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"Research Helps Solve WC Disputes" by Billie Grover, M.ED. Although the law in general respects the opinion of health professionals in dispute resolution in workers' compensation cases, their informed judgment carries less weight today than in the past. Courts often require scientific evidence, demonstrated by authoritative medical references.
Similarly, insurance professionals and attorneys can derive significant benefit from acquiring their own understanding of the medical conditions in dispute. Research of relevant medical literature can show whether or not a given condition can be the result of an on-the-job injury. In a recent Florida case, the claimant, injured by a crane on a construction site, sued for benefits, claiming his ongoing pain since the accident worsened his pre-existing high blood pressure and diabetes. Thorough research of the medical literature, however, did not validate this claim. In fact, the following was found: the higher the blood pressure, the lower the sensitivity to pain; people taking calcium channel blockers for high blood pressure often report joint pain; and diabetics commonly complain of deep, aching pain(neuropathies). These three findings supported the argument that the claimant's pre-existing medical conditions predisposed him to increased pain, not that the injuries worsened his pre-existing conditions. Upper extremity cumulative industrial trauma, mostly carpal tunnel syndrome, often generates litigation when not compensated. The medical literature contains documentation supporting causal links between this condition and job factors. However, researching the medical literature reveals that carpal tunnel syndrome also can have an underlying systemic cause. Recently, patients and attorneys have shown interest in the possibility that cumulative lower extremity disorders may be causally related to job factors. An article last year in Foot and Ankle International critically reviewed the literature and found no scientific validity for such a contention relative to many lower extremity disorders.
Among the conditions ruled out as cumulatively job-related were adult hallux vulgus, interdigital neuroma, heel pain, and tarsal tunnel syndrome. However, the literature did support a connection between osteoarthritis in weight-bearing joints- such as the knee- and certain occupations, such as mining and cargo handling. Responsible employers and workers' compensation carriers strive to provide both quality and cost containment in the administration of their programs. Seeking authentication and scientific explanation in clinical medical literature of the causation of injuries and medical conditions will help industry professionals and attorneys attain these goals. SOME LITERATURE OF INTEREST Why most workers with occupational repetitive trauma do not file for workers' compensation. Rosenman, KD. J Occup Environ Med 2000 Jan; 42(1):25-34. The effect of legal representation on functional recovery of the hand in injured workers following carpal tunnel release. Braun, RM. J Hand Surg(AM) 1999 Jan; 24(1):53-8. Evidence-based medical dispute resolution in workers' compensation. Guidott, TL. Occup Med 1998 Apr-June;13:289-302. Contested claims in carpal tunnel surgery: outcome study of workers' compensation factors. Olney, JR. Iowa Orthop J 1999; 19:111-21. Chronic pain disorder following physical injury. Streltzer, J. Psychosomatics 2000 May-June; 41(3):227-34. Marketplace. With workers' compensation outlays set to rise there's renewed interest in how to contain costs. Moskowitz, D. Med Health 2001 Feb 5;55(6):suppl 1-2. Carpal tunnel syndrome: Is it work-related? Atcheson, SG. Hosp Pract(Off Ed) 1999 Mar 15;34(3):49-56. Cumulative industrial trauma as an etiology of seven common disorders in the foot and ankle: what is the evidence? Foot Ankle Int 2000 21(12)1047-1055.
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