Between Correlation and Causation
Employers should not automatically accept a physician’s report that an injury was caused by a work-related event.
And should a claim’s denial be challenged, employers shouldn’t rely on a medical expert who always agrees with them, said Stuart Colburn, an attorney at Downs Stanford, at a session, “How to Use a Medical Expert so You Don’t Get Burned on Causation,” on Thursday at the National Workers’ Compensation and Disability Conference® and Expo.
You are not going to win any cases with those doctors,” he said. “Don’t use them.
“Pick experts that are believable, not that give you the opinion you want.”
It is important that physicians are fully informed about recent research when determining causation of an injury, he said. When necessary, it’s up to the employer to educate physicians.
When analyzing causation, the review should include individual clinical findings, individual workplace exposure, and scientific literature linking or not linking the exposure to the condition.
Don’t just accept prevailing opinion about injury causation, said Dr. Jacob Lazarovic, chief medical officer and SVP, Broadspire. It can be wrong, such as the opinion that carpal tunnel syndrome results from keyboarding.
“Pick experts that are believable, not that give you the opinion you want.” — Stuart Colburn, an attorney at Downs Stanford
Rather, research shows a workplace function would require “significant hand force” to cause carpel tunnel syndrome, he said.
Other research disputes the link between occupational activity and back pain, he said, finding instead that most such injuries have a genetic basis.
Lazarovic also noted there are “significant error rates” in interpreting diagnostic imaging results.
He noted one study found that 33 percent of experienced radiologists disagreed with another physician’s reading of an image. In addition, 25 percent of those physicians disagreed with their own reading, when given the image on another day.
When disputing a claim, Colburn noted that the “exact same wording” about causation will be treated differently, depending on which state the claim is litigated.
Mental Health Matters
The mental health of employees impacts their healing process as well as their productivity on the job.
“Mental health is always in the top three reasons … for absence,” said Kimberly George, senior vice president, Sedgwick Claims Management Services Inc., at a “Mental Matters: How Mental Health Impacts Productivity and Performance” panel on Wednesday, Nov. 30.
About 6,000 workers’ comp professionals and specialists attended the National Workers’ Compensation and Disability Conference® & Expo at the Ernest N. Morial Convention Center in New Orleans.
Scott Daniels, director of disability, global benefits, Comcast NBC Universal, said that in revamping his company’s absence management program, the impetus was “about changing the employee experience,” rather than generating return-on-investment.
“We really need to focus on the intersection of physical and mental health.” — Hilary Mitchell, director of employee health absences, Pitney Bowes Inc.
The program requires all employees who file a short-term workers’ compensation claim to be evaluated for mental health issues, he said. The company leverages its employee assistance program for not only assessments, if the employee does not prefer a specialist, but also to help fill out claims paperwork.
Comcast pays for five free sessions with the EAP for employees, which it will expand to 10 sessions next year, Daniels said. It also pays the copay for employees who see their own specialists.
In six months, the company saw a 4 percent to 5 percent decrease in claim duration and a relapse rate that currently is “extremely low.”
Hilary Mitchell, director of employee health absences, Pitney Bowes Inc., said her company’s program includes physical and mental health education, on-site nutritionists and clinicians, tiered network and preventive drugs, a psychologist on retainer for executives, and a “dial ohm” telephonic meditation program.
Pitney-Bowes requires and pays for behavioral health assessments for all employees filing disability or drug abuse claims, she said.
“We really need to focus on the intersection of physical and mental health,” she said, but Mitchell noted that the “biggest challenge … is getting the word out” about company-provided benefits.
Increasing Children’s Chances
Helping the children of workers who were injured or killed on the job was the brainchild of Robert Clyatt, a workers’ compensation attorney in Georgia.
Having witnessed the devastating impact of workers’ injuries on their families, he created the first nonprofit Kids’ Chance organization in 1988 and began raising money to provide educational scholarships to the children of injured Georgia workers.
It spurred a national movement, said Vicki Burkhart, executive director of Kids’ Chance of America.
There are now Kids’ Chance organizations in about 40 states, she said. The national organization helps with fundraising and provides best practices. It also created a database so prospective scholarship recipients are entered into the system, regardless of age.
“The families are so impacted by these really serious workers’ compensation injuries,” she said. “Life as they knew it ceased to continue to exist and in many cases, they were left without a lot of support.”
That’s where Kids’ Choice comes in.
Kaitlyn, who is now a fifth grade reading and social studies teacher, credits Kids’ Chance of Maryland with helping her attend Towson University.
Her father, she said in a videotaped testimonial on the Kids’ Chance website, was a lumberjack at a sawmill who was accidentally sprayed with a chemical. After suffering for several years, he died. This happened when she was only 5.
“Kids’ Chance of Maryland was the biggest savior I could ask for,” she said. “They helped me pay for school and it took off some of the stress of how we were going to manage.”
Among the many testimonials on the site is one from the three daughters of a Tucson police officer, who offered their thanks to Kids’ Chance of Arizona for scholarship assistance after their father was permanently disabled in the line of duty.
Another is from Pedro, a student at Rutgers University in New Jersey, whose father was left fully disabled after a truck accident at work.
“Not only has it been an emotional burden seeing my father battle the pain of his injuries these past three years, but a huge financial burden every time the term bill is due for school,” he wrote, praising the help of Kids’ Chance of New Jersey.
Since its inception, Kids’ Chance organizations awarded more than 5,600 scholarships totaling about $16 million.
For more information, visit http://www.kidschance.org. &