Texas Workers – Your Recovery Team

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We understand that dealing with an injury can sometimes be stressful and confusing.  You are not in this alone and there are a number of resources available to you.

You (The Injured Employee)

It goes without saying that you are vested in your recovery.  The things you can do to help ensure you remain on track include: 

  • Communication  
    • Immediately tell your employer and adjuster when your attending physician gives you updated work capacities and/or limitations 
    • Pay attention to appointments, time limits and dates 
    • Keep copies of all letters you send and receive 
    • Tell medical providers you are being treated for an on-the-job injury/illness 
    • Reach out to one of the entities below if you have questions or concerns 
  • Keep all appointments
  • Actively participate in all activities supporting your recovery and return to work. 
  • Be respectful to providers. 
  • Cooperate with the insurance company regarding interviews and independent medical examinations.
Insurer/Adjuster

Your claim is assigned to an insurance adjuster who is responsible for your claim.  They determine compensability, make sure you receive accurate time loss payments if you miss time from work, pay for the medical care you receive for your injury, and are a resource when you have questions about your claim. 

Workers’ Compensation Healthcare Network (HCN)

The HCN has a network of providers focused on delivering timely, effective care to injured employees.  Majoris provides utilization review to ensure the care you are receiving is appropriate.  Majoris can help if you need assistance with finding a provider or scheduling an appointment. 

Treating Doctor

Your treating doctor is responsible for developing a plan of care directed at resolving your work injury.  The treating doctor directs care, including referrals for care such as diagnostics, specialty consultations, or ancillary care such as physical therapy.  The treating doctor is also responsible for addressing your work ability by documenting your physical capacities and/or limitations at each appointment unless/until you are released to your regular work duties.  

Employer

Specific to your work injury, your employer is responsible for considering work capacities/limitations given by your treating doctor.  If your treating doctor has not released you to regular work, your employer may be able to offer you a modified job position until you are released to regular work by your treating
doctor.  

Attorney

If you have retained an attorney for your claim, your attorney can assist you in navigating the workers’ compensation division and can answer questions you might otherwise ask your claims adjuster or the Texas Ombuds Office.  While not necessary to file an appeal, an attorney can also represent you if you so choose.

The Office of Injured Employee Counsel (OIEC)

The OIEC is a state agency that offers injured employees free help with workers compensation claims. If you want help from an ombudsman, contact OIEC at 866-393-6432 x 44186. An ombudsman can help you identify and develop the issues in a dispute in your case and try to resolve them.

Majoris offers a unique medical review process that ensures high-quality care from enrollment to resolution. We proactively monitor key events, maintain regular communication with claims adjusters and managers, and leverage our physician reviewers to handle complex cases. Our approach includes:

  • Proactive File Review Medical Management
  • Medical Treatment Reviews by Board-Certified Physicians
  • Evidence-Based, Peer-Reviewed Guidelines
  • Physician-to-Physician Treatment Collaboration

Additionally, we address common concerns within the workers’ compensation system with innovative programs like our prospective opioid management and sprain/strain programs. This ensures treatment plans and physical restrictions are informed by objective findings, are focused on the work injury, and incorporate a progressive return to work and life activities. The result is higher quality care and significant long-term savings.

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Better networks create better results.

Majoris is selective in the providers we partner with, seeking those who understand the unique demands of treating workers’ compensation patients and who meet high credentialing standards. Our provider relations staff keeps in close contact with our providers to support strong relationships, providing training on workers’ compensation best practices and outreach on individual cases experiencing administrative stall-outs.

When there are questions about treatment, providers can expect to speak with a board-certified physician with a background in treating injured workers. Our outreach is centered on collaboration, with the goal of finding the right treatment plan for each patient’s unique needs.

Credentialing

Credentialing goes beyond confirmation of licensure and malpractice history – we look at past treatment records to ensure there is evidence of sound medical reasoning, reliance on objective medical findings and integration of daily activities and work into the overall rehabilitation plan.

Best Practice Standards

To support their responsibilities as a provider of care to injured workers, Majoris developed a series of guidelines, protocols and techniques to facilitate efficient delivery of care within the workers’ compensation framework. This includes support of other stakeholders’ responsibilities.

Our provider manual offers a road map of best practice, streamlining the flow of required information to reduce effort and administrative burden for all. Our treatment guidelines are derived from evidence-based medicine and specific to the workers’ compensation patient population when the data is available.

All network providers have committed to following these best practices, and our provider relations team provides hands-on support when needed to ensure information is received and timelines are met.

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We utilize sophisticated IT solutions, featuring customized programs and advanced data interfaces. The result is seamless collaboration with all stakeholders and high data integrity. Our cutting-edge technology streamlines operations, enhances communication, and drives effective collaboration.

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