Malinger for the Money?

Studies have shown that patients receiving Workers’ Compensation are more likely to be receiving disability benefits and were less likely to report relief from symptoms in quality of life than patients who had not been receiving Workers’ Compensation. This certainly is something I have seen in my practice as a case manager with many diagnoses, not just lumbar disc injuries which this information is based from. In short we need to know that money may be one of the strongest motivations for treatment.

Fact: patients who were receiving Workers’ Compensation at baseline in this study were more likely to be young, male, and employed as laborers, they reported worse functional status; however, the clinical findings for these patients were similar to those for patients who were not receiving Workers’ Compensation.

Return to work. Patients who had been receiving Workers’ Compensation at baseline were more likely to be receiving disability benefits at the time of the four-year follow-up compared with those who had not; however, they were only slightly less likely to be working at the time of the four-year follow-up.

Surgery for money? Operative management did not influence these comparisons, but it decreased symptoms and improved functional status. Patients who had been receiving Workers’ Compensation at baseline also had significantly less relief from symptoms and improvement in quality of life than patients who had not been receiving Workers’ Compensation.

The conclusion is that we must be aware of all potential factors influencing a work compensation claim and understand that money can be a big factor influencing a patient’s decisions. Some clinics or doctors may also push towards procedures that are highly profitable to their clinics. Our best defense and support comes from evidence-based guidelines which provide structure for treatment plans moving from conservative to aggressive. As case managers we need to use this knowledge to keep our patients safe, well informed, and less likely to risk their health and wellbeing to maintain income benefits.

References: Long-Term Disability and Return to Work Among Patients Who Have a Herniated Lumbar Disc: The Effect of Disability Compensation*
STEVEN J. ATLAS, M.D., M.P.H.†; YUCHIAO CHANG, PH.D.†; ERIN KAMMANN, M.S.†, BOSTON; ROBERT B. KELLER, M.D.‡, MANCHESTER, MAINE; RICHARD A. DEYO, M.D., M.P.H.§, SEATTLE, WASHINGTON; DANIEL E. SINGER, M.D.†, BOSTON, MASSACHUSETTS