Update on “Tough Love”

I attended a meeting last night of medical practitioners with an interest in Workers Compensation. Some of them had read my blog article “Tough Love”. There was almost universal agreement that doctors do have a role in explaining to potential claimants the risks and benefits of entering the workers compensation system, as well as providing some indication as to whether they do have a work-related condition, or at least a condition that is consistent with the “stated cause”. While there were some differences in the extent to which the doctors would try to dissuade patients from making a claim there was consensus that doctor’s do have an important role in this area. Interestingly there was one doctor who seemed to disagree. The doctor raised concern from the perspective of a medical indemnity insurer that a doctor might be unfairly using the unequal power of the doctor patient relationship to deny a worker their legal entitlement by being seen to influence a decision about a claim. It was suggested the doctor should complete the certificate in all cases, but annotate the certificate accordingly if there were any doubts in their mind. In Tasmania, there is a box on the certificate where there is the option to indicate that the claimed condition is inconsistent with the stated cause. I think it is fundamentally important that it is the patient’s choice about submitting a claim or otherwise. While a doctor can influence the decision to submit a claim, it is important that, if the worker makes an informed decision to request a workers compensation certificate, that the doctor complies with that request, honestly completing that certificate to the best of their ability and, if necessary, raising any concerns about inconsistency on the issued certificate. It is a nonsense to suggest that doctor’s have no role in informing a worker about the potential negative consequences to their health from our compensations systems. I am interested in comments.

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About Tasworkdoc

As an occupational physician in private medical practice in Hobart, Tasmania - the southernmost state of Australia, I see workers referred by their general practitioners with various types of work-related injuries and diseases. These are mostly musculoskeletal injuries, both of traumatic and gradual onset as well as various associated psychological disorders. With interaction with patients for treatment and providing advice about rehabilitation, I have the opportunity, first-hand, to observe interactions between individual patients and compensation systems. I also conduct independent medical assessments, including impairment assessments for musculoskeletal injuries and asbestos-related disease compensation. This provides another perspective of workers within compensation systems.
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One Response to Update on “Tough Love”

  1. Justice Seeker says:

    I think I have posted on this subject before but will make comment again. If the treating doctor feels the injury is not wholly as a result of the workplace incident they can say so on the certificate but it is up to the legal system to allocate apportionment. In NSW it is legislation that a worker and an employer report a workplace injury and down the track their can be serious consequences if injuries are not reported. An injured worker who fails to report an injury for fear of being treated badly by the insurer can lose all entitlements ie treatment, weekly payments, lump sums as there are time limits for making workers compensation claims. Where would a treating doctor stand if they recommended the injured worker not put in a claim when it later turned out the injured worker lost all such entitlements because they took the advice not to claim? The legal interpretation of such matters may not be understood by medical practitioners so regardless of the fact, and I agree, the injured workers will most likely be made worse to some degree due to the treatment from the insurer, the injured worker is legally obligated to report a work related injury just as the nominated treating doctor is legally obligated to fill out the medical certificate as accurately as they can taking into account the facts they know. The real problem is the reason injured workers are made worse while on workers compensation and this is the issue we need to deal with.
    In my case the insurer actively undermined me and now I have my file where it is all set out in writing I have the proof of what I suspected. The file demonstrates the CM lied to WorkCover when complaints were made, also where the CM stated they had carried out various actions that were never carried out while other matters are omitted from the file. In one email my case manager has communicated to a so called “independent” assessor not to tell me they had sent certain information nor to mention it in their report. Another example demonstrates the IME was told to find my injury was not work related. I was pressured by the insurer in all sorts of ways and found the whole thing did make me worse and if I my treating practitioners had not stood up for me I would most likely not be here to tell the story. I had a legal obligation to put in my claim and I did because my claim was genuine and I would have had nothing if my practitioners had advised me not to make a claim. It is the mismanagement of injured workers that is the problem not the fact a worker is injured, so a treating doctor should act in good faith according to the law not their opinion of the law.

    I just really appreciate the fact my treating practitioners accepted me as a patient rather than as a workers comp claim.
    It is really easy for everyone to view the source of the problem as the worker being on workers compensation and we all know the treating doctor will have to do more work and make more justifications for treatment and will most likely be subjected to bullying from claims managers so ask yourself if the source of your discomfort is what you will have to go through and then ask yourself what your injured patient will go through if you don’t support them. Many good doctors just refuse to take on Workers Compensation patients which is a loss for the patient and a gain for the insurer who is happy when they don’t have to meet their legal obligation to pay genuine claims.
    Thanks for listening!!

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