Telehealth: What Insurers Need to Know in 2025

The main benefit of telehealth for claims management is ensuring OSHA compliances are met by allowing employees to make prompt appointments with their physician after a work injury.

Overcoming Barriers to Treatment

Workers who previously had challenges interacting with the workers’ compensation system will potentially benefit the most. This includes workers in rural locations who may otherwise have traveled long distances to meet with a qualified physician. Telehealth can also mitigate language barriers as translators or bilingual physicians can be available.

In contrast, some patients may not be comfortable self-reporting vital signs. Others do not have access to the devices, lack sufficient internet bandwidth, or are uncomfortable with the technology required for a telehealth visit.

Overcoming Treatment Barriers: Telehealth is a lifeline for workers with children who endure the added cost of finding childcare while they go to an appointment. Another group who faces difficulty in accessing care are people who live in rural areas (which many times blue-collar workers do) with debilitating injuries like a dislocated shoulder or broken ankle. The incorporation of medicine and technology bridges the gap between a worker in rural America who can avoid a three-hour drive and see a specialist online, with translators there to help!

Telemedicine Legislation

The Department of Labor (DOL) and workers’ compensation programs are working to enhance care delivery. Under the Federal Employees Compensation Act (FECA), authorized providers can now offer routine medical care via telemedicine without prior authorization.

• Who’s an Authorized Provider?
  An Authorized Provider is a physician permitted to deliver telemedicine care based on state laws and licensure. The DOL ensures compliance but doesn’t interfere with their qualifications.

Providers can also have a medical professional, such as a Registered Nurse or Physician Assistant, present during telemedicine sessions. This is particularly useful for cases involving field or telephonic case managers.

This would be especially beneficial for patients with assigned field case managers or telephonic case managers.

Below, we will discuss some important guidelines for your physicians and case managers to follow when filing a workers’ compensation claim, straight from the Office of Workers Compensation Programs (OWCP). 

When submitting bills, providers must include:

• Detailed appointment notes with telemedicine method and visit length.
• Collected vitals or medical evidence.
• An outline of the medical needs and benefits of the appointment.
• Compliance with FECA regulations.

Insurer Perspective

From an insurer’s perspective, telehealth availability supports OSHA compliance and ensures that workers receive prompt care necessary for filing claims. Yet, insurers are still wary of this new technology. The benefits of telemedicine are found in identifying its strengths and limitations.

For example, telehealth excels in triaging injuries and follow-up care, but it might not fully replace that first in-person visit. A major benefit is the reduction in missed appointments and the elimination of small but frequent expenses like mileage and parking for in-person visits.

However, the benefits of an in-person visit with an actual doctor who can conduct drug testing, witness the effects of an injury, and talk to the patient are invaluable. It’s harder to spot fraudulent claims or the extent of an injury through a screen. This is a reminder that telehealth can be a powerful tool for insurers with the right implementation.

Employer Perspective

Telehealth directly benefits employers by potentially reducing medical and indemnity payments, leading to lower workers’ compensation premiums, and ultimately cutting costs.

Let’s look at a perfect use case example of telemedicine: Starbucks.

What is the Starbucks’ strategy?

Starbucks has mastered workers’ compensation claims management with a focus on employee advocacy.

They empower employees to self-report claims and use a workers’ comp call center operated by TPA partners for quick, live support. Steve Legg, Starbucks’ Director of Risk Management, notes that live support can answer 70-85% of questions in minutes.

Self-Reporting and Trust:  This approach not only benefits the bottom line but also boosts employee satisfaction by eliminating unnecessary time off for doctor visits.

Telephonic Case Management: Each claimant is assigned a dedicated telephonic case management nurse, resulting in a 51-86% release-to-work rate and litigation rates under 6%.

Beyond the financial perks, telehealth makes for happier employees. Nobody enjoys having to take a day to go to the doctor’s office. Instead, patients are given the option to schedule their care during their schedules resulting in a win-win for both your company and employee.

The Risks of Telemedicine

In 2024, insurers are trying to balance the real risks that come with telemedicine. As Dr. David Anderson from Stanford Health Care highlights, “Telemedicine is great for follow-ups but not optimal for initial exams,” due to its inability to pick up on physical cues and patient interactions. The American Medical Association cautions that “telemedicine may not adequately assess complex cases where in-person examination is crucial.”

This limitation can lead to negative outcomes caused by the inability to provide an accurate diagnosis. Can we confidently say laptop cameras are up to the task? Can we expect patients to develop trust over the phone? In worst-case scenarios, this technology can result in risk mismanagement.

It’s important to know who is providing virtual care to insureds and to trust those integral case managers and nurses involved in the most critical and at times arduous moments of a claim. Want to learn more about the pros and cons of medical management or the current cost of case management? Click on our links!

Read more about OSHA requirements and our use case:

https://www.dol.gov/agencies/owcp/FECA/regs/compliance/DFECfolio/FECABulletins/FY2020-2024#FECAB2108

https://riskandinsurance.com/starbucks-workers-comp-program-earns-a-teddy-award-for-its-exceptional-employee-advocacy/

Dr.David Anderson from Stanford Health Care

Updated January 31st, 2025