ Compensation insurer will not be required to pay for medical services.