Legal MDs Consulting Response:
Workers’ compensation cases involving occupational disease or repetitive trauma present unique challenges that differ significantly from acute injury cases. Establishing that a medical condition is work-related often requires detailed analysis of the occupational history, the medical literature on dose-response relationships, and the specific clinical presentation. Our physician consultants are frequently called upon to bridge the gap between the medical facts and the legal standard of work-relatedness.
The medical literature on occupational disease is extensive and continually evolving. Rosenman et al. in the American Journal of Industrial Medicine (2006, Volume 49, Issue 5, pages 343–351) found that occupational diseases are substantially underreported and underdiagnosed, in part because many clinicians lack training in occupational medicine and fail to take adequate occupational histories. This underdiagnosis translates directly into undervalued workers’ compensation claims, as conditions that are legitimately work-related may be attributed to non-occupational causes.
The standard for establishing work-relatedness varies by jurisdiction but generally requires a showing that the employment was a “substantial contributing factor” to the condition. This is a medical question that must be supported by medical evidence. The treating physician’s opinion carries significant weight, but it must be grounded in accepted medical principles. Bernard et al. in the American Journal of Industrial Medicine (1997, Volume 32, Issue 1, pages 76–83) identified specific risk factors for work-related musculoskeletal disorders including repetition, force, posture, and vibration. Quantifying these exposures and connecting them to the clinical findings through the literature is the core of the physician consultant’s contribution.
The legal framework for occupational disease claims has its own complexities. Many states have specific statutes of limitations for occupational disease that differ from those for acute injuries. In addition, some states apply a “last injurious exposure” rule while others require apportionment across multiple employers. Larson’s Workers’ Compensation Law (Matthew Bender, updated annually) remains the authoritative treatise on these jurisdictional variations. Attorneys handling workers’ compensation cases should be aware of their state’s specific requirements for medical evidence of work-relatedness.
We recently worked with an attorney whose client, a 52-year-old meat processing plant worker, developed bilateral carpal tunnel syndrome. The employer’s insurer denied the claim, arguing the condition was related to the worker’s diabetes and age rather than her repetitive hand-intensive work. We reviewed the occupational health literature, including studies by Palmer et al. in the Scandinavian Journal of Work, Environment and Health (2007, Volume 33, Issue 6, pages 401–412) demonstrating that highly repetitive and forceful hand work is an independent risk factor for carpal tunnel syndrome even in the presence of other risk factors such as diabetes. Our report opined that the occupational exposure was a substantial contributing factor and addressed the insurer’s causation arguments point by point.
If you have a workers’ compensation case where work-relatedness is being challenged, our physicians can evaluate the occupational exposure history, review the medical literature on the specific condition, and provide a well-supported opinion on causation that meets the legal standard in your jurisdiction.
References
Rosenman KD, Kalush A, Reilly MJ, et al. “How much work-related injury and illness is missed by the current national surveillance system?” Journal of Occupational and Environmental Medicine. 2006;48(4):357-365.Bernard BP, ed. Musculoskeletal Disorders and Workplace Factors: A Critical Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders. NIOSH Publication No. 97-141. Cincinnati: NIOSH; 1997.Palmer KT, Harris EC, Coggon D. “Carpal tunnel syndrome and its relation to occupation: a systematic literature review.” Occupational Medicine. 2007;57(1):57-66.Larson A. Larson’s Workers’ Compensation Law. New York: Matthew Bender; updated annually.
This situation is another example of how we can assist you with all the medical issues in your cases. Call (954) 649-5739 or email DrC@legalmds.com to schedule a time to talk about one of your cases.
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