Dr. Mullen and the team at Mullen Orthopedic Clinic can help patients get back on their feet after a work injury.
All workers’ compensation clients/patients must follow these guidelines:
Patients must demonstrate compliance with medical recommendations and routine follow-up visits as requested.
If you are a prospective patient, continue to the Patient Information section below. If you are a Workers’ Compensation Payer, an Employer or an Attorney, continue to the WC/Employers/Attorneys Information section below.
A worker injured while working is entitled to file a Workers’ Compensation (WC) claim. By Arizona law, employers are obligated to provide Workers’ Compensation insurance for their employees. Agreeing to pay for medical expenses outside of the insurance system is not a legal alternative to an employer providing formal workers compensation insurance for all employees.
After the filing of a Workers’ Compensation claim, patients are often seen by either an Occupational Medicine doctor or a PA for their initial visit. These providers have a general knowledge of orthopedic problems but are not specialists in the musculoskeletal system. Dr. Mullen is an expert in orthopedic problems concerning the shoulder, the knee, and the elbow.
It is important to know that Dr. Mullen does not work for your employer nor does he work for an insurance company. He works for you, the injured worker. Dr. Mullen’s job is to diagnose or confirm the diagnosis of your problem and provide you with treatment alternatives that you and he can discuss before determining what is deemed the best option for you. Despite the fact that Dr. Mullen does not work for the insurance company, you should understand a little bit about the process. The insurance carrier is entitled to know all about your current and past medical conditions, regardless of whether or not you feel they are relevant. They are allowed to be involved in the decision-making process on treatment. They have the right to have doctors of their own choosing provide second opinions from time to time, particularly when there is a delay in returning to work given the statistical norms of other workers in the past who have had similar problems to yours. If you miss an appointment the insurance carrier may terminate your benefits. The good news is, the Workers’ Compensation system has been set up to pay for all your medical expenses related to your specific injury. You do not have to use your private insurance. You will have no co-pays, no deductibles to meet, no out of pocket expenses, and you may be entitled to all or a portion of lost wages while out of work.
The Workers’ Compensation system is designed to protect injured workers, but requires that the injured worker be compliant with the treatment plan. You have to actively participate in your own care. The goal of both the system and the injured worker should be to recover from the injury safely while ensuring minimal lost time from the workplace.
Regardless of your job and what it entails, at each visit with Dr. Mullen will give you an updated Work Status. This will also be given to your employer and the insurance carrier and will define safe guidelines for return to work. In the event you are not returned to Full Duty, you may be released to Light Duty. This note will outline not what you can do but what you should not be doing that could potentially cause harm to the injured body area. This work status will always be based on objective findings and the known risks as it relates to the recovery from your specific injury. It is not based on the subjective experience of pain alone.
Whether or not your employer has Light Duty, you may be given a Work Status that indicates that you can perform Light Duty. It then becomes your employer’s obligation to determine if they have a job or position that tolerates our medical restrictions. If they do not, you may be told by your employer not to return to work. This will always be your employer’s choice, never yours or mine. If the employer has a job you can do you within the parameters of the Light Duty restrictions, you have no choice but to go back to work, regardless of whether it is the exact job you used to do or not. Off Work status is generally reserved for only the short time immediately after a surgery.
Upon completion of active medical treatments, you will be given an Impairment Rating. This rating is calculated through the tables and formulas published in the "AMA Guidelines to the Evaluation of Permanent Impairment, 6th Edition". The final % impairment calculated is done with regard to the problem itself and not how it influences the type of work you perform. That is the difference between Impairment and Disability. For example, the Impairment Rating for a broken finger will be the same regardless of whether the injured worker is a taxi driver or a concert pianist. A Disability Rating may relate an Impairment Rating to a particular occupation, and can be much different. Disability Ratings are not done here, only through specialized disability offices.
Along with getting an Impairment Rating, at the completion of active medical treatment Dr. Mullen may recommend that you receive Supportive Care. Dr. Mullen may recommend a specific number of additional follow-up visits to monitor an injured worker over a longer but defined period of time, possibly to obtain tests, provide medications, or even petition to reopen the case for further active treatment in rare instances.
Injured workers should understand that pre-existing conditions can be aggravated or exacerbated through a work related injury. If the pre-existing condition is a tear or anatomical defect that can be measured objectively to have become worse, then the treatment of this WC injury can be covered in its entirety. If the new injury only made the symptoms of the pre-existing condition worse without any other measurable change in the pre-existing condition, the WC claim will cover treatment of the new symptoms but not necessarily the definitive treatment of that pre-existing condition in its entirety (ie, arthritis). When this distinction is unclear, the case manager may have the worker get a second opinion, or even have a judge from the Industrial Commission of Arizona decide what is new and what is old.
The Workers Compensation System is designed both to protect the worker but also to be fair to all parties. The ultimate goal is to provide medical treatment that allows the injured worker to get back to work as quickly and safely as possible. Injured workers who tried to use the Workers Compensation System as a fraudulent avenue to get corrective medical treatments for known degenerative problems may become frustrated when there goals are not met. The more you know about the system, the greater the chance you will have a satisfactory result in the end.
ALL patients must be referred by one of the following:
Workers’ Compensation case manager
Current treating physician (prior approval to seek services with Dr. Mullen is required from case manager)
Workers’ Compensation attorney (prior approval also required to seek services with Dr. Mullen from case manager)
It is the responsibility of the patient to notify Dr. Mullen’s Workers’ Compensation Coordinator when you are calling for a Workers’ Comp appointment . Dr. Mullen’s WC Coordinator will verify the status of your claim and confirm with the Claims Adjuster that
Dr. Mullen indeed has consent to treat. Please supply Dr. Mullen’s WC Coordinator with the following:
Date of injury
Insurance company billing address for Workers’ Compensation case AND phone number of Workers’ Compensation carrier
Name and Phone # of Case Manager with direct contact line and extension, if applicable
(Patients must have completed their First Report of Injury with your employer before seeing Dr. Mullen)
Note: We understand that you have filed a claim for workers’ compensation insurance coverage for your injury and treatment. If your claim is denied or if it is in dispute, we will bill your regular medical insurance carrier. You will be required to pay any contractual deductibles, co-insurance, and co-pays at the time of service. If the claim is resolved and accepted as compensable, we will submit all visits and their charges to the WC carrier. Once claims are paid in full, we can issue a refund for your Out of Pocket costs and/or those to your personal insurance carrier.
If a patient is already being seen elsewhere but wants to be referred to our practice instead, they will need to notify their current treating physician who is providing care for their work injury OR if they are represented by an attorney, they can make their request for treatment through their legal representation. Some patients may not have an attorney and may be corresponding with their Workers’ Compensation adjuster and/or case manager directly. If this is the case, the patient will need to make their wishes known to the adjuster or case manager.
Once our office has been notified of the patient’s referral, the clinic will contact the referring party to obtain necessary records and information. Upon acceptance to the clinic, our staff will notify Workers’ Compensation, and the patient will be scheduled for services as agreed upon.
Criteria for referring a Workers’ Compensation patient:
Records may be required to determine if our clinic is appropriate for the patient’s current needs. Dr. Mullen specializes in work-related shoulder, knee, and elbow problems. Some cases may require prior diagnostics if not available from records to provide a more accurate assessment of the patient’s treatment needs at the time of consultation. Prior approval from the patient’s case manager is needed to request a referral to see Dr. Mullen.