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