‘Medical scarcity’ could lead to more litigation in comp: Panel

ORLANDO, Fla. — Whether an injured worker can promptly see a medical professional is a good predictor of whether that worker will eventually see a legal professional, according to a panel of medical professionals.

Provider shortages and litigation top the list of controversial medical issues in  workers compensation, said the panelists, who spoke Monday at the Workers’ Compensation Educational Conference.

So-called “medical scarcity” is the result of provider shortages that have made it a challenge for claims managers to ensure a worker sees a doctor on time, according to Dr. Teresa Bartlett, Southfield, Michigan-based managing director and senior medical officer at Sedgwick. The problem is only set to get worse, as the medical community predicts a shortage of 30,000 providers by 2030, potentially rising to 60,000 by 2036, she said.

Delay in treatment is the “biggest predictor” of litigation, said Dr. Paul Meli, who treats injured workers with Paul Meli Orthopedic Surgery in Fort Lauderdale, Florida.

Finding appointments with medical specialists who treat injured workers is especially challenging, said Dr. Robert Hall, Orient, Ohio-based corporate medical director for Optum’s Workers’ Comp and Aut No-Fault. “It’s taking longer and longer,” he said, adding that what follows is a “cascade of delays” in getting the worker better.

The issue also could be the comp industry itself, as more younger doctors prefer not to treat workers comp patients, according to Dr. Meli, who added that “administrative burdens” associated with the industry could be at play. Burnout also is an issue, he said.

The fallout could mean more litigation in claims, as injured workers don’t think they’re being cared for, the panelists said. Delays in care also could lead to more mental factors in a claim, whether or not the injury and recovery warrant it, they said.

Dr. Meli said he’s increasingly seeing both factors come into play. “I see a patient come in and he says, ‘Well, I am depressed,’ and I ask him more and he says, ‘My lawyer told me to say that,’” he said. “They are looking for us to check this box to say they are depressed, and I look at his chart and see a lawyer got involved.”

Dr. Michael Lacroix, Sarasota, Florida-based medical director at The Hartford, said part of the solution is already at play, with more injured workers seeing providers such as physician assistants, who are legally allowed to treat patients.