Physicians as Gatekeepers in Workers’ Compensation

Of the over three million workers a year seriously injured on the job, only a small fraction receive any workers’ compensation. Compared to the general population, Latinx immigrant workers, especially if undocumented, are highly vulnerable to workplace injury. In fact, workplace fatality rates for Latinx immigrants are 50% higher than for all other workers. Immigrant workers are also more likely to have their workers’ compensation claims contested.

Latinx immigrant workers face barriers to reporting workplace injuries and filing worker compensation claims. In collaboration with Fuerza Laboral, a worker center in Rhode Island, I analyzed interviews with Latinx workers injured at work, medical practitioners who see workers’ compensation patients, and legal professionals who work in the compensation system. This research found that the gauntlet workers must run to file claims in Rhode Island includes uncertainty about their rights; misleading information from employers; threats of retaliation, dismissal, or being reported to immigration; and language barriers. My analysis of injured workers’ stories also make it clear that medical providers act as sentinel gatekeepers to healthcare and benefits.

People who make a worker compensation claim are not seen as fully trustworthy because they have motives to gain from reporting pain or damages. Physicians are thus required to serve as impartial and scientific arbiters who evaluate employee injuries. Consequently, the medical and legal systems create additional barriers for patients and medical professionals. The Injured workers I interviewed reported missing treatments, feeling uncertainty about the loyalty of their physicians, and confusion about their treatment options. They are overwhelmed with contradictory opinions from a tangle of providers.
The physicians I interviewed, in turn, acknowledged frustration with the requirements of “impartial” exams, delayed patient treatment, additional work communicating with insurance companies, and increased difficulty building rapport with patients.

A doctor’s report can support a patient claim, but if a worker’s reported symptoms diverge from the doctor’s conclusions, the legitimacy of their need for compensation may be questioned. And, while judges have the ultimate say, the assumed objectivity of biomedical information can make judges feel dependent on physicians’ conclusions.

Compared to the general population, Latinx immigrant workers, especially if undocumented, are highly vulnerable to workplace injury.

Supplanting injured workers’ testimonies with medical reports complicates recovery and medical treatment, and leaves courts susceptible to influence by physician’s opinions about a claimant. Physicians described how they decide what to emphasize or play down in a report and their methods of trying to decipher the validity of patients’ pain. The effects of physician bias are being increasingly documented. That research begs a reevaluation of legal systems that rely on medicine being objective. A workers’ compensation claim, like any claim for public assistance, is stigmatized. Claimants are typecast as abusing the system or lazy. For low-wage immigrant workers, their value to society is deeply intertwined with their productive capacity, or their ability to work. These popular narratives are reinforced by the mass media, and medical providers are not immune. In worker compensation systems, the perceptions physicians hold will likely shape their actions in response to treating or evaluating an immigrant worker injured on the job.

Analysis of injured Latinx immigrants’ experiences within the RI workers’ compensation system also calls for evaluation of medical education. For example, the orthopedic surgeons I interviewed reported a widespread belief among physicians that Latinx patients expressed or experienced more pain due to “cultural or ethnic” differences. These same doctors acknowledged they often lack interpreters and have difficulties communicating with the same patient population. Still, they believed culture was the main driving factor of Latinx patients’ longer recoveries, and overlooked the impact of structural issues like safety, language barriers, lack of transportation, and the effects of racism.

Analyzing the experiences of those affected by workplace injury exposes pitfalls in coupling medical evaluation and access to healthcare. This research demands a reevaluation of the workers’ compensation system in light of growing data on the effects of physician bias. It also calls for medical education reform that gives priority attention to structural barriers to health.

Image from Balazs Gari, GB.USA.07.0028 (detail), CC BY-NC-ND 2.0