Ratings don't predict disabilities accurately

USA Today (Society for the Advancement of Education), April, 2007

A study of settlement decisions in workers' compensation claims for low back pain has found almost no relationship between the rating of the disability's severity when the claim was settled and reported pain and disability 21 months later. Findings were counterintuitive: Claimants with higher disability ratings, which suggest greater severity and less ability to work, fared better than those with lower ratings. The study shows that "administrative decisions made at the end of the workers' compensation claim process about the ability of someone to work after back injury has very little predictive validity," indicates Norton Hadler, professor of medicine and microbiology/immunology at the University of North Carolina, Chapel Hill.

Workers' compensation is a vital part of America's health-care system, accounting for three percent of an employer's gross income, Hadler points out. "Clearly, the rating schemes for workers' compensation are inconsistent, and that fact is stirring enormous pots across the country.... There is a need to reform how disability is determined."

Another paradoxical finding shows that white claimants faired no better than blacks, even though previous reviews found that blacks are much less likely than whites to be diagnosed with a herniated disk or to undergo back surgery, have less money spent on their care, and receive lower disability ratings and smaller settlements.

"It's one of the more perverse observations in our study," explains Hadler. "African-Americans were much less likely to be operated on, but the care that the whites got, even though it looks like more care, because it's surgery and it's more expensive, didn't do anything for them."

Hadler emphasizes that workers' compensation claims for low back pain represent only 20-30% of all claims filed, but consume a majority of the workers' compensation budget.