R Herbert1, K Janeway, C Schechter. 1. Department of Community Medicine, Mount Sinai Medical Center, New York, NY 10029, USA. rherb42654@aol.com
Abstract
BACKGROUND: This study evaluated the experience in the New York State workers' compensation (WC) system of 135 patients with work-related carpal tunnel syndrome diagnosed at an academic occupational medicine clinic between 1991-1994. METHODS: Worker's Compensation Board (WCB) records were reviewed to ascertain: (1) the proportion of WC claims that were not initially accepted (i.e., that were challenged) by the WC insurer, (2) the proportion of challenged claims ultimately decided in the claimant's favor, (3) the length of the period between case filing and claim adjudication, and (4) risk factors for claim challenge. RESULTS: Seventy-nine percent of the claims were not initially accepted by the WC insurer (challenged/no response). Of the 81 challenged/no response cases adjudicated (ruled on) at the time of the study, 96.3% were accepted as work-related. Mean time from claim initiation to adjudication was 429 days (range 58-1,617). Mean time from physician request for any treatment and WCB authorization was 226 days (range 0-1,296). Mean time from physician request for surgery authorization and WCB authorization was 318 days (range 7-595). Claims filed by non-whites, low-wage workers, and union members were significantly more likely than others to be challenged. CONCLUSIONS: Patients with work-related carpal tunnel syndrome face frequent claim challenge by WC insurers in NY State, with attendant prolonged delays in adjudication and treatment authorization. Likelihood of claim rejection was strongly related to ethnicity and socio-economic status.
BACKGROUND: This study evaluated the experience in the New York State workers' compensation (WC) system of 135 patients with work-related carpal tunnel syndrome diagnosed at an academic occupational medicine clinic between 1991-1994. METHODS: Worker's Compensation Board (WCB) records were reviewed to ascertain: (1) the proportion of WC claims that were not initially accepted (i.e., that were challenged) by the WC insurer, (2) the proportion of challenged claims ultimately decided in the claimant's favor, (3) the length of the period between case filing and claim adjudication, and (4) risk factors for claim challenge. RESULTS: Seventy-nine percent of the claims were not initially accepted by the WC insurer (challenged/no response). Of the 81 challenged/no response cases adjudicated (ruled on) at the time of the study, 96.3% were accepted as work-related. Mean time from claim initiation to adjudication was 429 days (range 58-1,617). Mean time from physician request for any treatment and WCB authorization was 226 days (range 0-1,296). Mean time from physician request for surgery authorization and WCB authorization was 318 days (range 7-595). Claims filed by non-whites, low-wage workers, and union members were significantly more likely than others to be challenged. CONCLUSIONS:Patients with work-related carpal tunnel syndrome face frequent claim challenge by WC insurers in NY State, with attendant prolonged delays in adjudication and treatment authorization. Likelihood of claim rejection was strongly related to ethnicity and socio-economic status.
Authors: Michael S Cartwright; Francis O Walker; Jill N Blocker; Mark R Schulz; Thomas A Arcury; Joseph G Grzywacz; Dana Mora; Haiying Chen; Antonio J Marín; Sara A Quandt Journal: J Occup Environ Med Date: 2012-02 Impact factor: 2.162
Authors: A d'Errico; L Punnett; M Cifuentes; J Boyer; J Tessler; R Gore; P Scollin; C Slatin Journal: Occup Environ Med Date: 2006-12-20 Impact factor: 4.402
Authors: Michael S Cartwright; Francis O Walker; Jill C Newman; Mark R Schulz; Thomas A Arcury; Joseph G Grzywacz; Dana C Mora; Haiying Chen; Bethany Eaton; Sara A Quandt Journal: Am J Ind Med Date: 2013-08-31 Impact factor: 2.214