Trust and guidance for clinicians
|
Automatically approval of treatment could be perceived as a sign that that the claims managers trust the clinicians’ judgement
|
Limiting over-servicing
|
Recommendations about MRIs and certain surgeries could limit over-servicing, although solicitors could still get it anyway
|
Patient expectations and claimant monitoring
|
Tool may assist with managing patient expectations, as it sets timeframes about RTW
|
Individual differences & psychosocial factors
|
Tool may inadequately consider individual differences and psychosocial factors. Most patients are not one size fits all
|
Clinical judgement
|
Clinical judgement is important. Tool should not overpass clinical judgement
|
Patient preference
|
Some patients prefer to have non evidence based treatments but in general those patients can be convinced to value EBM
|
Quality of evidence
|
For many topics the evidence is not replicated, or very specific to certain populations
|
Quantity of evidence
|
Lack of evidence should not imply denial of treatment
|
Timeliness and risk assessment
|
Tool may not adequately assess risk of prolonged recovery, and therefore not sufficiently focus on timely treatment
|
Critical appraisal and guideline development
|
Interpretation of evidence is dependent on who does the interpretation. American tool might not be applicable in Australia
|
Claims managers using the EBM tool
|
Inexperience or limited training for claims managers could lead to rigid usage and unfair denials
|
Tool is no solution
|
Tool may not assist with the 20% most problematic cases, and does not recognise employer factors that prolong return to work
|