Understanding the Workers Compensation System, My Philosophy
- Samantha Diaz
- Sep 3
- 3 min read
Dr. Jose Ortega is a board-certified orthopaedic surgeon located in West Palm Beach, Florida.
He is currently board certified in sports medicine and general orthopaedics. Dr. Ortega completed his sports medicine fellowship at the Cleveland Clinic Foundation in 1998. His area of expertise includes soft tissue injuries of the shoulder, knee, and elbow.
Dr. Ortega has been serving the West Palm Beach community for 25 years. He is a partner at the Center for Bone and Joint of the Palm Beaches.
The purpose of this publication is to share my personal experience and strategy when treating workers compensation (W/C) patients. I believe that a comprehensive approach will assist in returning the patient to work sooner, reducing healthcare costs and resources, and potentially eliminating legal conflict.
I have asked myself many times what makes workers compensation patients different from the general population.
It has been well established that W/C patients:
Experience less post operative improvement and functional outcomes
Take longer to return to work
Have less satisfaction than the general population
This stigma may have a negative impact on how the physician treats this population, and patients should never experience prejudice when being treated.
But why do these patients have worse post-op outcomes?
My own experience has shown that some of these patients have poor workplace relationships and minimal support. Job dissatisfaction is a major factor that has been consistently mentioned at initial office visits.
In some cases, anxiety and depression can be observed as factors that need to be addressed. Uncertainty about the future and the state of their financial situation can also have a negative impact.
In my opinion, addressing psychosocial factors plays a major role in patient management.
I believe that we can reduce the risk of a negative outcome by following a comprehensive approach.
It is imperative to choose the right plan of care and exhaust all non-surgical options, “Do No Harm!”
Good communication with the patient is key to a good patient-physician relationship.
The patient should understand their particular problem and have a detailed plan of treatment.
If surgery is indicated, the physician needs to explain the procedure in detail, including recovery and time out of work.
I prefer avoiding delays in treatment and unnecessary urgent care center visits. Studies have shown that delays in intervention for workplace injuries can have significant negative impact on an injured worker’s well-being and their ability to recover.
After surgery the goal is to get the patient back to work as soon as medically possible.
Work-place accommodations should be available when needed.
Adjustments to the work environment or job description may help the patient reduce stress and anxiety and ultimately accelerate recovery.
Good communication with the case manager is crucial. Updates on the patient's progress are essential and are an important part of the treatment and recovery plan.
Work restrictions can be evaluated and discussed at each visit with the aim of increasing physical activity whenever possible.
The goal is to minimize frustration and dissatisfaction. Dissatisfied and frustrated patients:
Have the longest recovery time
May never return to work at full capacity
This ultimately has a negative impact on healthcare resources reflected in increased utilization and longer treatment plans.
In my opinion, dissatisfied patients also have a higher probability of seeking legal advice. Legal costs in the W/C system can sometimes exceed medical treatment costs. Attorney fees, medical records, court filings, expert witnesses, and traveling can quickly add up but could potentially be avoided.
To summarize:
Choosing the right patient and surgical indications
Allowing early working accommodations
Good communication as a team
These factors can positively impact the outcome and accelerate a safe recovery and return to work.
Written by Jose Ortega, MD
Editorial Notice
An earlier version of Dr. Jose Ortega’s article contained formatting errors that affected the presentation of his work. We sincerely apologize for this mistake.
The corrected article will be republished here on the OM Blog and will also appear in the next edition of Bloom Magazine.
We thank Dr. Ortega and our readers for their understanding as we ensure his full article is presented accurately.
— Bloom Magazine & OM Editorial Team
Jose Ortega, MD
Board-Certified, Fellowship-Trained Orthopedic Surgeon
The Center for Bone & Joint Surgery of the Palm Beaches