The current workers' compensation system is a medical driven legal compromise, commonly described as the "grand bargain" between employers and labor.
The impact of the workers' compensation system was clearly stated as long ago as 1982, by Florida District Court of Appeals Judge E.R. Mills, in the case of Singletary v. Mangham Construction (418 So.2d 1138). According to Judge Mills, "Workers' Compensation is a very important field of law, if not the most important. It touches more lives than any other field of the law. It involves the payments of huge sums of money. The welfare of human beings, the success of business, and the pocketbooks of consumers are affected daily by it."
Interacting with the workers' compensation system
Approximately 30 percent of patients seen at an average orthopaedic practice are workers' compensation patients. Fractures, back pain, and musculoskeletal pain of undetermined origin are some of the most common kinds of orthopaedic issues treated in these patients.
Although orthopaedists have the most training in treating musculoskeletal conditions, they often lack training in "occupational" considerations. In workers' compensation cases, the physician is often asked questions regarding causation, diagnosis, treatment, outcome, return-to-work guidelines, and impairment. Although these concepts are familiar to most orthopaedists, interacting with the workers' compensation system can often increase the demands on the physician through administrative, insurance, legal, and government-based burdens.
Although improvements in the workers' compensation system could be made, the current state-based system remains the most suitable means of addressing workplace injuries. As physicians, we will probably have little influence on future legislative changes, but we can have an immediate and effective impact on the outcomes and the quality of life for our patients.
Similar skills are required to treat and enable an individual to return to activities—whether the individual is an athlete returning to sports or an injured worker returning to work. The expertise of how to determine and report causation, diagnosis, treatment, outcome, return to work, and impairment is available from the Academy. This know-how reduces the "burden" and improves the outcomes.
For this reason, the AAOS annually sponsors a continuing education course on workers' compensation subjects. This course is designed to provide fresh perspectives and develop skills for treatment options, patient care management, and strategies for handling both nonmedical and medical issues associated with treating workers' compensation patients.
J. Mark Melhorn, MD, is the course director for "Workers' Compensation and Musculoskeletal Injuries: Improving Outcomes with Back-to-Work, Legal, and Administrative Strategies" and the linked course "AAOS Expert Witness: Solving the Legal Quagmire of Medical Liability—Methods and Insights."
This year, the AAOS course, "Workers' Compensation and Musculoskeletal Injuries: Improving Outcomes with Back-to-Work, Legal, and Administrative Strategies," will be held Nov. 4 to 6 in Chicago. It will be preceded by a linked course, "AAOS Expert Witness: Solving the Legal Quagmire of Medical Liability—Methods and Insights." on Nov. 3. For more information, visit http://www.aaos.org/coursecalendar/