Workers' compensation injuries and illness are often associated with inappropriate care, poor outcomes, and needless disability. System design and resulting behaviors contribute to increased claims 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:  Achieving Better Outcomes.” The goal is to provide attendees with insights and tools that will promote functional recovery.

As a nation, as employers, and as insurers, today we confront ever-increasing costs from poor health and disabilities. As individuals dealing with injury or illness we face the personal risk of living possibly diminished lives—even when we may not need to. Common conditions of life such as back pain, degenerative changes associated with aging, and sleep difficulties are labeled as clinical conditions needing treatment—and providing income for health care providers, pharmaceutical companies, and attorneys. Causation, particularly for chronic conditions, is often based on self-reports, not evidence-based medicine (with analysis of cause, effect and relationship between cause and effect).  

The AMA Guides to the Evaluation of Permanent Impairment are purposefully misapplied to increase the ratings (confirmed in many studies). Workers are inappropriately removed from work, depriving them of the healthy benefits of work. These problems are seen because the design of the system drives certain behaviors, particularly with certain health care providers and attorneys.

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

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

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

In “Part II: Early Intervention in Chronic Pain Claims: Not Just A 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 best practices approach to managing chronic pain claims. The model is now proven to help avoid both the over-medicalization of patients and needless mental health diagnoses with their invariably protracted palliative symptom management. The pain screening questionnaire will be introduced as an evidence-based tool to identify these injured workers.

In “Part III: Successful Outcomes through Non-Interventional Pain Rehabilitation,” Michael J. Webb, MD, regional medical director of Liberty Mutual Insurance, and Virgil Wittmer, PhD and Mark Hoffman, MD of Brooks Rehabilitation Center, will discuss the importance of both appropriate diagnostic and therapeutic interventions, and teaching patients to regain control of their lives.