Work & Personal Injuries

Personal injuries are those that result from motor vehicle accidents (MVA) or other accidents such as a slip-and-fall episode in a store.

Personal injuries represent special circumstances under most Health Maintenance Organization (HMO) plans. While they may not specifically be excluded from policy coverage, they are not considered as part of the monthly capitated fee paid to your primary care physician under the HMO agreement. Because of this, your primary care physician is not reimbursed for the significant time and expenses incurred while providing medical care for these injuries.

We are willing to provide care to our patients for these injuries, but cannot do so for free. Therefore, if you would like to pursue care for a personal injury through our office, appropriate payment arrangements must be made for at the time of the initial visit. Otherwise, payment is expected at the time of each visit. 

For motor vehicle injuries, your automobile insurance would be the first line of coverage.  In the event that there are no (or insufficient) injury benefits under the automobile plan, only then will the bills be submitted to your personal PPO or HMO plan.

Under certain circumstances, we may be able to provide coverage under a medical lien (a lien is an agreement to pay the physician’s bill in full from the proceeds received from settlement of a personal injury case). [In case you were wondering…….Failure to pay a physician’s bill with money received from an insurance company is akin to theft. Patients who disregard their financial responsibility will be turned over to a collection agency, which will also significantly affect your credit rating. In addition, a 1099-C report will be made to the Internal Revenue Service.]

Also, it is commonplace for attorneys to request a reduction of the final charges following their settlement "so that their clients may come away with more money." Be advised that this is unethical and we do not operate in this manner. The purpose of a medical lien is to help our patients with the burden of paying certain medical costs up front, so that they may receive prompt and appropriate treatment of their personal injuries. In essence, it is an interest-free loan to the patient for their benefit. [For the record, our charges are in line with the rest of the medical community. We do not inflate them to help attorneys win larger settlements. And, like most small businesses, we have staff who expect to be paid for their hard work.] Consider this: would an auto dealership permit someone to pick up and drive a new car for a year or two, only to be paid half of what they were due? Of course not! Bottom line: if you cannot live with the above policies, please feel free to seek medical attention elsewhere.

Injuries or illnesses that occur as a result of one’s employment are covered by the state Workers’ Compensation (WC) insurance that is paid for by your employer. Physicians are obligated by state law to report any work injuries within 5 days of presentation. Unless your private insurance is a special combined plan that includes WC benefits, you must therefore treat your occupational condition through the WC system. We have a great deal of experience in the treatment of industrial injuries and illness, hence we can help you to navigate through the system in order to receive prompt and appropriate medical care.

Per Workers' Compensation guidelines, one's employer is responsible for providing prompt medical attention for any occupationally-related injury or illness. Most employers have contracted out their medical services with a local clinic of their choice (usually, this is the same clinic that your employer uses for post-job offering examinations and urine drug screens). The treating physician selected by your employer has control of your care for the first 30 days after you report your injury.

If you are satisfied with the care being provided by your employer's clinic physicians, then you should continue treating with them.  On the other hand, if you are not satisfied with a particular physician's care, you may select another from a panel of physicians provided by the WC insurance carrier. [We regret that we have stopped accepting new work injuries, but Dr. Pearson can offer advice regarding local specialists, if requested.]