Why is it so hard to get Medical Treatment?

For over 100 years, the worker’s compensation system allowed an injured worker to receive treatment that would help him or her get better or feel better from their work related injuries.  In 2003, the State Legislature changed how the injured worker was able to obtain treatment, taking the question of treatment out of the hands of the judges and lawyers, and putting it into the hands of a medical “cookbook.” 

The Legislature believed that there should be greater uniformity and consistency in the provision of medical care in the workers’ compensation system.  Moreover, they wanted treatment to be determined by evidence based treatment guidelines.  The Legislature directed the Department of Industrial Relations to develop a Medical Treatment Utilization Schedule (MTUS) that uses evidence based medicine to determine the reasonable medical necessity for any treatment recommended by a treating physician. 

The MTUS is a one size fits all treatment guideline.  The are other treatment guidelines like the American College of Occupational and Environmental Medicine (ACOEM) and the Official Disability Guidelines (ODG), however they all work the same – like a cookbook. 

Thus, if you wanted to bake a cake, you’d need ingredients like flour, yeast, milk, eggs, sugar, etc.  If you’re missing an ingredient, you won’t get your cake.  Similarly, if you want treatment, you now must show a series of ingredients (symptoms, treatment, diagnostic tests) in order to get that treatment.  If you’re missing one of the ingredients, you don’t get the treatment. 

For the most part, doctors are not trained to use the MTUS, ACOEM or ODG when figuring out what treatment would work for you.  Instead, they rely on their skill, education, training, knowledge and experience to decide which treatment might help.  Now, the treatment must conform to these treatment guidelines and it will take several decades before the doctors adapt to this new method of delivering health care.  Until then, it is a continually process of educating the physicians so their treatment recommendations are consistent with these guidelines, so treatment will be approved and provided.