Through my work as an occupational physician, I regularly interact with doctors who have a variety of roles in the assessment and management of work-related injuries. Most often I am a member of a team of treating health professionals, but at times as an independent medical examiner, I provide analysis and critique of other doctor’s opinions.
I tend to see patients with injuries that take longer to resolve or require intervention including some who require spinal and other types of surgery. There are more frequently chronic pain patients than in general practice. As an independent medical examiner, I see workers involved in litigation, often having had a prolonged and frustrating period in the workers compensation system.
I have taken a particular interest in other doctor’s views about workers’ compensation issues and have surveyed views of local specialists who interact frequently with the system and participated in discussions with doctors who have concerns about managing patients within compensation systems. While I have not conducted a scientific study of doctors opinions, I can make a number of observations from my perspective.
Doctors have a spectrum of views about workers compensation including some who are cynical about any patient who claims workers’ compensation benefits. Most doctors with a focus on treatment and who interact with the system however are negative about the processes adopted by insurers and the opinions of independent doctors engaged by the insurers.
Doctors have concerns about increasing impositions from claims management practices and legal involvement. Some are reporting difficulty providing care under these constraints and some no longer see workers compensation patients for these reasons.
Doctors have expressed concerns about delays to the provision of appropriate care due to problems with access to consultant medical practitioners and, at times, control over selection of consultant level care by insurers.
Doctors express concerns that there are more requests from insurers to provide reports to justify investigation and treatment expenses. This extends not just to the costs of expensive procedures, but can extend to matters as simple an imaging investigation or the addition of a new medication.
Doctors express concerns that approval for recognised investigation and treatment procedures are often rejected or decisions delayed on the basis of clerical decisions or the opinions of doctors contracted by the insurance industry i.e., from independent medical assessors. There are often significant delays waiting for an insurer to obtain an independent medical opinion to approve a relatively straightforward investigation or treatment procedure.
Doctors are concerned that delays or rejection of funding for recommended treatment can have significant implications for recovery. This has negative consequences for the patient’s psychological health, compounding the risk of a poor outcome.
There are concerns that independent medical assessors at times provide opinions outside their area of expertise, are not up to date in their knowledge of current practice or consider only selected information provided by the insurer. Unnecessary independent medical reviews can lead to confrontation changing the mind-set of the patient to proving their case with detrimental effects on recovery.
Doctor can become overwhelmed by requests from insurers for reports of a medico-legal nature. This can contribute to delays in timely responses from the doctors and reduces their availability to provide treatment and care.
Doctors express concern about reluctance by insurers to fund interventional pain procedures and some surgical procedures.
Doctors are concerned that rehabilitation providers lack independence from the insurers who directly appoint them and fund their services. They sometimes provide advice to the patients, insurers about treatment, or where to seek treatment, outside of their field of expertise. At times rehabilitation providers document an unrealistic ‘return to work’ goal without any understanding of the injury prognosis or discussion with the treating practitioners. This creates wrong expectations for those involved. Unnecessary attendance by the rehabilitation at every doctors appointment can waste time and resources.
Doctors are concerned that insurers often resist funding for retraining and redeployment when it is clear that an injured patient cannot return to their pre-injury work. The focus by insurers is often on return to pre-injury work without recognising when this is not achievable.
Doctors are concerned about unnecessarily confrontational systems to resolve claims where patients reach maximal medical improvement, but are unable to return to their pre-injury work. With the current system insurers can only resolve matters by seeking negative reports from independent doctors to bring matters to settlement. This can be a damaging process psychologically to the worker.
In summary, there are many concerns expressed by doctors about the workers compensation system in Tasmania. Doctors are a key part of the system to provide necessary care for injured workers. Withdrawal from the system by doctors can only degrade the outcomes achieved. The designers of our workers compensation system need to take into account doctor’s views, not just the views of the employers and workers and their representatives.