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Physicians’ opinions in comp claims correlate with who’s paying

medical court

Physicians’ opinions in workers compensation claims for black lung disease largely correlate to who is paying for their time, experts say, calling for independent review programs and mandatory physician conflict disclosures.

“It’s pretty surprising to see an expert not aligning” with the parties who hired them, said Michael Duff, professor at the University of Wyoming College of Law. “The way our adversarial (comp) system is structured, we almost presume that the opinions offered by partisan experts are going to be weighted toward the party that retained those experts.”

In a study conducted by the University of Illinois at Chicago, researchers found that physicians’ diagnoses in black lung cases often correlated with those who hired them.

Physicians hired by employers were substantially less likely to find evidence of black lung disease in an X-ray, whereas physicians hired by miners were more likely to identify the worker as having the disease, said Lee S. Friedman, associate professor in UIC’s School of Public Health and lead researcher of the study.

Using data from the U.S. Department of Labor-administered Federal Black Lung Program, Mr. Friedman and his team evaluated nearly 8,000 court decisions between 2002 and 2019 to evaluate financial conflict of interest for each physician. In one-fifth of the black lung claims reviewed, the physicians made the same decision for all patients 95% of the time — either finding that nearly all of the patients had black lung or didn’t. The majority of the physicians opining on those claims were hired by mines and reported an absence of pneumoconiosis.

“I don’t think there’s any question that there is bias … because of the financial incentives but also because on some level you say, ‘That’s my team, I work for that team,’ and the subtle pressure that exerts on the human mind,” Mr. Duff said.

“People do perceive this as a broader issue … but I think the vast majority of physicians really only care about doing what is in the best interest of the patient,” said David Langham, deputy chief judge of the Florida Office of Judges of Compensation Claims in Tallahassee. “The other 2% or less are people motivated by a poor alignment of ideology.”

One issue that may exacerbate the problem is that the comp industry has misaligned incentives because it does not tie physician reimbursement to how quickly workers recover, Mr. Langham said. Another is the lack of physician choice, which can reduce a worker’s “feeling of helplessness” by giving each side “some modicum of control.”

For instance, in California’s independent medical evaluation system, each party eliminates a physician from a panel of three, with the last one standing tapped to conduct the evaluation of the injured worker.

“If you’re going to set up a neutral structure, you need to be vigilant about the actual ties of those so-called neutral parties,” Mr. Duff said.

Requiring physicians in the workers compensation system to make public disclosures regarding their relationships — similar to the mandate under the Affordable Care Act that doctors disclose relationships with medical supply and pharmaceutical companies — could be another way to address the problem, Mr. Friedman said.

“There’s so much discretion in terms of behavior at the insurance level, the policy management level, the clinic level and even the physician level,” he said. “We know it’s an unbalanced system but don’t know what the right solutions are.”