Are Workers Compensation Patients at a Higher Risk For Permanent Nerve Damage?
Unfortunately patients that have experienced work related spinal injuries follow a clinical pathway that is typically longer than the average private practice patient. Numerous scientific publications state the clinical outcomes of patients treated for work related spinal injuries are significantly poorer long term in regards to leg or arm pain, weakness, and or numbness when compared to patients involved in the spinal treatment clinical pathway provided by conventional third party payers.
Workers Compensation organizations tend to have a rigorous process for reporting possible work related injuries. In the case of a spinal injury resulting in a symptomatic pinched nerve a race against time before the onset of permanent nerve damage begins. Patients relying on workers compensation benefits to assume financial responsibility for their medical claims, have to not only seek medical treatment, but first prove to their employer’s workers compensation carrier that they have the right for benefits to be applied to their medical condition. This process of obtaining approval for workers compensation benefits can take up valuable time (several months) when a nerve is possibly at risk for permanent damage.
The tactics used by the workers compensation carriers to shake out false claims is understandable. However, it seems the stance that all workers compensation claims are false until proven legitimate can have long term consequences for these patients. Some legitimate claims lack witnesses or significant documentation while other legitimate workers compensation patients become frustrated by the process and abandon it altogether and seek medical treatment in other capacities. In either scenario a financial benefit to workers compensation is obtained. The patient with legitimate claims that perseveres through the approval process is usually physically too impaired to perform work. Before treatment on this patient population can begin the symptoms relating to their work related spine injury are usually more advanced than when they initially set out to seek medical treatment. In the clinical pathway, for patients whose medical financial obligations are tied to a conventional third party payer the valuable time wasted on an approval process is not a factor unless a primary care physician referral to a specialist is needed to satisfy HMO requirements. This extra step for the conventional third party payer environment only represents one extra patient encounter.
Once benefits are approved, the WC patient must only visit the physician approved by the workers compensation carrier. Once the treatment process begins, WC compensation patients cannot schedule tests, treatments, follow up appointments, and surgeries like normal conventional third party paid patients. Each future encounter must be approved by the workers compensation carrier prior to being scheduled. Other potential delays in the WC clinical pathway come by way of peer to peer conferences between the treating physician and the approving physician for the WC carrier.
The significantly poorer long term clinical outcomes of workers compensation spine claim patients compared to the long term clinical outcomes of patients who have entered the medical care system by way of a conventional third party payer can also be linked to the following statistics. The majority of workers compensation claims are filed by employees that perform physical tasks and are at a higher risk of injury than employees who are assigned to a desk full time. Published scientific data suggest long term professional physical labor can be a catalyst for degenerative disc disease. This condition can make the disc more vulnerable to a disc injury causing a pinched nerve and make the employee’s spinal column more prone to developing spinal stenosis due to a loss of disc height at multiple levels. Using return to work as a metric of comparison is not in favor of most WC spinal injury patients also due to the physical nature of the employed position in which they were functioning.
Chronic degenerative spine diseases have been linked to permanent nerve damage in the regions of the central or peripheral nervous systems. Patients that have been treated well after the onset of a symptomatic pinched nerve vs those who are treated immediately experience a higher instance of nerve damage. The scientific publications that deal with patient spinal treatment clinical outcomes with respect to the workers compensation population have not addressed the lag time or extra measures and the amount of time that is spent on them.
In conclusion, workers compensation patients experience an approval process that wastes valuable time when a nerve is at risk for permanent damage. Can this process be negligent in the cases of permanent nerve damage if a timely intervention could have save the nerve from permanent damage?
