Confronting the Workers' Compensation Problem

NEWPORT BEACH, Calif. -- The International Association of Industrial Accident Boards and Commissions (IAIABC) is a professional association of workers' compensation specialists from the public and private sector. Virtually every state workers' compensation board has a representative, as do many of the larger Fortune 500 corporations. Membership outside the US includes representatives from Canada, New Zealand and Australia.

In 1973, IAIABC developed its Workers' Compensation College with a curriculum "designed to assist and educate people who are engaged in the management and professional disciplines which are involved in workers' compensation programs." In 1988, the IAIABC established the International Workers' Compensation Foundation to "facilitate funding of research and education projects envisioned by the IAIABC."

In short, for more than 80 years, those involved in workers' compensation and industrial accidents have come together at IAIABC meetings to share information and make their state and corporate programs more effective. Much of your state's current workers' compensation policies have been influenced by information presented at IAIABC meetings.

The first chiropractor invited to become a member of the IAIABC was Charles Herring, DC, of Louisiana (please refer to "The Future of Chiropractic within Workers' Compensation," August 18, 1990 issue). It was Dr. Herring's work as a Louisiana legislature that gave him the opportunity to become part of an organization that was historically skeptical of chiropractic.

The recent forum, "Chiropractic Issues," presented by the International Workers' Compensation Foundation for its members, was held in Newport Beach, Calif., and included participants from across the United States. The panel was moderated by Walter Turner, commissioner of the Kentucky Department of Workers' Claims. Presenters included:

• Scott Haldeman, DC, MD, PhD, speaking on the AHCPR's guidelines, Acute Low Back Problems in Adults. He summarized studies looking at pain control, patient satisfaction, functional improvement and the cost associated with back problems. Dr. Haldeman emphasized the fact that spinal manipulation was the only active form of care recommended by the Agency for Health Care Policy and Research (AHCPR) in the initial treatment of acute low back pain.

   

• Reed Phillips, DC, PhD, DACBR, speaking on the results of the 1986 and 1989 Utah workers' compensation studies, two studies that he was part of. Chiropractic care was shown to be less expensive in many cases and only slightly more expensive in others. The big difference was in compensation costs. Chiropractic was much more effective in getting patients back to work faster. So much so, that the total costs (the cost of care and compensation) for medical care was as much as three times greater than the cost for chiropractic for back pain patients.

The question and answer session was perhaps the most interesting. Through it Dr. Haldeman was able to argue that MDs were not capable of being the gatekeepers for neuromusculoskeletal problems. Dr. Phillips suggested that the real problem was overutilization; that providers whose profile were outside of two standard deviations from the norm should be scrutinized.

The questions were probing, pointed, and sometimes on the verge of insulting. One could readily see there were prejudices against chiropractic among the workers' compensation people. The "warfare" between workers' compensation and chiropractic was quite apparent. The few overutilizers within the chiropractic profession have put a heavy burden on all DCs. But Drs. Haldeman and Phillips did make some headway. Their presentations were seen as reasonable and, for the most part, accepted.

It will be a long time before the sins of a few "big hitters" can be fully erased, but the efforts of researchers and chiropractic representatives can do much to change opinions and encourage equal treatment for chiropractic in the workers' compensation arena.