A recent report came across my desk where the provider attempted to assign an impairment rating for a flexion contracture of the knee, and the clinical records clearly showed the pathology objectified was an extension lag. Unfortunately, this is a mistake I see on occasion and can be a huge difference maker in the impairment rating assigned. Clearly, issues with the overall functionality of the knee can interfere with mobility,…
During the course of the last week, I stumbled across three separate items that tend to ignite certain passions. In one case, I had to clarify a certain legal position which led me to discuss my three least favorite items, the lack of use of current evidence-based medicine, liberal construction and presumption. The Widening Gap: Evidence-Based Medicine in a Rapidly Changing World When I was in my clinical training, it was…
One of the very first lessons I learned in my clinical career was a quote from Dr. William Osler dating back to 1895. Dr. Osler was at the Johns Hopkins medical school and his quote is “Listen to your patient, he is telling you the diagnosis.” Another is “The good physician treats the disease; the great physician treats the patient who has the disease.” Medicine as Art and Science: The…
Challenges to Established Practices In general, workers’ compensation systems will not cover experimental medical procedures or treatments. This is because these procedures have not yet been proven to be safe or effective and therefore may not be considered “reasonable and necessary” medical treatment for a work-related injury or illness. However, with the unfettered access to medical literature, and the use of artificial intelligence platforms, injured employees have decided that this experimental…
Those who know me understand that my initial formal training was as a Physician’s Assistant. When I attended PA school, the standard of entrance for such training was to utilize those individuals who served as medics during that era’s conflict. These individuals would undergo an intensive 24-month training program and be utilized to provide healthcare in areas with noted shortages. After my training, there was a national certification that required…
As an individual who has been dealing with impairment ratings for more than 35 years, it is clear that the original intent was to establish an objective parameter to begin the point for the discussion of the last aspect of indemnity benefits or compensation for the injured employee. Unfortunately, there are problems with this process. However , there are several proactive steps to be taken to ameliorate any issues that…
It seems there is always a new tool to make handling a workers compensation claim that much easier. Remember when we had cardboard wheels to assess future dates? The newest tool in the chest would appear to be the use of artificial intelligence (AI) and using predictive analytics to aid you in managing that file. We all know that the workers compensation claims file landscape is changing, rules are always…
Subsequent to the December 2024 tragedy in New York City, it is clear that frustrations with the overall insurance process can rise to a level of significant tragedy. It is not lost on those of us in the workers’ compensation ecosystem that similar frustrations are at all to frequent occurrence. Fortunately, to my knowledge, it has not risen to the level of assassination. However, I find it quite astonishing that…
To paraphrase David Letterman, here are my Top 10 reasons that constitute barriers to successful adjudication of a workers compensation claim: 10. High caseload: Not to be overly simplistic, there are simply a limited number of hours in the workday. Paying attention to an excessive number of cases leads to errors, oversight, and compromising the attention each case deserves. Additionally, studies have demonstrated that high caseloads lead to “burnout” and…
It is the season at a time for political change. With the current power structure being shifted significantly, one must take into consideration the politics of healthcare and the Worker’s Compensation system. Healthcare within the Worker’s Compensation system is deeply intermingled with the prevailing political forces within any particular jurisdiction. A key question is are cost issues more important than providing all appropriate care to address the actual injury sustained?…
