HOW TO REPORT

WORKERS’ COMPENSATION INJURIES

 

 

Employee Rights and Responsibilities

 

Eckman Freeman is committed to insuring that you receive appropriate medical if injured on the job.  You will be provided a directory of MCO Network providers upon your enrollment in the program.  At this time, you will be provided with complete information regarding your rights and responsibilities and will be asked to sign a document verifying you have been provided this information.  Your employer has a directory of MCO Network Providers and can assist you in selecting a Gatekeeper Provider.  The Kentucky Managed Care Regulation (803 KAR 25:096) indicates it is your responsibility to select a Gatekeeper Provider.

 

Complete the Form 113/Notice of Designated Physician immediately and return it to your employer within 10 days.

 

Treatment from a non-participating provider may be necessary in the following events:

 

  1. In the event of an emergency;
  2. When a plan provider is not available;
  3. When referred outside the Plan by the Gatekeeper Provider;
  4. To obtain a second opinion when a Managed Care Plan provider recommends surgery.

 

If treatment outside the network occurs for reasons other the events listed above, the injured employee may be responsible for payment of medical bills.

 

If you are currently being treated for an injury that occurred prior to implementation of the MCO, you may remain with your provider for the remainder of your treatment.  However, if you wish to change providers, you must select a Gatekeeper Provider participating in the Managed Care Plan.

 

As an employee covered by the new Managed Care Plan you have the right to expect that you will:

 

  1. Receive emergency medical treatment as soon as practical, preferably by a participating provider;
  2. Receive initial treatment by a Managed Care Plan Gatekeeper Provider within 24 hours of the request for treatment;
  3. Receive specialized medical services that the Managed Care Plan is not otherwise able to provide;
  4. Have the right to file a grievance to resolve a dispute related to medical services.  A grievance must be in writing and must be filed within 30 days of the occurrence of the event that caused the dispute.  Eckman Freeman will render a decision within 30 days of having received your written grievance.  You also have the right appeal this decision.

 

The Kentucky Managed Care Regulation (803 KAR 25:096) requires that you comply with the requirements for provider selection.  “The unreasonable failure of an employee to comply with the requirements of this section may suspend all benefits payable under KRS Chapter 342 until compliance by the employee and receipt of Form 113 by the medical payment obligor has occurred.”

 

The Kentucky Workers’ Compensation Law also states that any person or entity who willfully and knowingly makes any false statement or representation for the purpose of obtaining any benefit or payment, for the purpose of defeating or wrongfully increasing or decreasing any claim for benefit or payment of workers’ compensation coverage, or aides and abets for said purpose, could be found guilty of a Class D felony.