Pain of spinal origin forms the basis for an extremely high number of WorkCover claims. No condition is responsible for more time off work, more cost in terms of lost revenue, and more psychological upset than back pain. No condition is less suited to be covered by workers compensation claims than back pain. Except for very rare instances where a work injury has caused a fracture in the spine, or an acute disc prolapse in a previously normal disc, most work injuries causing back pain simply represent an aggravation of some underlying degeneration.
It is imperative that any person with a WorkCover claim for back pain read the pages on spine anatomy and mechanics and the causes of back pain and radiculopathy. Without reading these pages it is impossible to understand how WorkCover claims get handled, assessed and treated.
When the underlying degenerative process has been aggravated at work, even if the patient has never had symptoms before, it is very hard to distinguish between what proportion of the symptoms are due to the underlying degeneration, and what are due to the work event. When a suitable period of time has elapsed for the effects of the aggravation to cease (often 4-6 months) it is usually reasonable to assume that ongoing symptoms are due to the underlying degeneration. At this time most WorkCover institutions consider the work-related component to be stable and stationary and liability is ceased. This however does not mean that no more treatment is required - merely that no more is required for the work component. More often than not patients do remain symptomatic after this period of time and find it hard to accept that the liability of WorkCover is over. Often it is in the best interest of the patient that the work-related component gets sorted out and finalised as soon as possible so that necessary and definitive treatment can be instituted before the symptoms become permanent.
To this end, at South Coast Spine, a dedicated WorkCover clinic operates twice monthly on alternate Wednesdays in conjunction with specialists from CORE Injury Management. This clinic by virtue of early intervention, education and management has now an unprecedented rate of over 90% of returning injured workers to some form of gainful employment. It also rapidly sorts patients who require surgery from those who do not and prevents spinal injured patients from being unfairly assessed by non-spinal specialists.
Patients generally fall into one of three categories:
- Those that do not require surgical intervention but simply education, and management in the form of physical therapies and occupation rehabilitation. These patients are almost universally managed by CORE Injury Management. Examples are muscle strains, aggravations of long-standing arthritic pain, aggravations of long-standing degenerative disc pain, minor whip-lash injuries etc.
- Those that do not require surgery to manage the work injury/strain but will predictably require surgery in the future to manage the underlying condition (usually degenerative). These patients are managed in the short term by CORE Injury Management but are kept under observation by myself, until such time is appropriate to consider surgical intervention. Examples are patients with 2 or 3 level disc disease who predictably in the future will need disc replacements or fusions but whose immediate problem is an acute episode to one of those discs. Another example is a severe whiplash injury which often shows no sign of real damage until 18 months or 2 years after the accident. Such patients are STRONGLY advised to take out private health insurance as third-party insurers are not required under the current legislation to pay for treatment for underlying degenerative conditions.
- Patients who obviously require surgery before it is possible to rehabilitate them. Examples include acute disc prolapses with neurological deficits or vertebral body fractures which are unstable. These patients are managed by myself, and then rehabilitated with CORE Injury Management.
A few guidelines for WorkCover patients
- With regard to WorkCover certificates - usually no-one is totally incapacitated for work as a result of their spinal condition. The fact that a patient can travel to see me, sit in a waiting room, fill in forms and have an intelligent conversation with me means that they have capacity for some form of work - even if only the most sedentary type. If your employer / WorkCover cannot provide such a role then this scenario often defaults to being unable to work.
- Indicate at the time of the consultation if certificates or forms need to be filled out or renewed. It is not possible to write one out the next day following a call to my secretary.
- As a treating spine surgeon, I do not get involved in offering definite opinions on whether or not a work injury / event is responsible for the current symptoms the patient has. Blame / causation is a legal argument.
- Again, as a treating spine surgeon, I do not get involved with offering opinions on what a patient can and can't do at work. This is different from suggesting various restrictions a patient should adhere to in order to prevent any further increase in symptoms, or from perusing return-to-work plans to make sure they comply with suggested restrictions. Detailed assessments regarding exact work-functions and their suitability for the patient are best addressed by occupational therapists.
- Please don't get mad with your case manager - usually these people are on your side and are trying their best to help you. If you're having a frustrating time with your case manager, it usually simply reflects the fact that the WorkCover system is hopelessly designed to handle spinal issues and your case manager is just as much at a loss as to what to do as you are.
- Please don't get mad at me or my staff if your claim is ceased following any report I have fashioned for WorkCover. More often than not any report I fashion for WorkCover is concerned with diagnosis and possible treatment options and deals with liability as little as possible. I tend to talk about balance of probability if pushed but have no ability to keep a claim open when a panel of independent medical examiners / tribunal has decreed otherwise.