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How Doctors’ Opinions Prove Major Cause In Comp Cases

Injured workers who must prove they need treatment primarily because of their work injury depend on their doctors’ opinions to do so. What makes for a legally convincing medical opinion?

 

Recent changes in the Workers’ Compensation law which require a showing of “major cause” in some contexts have created a semantic challenge both for lawyers representing injured workers and the physicians called upon to render care and opinions regarding the need for this care. The purpose of this article is to show how the law understands your words, so you may avoid being misinterpreted.

THE DOCTOR’S WORDS

One recent case, as reported in our last issue, says that if the doctor says the work injury was the “major” cause of the worker’s immediate need for treatment, that the worker will be compensated for this injury. Another court decision ruled that if the doctor calls the injury the “precipitating” cause of the need for treatment (or says the injury “precipitated” the need for treatment), then that is not good enough for the injury to merit compensation.

As the doctor, you are dragged into the middle of this. If you believe that your patient’s work exposure or injury is the main reason your patient now needs treatment (or is disabled), then using expressions like “major cause” and “primary cause” are more likely to help your patient obtain compensation. On the other hand, using the word “precipitating” may be more akin to placing your patient on a “precipice”!

THE DOCTOR’S REASONING

Those making comp decisions will be looking not only at your words, but also at your reasoning. It need not be sophisticated. It may be simple common sense – such as the fact that your patient had no symptoms or need for treatment before the injury (or was not disabled before the injury), plus the medical fact that the type of exposure is the kind which can cause the symptoms or conditions for which treatment has been rendered, therefore the major cause of the patient’s immediate need for treatment (or present disability) after the injury is the work exposure. But this is only the first step.

Here’s the second step: Your reasoning must also take into account other potential causes. When you are called upon for an opinion on “major cause,” the context is usually one of those situations where a “pre-existing condition” is claimed to be a causal factor. So, if you compare the relative causal contribution of the work exposure (say, a back injury) to the causal contribution(s) of “pre-existing” condition(s) (say, asymptomatic disc disease) relative to why your patient now needs treatment (or is disabled), then you will assure the decision-makers that you have taken into consideration the other possible causes, when you conclude the work injury to be the major cause. In short, having identified the “major” cause, you are now identifying the more minor cause(s) you are comparing it to. If this is not stated clearly, the decision-makers will find your answer incomplete and your patient will not receive compensation.

One way to evaluate relative degrees of cause is to assign percentages to each potential cause, as each relates to the disability or the need for treatment of your patient’s “combined condition”.

For example, if your patient comes in with severe low back pains after a lifting incident at work and diagnostic imaging reveals a previously unknown or asymptomatic degenerative disc condition, you may be asked to identify the major cause of his/her present need for treatment (and/or disability). Or your patient’s “pre-existing conditions” may be a history of low back problems or even low back surgery, but no symptoms or restrictions at the time of the work injury.

The answer most useful legally to your patient will identify which of these potential causes (the work incident or the pre-existing) is the major reason your patient now needs treatment and/or is disabled (assigning percentages of causation, if you wish) and will explain the reasons for your opinion.

In our last issue we recommended consulting with your patient’s attorney before doing a deposition. We hope this article will help insure that your answers are applied in the way you intended.

This article was prepared by Robert L. Chapman

Posted in: Workers' Compensation Lawyer Articles