Many physicians are reluctant to accept workers’ compensation (WC) cases — and for good reason. From complicated paperwork and rigid fee schedules to delayed payments and legal headaches, the process can feel overwhelming. However, with the right approach and support, treating injured workers can become a valuable and reliable revenue stream.

If you’re a doctor who has hesitated to enter the workers’ comp space, this guide will help you understand the challenges, debunk myths, and show how partnering with experienced billing and lien management experts can make WC cases worth your time.

Why Do Doctors Avoid Workers’ Comp Cases?

Doctors cite several reasons for avoiding WC cases, including:

1. Complex Regulations and Paperwork
California’s workers’ comp system is highly regulated. The Official Medical Fee Schedule (OMFS), utilization review (UR) processes, and lien requirements create added administrative burdens.

Stat: California’s OMFS is updated regularly, with over 10,000 individual codes and services subject to review and change annually. (Source: California Department of Industrial Relations, DWC OMFS Overview)

2. Delayed Payments and Disputes
Pre-authorizations, denials, and lien disputes often result in slow payments.

Stat: In 2022, the average workers’ compensation claim in California took 16.8 months to close. (Source: California Workers’ Compensation Institute (CWCI))

3. Low Reimbursement Rates
WC rates are generally lower compared to private payers or Medicare.

Stat: California WC medical reimbursements are about 30-40% lower than private insurance rates, depending on specialty and service. (Source: Medicare Payment Advisory Commission & CWCI)

4. Legal and Compliance Risks
Lien deadlines and proper documentation are non-negotiable. Errors can result in total claim denials.

Stat: Approximately 35% of medical liens in California are dismissed or disallowed annually due to non-compliance or missed deadlines. (Source: Division of Workers’ Compensation, Lien Filing Data)

The Hidden Benefits of Taking Workers’ Comp Cases

Despite the challenges, there are significant reasons to reconsider WC patients:

Steady Referral Source
Workplace injuries are unavoidable, and employers are required to send injured workers to doctors within Medical Provider Networks (MPNs).

Stat: California reported over 483,000 nonfatal workplace injuries and illnesses in 2022, a significant potential patient pool. (Source: U.S. Bureau of Labor Statistics)

Lower Patient Acquisition Costs
Workers’ comp patients are assigned through employer networks, reducing the need for marketing and outreach.

Potential for Long-Term Cases
Injured workers often require ongoing care, which leads to repeat visits and steady revenue.

Recoverable Revenue with Expert Help
Partnering with lien management experts makes collecting aged and disputed claims achievable.

How Doctors Can Avoid Common Pitfalls

Succeeding with WC patients requires preparation and the right partners:

1. Understand Regulations and Requirements
Doctors must become familiar with OMFS rates, UR/IMR processes, and lien filing deadlines.

2. Use Certified Coders and Experienced Billers
Accurate coding reduces rejections and speeds up payment.

3. Partner with a Lien Management Expert
Companies like Medical Lien Management (MLM) provide full-service solutions, including filing, collections, and litigation.

4. Monitor and Follow Up on Claims
Dedicated follow-up teams prevent claims from being forgotten or written off.

Final Thoughts: Is Workers’ Comp Right for Your Practice?

Workers’ comp cases come with unique challenges, but they are not insurmountable. With the right billing processes, legal support, and lien management strategy, doctors can turn WC patients into a reliable source of revenue.

For practices ready to expand, Medical Lien Management offers a free audit and expert support to help you enter the space confidently and profitably.

Explore how MLM can help you recover more with less hassle — contact us for a complimentary lien review today.