The Physician Network, Inc. ®
Short & Long Term Disability Disability insurance was designed to provide income for those with an injury, illness or condition that results in a loss of function, preventing the employee from earning a living.
Disability or Work Capability? Today’s challenges: Too often physicians inaccurately label their patients “disabled” for several reasons: they lack training in understanding how to objectively assess function; they believe they are helping their patients by being their advocate; or they rely on uncorroborated data. Some physicians believe that a patient is “entitled” to “total disability” simply based upon the fact that the patient had or claims to have had an injury or illness, without consideration for what impact, if any, the injury or illness actually has on the patient’s ability to function. Others, in an effort to “err on the side of caution” propose restrictions and limitations (R&L’s) as a precautionary measure as opposed to providing medically supported R&L’s. Many physicians are also reluctant to return patients to work out of fear of re-injury and malpractice lawsuits.
The value of a well-trained, independent medical consultant: A physician experienced in treating patients with injuries and illnesses that is also trained to objectively evaluate function is neither a “patient advocate” nor an “insurance doctor”. This physician assumes nothing; everything is decided based solely upon the facts: medically supported diagnoses, recorded patient interviews, video surveillance, diagnostic studies and personal experience diagnosing, treating and safely returning patients to work who have had the diagnosis in question.
Attending Physician Interview: The importance of a Peer to Peer discussion cannot be overstated. This is not a confrontation between two doctors, but rather a brief, well thought out and focused discussion of the supported facts and medically supported restrictions and limitations (R&L’s). Based upon this approach, most patients are not “totally disabled”. Although many people have diagnoses requiring R&L’s, most can still perform full-time work within these R&L’s. In fact, many people can perform the essential duties of their usual jobs, some with slight modifications, on a full-time basis. Our physicians are trained in interviewing attending physicians and are effective at obtaining agreement on medically supported R&L’s.
Why TPN? TPN has been in the business of medical consultation since 1991 and has run an outsourced medical advisory program in the Disability market since 1998. TPN has a recruitment and training process that attracts highly skilled, independent physicians.
The TPN Result Successfully consulted with the treating physician
Industry Benchmark
TPN Outcomes
10-20%
86%
15%
67%*
Treating physician in aggreement with reviewers’ findings Reviewer concludes patient has full-time work capacity
97%**
No Data Available
Written report turn-around time
20 days
7 days
*Does not include 20% of the physicians who did not dispute our assessment findings. ** Industry does not publish this data. TPN results are based upon our best practices case selection.
What We Offer Case Discussion with client Comprehensive Review and Peer to Peer Case Discussion with Detailed Medical Report
The Physician Network, Inc. ®
164 NH Rte. 25 • Suite 2 • Meredith, NH 03253 Toll-free: 800-777-6160 / Fax: 800-999-6160 E-mail: scheduling@TPNexpert.com
www.TPNexpert.com
Providing insight into medical claims ®