Balancing the Ethical Challenges of Workers’ Compensation Cases

The relationship between physician and patient is one of the oldest and most protected bonds. However, in the often complicated situation of treating an occupational illness or injury, the private relationship becomes more public with the additional agendas of an employer and an administrator. Keeping the ultimate goal of improving patients’ conditions in mind can carry physicians through the ethical considerations.

When presented with a workers’ compensation case, every physician should familiarize him or herself with the forms and regulations for treatment of occupational illnesses and injuries in the state in which the condition developed, as well as the state in which treatment will occur, should the two be different. Clear communication with all parties involved in the cases, an evidence-based treatment plan and a realistic prognosis will ensure the best outcome for the patient, regarding employment and health.

The Guidelines

As re-establishing a functional ability is the primary goal for workers’ compensation cases, using a series of objective measures to track progress removes the chance for personal bias. Physicians should watch for decline or improvement in ability to perform daily living activities, cognitive and psychological behavior, range of motion, stamina and strength through a follow-up visit every two to three weeks.

While the patient’s experience of pain should be documented, it should not singularly determine the length of his or her leave or type of treatment. In setting a patient’s return-to-work date, physicians should utilize resources such as the Medical Disability Advisor and the Official Disability Guidelines. Adhering strictly to personal opinion or patient requests can jeopardize a patient’s employment status and put the employer in the dark regarding its employee’s condition. Also, the American Medical Association’s book The Physician’s Guide to Return to Work offers body system-specific treatment plans and case-by-case examples for effective negotiations.

Paperwork 101

States require different forms to communicate among the three to four parties involved and document the varying stages of treatment. The standard paperwork typically includes a first report detailing the physician’s initial examination and course of action, progress reports that record any major change in condition or treatment proposal and a final report that makes a definitive determination about the nature of the illness or injury.

Most documents are extremely time sensitive and have implications for a physician’s reimbursement, as well as an employer’s planning and a patient’s future employment.

Upping Fees to Cut Costs

A persistent stumbling block for the proliferation of quality physician care and occupational health programs is the low fee schedules associated with physician reimbursement. However, the American College of Occupational and Environmental Medicine (ACOEM) is supporting a movement to realign the schedule with a “pay for performance” philosophy. The organization argues that offering higher reimbursement levels, in addition to requiring the adoption of its Occupational Medicine Practice Guidelines, will grow the number of physicians providing care for workers’ compensation cases and enhance the patient outcomes as physicians will be following guidelines for treatment drafted on the latest scientific studies. ACOEM guidelines have already provided the standards for California and New York state policies and include measures for preventive medicine to head off complications resulting from an occupational illness or injury.

MD News April 2011