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PubMed1982

Mortality among miners receiving workmen's compensation for silicosis in Ontario: 1940-1975.

We investigated mortality among 1,190 Ontario miners who received Workmen's Compensation awards for silicosis from 1940 through 1975. In comparison with the general population of Ontario these men had elevated all-cause mortality rates, with deaths attributed to nonmalignant respiratory diseases and tuberculosis being primarily responsible. The group of miners receiving their compensation awards between 1940 and 1959 has experienced more than twice as many lung cancer deaths as expected while men receiving compensation awards after 1959 have had lung cancer rates similar to the general population. It is concluded that silicosis is not a benign disease and that efforts must be continued to prevent its occurrence.

Adult↗
PubMed1960

Heart disease under workmen's compensation.

In expert testimony before the Industrial Accident Commission, all physicians are taken as equally competent. The value of their testimony depends upon the validity of their data and the reasons for the conclusions drawn. In case of conflicting opinion, the referees, who are laymen, must decide on the basis of the testimony. Therefore physicians preparing reports must see that data are complete, that all routine investigative procedures are not only applied but reported, and that the reasons for claiming connection of injury with employment are fully stated. Moreover, other recognized causes of the patient's condition should be considered and ruled out for reasons given. The increasing number of claims for workmen's compensation in heart disease, and the increasing tendency of insurers to settle rather than contest claims, may actually be harmful to the welfare of persons with heart disease, for it deters employers from hiring them and thus risking higher insurance costs. Physicians concerned with compensation claims must develop more widely acceptable standards that properly separate the inherent risk of heart disease from that incurred through employment for which the employer may reasonably be considered liable.

Accidents, Occupational↗
PubMed1996

Congenital spine deformity, congenital stenosis, diastematomyelia, and tight filum terminale in a workmen's compensation patient: a case report.

STUDY DESIGN: This case report concerns a patient injured at work who was denied adequate evaluation and treatment by a Workman's Compensation Commission, resulting in nearly complete paraplegia. OBJECTIVES: For a patient with a congenital spine deformity, a diastematomyelia, a tight filum terminale, and a congenital stenosis, denial of magnetic resonance imaging evaluation and appropriate surgery cannot be justified. SUMMARY OF BACKGROUND DATA: This 35-year-old man injured his knee and back in a fall at work but was able to work for 1 week. Progressive neurologic deterioration was documented, but magnetic resonance imaging evaluation was denied. When it finally obtained and the lesion identified, appropriate neurosurgery was denied. METHODS: When seen by the authors more than 3 years after his injury, he had a nearly complete paraplegia. Despite neurosurgical decompression and spine stabilization, no significant recovery occurred. RESULTS: A nearly complete paraplegia resulted from this combination of lesions coupled with intolerable delay in diagnosis and therapy, both the result of "foot-dragging" by a Workmen's Compensation Commission. CONCLUSIONS: In an effort to be "cost-conscious" and to avoid "unnecessary low back surgery," a Workmen's Compensation Commission has caused a patient to become paraplegic. Such management is neither cost-effective nor of adequate quality.

Adult↗
PubMed1981

The role of the defense psychiatrist in workmen's compensation cases.

Tomorrow's psychiatrist should be more cognizant, competent, and comfortable in forensic science matters. Psychiatric cases are increasingly the subjects of litigation, but justice in the court depends on able advocacy by all parties. Advocacy for patient-plaintiffs is more similar to customary clinical roles than is advocacy for defendant insurance companies, which nevertheless are as needful of competent psychiatric experts as patient-plaintiffs if justice is to be done. Ironically, defense psychiatrist can do much to help patient-plaintiffs if they understand their roles correctly. Since legal systems are designed to produce justice, not therapy, the forensic competence of future psychiatrists will help to make litigation more therapeutic and just for patients. This paper describes the peculiarities of psychiatric work in litigated workmen's compensation cases, focusing on the role of the defense psychiatrist. We will highlight the constructive and therapeutically gratifying potentials of this work. Greater familiarity with the process will help to enlist the interest and participation of psychiatrist in workmen's compensation cases for the ultimate benefit of the patients and improvement of the legal system.

Expert Testimony↗