Abstract

Background: Workers’ compensation was originated to provide a no-fault, timely access to appropriate medical care. Unfortunately, we have found that the system fails the injured worker in certain environments. By implementing procedural roadblocks in the form of initial claim denial and delay methods, the injured worker finds himself/herself in a battle of attrition. By delaying treatment and compensation benefits, the injured workers are “starved out” of their access to care and often walk away from their claim or accept a payout without treatment.

Methods: We performed a randomized, consecutive case-series where 300 hypothetical patients called medical offices to attempt to arrange a physician consultation. We analyzed the ability of a patient to gain access (an appointment) to a primary care (N=100), orthopedic (N=100) and neurology (N=100) physician after stating that they were injured at work. We analyzed two cohorts, one as an injured worker that was given a claim number (N=150) and the other that was injured at work but not yet given a claim number (N=150).

Conclusion: This study demonstrates how difficult it is to gain access to care as an injured worker. An injured worker in a low densely populated area without a claim number was unable to gain access to a primary care doctor in our cohort (100% denial rate). Even a patient with an accepted claim number in densely populated Cook County, IL had a 52% chance of being denied access to care with an orthopedic surgeon while a patient without a claim number had an 84% chance of being denied access to orthopedic care.

Keywords

workers compensation, access to care, orthopedic, neurology, primary care, denial to care, mandatory relinquishment, power imbalance, legitimately injured, full recovery, neuropathies, ulnar nerves, cubital tunnel syndromes, consecutive case-series, geographic center, injured worker