Monday, February 13, 2012

Causation and Return to Work - Hypocrisy

Causation is a funny concept in workers' compensation. In most situations it is not complex. If you're at work and you suffer an injury then you're covered by workers' compensation.

But what if the reason you got hurt at work was because of some other condition? What if you had a seizure at work, unrelated to any hazardous exposure, fell over and hit your head causing a skull fracture?

That case already occurred in California and the Supreme Court, in a deeply divided opinion, ruled that the injury and its attendant consequences were AOE/COE and covered by workers' compensation.

The Gideon case (1953 - before I was born!!), as it is known, is being challenged by a new case with surprisingly similar facts, which makes Gideon ripe for review.

Pablo Orrala, a baker for Harris Ranch's steakhouse, suffered an unexplained (or idiopathic) seizure at about 4 a.m., while he was preparing baked goods at the restaurant. Orrala fell to the ground and his head struck the floor, causing a severe skull fracture.

The Workers' Compensation Appeals Board followed the Gideon ruling and found the injury compensable.

The employer lost on appeal to the 5th Circuit and has asked the Supreme Court to revisit the Gideon rationale in light of the fact, cited by the employer, that 22 other cases have adopted the dissent in the Gideon case and would find Orrala's injury not compensable.

Obviously this could be argued both ways, which is why the Supreme Court's Gideon decision was split 5-4. Intellectually it is a tough call and as a consequence comes down to what the policy of the state is.

So what is the policy of the state? If we follow modern politics there is clear dispute as to how far entitlement programs go. What is the purpose of workers' compensation? What is the purpose of the health care system in general? Why have any program of disability indemnity? And what about return to work, productive employment forces, competition in the marketplace and social order?

All good questions but it all comes down to this: What do the PEOPLE want their state to be?

We in the workers' compensation industry all allegedly subscribe to one over-arching goal - return to work. We all have been preaching the mantra that return to work is best for the employee, and best for the people because it takes the injured off the public dole and puts them into production adding to the economy and creating prosperity.

Isn't it ironic then that Orrala, a 20 year employee of Harris Ranch, now permanent and stationary with a 32% permanent disability rating and ready to return to work, has been refused employment according to his attorney?

In my view this should not even be a debate. To me the fact that there is even an issue of causation smacks of hypocrisy. In this case, it seems, return to work is just hyperbole - a convenient phrase to utter when one doesn't have to actually act with good intent and face the reality of either taking back a loyal employee willing to provide continued production, or place that worker on the public system for the rest of us to take care of.

Yeah, the old phrase "business is business" compels decisions that may be void of compassion.

Would the outcome be different if workers' compensation wasn't a separate system from all of the other medical treatment and disability programs out there? In other words, would the result be different if this were subject to a single source medical system?

If Orrala's attorney's opinion is correct, that the real reason Harris Ranch has challenged the decision is to avoid a $300,000 medical lien filed by the hospital that treated Orrala, then the argument for single source medical, and disassociating the medical component from the indemnity/RTW component in work comp, takes on even greater validity.

I have heard many arguments that the reason we can not have a single source medical treatment system is because the target outcomes of general health and workers' compensation are different - because general health is only concerned with getting the medical condition right, and workers' compensation is concerned with returning the injured back to work.

Doesn't seem to me that, at least in this case, there is any difference at all.

Causation is a funny thing - when it is illogically argued to suit one's singular purpose.workers compensation, work comp, injured worker

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