Knocking at the wrong door: insured workers' inadequate psychiatric care and workers' compensation claims

ObjectiveTo describe the prevalence of inadequately evaluated and treated psychopathology among insured workers making workers' compensation claims for psychiatric disability whose cases were reviewed by one forensic psychiatrist. To assess the relationship of inadequate evaluation and treatment to the outcomes of these workers' compensation claims.MethodsRecords of a series of 185 workers' compensation cases reviewed in 1998 and 1999 by a California forensic psychiatrist were abstracted. Patient factors (gender, Axis II pathology, psychosocial circumstances, substance abuse), case factors (psychiatric injury secondary to physical injury, or secondary to psychological stresses), type of provider (mental health, or other), adequacy of evaluation and treatment, forensic psychiatrist's recommendation, and claim outcome were categorized. The relationships between case characteristics, adequacy of care, and claim outcome were described.Results22% of cases had adequate evaluation, 48% superficial, and 30% had no evaluation. 11% had adequate treatment, 67% superficial, and 22% had no treatment. Compared to claims for psychiatric disability related to a physical injury, claims related to psychosocial stresses more often had superficial diagnostic evaluations and treatments. Those with superficial treatment were less likely to have their claim granted (19.3%) than those with no treatment (47.5%) or those with adequate treatment (36.8%). Success of claim was not related to provider type.ConclusionsThe majority of the studied workers with employer-provided health insurance who sought workers' compensation for disability due to mental illness did so inappropriately, in that the workplace did not cause the psychopathology. Their seeking workers' compensation was plausibly due to the observed inadequate evaluation and treatment available through their employer-provided health insurance. The adequacy of their care influenced the likelihood their claim would be granted. The relations observed here merit further research to establish their generality and to determine their causes.     

Using decision science to gain insight into ethical issues: an example involving thresholds in workers' compensation.

Systematically analyzing and comparing the ethical dimensions of policy-decision alternatives is remarkably difficult. The ethical implications of a set of decision alternatives, as well as the ranking of that set, are subject to any number of quantitative and qualitative variables, not the least of which is differing individual interpretation. In spite of this, decision science offers a consistent, transparent framework from which to analyze the ethical components and implications of policy decisions. Workers' Compensation insurance programs are state-governed systems of insurance in which workers, in exchange for giving up the right to sue their employer and their coemployees, receive some compensation if they are injured on the job, without regard as to who was at fault. Importantly, Workers' Compensation does not compensate workers for all losses. Thus, injured workers often sue those who provide goods and services to their employer's production system. Different states set different thresholds relating to who can be brought into such a lawsuit and under what conditions a sued means-of-production entity can, in turn, bring the injured party's employer into the suit as a third-party defendant. Forensic engineers are often involved in such lawsuits to evaluate whether or not a given component of a production system is or is not defective. Using Workers' Compensation as an example, this paper explores the methodology and the difficulty of quantifying the ethical implications of policy decisions by examining the concept of thresholding a policy variable. Thresholding will be defined and the ethical effect on the various parties of varying a policy threshold will be discussed.     

医疗损害赔偿的相关问题分析与规范化处理

医疗损害赔偿是现阶段医疗纠纷处理中最现实和最敏感的问题,如何公正、合理、有效地处理医疗损害赔偿问题一直被社会公众所关注。本文围绕如何正确理解医疗损害赔偿责任的构成,准确把握法律适用和规范赔偿处理行为等关键性影响因素作出分析和阐述,并力求在法理性与规范性方面为医疗损害赔偿问题的处理提供相关借鉴。     

Cumulative injury or disease claims: an attempt to define employers' liability for workers' compensation

The workers' compensation systems of several states have been expanded in recent years to include injuries and diseases caused by cumulative injury and occupational stress. This expansion has placed a financial burden on the respective systems, on employers, and on consumers, who ultimately must pay the cost of claims through higher priced products or services. This expansion may not be justified from a social perspective, however; extant medical and sociological evidence is not conclusive as to whether occupational-stress injuries or diseases--such as coronary heart disease, hypertension, stroke, and neuropsychiatric illness--are the direct result of stressful work environments. Using the California workers' compensation system as a model, the authors submit that the underlying premises of liability governing the expanded systems should be reassessed based (1) on economic factors, specifically, the increasing costs of workers' compensation; (2) on the capacity of the system to process an ever-increasing number of claims; and (3) on the principle on which workers' compensation systems were established, that of equity between the employer and the employee. On the basis of these three factors, the authors evaluated three legislative approaches to restructuring the expanded system: presumption of compensability, apportionment of liability, and threshold of compensability. The first recognizes that although certain health problems are related to the workplace, the degree of causation is difficult to prove; under this approach, therefore, causation is presumed, and injury compensated, for all diseases and injuries that the system defines as work related. The second holds that where a causal relationship between the work and the injury can be proved, the employer nevertheless should be responsible only for that portion of the disability actually caused by the workplace. The third directs that the injured employee be compensated only when a direct causal link between the job and the injury or disease can be proved. The authors recommend that legislators implement this third alternative. For one reason, it is feasible economically; for a second, it would not burden the system or increase litigation; for a third, it is equitable to both employees and employers.