Healing or Harming? Healthcare Provider Interactions with Injured Workers and Insurers in Workers’ Compensation Systems

Kilgour, Elizabeth; Kosny, Agnieszka; McKenzie, Donna; Collie, Alex

doi:10.1007/s10926-014-9521-x

Cited by 87 publications

(46 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent paper about the scheme argued that ‘in spite of an abundance of government recommendations and scholarly evidence prioritising timely return to work for injured workers, the NSW Workers’ Compensation Scheme systematically fails to support this objective’ [26]. The interaction between HCP and the claims managers in the workers’ compensation scheme has been found challenging [27]. It seems that, besides or before implementing an EBM tool, the interaction between HCP and claims managers, and claims manager training should be improved.…”

Section: Discussionmentioning

confidence: 99%

Health care professionals’ attitudes towards evidence-based medicine in the workers’ compensation setting: a cohort study

Elbers

Chase²,

Craig

et al. 2017

BMC Med Inform Decis Mak

View full text Add to dashboard Cite

BackgroundProblems may arise during the approval process of treatment after a compensable work injury, which include excess paperwork, delays in approving services, disputes, and allegations of over-servicing. This is perceived as undesirable for injured people, health care professionals and claims managers, and costly to the health care system, compensation system, workplaces and society. Introducing an Evidence Based Medicine (EBM) decision tool in the workers’ compensation system could provide a partial solution, by reducing uncertainty about effective treatment. The aim of this study was to investigate attitudes of health care professionals (HCP) to the potential implementation of an EBM tool in the workers’ compensation setting.MethodsThe study has a mixed methods design. The quantitative study consisted of an online questionnaire asking about self-reported knowledge, attitudes and behaviour to EBM in general. The qualitative study consisted of interviews about an EBM tool being applied in the workers’ compensation process. Participants were health care practitioners from different clinical specialties. They were recruited through the investigators’ clinical networks and the workers’ compensation government regulator’s website.ResultsParticipants completing the questionnaire (n = 231) indicated they were knowledgeable about the evidence-base in their field, but perceived some difficulties when applying EBM. General practitioners reported having the greatest obstacles to applying EBM. Participants who were interviewed (n = 15) perceived that an EBM tool in the workers’ compensation setting could potentially have some advantages, such as reducing inappropriate treatment, or over-servicing, and providing guidance for clinicians. However, participants expressed substantial concerns that the EBM tool would not adequately reflect the impact of psychosocial factors on recovery. They also highlighted a lack of timeliness in decision making and proper assessment, particularly in pain management.ConclusionsOverall, HCP are supportive of EBM, but have strong concerns about implementation of EBM based decision making in the workers’ compensation setting. The participants felt that an EBM tool should not be applied rigidly and should take into account clinical judgement and patient variability and preferences. In general, the treatment approval process in the workers’ compensation insurance system is a sensitive area, in which the interaction between HCP and claims managers can be improved.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-017-0460-2) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 99%

Health care professionals’ attitudes towards evidence-based medicine in the workers’ compensation setting: a cohort study

Elbers

Chase²,

Craig

et al. 2017

BMC Med Inform Decis Mak

View full text Add to dashboard Cite

show abstract

“…Several studies have found that access to healthcare for IW may be negatively affected by physician aversion to the gatekeeping role [Ison, ; Lax and Manetti, ; Lippel, ; MacEachen et al, ; Kilgour et al, ,], including bureaucratic requirements [Kosny et al, ; Kilgour et al, ] and increased scrutiny [MacEachen et al, ], that sometimes affects their treatment choices because of the need to provide “objective findings” [Ison, ; Lax, ]. A study of Ontario doctors treating patients covered by WC found they resented the time required to complete the forms, the repeated requests for more and more precise evaluations and being ignored after providing advice on treatment or functional abilities [MacEachen et al, ], findings confirmed in our study.…”

Section: Discussionmentioning

confidence: 99%

“…While several studies have examined the workers’ perception of the compensation process [Kilgour et al, ] only a few have specifically focused on the experience of doctors involved in compensation systems [Kosny et al, ; Murgatroyd et al, ; Kilgour et al, ; Brijnath et al, ], or in sickness absence certification [Gerner and Alexanderson, ].…”

Section: Introductionmentioning

confidence: 99%

The structure and process of workers’ compensation systems and the role of doctors: A comparison of Ontario and Québec

Lippel

Eakin

Holness

et al. 2016

American J Industrial Med

View full text Add to dashboard Cite

show abstract

“…Internationally, compensation schemes are based on mechanism of injury and/or type of disability, and/or governing legislation to access financial entitlements. Notwithstanding that, themes from qualitative research appear to be consistent across jurisdictions and countries [21, 22]. Further, increased BMI has been associated with greater absenteeism, healthcare costs and claim rates across numerous jurisdictions, albeit in larger cohorts [55, 56].…”

Section: Discussionmentioning

confidence: 99%

Predictors of seeking financial compensation following motor vehicle trauma: inception cohort with moderate to severe musculoskeletal injuries

Murgatroyd

Harris

Chen

et al. 2017

BMC Musculoskelet Disord

View full text Add to dashboard Cite

BackgroundCompensation related factors have been repeatedly associated with poor recovery following orthopaedic trauma. There is limited research into the factors associated with seeking financial compensation. Further understanding of these factors could facilitate injury recovery by purposeful compensation scheme design. The aim of this study was to investigate the predictors of seeking financial compensation, namely making a claim and seeking legal representation, following motor vehicle related orthopaedic trauma. The study was conducted in New South Wales (NSW), Australia, in motor vehicle crash and workers’ compensation schemes.MethodsParticipants were patients admitted with upper or lower extremity factures following a motor vehicle crash to two trauma hospitals. Data were collected at baseline within two weeks of injury. Participants were followed up at six months. Analysis involved: descriptive statistics for baseline characteristics; comparison of compensable and non-compensable participants with Analysis of Variance (ANOVA) and chi-squared tests; and logistic regression for predictor models.ResultsThe cohort consisted of 452 participants with a mean age 40 years; 75% male; 74% working pre-injury; 30% in excellent pre-injury health; 56% sustained serious injuries with an Injury Severity Score (ISS) 9-15; 61% had a low-middle range household income; and 35% self-reported at fault in the crash. There was no significant difference in pre-injury/baseline health between compensable and non-compensable participants. Follow up data was available for 301 (67%) participants.The significant predictor of claiming compensation in the adjusted analysis was higher body mass index (BMI) (overweight Odds Ratio [OR] 3.05, 95% Confidence Interval [CI] 1.63-5.68; obese OR 1.63, 95% CI 0.83-3.20). Participants less likely to claim were: involved in a motorcycle crash (OR 0.47, 95% CI 0.28-0.82); socioeconomically less disadvantaged (OR 0.37, 95% CI 0.17-0.82) or least disadvantaged (OR 0.39, 95% CI 0.17-0.90); at risk for short term harm (injury) due to alcohol consumption (OR 0.56, 95% CI 0.32-0.97); and with fair-poor pre-injury health (OR 0.30, 95% CI 0.09-0.94). The predictors for seeking legal representation were speaking a language other than English at home (OR 2.80, 95% CI 1.2-6.52) and lower household income (OR 3.63, 95% CI 1.22-10.72). Participants less likely to seek legal representation were least socioeconomically disadvantaged (OR 0.15, 95% CI 0.04-0.50).ConclusionsSeeking financial compensation was associated with a higher pre-injury BMI rather than injury-related factors. Seeking legal representation was solely related to socio-economic factors.

show abstract

Healing or Harming? Healthcare Provider Interactions with Injured Workers and Insurers in Workers’ Compensation Systems

Cited by 87 publications

References 52 publications

Health care professionals’ attitudes towards evidence-based medicine in the workers’ compensation setting: a cohort study

Health care professionals’ attitudes towards evidence-based medicine in the workers’ compensation setting: a cohort study

The structure and process of workers’ compensation systems and the role of doctors: A comparison of Ontario and Québec

Predictors of seeking financial compensation following motor vehicle trauma: inception cohort with moderate to severe musculoskeletal injuries

Contact Info

Product

Resources

About