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Dec. 19, 2006
Workers' compensation ratings don't accurately predict
CHAPEL HILL - A study of settlement decisions in workers'
compensation claims for low back pain has found almost no relationship between
the rating of the disability's severity when the claim was settled and reported
pain and disability 21 months later.
Findings were counterintuitive: Claimants with higher
disability ratings, which suggest higher severity and less ability to work,
fared better than those with lower ratings.
The study shows that "administrative decisions made at the
end of the workers' compensation claim process about the ability of someone to
work after back injury has very little predictive validity," said Dr. Nortin
Hadler, a professor of medicine and microbiology/immunology in the University
of North Carolina at Chapel Hill's School of Medicine.
Hadler is a co-author of the paper, which was published in
the December issue of the Journal of Pain, with colleagues from St. Louis
University and the University of Florida. It was based on administrative
records in Missouri of workers' compensation claims for low back pain.
Workers' compensation is an important part of America's
health-care system, accounting for 3 percent of an employer's gross income,
"Clearly, the rating schemes for workers' compensation are
inconsistent, and that fact is stirring enormous pots across the country,"
Hadler said. "If the outcomes from Missouri generalize, then there is a need to
reform how disability is determined."
Another paradoxical finding showed that white claimants
faired no better than blacks, even though previous reviews found that blacks
were much less likely than whites to be diagnosed with a herniated disk or to
have back surgery, had less money spent on their care and received lower
disability ratings and smaller settlements.
"It's one of the more perverse observations in our study,"
said Hadler. "African-Americans were much less likely to be operated on, but
the care that the whites got, even though it looks like more care, because it's
surgery and it's more expensive, didn't do anything for them."
For their study, the researchers interviewed 580 black and
892 white workers' compensation claimants an average of 21 months after claim
settlement to assess how well they were functioning and to determine the
contribution of impairment, race and socioeconomic status to their disability
Hadler said that workers' compensation claims for low back
pain represent only 20 to 30 percent of all claims filed but consume a majority
of the workers' compensation budget.
The article concludes that "the pattern of results suggests
that race/ethnicity and other sociodemographic factors influence medical
decision making and
the outcomes of medical care." Furthermore, the
flaws in the system "are not distributed evenly" but "are visited
disproportionately" on minorities and persons of lower socioeconomic
Study collaborators were Drs. John T. Chibnall and Raymond
C. Tait from Saint Louis University School of Medicine and Dr. Elena M.
Andresen of the University of Florida. Tait was the study's principal
investigator and lead author of the article. It is the fifth article that the
quartet have published over the last two years.