Medical Details for Workers’ Compensation

1. Medical Providers Management

• In the Medicals tab, users can store details of medical providers treating injured workers.
• Allow the addition of multiple medical providers with fields for:
  • Hospital/Clinic Name
  • Doctor’s Name
  • Specialization
  • Hospital Address
  • Contact Information
  • NHIF Accreditation Status (Since Kenya’s National Hospital Insurance Fund (NHIF) plays a key role in workers’ compensation claims)
  • Private Insurance Acceptance (if applicable)

2. Document Requests Tracking

• Users can track medical document requests by selecting a medical provider and adding:
  • Request Date
  • Type of Document Requested (Medical Reports, X-Rays, Surgery Reports, NHIF Forms)
  • Expected Response Date
  • Status (Pending, Received, Delayed)
  • Internal Notes (e.g., follow-up reminders)
• Automated Alerts:
  • Add a Document Request Widget that alerts staff about outstanding document requests.
  • A Global Document Request Report will provide a summary of all pending medical record requests.

3. Managing Medical Invoices

• Users can enter and track medical invoices associated with each provider.
• Fields for invoices:
  • Invoice Date
  • Service Start & End Dates
  • Initial Invoice Amount
  • Insurance Adjustments (if any)
  • Final Invoice Amount
  • Balance Due
  • Payor Details (Right-click to add multiple payors such as NHIF, employer, or private insurance companies)
• Adjustments Section:
  • Track negotiated adjustments between medical providers and insurers.
  • Maintain a record of any NHIF-covered vs. privately covered amounts.

4. Medical Reports for Workers’ Compensation

LiraDocs should generate the following reports to assist Kenyan law firms in managing workers’ compensation claims effectively.

A. Medical Provider Reports

1. Medical Provider Summary Report
   • Lists medical providers, service dates, and invoice amounts.
   • Can include contact details for easy reference.
2. Chronological Medical Provider Report
   • Orders medical treatments by date for case reviews.
3. Medical Provider Outstanding Amounts Report
   • Highlights unpaid balances for each provider.

B. Invoice Tracking Reports

4. Medical Invoice Line Items Report
   • Details service descriptions, insurance adjustments, and amounts paid.
5. Invoice Line Items Report with Payors
   • Shows payments made by NHIF, private insurers, or employers.

C. Document Management Reports

6. Medical Documents Requested Report
   • Tracks pending and completed medical records requests.
7. Medical Documents Requested Report with Notes
   • Includes internal notes about document requests, e.g., follow-up reminders.

5. Compliance with Kenyan Workers’ Compensation Laws

• Ensure medical details comply with Kenya’s Work Injury Benefits Act (WIBA), which governs workers’ compensation.
• Generate WIBA Forms automatically for submission to insurance companies and NHIF.
• Track employer obligations for medical treatment coverage under Kenyan labor laws.

Best Practices for Medical Records Management in LiraDocs

✔ Automate tracking of medical invoices to ensure workers receive proper medical compensation.
✔ Include NHIF integration for tracking government-covered medical expenses.
✔ Enable document request automation for faster access to medical reports.
✔ Customize medical invoice reports to comply with employer and insurer requirements.

By integrating these adjustments, LiraDocs will be fully equipped to handle Kenyan Workers’ Compensation cases, making it easier for law firms to track medical details and ensure timely settlements for injured workers.