Controlling workers’ medical treatment

In the words of a Nova Scotia medical specialist, dealing with the workers’ compensation system is “appallingly disturbing” (CBC News Oct. 10, 2014). The clinical neurologist says the opinions of the Board’s doctors – even if they have never seen the patient – are given more weight than those of the injured worker’s own physician. She speaks bluntly of how injured workers, to avoid having their benefits cut,  may be coerced into accepting the treatment recommended by the WCB.

An Ontario study led by Agnieszka Kosny of the Institute of Work & Health also talks of injured workers being caught “between a rock and a hard place” given the Board’s decision-making authority over a worker’s health and claim. “Some workers may have to choose between following their doctor’s recommendations or following the recommendations of the clinical management guidelines used by workers’ compensation boards in order to secure their claim”. (see full report in “The role of health-care providers in long-term and complicated worker’s compensation claims,” Journal of Occupational Rehabilitation 2011 21(4):582-90)

The issue has long been a topic of debate south of the border. The standard of care until recently meant the treating physician determined what medical treatment was necessary. However as a presentation to the American Academy of Orthopaedic Surgeons pointed out, states are increasingly implementing mandated “evidence-based” guidelines. (“Workers’ compensation system under attack: do treatment guidelines threaten the patient-physician relationship?” AAOS News, Jan. 2014). These guidelines (state-written, the Official Disability Guidelines prepared by the private, insurance-funded Work Loss Data Institute or the ACOEM Practice Guidelines) are used by almost all workers’ compensation insurers. However it is the mandated use which switches the burden of proof so that “now the guidelines are assumed to be correct and the doctor has to prove otherwise”.

As the just-published “National Trends and Developments in Workers Compensation” (Oct. 2014)  by the National Economic & Social Rights Initiative (NESRI) reports, a growing number of states are giving employers and insurers control over choosing the treating doctor and thereby influence over important medical decisions.
Injured workers are losing an important historic right.