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Medical Cost Containment

“Protecting the Workers’ Compensation Dollar”

At OMCA, we use the latest medical science and highest industry standards to help workers’ compensation payers control their medical costs and case reserves.

Medical Case Management

OMCA’s medical case management goal is to facilitate quality care, appropriate specialty referral, optimal recovery and timely return to work for employees sustaining a work injury. The RN Case Manger utilizes medical management guidelines to assess, coordinate, monitor and evaluate a provider’s plan of care for the injured worker.

  • Aggressive Return To Work Approach -The earliest possible return to work is established by timely communication among the injured employee, employer, adjuster and physician. Modified duty, temporary alternative duty and statutory requirements are considered while working together with the employer and adjuster to achieve the earliest safe return to work for the injured employee.
  • Customized Protocols – Communication is a key element for successful medical case management. OMCA will tailor communication protocols to the needs of the employer, TPA, or insurance carrier. Effective and timely communication is essential for successful claims management.
  • Treatment Plan Formulation – OMCA medical case managers work with treating physicians to develop and implement an effective treatment plan for the injured worker. Plans are reviewed and modified as the patient progresses in the recovery process.
  • Timely Referrals to Specialists – Medical case managers monitor the progress of each injured worker to ensure they are moving toward MMI. Patients will not be allowed to treat ad infinitum with a physician if no objective improvement is documented. These patients will be referred to an appropriate specialist to maximize their rate of progress.
  • Diligent Medical Oversight – Case managers monitor treatment for the workplace injury to ensure that it is compatible with any treatment the patient may be getting for other medical issues.
  • Prompt Adjuster Notification – Adjusters are notified of case management activity within 24 hours. Issues such as MMI and a change in work status are communicated to adjusters immediately.

Physician Reviewers

Choosing the right physician is critical in achieving the best outcome. It’s as important for the payer to choose the most qualified reviewer as it is for the claimant to choose the most qualified surgeon. If we are to realize the best outcome from an administrative law judge, we must present the ALJ with the most persuasive evidence,

We use the latest scientific evidence from the most qualified physicians. Only then can we hope to overcome the presumption that is often given the treating (or mistreating) physician.

OMCA makes every effort to have the best physicians in the country available to review and evaluate your cases. They represent the finest in their particular specialties and are uniquely qualified to assist with your issues. All of our reviewers are Board Certified in the following specialties:

Neurosurgery, Neurology and Psychiatry, Orthopedic Surgery, Anesthesia, Hand Surgery, Plastic Surgery, General Surgery, Addiction Medicine, Occupational Medicine, Emergency Medicine, Physical Medicine and Rehabilitation, Quality Assurance and Utilization Review, Infectious Disease and Pulmonary Medicine.

Additionally our reviewers include:

  • Authors of a variety of chapters of AMA Guides, Official Disability Guides (ODG), American College of Occupational and Environmental Medicine (ACOEM)
  • Officers of National Association of Spine Surgeons, American Academy of Disability and Evaluating Physicians (AADEP)
  • Former state workers’ compensation Medical Director.
  • PhDs in psychology, pharmacology (also MD) and epidemiology (also MD)

All of OMCA’s products can be accessed individually or together. Our unique group of professionals can assist you without changing existing vendor relationships. For over 25 years carriers, third party administrators, attorneys, self-funded employers and excess/reinsurance carriers have better controlled their workers’ compensation costs and case reserves through the services provided by OMCA.

To hear more about OMCA’s Medical Cost Containment, contact William Faris, J.D., President & CEO at william.faris@omca.biz

From our Clients & Colleagues

Madonna Senger Workers' Comp Adjuster

“The best network ever was the original PPO network of OMCA.”



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