Urgent Care: What’s Its Role in Workers Compensation Cases?

 

Learn Why Employers Send Injured Workers to Urgent Care and What You Can Do to Get the Care You Need for an Occupational Injury

 

“Go to urgent care.”

 

These instructions sound familiar, don’t they?

 

You likely heard them after reporting a work injury.

 

Indeed, many employers tell supervisors to send injured employees to urgent care after a work accident.

 

But you may be concerned about urgent care’s ability to handle work injuries. Especially if you have a broken bone, head trauma, or a herniated disc in your back or neck. Or if you need diagnostic testing, such as magnetic resonance imaging (MRI) or a CT scan.

 

We get it.

 

Occupational injuries and illnesses can end careers. Or, at a minimum, cause extended disability from work.

 

And a doctor you have never met at an urgent care center you never go to may cause uncertainty.

 

This article answers these questions and more:

 

• • What is urgent care medicine?

 

• • Why do employers, workers comp insurers, and claim administrators (Sedgwick, ESIS, Gallagher Bassett, etc.) put urgent care centers on physician panels?

 

• • What treatment can an urgent care center give for a work injury?

 

• • Can an urgent care physician give medical work restrictions that my employer must obey?

 

• • What happens if you need treatment beyond what urgent care can do?

 

Read on for more information about workers compensation.

 

Then call us at (804) 251-1620 or (757) 810-5614 for a free consultation.

 

We get top-dollar workers compensation settlements for injured workers in Virginia and Maryland. And we want to get results for you.

 

What is an Urgent Care Center?

 

The American College of Emergency Physicians defines an urgent care center as “a walk-in clinic focused on the delivery of medical care for minor illnesses and injuries in an ambulatory medical facility outside of a traditional hospital-based or freestanding emergency department (ED).”

 

Ambulatory care is medical treatment given on an outpatient basis.

 

How Many Urgent Care Centers Are There?

 

If you are like me, you can only drive up to a few blocks before you see an urgent care center. Indeed, three of these clinics have opened within one mile of our firm’s Richmond office in the past five years.

 

Similarly, many urgent care centers have opened near our Newport News office.

 

So, the data on the number of urgent care centers isn’t surprising.

 

The Urgent Care Association (UCA) says there are over 14,000 urgent care centers in the United States.

 

Virginia alone has more than 300 such facilities.

 

The number of urgent care centers keeps growing, from seven to 10 percent yearly.

 

Where are Urgent Care Centers Located?

 

You will find urgent care centers in convenient spots, such as shopping centers.

 

Some are free standing on busy highways or in strip mall parking lots.

 

One study found that non-hospital-based urgent care centers are located in areas that:

 

• • are urban;

 

• • have higher income levels; and,

 

• • have a high percentage of residents with private insurance.

 

This conclusion is unsurprising.

 

The ACA says that over 78 percent of the U.S. population lives within a 10-minute drive of urgent care. And the growth of these facilities in suburban areas increased nearly 20 percent from 2019 to 2022.

 

Who Owns Urgent Care Facilities?

 

Few regulations govern urgent care centers compared to other health care providers.

 

And ownership varies.

 

Urgent care center owners include:

 

• • Corporate entities (such as large chains, independent facilities, or a group of walk-in clinics)

 

• • Physicians

 

• • Hospital systems

 

• • Investors

 

• • Combinations of these owners

 

Who are the Largest Urgent Care Center Operators and Brands in the United States?

 

Major urgent care operators and brands include:

 

• • Adventist HealthCare (including Patriot Urgent Care)

 

• • AmCare – Doctors Urgent Care

 

• • American Family Care (AFC Urgent Care)

 

• • Ascension Urgent Care

 

• • Atrium Health Urgent Care

 

• • Banner Urgent Care

 

• • BetterMed Urgent Care

 

• • Bon Secours Urgent Care

 

• • CareFirst Urgent Care

 

• • CareNow Urgent Care

 

• • CareWell Urgent Care

 

• • Centra Urgent Care

 

• • CityMD Urgent Care

 

• • Concentra Urgent Care

 

• • CVS Minute Clinic

 

• • DispatchHealth

 

• • Doctors Care

 

• • Doctors on Duty

 

• • ExpressCare Urgent Care

 

• • FastMed Urgent Care

 

• • Fast Pace Health Urgent Care

 

• • HCA CareNow Urgent Care

 

• • Healthcare Clinic at Walgreens

 

• • I & O Medical Centers

 

• • Inova-GoHealth Urgent Care Center

 

• • Kaiser Permanente

 

• • LifeBridge Health

 

• • Mary Washington Health Care Urgent Care

 

• • M.D. Express Urgent Care

 

• • MD Now Urgent Care

 

• • MedExpress Urgent Care

 

• • MedStar Prompt Care

 

• • Metro Immediate & Primary Care

 

• • NextCare Urgent Care

 

• • Next Level Urgent Care

 

• • Nova Patient Care

 

• • Old Dominion Urgent Care

 

• • PACS Urgent Care

 

• • Patient First 

 

• • Physicians Immediate Care

 

• • Sentara Health Walk-In Clinics

 

• • University of Maryland Urgent Care (formerly ChoiceOne Urgent Care)

 

• • Velocity Urgent Care

 

• • Virginia Hospital Center Urgent Care

 

• • WellNow Urgent Care

 

• • WellStar Urgent Care

 

• • WellStreet Urgent Care

 

• • ZoomCare

 

Many of these urgent care clinics treat patients in Virginia and Maryland. Indeed, the UCA reports more than 300 such facilities in Virginia.

 

Further, Inova (Falls Church), M.D. Express (Hampton Roads), MedStar Health (Columbia, MD), Patient First (Richmond), Bon Secours Mercy (Marriottsville, MD), I & O (Hampton Roads), Centra (Lynchburg), and Sentara (Norfolk) have local headquarters.

 

What Types of Medical Providers Work at an Urgent Care?

 

Urgent care staff often includes:

 

• • At least one physician specializing in family, internal, or emergency medicine;

 

• • Physician assistants;

 

• • Nurse practitioners;

 

• • Medical assistants;

 

• • Respiratory techs;

 

• • Radiologic techs;

 

• • Licensed practical nurses (LPNs);

 

• • Certified nursing assistants (CNAs);

 

• • Administrative staff; and

 

• • Front office staff

 

What Services Do Urgent Care Centers Provide to Workers Comp Patients?

 

Urgent care facilities may provide these services to injured workers:

 

• • Basic fracture care, such as splinting, casting, and minor reductions not requiring surgery;

 

• • Basic/pre-placement physical exams;

 

• • Defibrillators;

 

• • Diagnostic tests, including plain x-rays;

 

• • Department of Transportation (DOT) physicals for truck drivers who operate commercial motor vehicles;

 

• • Drug and alcohol testing;

 

• • Evaluation of chest pain and respiratory distress;

 

• • Fit for duty physicals;

 

• • Hazardous materials testing;

 

• • Hearing tests

 

• • Laboratory tests, including blood and urine testing;

 

• • Maritime physicals;

 

• • Monitoring after exposure to toxic chemicals and gases;

 

• • OSHA respirator fit testing;

 

• • Pre-operation screening when an orthopedic surgeon has scheduled surgery;

 

• • Prescribing durable medical equipment for daily or extended use, such as oxygen tanks, canes, wheelchairs, walkers, and crutches;

 

• • Prescribing medication;

 

• • Referrals to hospitals and specialists when necessary;

 

• • Referrals to mental health specialists when necessary (when the urgent care doctor suspects depression, anxiety, or PTSD from the work accident);

 

• • Stitches for lacerations and cuts;

 

• • Treatment of concussions, sprains, and strains that heal within two to three months;

 

• • Treatment of insect bites and stings;

 

• • Vision testing; and

 

• • Wound care for second degree or split thickness burns covering a small percentage of the body.

 

How Many Patients Do Urgent Care Centers See Daily?

 

The UCA reported a median patient volume of 56 patients per day in these facilities.

 

These visits included:

 

• • Four workers compensation visits;

 

• • Five occupational medicine visits;

 

• • 40 provider visits;

 

• • Four nurse visits; and,

 

• • Three digital health visits

 

As you can see, urgent care facilities are high-volume health care providers.

 

Occupational medicine and workers comp visits contribute significantly to their revenue and profits.

 

Indeed, urgent care centers rely on workers comp because of the seasonal nature of what they treat. For example, many non-workers comp patients come to these facilities for sore throats, colds, sinus infections, and the flu. And these are seasonal illnesses.

 

What are the Benefits of Using Urgent Care for Occupational Injuries?

 

Urgent care has these advantages over emergency rooms (ERs) and primary care physicians (PCPs):

 

• • Extended hours: Many urgent care facilities open by 8:00 a.m. and close after 7:00 p.m. This means urgent care can treat injured employees who work shifts other than 9:00 a.m. to 5:00 p.m. (for example, Walmart and Amazon warehouse workers).

 

• • Local: Many hospital emergency departments are located in urban and suburban areas. But your work injury may occur elsewhere. Or you can avoid traffic to get treatment quicker. Industry data says that roughly 90 percent of the U.S. population lives within twenty minutes of an urgent care facility.

 

• • Lower wait times: Major hospital ER wait times are often long and unpredictable. For example, a data brief published by the Centers for Disease Control and Prevention (CDC) found wait times over one hour in some major hospital ERs. And total treatment time was longer. In contrast, the UCA says the average urgent care wait time is under 30 minutes. And most patients receive treatment and leave in under one hour.

 

• •  Lower cost: The average emergency room visit often costs multiples of the average urgent care visit. Indeed, some reports show that treatment at an ER can cost five to ten times as much as treatment elsewhere for the same injury.

 

What are the Disadvantages of Using Urgent Care for a Work Injury?

 

Urgent care has its drawbacks when it comes to treating workers compensation patients.

 

These drawbacks include:

 

• • You may need specialized care. Although an urgent care facility can treat minor injuries and illnesses, you will need specialized care for more extensive damage. For example, urgent care must refer you to an orthopedic surgeon if you have a torn ACL or meniscus after a knee injury. Or you may need a referral to a neurologist for a traumatic brain injury (TBI) resulting in post-concussion syndrome. 

 

• • You may not see the same medical provider at each visit. One disadvantage of urgent care is that you may not see the same doctor, nurse, or physician’s assistant at each appointment. This lack of continuity means you may feel you are “starting over” at each visit. Further, the inability to build a relationship like you can do with a primary care doctor may mean that specific injuries or conditions get missed because the same person is not monitoring your healing. 

 

• • The urgent care center may have a “cozy” relationship with the insurer. Many urgent care facilities depend on occupational medicine and workers comp referrals from insurers to earn money. Indeed, one report found that workers comp pays a much higher percentage of urgent care charges than private insurance and government health care plans. This financial dependency may bias the acute care providers if your nurse case manager or claim adjuster pressures them to release you to return to work before you feel ready.

 

Does Workers Compensation Pay for Urgent Care Visits?

 

Yes.

 

Your employer and its workers comp insurance carrier must pay for treatment given by or at the direction of an urgent care facility if you have an Award Letter for lifetime medical benefits and:

 

• • You selected the urgent care facility from a panel of physicians offered by your employer or the insurer or

 

• • Your employer told you to pick your doctor after you reported the work accident and gave no further guidance.

 

Similarly, your employer and the insurer must pay for urgent care visits if they deny your claim, but you ultimately win on eligibility (compensability) at a workers comp hearing.

 

Do Insurers and Claims Administrators Prefer Urgent Care over Emergency Rooms?

 

In our firm’s experience, workers compensation insurance carriers and third-party administrators (TPAs) prefer urgent care centers over hospital emergency departments.

 

Two reasons explain this preference.

 

First, the urgent care facility will charge and accept less money than the ER.

 

Second, the insurer must offer a list of physicians besides the ER because the hospital will not continue to treat you after discharge.

 

Can I Use Medical Work Restrictions from Urgent Care to Get Workers Compensation Benefits?

 

Yes.

 

Medical providers at urgent care facilities can give work restrictions. Indeed, I have seen countless urgent care medical records restricting injured workers to light duty or disabling them from all work pending a visit with a specialist.

 

You can use these disability letters as evidence to support a claim for wage loss payments, including temporary total and temporary partial disability benefits.

 

Can Urgent Care Perform Surgery?

 

No.

 

Urgent care facilities will not perform surgery for workers compensation patients.

 

For example, you must see another doctor if you need surgery for a torn rotator cuff, a total knee replacement, or a spinal fusion.

 

Helping Injured Workers from their First Visit with Urgent Care through Settlement

 

Urgent care for an occupational injury can help start the recovery process sooner.

 

But you must take charge of your care and ensure you receive referrals if you need a specialist.

 

Our law firm ensures the insurance carrier does what it is supposed to and fights against any medical treatment denials.

 

Then we can use your urgent care notes to make a strong settlement demand and negotiate a fair deal for you.

 

Contact us now to start.