This is an important topic. Thanks to Dr. McKenna for raising it.

I agree with Dr. Yarborough. It depends on what type of causation is at issue, and whether or not directing care (to include work relatedness, diagnostics, treatment, disability …) by any and all parties (insurance, employer, attorney, treating physician supervisor, union rep…) are likewise prohibited.

Work Comp is a legal system that varies from state to state. Most work comp laws are liberally construed and the fact finders (administrative judge, attorneys, investigations) have more factual information than healthcare professionals. Most work comp systems in US do not have jurors. In addition, most treating physicians are not considered as experts. Furthermore, the legal standard of “causation” for industrial injury/occupational disease is quite different from that of scientific/medical causation. For example, causation analysis (including aggravation of pre-existing underlying condition) is based on case law. For California, the standard is Southcoast Framing v WCAB  S215637 Ct. App. 4/1 D063945.  The legal standard always supersedes medical (expert) opinions. However, as healthcare professionals, we must abide by the scientific causation analysis under the excellent document of ACOEM Guideline. We should let fact finders argue and weigh admissible evidence on causation/compensability.  

Fred Fung, MD, JD, Esq.