Evidence-Based Medicine (EBM) in Workers’ Comp: A Case Study on Partial Rotator Cuff Tear

Once employers and adjusters understand the value of evidence-based medicine (EBM) in workers’ compensation claims, the next challenge is applying it effectively. EBM helps ensure that medical treatments align with standardized recovery timelines, reducing unnecessary disability durations and claim costs. This article explores a real-world example of how EBM can be utilized to drive optimal claim outcomes.

Case Study: Partial Rotator Cuff Tear – Employer/Adjuster Perspective

Claimant Information

• Employee Name: John Smith
• Job Description: Warehouse worker, loading & unloading boxes
• Injury: Partial Rotator Cuff Tear (ICD-10 M75.11)

As an employer, receiving a claim for a partial rotator cuff tear raises key questions:

1. How long should John be expected to be out of work?
2. Can John be placed in a temporary light-duty role during recovery?

EBM provides clear, data-backed injury duration guidelines to help answer these questions. By referencing authoritative sources like ODG (Official Disability Guidelines) and MDGuidelines, employers and adjusters can make informed decisions about recovery timelines.

Expected Recovery Time for a Partial Rotator Cuff Tear

According to MDGuidelines, the expected injury duration varies depending on the type of work required:

Type of Work	Minimum (Days)	Optimum (Days)	Maximum (Days)
Sedentary	0	3	4
Light	0	3	4
Medium	8	21	42
Heavy	21	42	85
Very Heavy	21	42	85

Interpreting the Data for Return to Work

John’s job as a warehouse worker involves lifting 50-pound boxes, classifying it under the heavy work category. His expected optimum recovery time is 42 days, but he could be back in as little as 21 days or as long as 85 days, depending on individual factors.

However, one of the most common misinterpretations is assuming that John must be completely off work for the full six weeks. This misconception increases claim costs and reduces return-to-work success rates.

Best Practice: Immediate Return to Light-Duty Work

According to EBM principles, 90%+ of injured employees should return to work in a modified-duty capacity within 0-4 days of injury. For John, this means:

• He should be placed in a light-duty role immediately after his injury.
• Tasks could include inventory management, quality checks, or administrative duties that do not require heavy lifting.
• By keeping him engaged at work, the employer reduces indemnity payments and increases the likelihood of a full return to normal duty.

Challenging Inappropriate Work Restrictions

Dr. Jacob Lazarovic, a recognized medical expert, emphasizes that EBM-based injury durations represent the expected physiological healing time. If a treating physician prolongs work restrictions beyond these guidelines, the employer and adjuster should challenge the medical rationale and request supporting clinical evidence.

Key Takeaways

1. Use EBM guidelines to set appropriate expectations for injury recovery timelines.
2. Avoid misinterpreting injury durations—most employees can return to modified duty immediately.
3. Engage in early return-to-work planning to minimize lost time and claim costs.
4. Challenge extended work restrictions if they deviate from evidence-based norms.

By integrating EBM into claims management, employers and adjusters enhance recovery outcomes, control costs, and ensure injured employees return to work efficiently.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%. He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors. IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

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