Psychologist Offers Advice to Meet Ethical Challenges in WC

Sarasota, FL (WorkersCompensation.com) - Claims examiners, adjusters, case managers and others who work with injured workers often have a tough time doing what is ‘right.’ They may find themselves walking a fine line when it comes to doing what is ethically the best option.

The employer/payer wants the injured worker to go a provider who always determines carpal tunnel is not causally related; the best provider is also a close relative; the injured worker has ‘kidded’ about doing harm to himself or others. Deciding the most ethical way to handle these situations can be challenging, especially if there are multiple and conflicting codes of ethics in effect. But there are strategies that can be used a decision-making guide.

Ethical Decisions

Ethics are the principles of conduct that govern a person or group. They are not the same as morals, which are an individual’s own principles regarding right and wrong.  

Many organizations have ethics codes; such as the American Nursing Association, Adjuster State Licensing organizations and URAC. They are designed to be a guide to maintain professional accountability, not to provide clear-cut answers. They are also not the same as laws, which always take precedence.

The most appropriate decision may require opting for a lesser harm over a greater one. “Those decisions often don’t feel good,” said Michael Coupland, network Medical Director for Integrated Medical Case Solutions. “There are real conundrums here.”

As a psychologist, he’s run into situation where an injured worker has discussed possible causing injury to himself or others. “A duty to disclose comes with that,” Coupland said during a recent webinar produced by Genex. “Those are usually guided by the state, but there’s a really tough decision point; how do I know if somebody is kidding around? How much do they mean it? It’s a really big step to inform on somebody that they are threatening someone in the workplace.”

In that scenario, Coupland suggests either talking to a colleague who has the same licensure qualifications, or speaking with someone who is on an ethics committee of an organization — without disclosing any personal information.

“It really does help because often in these decisions you’re under the mushroom with these,” he said. “You can’t talk to a whole lot of people but generally you can talk to somebody whose ethics directives would lead you to help form the decision. Then, document how you made your final decision.”

Coupland also offered 5 principles that can help make the best ethical decision.

1. Autonomy. This is the right for a person to make his own decisions while balancing them with doing what is perceived to be best for the client. The challenge comes, for example, when the payer wants the injured worker to be treated by a provider known for bending to the payer’s side. “Do you push back because you know you are being pushed into something not fair for the patient, or do you want to keep the customer happy?” Coupland said. “You will need support in this decision-making. It goes back to what is in the best interest of the patient. You have some responsibility for protecting the rights of the injured worker.”
2. Beneficence. The quality of doing or producing good, this is the foundation of the case management process. An example would be finding a surgeon who can perform surgery for the injured worker in a timely fashion, rather than forcing him to wait.
3. Nonmaleficence. This translates to doing no harm — either to another person or to the self. A case manager who is asked to visit the home of an injured worker who is known to have impulse control issues and a history of sexual assault would be justified pushing back against the request.
4. Justice. Providing equal access and equal treatment. An example is when a peer reviewer says a post-surgical embolism is not causally related, and the adjuster thinks it is.
5. 5Fidelity. This is loyalty, and includes confidentiality and informed consent.

“Use these principles to guide you,” Coupland advised. “Have documentation to back up your decision-making process.”

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