Does Medical Directions Make any Differences in Workers' Compensation System? Analysis of Employee and Employer Directed Medical Care in Relation to Prolonged Physical Therapy and Attorney Involvement among Rotator Cuff Tear Claims

Xuguang Grant Tao ¹, Paul Kauffman , Nimisha Kalia

⁰Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland. (Dr Tao, Dr Tsourmas, Dr Kalia, Dr Leung, Mr Yuspeh, and Dr Bernacki,); From AF Group, Lansing, Michigan (Mr Kauffman); General Electric, Norwalk, Connecticut (Dr Kalia); Texas Mutual, Workers' Compensation Insurance, Austin, Texas (Dr Leung and Dr Tsourmas).

Journal of Occupational and Environmental Medicine +

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June 25, 2025

View abstract on PubMed

Summary

Employee-directed care for workplace injuries leads to longer physical therapy (PT), while employer-directed care increases attorney involvement in workers' compensation claims.

Area Of Science

Occupational Medicine
Health Services Research
Workers' Compensation

Background

Medical care direction in workers' compensation claims can be employee-directed, employer-directed, or shared.
The influence of these different medical direction models on claim duration and outcomes is not fully understood.
Prolonged physical therapy and attorney involvement are key factors impacting workers' compensation claim costs and resolution.

Purpose Of The Study

To investigate the association between employee- versus employer-directed medical care and prolonged physical therapy (PT).
To examine the relationship between medical care direction and attorney involvement in workers' compensation claims.
To identify differences in workers' compensation claim processes based on who directs medical care.

Main Methods

Analysis of 8,814 rotator cuff tear claims filed with a national insurance carrier between 2007 and 2022.
Comparison of prolonged PT (≥360 days) and attorney involvement across different medical direction groups (employee-directed, employer-directed, shared).
Statistical analysis using odds ratios to quantify the associations.

Main Results

Employee-directed medical care was associated with a 1.41 odds ratio for prolonged PT compared to employer-directed care.
Shared employee and employer-directed care showed a 1.58 odds ratio for prolonged PT.
Employer-directed care had a 2.33 odds ratio for attorney involvement compared to employee-directed care.
Shared medical direction also showed an increased odds ratio (1.62) for attorney involvement.

Conclusions

Employee-directed medical care is linked to increased utilization of prolonged physical therapy in workplace injury claims.
Employer-involved medical direction is associated with a higher likelihood of attorney involvement in workers' compensation cases.
The direction of medical care significantly influences key outcomes within the workers' compensation system.

Keywords:

attorney involvement medical direction occupational injury physical therapy physician choices rotator cuff repair rotator cuff tears shoulder injuries workers’ compensation