Evidence-Based Ergonomics—Making an Objective Determination of Work Relatedness

ABSTRACT

In these economic times, a workers’ compensation claim wrongly attributed to an employer can seriously impact the profitability of that employer. The employee may also suffer a serious disservice if the workers’ compensation claim wrongly implicates the workplace and the true cause of the condition is not sought. The true determination of work relationship is essential for employer survivability and employee health. Until a true cause is known, only symptoms are treated, thus creating an opportunity for the condition to recur. It is no wonder that many health-care providers simply choose not to treat individuals at the mere implication that the condition has any work-related component.

If evidence-based medicine is accepted as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients, then a health-care provider must consider workplace factors when treating occupational injury claims. As N.M. Hadler stated almost a decade ago, “It is time for internists to deal with the pathogenetic potential of the contemporary workplace.” This is especially true for ergonomic-related injuries because the true source of a condition may not surface without knowing all of the risk factors associated with the claimant.

Oftentimes, a health-care provider is asked to make the determination of work relatedness based on a description of the workplace by the claimant. Considerable challenges exist for a health-care provider to make this determination. One challenge is that the employee’s knowledge of the workplace may be naive or exaggerated. Another challenge as the American National Standards Institute 365 indicates is that more nonwork-related ergonomic risk factors exist than work-related factors.

The true cause and effect correlation of ergonomic type injuries to the workplace lacks considerable objectivity. To complicate matters, ergonomists have not sufficiently partnered with the medical profession to provide systematic research and methodology for health-care providers to gain a simple understanding of whether the ergonomic condition was a result of work- or nonwork-related causes.

A carpal tunnel injury claim is presented to explore how a health-care provider can establish requirements of the employer to objectively collect evidence for the work relatedness determination. With this finding, the clinician is able to better treat the patient and identify the root cause.