In two published studies in the Spine Journal in 2007 and 2008, by Dr. Eugene Carragee of Stanford University, it was shown that injured people do not always report their pre-injury condition to their medical provider. While Dr. Carragee’s study was based on automobile accidents, its results are applicable to workers compensation.
Patients reporting back and/or neck pain after an accident are normally asked whether there were spinal problems before the accident, with the reported pre-accident status being accepted at face value. The treating physician normally relies on the self-reported history of the injured employee. The employee’s history is central to the physician’s diagnostic, therapeutic, and prognostic decisions. [WCx]
Per Dr. Carragee’s studies, injured people do not recall their pre-accident history all that well, or choose not to be accurate in the recounting of prior spinal problems. The majority of the patients were “somewhat partisan” in their recollection of their own medical history. In a large multi-clinic random sample, 48% of the patients denied previously documented back pain and 42% of them denied previously documented neck pain.
In a random audit of pre-accident medical records, 76% of the injured parties did not accurately report their pre-accident medical history. Pre-existing conditions such as previous neck or back pain, drug or alcohol abuse, and psychological diagnoses were not properly or fully disclosed to the medical provider. Among injured parties with attorneys making compensation claims, 80% had a significant history of axial pain and/or comorbidities not disclosed in the spinal clinic evaluation.
In traffic accidents where the injured person considered the accident to be someone else’s fault, the injured people reported a much lower level of pre-accident spinal symptoms and psychological problems than would be expected from population based norms.
The reporting of medical history was also poor when the injured persons considered the accident to be their fault. People with a history of back pain and/or psychological troubles under reported their prior medical histories as well, just not to the extent of the injured people who considered the accident to be someone else’s fault.
Employers who are faced with sizeable workers compensation claims for neck and/or back injuries should seek to verify the employee’s pre-accident medical history. A medical authorization from the employee should be obtained along with a list of the employee’s prior medical providers. As noted above, the employee’s memory of prior medical issues may be faulty. A hospital sweep and a clinic sweep where an investigative service (most large surveillance companies do this) contacts all local medical providers to obtain the employee’s prior medical history can be beneficial. This is especially so if the current medical provider is considering surgery, or if the current medical provider is providing a permanent partial impairment rating.
If your state employment laws allow to ask employees about their medical history with a job application, be sure to ask about diabetes, hypertension, psychological problems, and other medical issues. Be sure to ask about any prior neck or back spinal problems. The job applicant is more likely to accurately report prior medical issues when there is not a claim than later when an injury occurs. A copy of the medical history should be provided to the claims adjuster whenever the pre-accident medical history is applicable. We are NOT saying these conditions will disqualify a person who has been offered a job, but in some states, such as Ohio, an employer who hired “handicapped” employees may be entitled to reimbursement if such an employee is further injured on the job. Reimbursement in Ohio is only available if such employees are listed on the inventory of handicapped employees. Interesting, huh?!
By obtaining the employee’s prior medical history, the extent of the disability can be apportioned between the current injury and the employee’s prior medical history. This can lead to a substantial reduction in the cost of the permanent partial impairment.
As the states
vary in how much pre-accident medical information the employer and/or insurance carrier can obtain on a workers compensation claim, please consult with your local legal counsel if you have questions in regards to obtaining the medical history of injured employees.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
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