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Notes from an emergency room doctor: I was chatting with an attorney recently who specializes in personal injury cases. He asked me if I knew what type of therapy resulted in the quickest improvement of symptoms in workers' compensation cases.

I shrugged, unsure of the answer. Was surgery most effective? Physical therapy? Medication?

It was none of those. "The green poultice works best," he said cynically, and reported that anecdotal research seemed to show that more patients became better sooner after receiving a monetary settlement than after any other form of therapy.

No one ought to question the need to protect workers from physical as well as financial harm caused by work related injuries. But more and more workers' comp cases are a logical side effect of the kind of work people do, as opposed to an accident at a work site. Construction workers complain of back pain associated with heavy lifting. Secretaries complain of wrist pain associated with frequent typing. Policemen complain of chronic headaches associated with the stress of dealing with crime.

Twenty years ago if you did a lot of lifting at work and your back hurt, or if you typed a lot and your wrists hurt, you simply suffered with it and waited for a weekend respite to cure you. Nowadays these same aches are workers' comp cases.

If a patient says something "hurts," I assume it does. And treatment begins. Treatment continues until both doctor and employer decide no further effort will make a difference. If that occasion arises, the employee is either retrained for another job, or given a cash settlement based on the percent of their perceived permanent disability.

Unfortunately, while most patients complaining of back pain, muscle strain, tendonitis, or emotional stress are indeed suffering, a few are feigning their illness or perhaps feigning the degree of their debility. For most of these ailments there are no definitive diagnostic tests. It is difficult if not impossible to dispute a patient's complaint, and that encourages fraud on the part of patients, as well as some doctors and lawyers eager for a piece of the workers' comp pie.

The average workers' comp benefit gradually rose from 55 percent of weekly wages in 1972 to 97 percent today. Every 10 percent increase in compensation resulted in a 5 percent increase in the number of claims filed.

The leading occupational illnesses in America today are "cumulative trauma disorders." This diagnosis covers everything from eye strain to back strain to wrist strain. There were about 25,000 cases reported in 1982. Ten years later, there were nearly 300,000 cases. Are there that many more people being injured by their work type? Or has workers' comp become another form of lottery?

One of the best states to try to win the workers' comp "lottery" is California. Just watch TV. and you can see lawyers hawking the "lottery" via 1-800-numbers. In California employers pay insurance premiums that are in the top third in the nation, but pay outs to injured workers are in the bottom third. For every dollar an injured worker receives, employers end up paying nearly another dollar to lawyers and insurers.

A costly and abused workers' comp system is jeopardizing individual businesses and, in turn, jobs. As workers' comp costs go up, either product costs and inflation have to go up, wages have to go down, jobs have to be cut, or businesses have to move.

The system has gone awry. Designed to protect a worker's health, it now endangers the nation's economic health. While certainly significant injuries sustained on the job should be covered, those more nebulous aches and pains that a reasonable person should expect to come with the job, perhaps should not be.

It would be nice if everyone had a stress free, tireless job. But they call work "work," because if it was fun or relaxing, they would have called it "vacation."