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
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
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
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."