The concept of Evidence Based Medicine has certainly been gaining ground in the workers’ compensation universe in recent years. The adaptation has not been easy, and certainly the concept still has its opponents. Yet, the question was recently posed to me; If we now use Evidence Based Medicine, why can we not adopt Evidence Based Causation?

Getting this idea into the mainstream of discussion is a mission of William Zachry, former VP of Risk Management at Safeway/Albertsons and now Senior Fellow at the Sedgwick Institute. We discussed it at last month’s annual conference of the California Coalition on Workers’ Compensation (CCWC). His premise is pretty simple; if we can base medicine on “reasonable use of modern best medicine,” why can we not determine causation on similarly sound principles?

Evidence Based Medicine is, according to the National Institute of Health’s National Center for Biotechnology, defined as “conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information. It is a movement which aims to increase the use of high quality clinical research in clinical decision making.” It is about applying known science and proven methods in the care of patients. It is a guideline, or map if you will, for clinicians to follow when tending to those in their care.

In a world where aging backs and knees are decaying with time regardless of employment condition, why could we not apply similar science in the determination of causation? 

There are obviously different schools of thought on this. Workers’ compensation was meant to be, after all, a no-fault system. However, that was not necessarily intended to mean it was a “catch all” for every natural ailment that people may eventually suffer. There was originally intended to be a correlation between the job requirement and the ultimate injury or illness that developed. I don’t need to tell most of you that this is no longer the case.

The prevailing opinion within our legal system at this time seems to be that an employer hires the “whole person,” and therefore assumes risk for things that may go wrong with them while they are in their employ. That means that a back injury that is attributable to a degenerative spinal disorder often becomes a compensable injury when manifested on the job. Certainly, there may be contributing factors that must be considered, but in some cases that “injury” was going to happen regardless of employment status. Yet today it usually becomes the domain and responsibility of the employer.

I suppose that means the arthritis naturally forming in my hands could become a workers’ comp claim if I allege that the thousands of hours I have spent pecking at this keyboard somehow caused the condition. That is a claim that will not be happening, and one that Evidence Based Causation would likely (and should likely) prevent.

Determining proper causation through an evidence-based program should not be confused with injecting fault into a no-fault system. The two have nothing to do with one another. It simply would be using prevailing science to help define what the responsibility of an employer is in an injury case. 

This concept will be controversial in some quarters, and resistance will be predictable from some stakeholders. Still, it is an idea that deserves further debate and discussion. In a world where some courts and legislators routinely ignore science in the process of legal minutiae, it will be a challenge to adopt.

But it is an interesting idea whose time may have come. Evidence Based Causation. Let the debate begin.

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