The doctor and the workers compensation patient

doctors-refuse-to-treat-workcover-patients

Injured or ill workers deserve good medical care, rehabilitation, as well as compensation for permanent injury. Unfortunately more and more doctors are shying away from treating patients in the workers’ compensation system, They should not but they should be aware of how the work-over system works.

Stigmatisation of injured workers occurs in the workplace, the system, even in families, friends, by the community generally, and even by medical doctors and specialists.

In addition to attempting to cope with the difficulties of an injury (including: the injury itself, fear of losing one’s job, fear of inability to get another job etc), injured workers are stunned to find that support is often not provided and that there is overt discrimination against them in all aspects of their life.

The workcover claims process also leads to disempowerment and loss of rights.

In addition, turning to carers for assistance can lead to further conflict and despair for many (more seriously) injured workers. The attitude of many GPs , and specialists, towards injured workers, for example, lead to further difficulty, and in increasing numbers.

There is active discrimination at all levels against injured workers in all aspects and at all stages of the injuries.

The doctor and the workers compensation patient

Refusal of medical care

  • There is —increased— refusal of many GPs to see patients with workcover claims.
  • There is —increased—specialist refusal to treat injured workers

In addition to GPs refusing to see patients with work related injuries (or illnesses), specialists, particularly surgeons (especially orthopedic surgeons) are declining to see patients with workcover claims in greater numbers (certainly in Victoria)
Neurosurgeons have also increasingly declined to treat work related conditions.

Why are GPs and specialists refusing to treat injured workers?

GPs and specialists have indicated several reasons leading to the decision not to treat workcover victims, these include:

  • increased harassment from insurers and rehab providers
  • loss of capacity to practice medicine without interference
  • increased need for paperwork in report writing, endless forms, endless requests to have basic parts of treatment accepted (i.e medication, surgery), and
  • many of these duties are not paid for
  • But there is also the false belief that there is tendency for a workers’ compensation patient to exaggerate their injuries, that they may not comply with things like ‘rehabilitation’; and that there is anecdotal evidence that for example, injured workers don’t recover well after surgery

Workers who are injured on the job deserve good medical care, rehabilitation, as well as compensation for permanent injury. Many of these injuries will be orthopaedic in nature. Orthopaedic surgeons (and any other medial practitioner) should not shy away from treating patients in the workers’ compensation system, but they should be aware of how the system works.

The orthopedic surgeon and the workers’ compensation patient

orthopedic

Orthopaedic surgeons are commonly asked to care for patients who have been injured in the course of their employment. Some of these injuries are employment-specific, such as a mangled hand from a punch-press injury; others are similar to those encountered in everyday practice, such as an ankle fracture from a fall at work, or carpal tunnel syndrome etc.

Caring for an injured worker poses special “challenges”. Indeed, many orthopedic surgeons are so concerned about those challenges that they refuse to accept workcover patients. However we believe a better understanding of the workers’ compensation system and its operation may help alleviate some of those concerns.

If you accept workcover cases, you must be familiar with applicable workcover laws. Treating workcover patients requires interaction with multiple entities—the exam room can get crowded, so to speak!

Below are some useful tips from injured workers

The injured worker

tipThe first person you deal with—and the person to whom you owe primary responsibility—is the patient- the injured woker. The workcover patient deserves the same level of diligent care you provide to any other patient, and should not be treated any differently because of the “system”!

tipDo not ever allow an employer or workcover insurer to dictate the medical care ; as the doctor/surgeon, you must decide and advise your patient on what you believe is the proper care for the injury.

tipYou may believe, or be led to believe that there may be a tendency for a workcover patient to exaggerate injuries or not comply with rehabilitation, because the greater the permanent disability, the larger the eventual “lumpsum or settlement”. This is most often unfounded and simply a myth. In the rare occasion that you believe there is such thing, then be assured that this tendency is unconscious, making it very different than malingering, which is intentional, fraudulent behaviour.

tipOrthopedic surgeons (and other medical practitioners or surgeons)  may also fear that injured workers are litigious and prone to file, for example, medical liability / malpractice lawsuits. Rest assured here is no evidence to support this concern. The fact of the matter is that in Australia, workers are required to file workers’ compensation claims for any work injury and the worker’s own medical insurance typically will not cover work-related injuries. While the injured worker may be involved in a legal process, it is directed at the employer/workcover insurer, not at the you, the treating doctor.

The employer and the insurer

In the workcover system, the employer is required by law to maintain workers’ compensation insurance and the workcover insurer is  responsible for paying for the injured worker’s medical care, rehabilitation, and other medical and like expenses.

tipHowever, the workcover insurer (a business geared to maximise profit) will, through their intermediaries—case managers, nurse case managers or nurse rehabilitation specialists, or whatever they may be called—will usually interface and interfere with you. The titles imply a level of expertise that these people do not, in fact, possess.

Unfortunately, there are many such ‘intermediaries’ who take a very confrontational role and actively interfere with patient (injured worker) care.

tipIf the employer is a small firm, the owner may also  attempt to interfere in the medical care.

At other times, the injured worker may be dealing with a personnel office or an immediate supervisor, who may be “less sophisticated” about, for example, the process and less willing to take the injured worker back on suitable or light duty.

The lawyers

Although the workers’ compensation system was designed to relieve the injured worker of the responsibility of proving in court that his or her injury resulted from an employer’s negligence( aka “no fault system”), it didn’t eliminate the role of lawyers. Many law firms specialise in representing either injured worker or employers in workcover cases.

Sometimes the worker may already have retained a lawyer before seeing you (the ortho or other surgeon); other times, the injured worker may need to be advised that representation may be helpful.

Generally, the first determination hat is required from the workcover insurer is whether the worker was injured on the job, and what is the extent of the short-term and permanent disability/impairment (if any).

An extended battle over “compensability” or “liability” to determine whether or not the injury occurred during employment may delay treatment, as may any “decision” that the medical treatment (i.e surgery) of a medically untrained case manager is “unnecessary”, “inappropriate” or even “experimental”. Needless to say that an injured who has to wait 2 – 3 years for a rotator cuff repair while the adversarial system decides who will pay for it will certainly not have an optimal result. In these cases, you are often called to write endless reports and deal with obnoxious and rude people. Keep detailed notes from your patient visits and your dealings with his/her workcover insurer.

Although you are the injured worker’s advocate as far as getting appropriate medical treatment, when it comes to “writing reports”, it’s best if you are a firm and neutral servant of the truth. Be aware of current literature on causation and treatment of injuries, and do not be afraid to say that a particular treatment (i.e. surgery) is really necessary for your workcover patient.

Please do not charge mind-boggling fees (i.e. $2000)  for a report (i.e. basic copy/paste medical report) requested by the injured worker’s lawyer, for purposes of dispute(s) or litigation, and remember that it is the poor injured worker who ends up paying for that report (as in disbursements).

The injured workers’ side of the “story”

Remember at all times that any injured worker was injured at work, meaning they were working people! They are not ‘lazy malingerers, seeking a free holiday”.

They were providing for themselves and their families, that’s how they got hurt in the first place! They weren’t hanging out eating lollies. They were productive members of society.

The workcover it is a truly  horrible system. It is not a cake walk for us, injured sods, and having to navigate through it.

Injured workers are routinely staked out, stalked, photographed, and filmed. They are forced to attend endless “independent” medical examinations (IMEs). When the workcover insurer is not happy with a doctor or an IME’s assessment, so they repeatedly send injured workers to different IMEs: which can cost them a thousand dollars a clip.Yet, they choose to doctor shop until they get the evaluation they want.

They will drag this process on for, sometimes, the lifetime of the workcover patient.

They will delay, deny and refuse proper care that is being requested by the treating doctor/surgeon, thus tying that doctor/surgeon’s hands, so s/he is unable to treat his/her patient the way s/he knows best.

How does the patient heal correctly when care is delayed or denied and the doctor/surgeon is being kept from getting that workcover patient better, so all involved can go on with living productive lives?

The system is geared to make it very difficult on a workcover patient trying to recover from injury. If they are trying to get better and try to do tasks they couldn’t do before and are filmed trying them, then they are subject to being accused of fraud. How does one get better, if they don’t try to improve for fear of being called a liar?

The stalking involved in these cases has the same psychological effects as having an unwanted admirer. The system is not a free ride.

And, sadly, may employers do try to “get rid of these injured employees” instead of helping them to recover (Which is the right thing to do). After all….these people were working!

 

Think about it, if YOU (doctor, surgeon) were injured at work, how would you feel? Would you also not feel insulted to be denied access to medical care simply because you are on workcover? Would you like to be treated differently because one day you went to work only to suffer an injury (and often through the sheer negligence of the employer)?

How would YOU (doctor, surgeon) feel if your doctor humiliated you, belittled you, allocated you much less time for a medical visit, or simply out-rightly denied you medical care? Think about it.

Somewhat related articles

[Post dictated by Workcovervictim and manually transcribed on her behalf]

 



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