Workers' compensation injuries and illness are often associatedwith inappropriate care, poor outcomes, and needless disability.System design and resulting behaviors contribute to increasedclaims and needless costs, both human and financial.

On Aug. 18, at the National Workers' Compensation Review,associated with the Workers' Compensation Institute, in Orlando,there will be a unique “Focus On” session on “This Is Your Claim—Not On Drugs: AchievingBetter Outcomes.” The goal is to provide attendees withinsights and tools that will promote functional recovery.

As a nation, as employers, and as insurers, today we confrontever-increasing costs from poor health and disabilities. Asindividuals dealing with injury or illness we face the personalrisk of living possibly diminished lives—even when we may not needto. Common conditions of life such as back pain,degenerative changes associated with aging, and sleep difficultiesare labeled as clinical conditions needing treatment—and providingincome for health care providers, pharmaceutical companies, andattorneys. Causation, particularly for chronic conditions, is oftenbased on self-reports, not evidence-based medicine (with analysisof cause, effect and relationship between cause andeffect).

The AMA Guides to the Evaluation of Permanent Impairment arepurposefully misapplied to increase the ratings (confirmed in manystudies). Workers are inappropriately removed from work, deprivingthem of the healthy benefits of work. These problems are seenbecause the design of the system drives certain behaviors,particularly with certain health care providers and attorneys.

Unfortunately, this ultimately takes its toll on workers bycreating a perspective that they are injured and ill, that theiremployers caused the problems, and they are permanently disabled.This is seen as an increased indemnity claims frequency. It ischallenging to identify the specific solutions; however, weneed to change “the system” so it provides benefits to those thatneed them and does not diminish lives. We need to educate andempower workers to make better decisions so they are living“abled,” not disabled; and we need to hold all stakeholdersaccountable for their actions that result in needless disability.These changes will require a biopsychosocial perspective and theapplication of evidence-based medicine.

In today's approach to our health and the management ofpotential disability, we seem to have missed an essentialcomponent: the importance of educating and empowering each of us totake greater responsibility for our own health and well-being.Increased knowledge, combined with positive coaching, can help uswork through the complex maze of systems and issues to achieve ourbest possible outcomes–and thereby reducing costs.

The first of the three-part “Focus On” presentations on Aug. 18is “Part 1: New Ideas for Your Worst Claims.” Jennifer Christian, M.D., MPH, president ofWebility, will discuss how to avoid poor claims outcomes by using a“biopsychosocial” approach which includes biological,psychological, and social elements. Our mind-body connections aresurprisingly strong. Physical, social, and work environmentsall affect health. Approaching claims strictly on a“biomedical” basis often results in poor outcomes. Pooroutcomes are often associated with social problems (such aslitigation or relationship issues) and behavioral issues.

In “Part II: Early Intervention in Chronic Pain Claims: Not JustA Truism Any More,” Michael Coupland, C Psych, R Psych, CRC,president of Integrated Medical Case Solutions; Jacob Lazarovic,MD, chief medical officer of Broadspire; and W. Frederick Uehlein,chairman of Insurance Recovery Group, will explain new bestpractices approach to managing chronic pain claims. The model isnow proven to help avoid both the over-medicalization of patientsand needless mental health diagnoses with their invariablyprotracted palliative symptom management. The pain screeningquestionnaire will be introduced as an evidence-based tool toidentify these injured workers.

In “Part III: Successful Outcomes through Non-InterventionalPain Rehabilitation,” Michael J. Webb, MD, regional medicaldirector of Liberty Mutual Insurance, and Virgil Wittmer, PhD andMark Hoffman, MD of Brooks Rehabilitation Center, will discuss theimportance of both appropriate diagnostic and therapeuticinterventions, and teaching patients to regain control of theirlives.