Workers comp rules change criticized by doctors

HONOLULU (HawaiiNewsNow) - The Hawaii Legislature is considering changing the rules of workers' compensation despite opposition from medical experts in the field who fear the move could hurt workers rather than help them.

The bill placed on the agenda for a Wednesday meeting of the House Ways Committee, HB466, sponsored by House Labor Chairman Karl Rhoads, would bar employers from getting independent medical examinations, or IMEs. Instead, if employer and employee cannot agree on a physician to examine the worker, a state official would choose one from a list.

The most striking opposition to the proposal comes from Chris Brigham, senior contributing editor to the American Medical Association's "Guides to the Evaluation of Permanent Impairment." One of the nation's leading experts on the issue, he is a resident of Kailua.

"The bill is ill-conceived and self-serving to certain stakeholders, including treating physicians who provide treatment that is not consistent with practice guidelines and current medical standards," Dr. Brigham says. "Some physicians tragically are using injured workers as pawns for their financial gain."

Dr. Brigham says it is a myth that independent medical examinations are biased or not fact-based, so the bill addresses a problem that does not actually exist. Moreover, he argues, the bill would help doctors who make money prescribing narcotic pain relievers to an extent that is "detrimental to injured workers." He urges lawmakers to "look more closely at the implications of this bill and why certain stakeholders are advocating for its passage."

The bill's removal of the right of employers to get an independent medical examination when a workers' comp claim has been submitted, has led the Chamber of Commerce of Hawaii to oppose the bill. "The IME process is the only real tool an employer has," the Chamber said in an emailing to its members, "to ensure the injured worker's claim is related to work and, if so, that the injured worker is receiving reasonable and necessary medical treatment." The Chamber describes the existing system as "generally amicable."

Other sources in the Hawaii medical community express concern about a list of approved physicians, saying it could reduce the chance of an examination being done by someone who is best qualified.

Dr. Lorne Direnfeld, a Maui neurologist who does consulting both here and on the mainland, submitted written testimony expressing the concern that such a system would lead to more medical expenses and more litigation.

Published reports on the mainland describe such an outcome after similar rule changes in California, where a study found that 3 percent of physicians prescribe nearly two-thirds of narcotic pain relievers.

Dr. Direnfeld says workers comp assessments are complicated because the doctor needs to sort out what injury may have been received on the job apart from underlying conditions a person may already have. It can work both ways. An apparent workplace injury may be a pre-existing condition, or a workplace exposure could cause a more profound health problem than is readily apparent in an initial examination. An experienced independent medical examinations specialist can sort things out to the satisfaction of employer, union and insurance claims adjuster, Dr. Direnfeld argues.

Copyright 2012 Hawaii News Now. All rights reserved.