Attorney referral medicine is a practice in which an injured worker’s attorney refers medical care to particular physicians or other providers for treatments and services related to the injury. The attorney may focus on medical providers more inclined to deliver services or render opinions favorable to the attorney but at the expense of the injured worker's health. For example, this can include having x-rays read by a disreputable radiologist, sending an injured worker to a chiropractor instead of an orthopedic surgeon (or other more highly qualified provider), or the provision of unnecessary, incorrect, incomplete, or more expensive treatments or services that are potentially harmful to recovery or otherwise cause serious impairment to the injured worker’s strength or ability to function.  

Attorney referral medicine may result in a higher total dollar value for an injury claim, but result in the injured worker not receiving the attention they need. Their injury may take longer to heal or they may be put at risk of further complications.  This practice frequently serves to increase the amount of damages claimed by and the compensation payable to the attorney. Referred medical providers may also offer special deals or discounts to the referring attorney to get the referral. In sum, attorney referral medicine is fraught with potential for abuse and may be unethical.

How are “letters of protection” used?  

A letter of protection is an agreement between a doctor and an attorney that states the patient will not be billed for the services provided until a settlement has been reached with the responsible party. Some states have specific regulations regarding letters of protection. The American Academy of Orthopedic Surgeons (“AAOS”) also encourages its members to carefully consider the potential implications of such agreements. The AAOS suggests that members should seek legal advice when entering into any LOP agreement and ensure that the terms of the agreement are clearly articulated and understood by all parties.

Letters of protection may help injured workers receive medical care they need without having to worry about the cost upfront. But it is important – especially for injured workers – to remain vigilant about the potential abuses noted above and make every attempt to access medical care and medical management support available under the applicable workers’ compensation or injury benefit program, solely at the employer’s expense.  

What is the impact of attorney referral medicine on employers?

First and foremost, attorney referral medicine can result in worse medical outcomes and slower return (or no return) to work for a valued employee. Attorney referral medicine is also intended to create an appearance that negligence of the employer caused the injury and the employer is not providing proper medical care to the injured employee – in spite of the fact that the employer may be ready, willing and able to pay for the best medical care from highly qualified providers. This practice may be less about finding the path to an optimal physical and mental recovery for the injured worker and more aimed at running up the highest claim for damages and increasing employer litigation costs to motivate a settlement more favorable to the injured worker’s counsel.

Five tips to avoid attorney referral medicine:

1. Reduce complexity by providing a simple explanation of benefits BEFORE the injury occurs, with a reminder at the time of injury that this information remains easily accessible at any time.

2. Reassure the injured worker of the employer’s commitment to pay 100% of all reasonable and necessary medical care from the best available medical providers.

3. Be responsive with good customer service that demonstrates a “we care” attitude through early communication, respect, empathy, and transparency toward the injured worker (without creating distrust by “hounding” the injured worker).

4. Earlier identification and  referral of appropriate cases for medical management, creating a sense of urgency that actively engages all key parties in the recovery process.

5. Provide supportive tools and promote a sense of injured worker agency and empowerment for their own recovery by following the doctor’s instructions, rest, exercise, eating a balanced diet, timely taking prescribed medications, seeking emotional support, and maintaining a positive attitude.

Click here for more tips from ARAWC on “Employee Advocacy” that can help avoid attorney referral medicine.

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