Employee injuries and medical conditions can have a seriousimpact on any employer, whether they developed as a result ofsomething that happened in the workplace or outside of it. However,do you know which components of your employee's injury are directlyrelated to his or her on-the-job accident?

On August 22, as the Workers' Compensation EducationalConference had just begun, attendees were immersed in science forthe breakout entitled “Using Health Science to Resolve Workers'Compensation Claims: Why Evidence-Based Medicine is Important.”Discussion revolved around the ways in which science can helpensure that an employee is not overpaid for a work-related injurythrough the teaching of which elements of a patient's condition maybe unrelated to his or her on-the-job accident. Attendees heardfrom physicians, defense attorneys, and more while learning how tobe objective.

“The full-day breakout for evidence-based medicine issues is atribute to the impact of evidence-based medicine in the practice ofmedicine and claims handling,” said Steve Tipton, an attorney withFlahive, Ogden & Latson out of Austin, Texas who was involvedin the breakout. “This is where medical practice and the law is—orshould be—going.”

Evidence-based medicine can be used by medical providers toachieve best practices; by risk managers in exploring predictiveoutcomes and controlling medical costs; by claims handlers indetermining what questions to ask and issues to pursue; and byattorneys in crafting valid evidence that can withstand legalattack—who then identify and exploit the limitations of opposingevidence.

“Establishing causation is a crucial medicolegal element ofproof for a workers' compensation claimant and his or her medicalproviders,” Tipton said. “It is an important research activityaffecting the delivery of good medical care.”

Tipton explained that only recently has there been a broad,aggressive move to make this a routine and truly scientificexercise on the state level in the workers' compensation context.One example of this is the state of Texas, which, among otherstates, provides an invaluable evidence-based tool for medicalproviders and carriers in evaluating causation and treatment issuesafter having adopted the Official Disability Guideline (ODG) as theofficial treatment guideline applicable to workers' compensationclaims.

Texas law now requires the use of and defines “evidence-basedmedicine,” “best evidence,” and “evidence-based standards” as theproper and preferred sources for medical and scientific evidence.The state also defines an expert opinion as “a belief or aninterpretation by specialists with experience in a specific areaabout the scientific evidence pertaining to a particular service,intervention, or therapy.” Essentially, the dominant portion ofexpert testimony must be about scientific evidence rather thanpersonal opinion.

The final presentation during this multi-session breakout wasentitled “How to Examine a Doctor Using Evidence-Based Medicine,”and included a panel discussion in which Tipton participated. Hedescribed it as a “nuts and bolts”-type presentation of specific,real fact scenarios. Amidst discussion of causation, diagnosis, andtreatment was conversation regarding what information should beelicited from opposing experts while questioning their credibilityand validity of their conclusions as well as using the toolsavailable in various states to reinforce the testimony of afriendly expert opinion.

Tipton pointed out that as U.S. Supreme Court Justice StephenBreyer once said, “In this age of science, science should expect tofind a warm welcome, perhaps permanent home” in U.S. courtrooms.Breakthroughs in the field of science will no doubt continue toconfirm the need for evidence-based medicine in the insuranceindustry, especially for those dealing with workers' compensationcases.