If you have a patient with a work injury, you probably know that your records are vital to her/his compensation claim. But did you know that your patient could lose out totally if your notes don’t meet the new criteria for “objective findings” recently written into Oregon law? The concept of “objective findings” may confuse doctors since the legal implications of the term often differ from a medical understanding. Let’s look at how this term applies to Workers’ Compensation claims.
In 1995, the Oregon Legislature changed the meaning of “objective findings” as relates to medical evidence verifying a work injury. A doctor’s chart notes that a worker is in pain is not enough. Now, a physician’s “objective findings” in support of medical evidence of the injury must be: reproducible, measurable, or observable to provide the verification needed for the injury to be compensated.
Specific “verifiable indications” of injury or disease include, but are not limited to: range of motion, atrophy, muscle strength and palpable muscle spasm.
Pure pain alone is not an objective finding. A worker’s description of his/her pain is not enough. Even if the doctor affirms that the worker is in pain. So, doctors are now encouraged to do the necessary testing, palpation, etc., and to record their findings.
For example, specific range of motion findings will provide “measurable” support. Your fingers may “observe” muscle spasms to provide the necessary objective findings.
Findings are “reproducible” if the same indication of injury or disease can be found more than once: at one visit and at a subsequent visit; or by one doctor and then another doctor; or even at the beginning and at the end of the same visit. Other “reproducible” findings include X-Rays, MRI’s, or CT scans.
Other “measurable” findings are hearing tests and EMG nerve sensory loss studies. Other “observable” findings include swelling, discoloration, or a laceration.
The impact of the new law is not yet fully known. However, testing and examination with recorded findings which are reproducible, measurable, or observable, describing such conditions as range of motion, atrophy, muscle strength and palpable muscle spasm, should help make “objective” those types of injuries or diseases formerly supported only by indications of pain.
Some of the examples above were set forth by the Workers’ Compensation Board in their Opinion in Garcia. But the Chair of the Worker’s Compensation Board cautioned that objective findings should not be limited to these examples. By way of illustration, he pointed out that several different physicians may confirm the same reflex to pressure on a trigger response (a reproducible finding). This should not be disallowed simply because it is not one of the examples specified in the Board’s footnote! The Chair felt that identifying only a few specific examples may be interpreted as a limitation in future cases, and was therefore, unwarranted.
You will be doing a favor for your patients with work injuries to examine them as thoroughly as needed to make “objective findings” as newly defined by Oregon Workers’ Compensation law.
This article was prepare by Arthur W. Stevens, III