The Role of Health Care Providers in Long Term and Complicated Workers Compensation Claim Iggy Kosny...

7/17/2019 The Role of Health Care Providers in Long Term and Complicated Workers Compensation Claim Iggy Kosny ACHRF 2012

http://slidepdf.com/reader/full/the-role-of-health-care-providers-in-long-term-and-complicated-workers-compensation 1/19

www.coeh.monash.org

The role of healthcare providers inlong term, complicated workers’

compensation claims

Agnieszka Kosny, Ellen MacEachen (PI),Sue Ferrier, Lori Chambers

Research conducted at the Institute forWork & Health (Ontario, Canada)



www.coeh.monash.org

Total of 69 in-depth interviews . 34 interviews with injured workers; 14peer helpers and 21 service providers

• Focus on issue of healthcare and role of HCPs because of importantrole in the compensation system

– involved in the legitimization of work-related injury

– provide treatment for injury or illness

– required to provide information and progress reports

– give recommendations about return-to-work capability

• Three key problems occurring between the healthcare andcompensation system that seemed to complicate workers’ progressionthrough the system and prolong claims



www.coeh.monash.org

Poor access to timely and appropriate care

• Workers access to HCPs was related to geography – ruraland northern areas = poor access

– Long waiting times

– Little choice in HCP

– Difficult to see specialists

• Access related to “claimant status” - Workers filing a claimcame to represent an “administrative burden” for HCPs



www.coeh.monash.org

“And then, every month you had to bring in a report for the doctorabout your injury. The doctor’s getting sick and tired of all therepetitiveness, paperwork, jargon and stuff, you know?…My doctor,

she just can't understand compensation. Like she’s got a real…hate-on for [workers’ compensation]! I don't like bugging her to get all thesereports filled out. Because she's got better things to do than filling outBS paper work. I mean, how many times does a doctor have to sayhe's never gonna get any better…Like he'll never be better! I mean

how many times you have to write that on a friggin' piece of paper?!(Martin, injured worker)



www.coeh.monash.org

• The amount of paper work was overwhelming

• HCPs continually required to submit forms/document changesin worker’s health status or medication use

• Paid less for workers’ compensation clients (physio: 19$ vs 45$per treatment)

• HCPs frustrated when they filled in reports and then theirmedical opinion was not taken into consideration or overturnedby those with less experience -- disincentive to engaging withworkers in compensation system


http://slidepdf.com/reader/full/the-role-of-health-care-providers-in-long-term-and-complicated-workers-compensation 7/19www.coeh.monash.org

“They say why am I going through all this work making thesereports. By the ability, the education and the status that I have as a

specialist… and I'm being overturned by a [compensation] boarddoctor who doesn't have the specialty in that field. And sometimesby an adjudicator. Or sometimes by a nurse case manager. Whyare [workers] being sent to specialists if you're going to ignore whatthe specialist is saying. It doesn't make sense.” (Alex, peer helper)



Poor understanding of workers’ compensation

requirements

• Important for HCPs to provide comprehensive, detailed and

timely information to the compensation board.• Workers did not always give HCPs a nuanced, detailed

description of their problems

– rushed during clinical encounters

– Intimidated by HCP

– unfamiliar with compensation system requirements

• Problems occurred when minor issues or secondary problemswere not documented but then became serious



“One of the root problems I think is with the doctor and the medicalreporting that goes on. Often workers don't relate the full story tothe doctors because a lot of them just are intimidated by those in

the medical profession. They almost feel hesitant or shy orembarrassed to be relating the details of an injury… And, youknow, I think the doctor's the key to the claim going smoothly in thebeginning. If the doctor doesn't get the right history, the reporting,then it's a nightmare right from the beginning. So much isdependent on the initial history being correct and consistent, that ifyou can't get that right it creates problems ALL the way down theroad.” (Terry, legal advisor)



HCPs also did not always fully understand:

• Compensation system requirements

• The level of detail required by the compensation board

• The negative impact that delays or incomplete reporting had onclaims



Diagnostic uncertainty and conflicting medical

evidence

• Injured workers with prolonged claims tended to haveinjuries/illnesses that were “invisible”, difficult to diagnoseand difficult to treat

• Many workers went from HCP to HCP to get a diagnosis or to

manage their problem – Worker driven

– Often a compensation board requirement – to gather evidence



• Consultations with multiple HCPs providers = conflictingdiagnoses, diagnostic uncertainty, inconsistent information

• This led to problems with the compensation board – further

investigations of claims, claim denials, payment delays

• This further led to mental health problems, financial strain,relationship breakdowns among workers



“An individual injured worker receives any type of a conflictingdiagnosis or opinion, even if it’s not actually conflicting but theproviders have used language that sounds different. Which happensa lot. You know, someone might say, oh, you have osteoarthritis of

your spine, somebody else might say you've got degenerative discdisease, or degenerative changes. The layperson thinks, well, I've

just received two very different opinions, when they're exactly thesame, in fact. And then there's the other situation where peopleactually do get a whole set of different opinions, and some of these

workers that we see come and say, you know, this doctor told me Ihad this, my physio said I have this, my chiropractor said I have this,and they probably are quite different opinions and I believe as soonas that happens, they go off the tracks.” (Anita, HCP)



• One consistent theme - worker was caught in the middle

• IWs often did not understand compensation requirements - madeit difficult to fulfill obligations fully or completely

• IWs had no control over requirements or level of evidenceneeded to establish injury or work-relatedness

• IWs had little control over what HCPs did (wrote down on form,

completeness or accuracy of information)

• Often compensation process strained the relationship



Recommendations

• Necessity of clearer communication between all compensationsystem parties.

• HCPs must understand full consequences of incomplete reporting

• Important to lessen the administrative burden of working with thecompensation system and claimants

– Pay more for forms, services

– Evaluate frequency and nature of reporting

• Financial resources should be provided to IWs when waiting formedical evidence to be collected.



In Australia…

HCPs also have a critical role in treatment and rehabilitation ofinjured workers

• GPs provide 95% of medical certificates in WC system (Victoria)• Mean number of GP visits during the course of a claim is 17.4

(Victoria)

• Between 2000-2010 the workers compensation regulator spent

$1.76 billion on GP services (Victoria)• Yet little research on the role of the HCP in the RTW process,

experience working with workers’ compensation boards,challenges of seeing workers’ compensation patients



One funded study that is underway:

FIT to Work: General Practitioners facilitating injured workers’ returnto work

Mazza, D, Collie, A, Kosny, A, Brijnath, B, Aylward, M, Cohen, D

1) In-depth interviews with GPs, injured workers, employers andcompensation scheme personnel to examine current knowledge,attitudes and practices of GPs, and role of GPs in RTW process

2) Quantitative analysis of WorkSafe claims data to correlate RTWand health outcomes of injured workers with GP practices designedto facilitate RTW (e.g. certification, prescription of medications andtreatments).



Two studies, funding requested, decision pending:

The role of GPs in return to work (RTW): Development of anevidence-informed national consensus and intervention.

Mazza D, Collie A, Kosny A, Brijnath B, Cohen, D

Migrants’ experiences with healthcare providers in the context ofthe Victorian Workers’ Compensation System

Kosny A, Collie, A, Mazza D, Brijnath B


http://slidepdf.com/reader/full/the-role-of-health-care-providers-in-long-term-and-complicated-workers-compensation 19/19www coeh monash org

To read the full article:

Kosny A, MacEachen E, Ferrier S, Chambers C. (2011)

The role of health care providers in long term and complicatedworkers’ compensation claims. Journal of Occupational

Rehabilitation. 21:582-590

The Role of Health Care Providers in Long Term and Complicated Workers Compensation Claim Iggy Kosny...

Documents

Transcript of The Role of Health Care Providers in Long Term and Complicated Workers Compensation Claim Iggy Kosny...