The article titled as ‘Physician review of worker’s compensation case files: Can it affect decision outcome?’ by Hammett et al (2012), highlights the compensation cases of the Federal workers which are referred specifically to the navy medial physicians in order to assess the final decision regarding the cases. The compensation cost of the medical injuries is at a rise merely because of the predicted increase in workers over 55 years (Hammett et al., 2012). Technically this age group is more prone to developing severe illnesses. Also, since the Federal Employees Compensation Act (FECA) covers all the medical costs of the employees which are covered by the local agencies, the Department of Navy is responsible to look into the matter of chargeback. In this regard, on the basis of the program formulated by the Navy Sea Systems in 2000, there were formalized procedures whereby which the compensation claims on the basis of medical injury was coherently examined in association with the medical role performed by the Navy physicians. In this regard, the main objective of this article is to examine the impact of the specific medical review by the Navy physicians of the compensation claims made by the workers along with focusing upon the way in which the Occupational and Environmental Medicine (OEM) physicians can aid in assisting the non-physicians who are responsible to deal with the claims. In this manner, this paper also aims at encouraging the OEM physicians to work upon improving the programs thereby boosting other researchers to direct their studies in this realm.
The hypotheses of this article are as follows:
HA1: There is a positive association between the claimant’s age and the category of the case/
HA2: The physician’s opinion is a bad predictor of the examiner’s case decision.
HA3: More males file cases as compared to the females
HA4: The acceptance rate of the study population is higher than the acceptance rates of total population.
Independent/ Dependent Variables
Independent variables: Compensation Claims, Claimant’s Occupation
Moderating variable: Age and gender
Intervening Variable: Examiner’s Opinion and Physician’s Opinion
Dependant Variables: Final case decision
Sample size and sampling technique
Since the study targeted the 325 workers who were registered from the Navy Injury Compensation Program Administrators from USA over the period of four years (2006-2010), it could be said that the research undertook the purposive sampling technique. Out of the 325 workers, 40 were excluded on the basis of claiming several illnesses or due to the fact that they were not (completely) reviewed by the Navy physicians.
As also incorporated in the study, the selection bias is obvious in the research because it was on the basis of the Navy ICPAs that a certain amount of the cases were excluded from the sample. If they had been a part of this study, future researches could have focused upon the unique findings being drawn out from the excluded cases which would also have added into a qualitative side of this research. Ironically, despite the exclusion of several cases, the study did not report skewed results because realistically, a research cannot focus on the complete population. Despite this, the study stated contrasting results because of the prominent difference between the acceptance rates of the study population as compared to the total population. However, instead of the purposive sampling, the use of a different sampling technique such as simple random or stratified technique would have given the chance of random selection thereby removing biasness. Also, instead of going for proportionate sampling especially on the basis of gender for different groups such as Wage grade and General Service along with study and total population, the research could have focused on one set of group in order to yield accurate data.
Since it was a quantitative epidemiological study, the data gathered was analyzed using various statistical tools using the SPSS software. K statistic was used to analyze the connection between the physician’s opinion and the final case decision by OWCP. Moreover, the z-test was used to assess the difference between the male proportions in the study and the total population. ANOVA was also incorporated in order to examine the age and the category of claim made by the worker. Descriptive stats such as mean, mode, median and frequency was also used to generate detailed results.
Since the sample was directly drawn from the records forwarded by the Navy Injury Compensation Program Administrators, there are minimal risks involved in this study that would raise any major ethical concerns. This is mainly due to the fact that the cases presented by the ICPAs did not require further assessment of the individuals by asking them to fill any questionnaire or respond to a specific data collection tool. In this way, the ICPAs did not reveal the identities of the claimants as conspicuous from their responses kept anonymous in this research. Also, although at one end excluding some cases would have been a subject of bias for the study, keeping conflicting cases away further minimized the risk of conducting this study.
Concerns and Problems of the Study
The study explicitly achieved its purpose of reviewing the way in which the medical opinion given by the Navy physician impacts the final case decision. However, incorporating a control group of cases not given Navy physician’s opinion and comparing it with the cohort receiving the opinion would have generated more accurate results that could have been generalized on to a greater population. Also, choosing a better sampling technique, a representative sample and minimizing the biases especially of assessing a number of groups at once, could have greatly improved the overall study.
Conclusion and Future Considerations
Hence, the focus of this study was quite straightforward in directing its attention towards employee compensation rates merely because of the predicted rise in the expense of the workers. In this regard, this study aimed at analyzing the impact of physician’s review about the medical claims made by the workers which influenced the final case decision. The research could have possibly undertaken a qualitative or a mixed method approach by incorporating a focus or a control group for clear comparative data. Also, using a random sampling technique or a stratified sampling strategy could have resulted in a more representative sample. Although the research had few limitations, it did achieve its target of not only assessing the relation between physician’s review and the final case decision, but it also laid a platform for future researches. In this regard, other studies could base their research on this federal issue and expand it by overcoming the limitations of sampling, research design and result gap faced by this study.
Hammett, M., Jankosky, C., Muller, J., Hughes, E., & Litow, F. (2012). Physician Review of Workers' Compensation Case Files: Can It Affect Decision Outcomes? Military Medicine, 177(1), 17-22.