You see many patients. You are always pressed for time, knowing another patient is waiting. But taking the time to elicit a good history of any related prior problems is critical to your patients’ work related claims.
A good history – along with an analysis of the bio-mechanics of the incident and objective medical findings – is key to determining whether your patient’s injury or condition was caused by the work-related event/exposure.
This is particularly important with occupational diseases which always must be proven to be the major cause of the condition or need for treatment. The doctor must weigh the relative contribution of all actual causes – work related and other – to the condition or disease.
Please explain your analysis. The doctor with the most well-reasoned analysis gets the judge’s nod. This calls for a clear understanding of both the past history and the ergonomics/bio-mechanics of the job task. Ask your patient to go through the motions he/she goes through at work! Claims are lost when physicians don’t have an accurate picture of the work activity. The reasoning of the analysis suffers accordingly.
Your opinion, as the treating physician, is very important to your patient’s Workers’ Compensation claim.
Generally, deference is given to the treating physician’s opinion unless there are persuasive reasons to reject it. However, when medical opinion is divided, the most weight is given to opinions which are well-reasoned and based on complete information.
A treating physician’s opinion may be rejected if it is conclusory or without analysis; if there’s no continuity in the chart notes; if it offers inconsistent opinions; if it lacks a complete history; and if it fails to weigh prior medical problems.
In a recent case before the Workers’ Compensation Board1, a worker’s twice-denied claim was found compensable despite several opposing medical opinions. The treating doctor’s opinion was given deference, not only because he was the treating doctor, but also because his opinion was well-reasoned and based on complete and accurate information.
The doctor repeatedly associated the worker’s low back problems and ultimately his lumbosacral disc herniation to the awkward position the patient had to assume to operate his machine at work. The doctor noted that this position was very uncomfortable to the patient’s back, which produced chronic back strain. Ultimately, the disc herniations were highly probably the results of this work position.
By contrast, the opposing doctors’ positions were lacking. One doctor said the disc herniation was not related to work, but this opinion was rejected as conclusory since no adequate explanation was offered.
Another doctor said the low back problems were the result of natural causes (i.e. spondylosis), but none of the records reviewed diagnosed spondylosis. Nor did degenerative changes appear significant on an MRI. This doctor’s opinion was rejected since it relied on an erroneous assumption not supported by the record.
Another doctor concluded the worker’s back problems were not work-related after viewing a video of the worker at work. However, the video had been taken after modifications had been made to claimant’s work site and so did not accurately reflect the conditions when the worker was developing his low back problems. This doctor’s opinion was also based on medical records relating to another region of the worker’s back. Based on these inaccuracies, this doctor’s opinion was of “little persuasive weight.”
It took two levels of legal review for these flawed medical opinions to come to light. Fortunately, this worker persisted and was properly compensated. This illustrates the types of errors which could compromise the deference usually afforded to treating physicians’ opinions. That’s why a treating physician who presents a well-reasoned analysis based on a complete and accurate understanding of the patient’s medical history and work situation is so vital. A worker’s livelihood and home may be on the line.
This article was prepared by Arthur W. Stevens, Ill