Inherent conflicts of interest in worker’s comp


On the job the dangers will lurk

If your boss is a jerk

     Work compensation

     With no documentation

Can’t distinguish illness from shirk.

Workman’s compensation is a system whereby an employee, injured on the job, receives medical care for the damages that result.  It’s the right principle. 

As in a lot of other arenas, principles can be misapplied.

The law in Nebraska says an injured worker needs to first report the injury to the firm or its representative, then pick out a doctor; the workplace may provide medical care on site, but the worker can choose any doc he or she wants.  Parameters specify that in the face of inadequate progress, the employers can specify a different doctor. 

In Iowa, by law, the employer picks the doctor. 

The system leaves room for a  lot of abuse on both sides of the river, for both employer and employee.

Work comp constituted a third of my business before St. Luke’s started their Occupational Health division.  I enjoyed the work while at the time, but when it evaporated I didn’t miss it.

Because I have minimal ability in ASL, the language of our deaf community, several employers have sent difficult patients to me.  Sometimes the language barrier constituted the problem, other times the patient didn’t want to get better, and on at least one occasion, the problem fell outside my area of expertise.

Last week the John Morrell hog slaughter plant shut down, but even after most of the people left the clean-up crew kept working.  One employee, of whom I have no personal knowledge, mixed bleach with acid, releasing chlorine gas.   Several workers became patients after wheezing developed.  Because John Morrell conducts business in Iowa, and because of the probability of long-term residual lung damage, I advised reporting to workman’s comp.

Once, a very large patient came in with hand pain, claiming an injury a few hours before at a packing plant.  The x-rays confirmed my suspicions, and when I came back into the exam room I confronted the worker.  “This is what’s called a boxer’s fracture,” I said and pointed at the knuckle of the little finger.  “It happens when you punch a stationary object.  It doesn’t happen the way you claim, when you fall off a box car and try to catch yourself.  You’re lying and I’ll testify to that in court.  I’ve talked to your boss and they’re willing to forego prosecution on fraud charges if you’ll drop your work comp claim now and go find another doctor.”

Several months later, the same patient came in, quite ill with a non work-related illness.  I said, “Last time you were here, you threatened to throw me off a box car.  Do you remember that?”  The patient didn’t.  “Do you still want me to treat you today?”  The patient did.  As always, I gave the patient my absolute best. 

I have had more patients injured on the job who didn’t want to turn in a work comp claim than patients who fraudulently wanted workman’s compensation.  They feared, unnecessarily, for their job.   I suspect that those without good documentation don’t report on the job injuries as much as they should.

It’s been my impression that the Iowa system brings slightly more fraud than the Nebraska system.  Workers distrust the company doctor (a sentiment, alas, occasionally justified) because of an obvious conflict of interest.  They don’t see that every doctor treating on-the-job illness has a first obligation to the patient and a second obligation to the employer.

One patient had a legitimate work related injury with abnormal MRI findings.  Over the course of years I did the best I could and obtained consultations when progress slowed.  Eventually we found a combination of limited work for part of the day and unlimited work part of the day, and kept the patient working.  Till a foreperson ordered unrestricted work, and the injury got worse.  After the patient reached maximum medical improvement, the patient was effectively fired for being injured.

I haven’t said, “Get a lawyer.”  I don’t know if I should, or if I even need to.  We have enough of them advertising on TV.

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One Response to “Inherent conflicts of interest in worker’s comp”

  1. Renae Steel Says:

    There’s good info here. I did a search on Google, Keep up the good work mate!

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