Carpal tunnel syndrome and workers' compensation among an occupational clinic population in New York State

Background This study evaluated the experience in the New York State worker s' compensation (WC) system of 135 patients with work-related carpal tunnel syndrome diagnosed at an academic occupational medicine clinic between 199 1-1994. Methods Worker's Compensation Board (WCB) records were reviewed to ascertai n: (1) the proportion of WC claims that were nor initially accepted (i.e., that were challenged) by the WC insurer (2) the proportion of challenged cl aims ultimately decided in the claimant's favor, (3) the length of the peri od between case filing and claim adjudication, and (4) risk factors for cla im challenge. Results Seventy-nine percent of the claims were not initially accepted by t he WC insurer (challenged/no response). Of the 81 challenged/no response ca ses adjudicated (ruled on) at the time of the study, 96.3% were accepted as work-related. Mean time from claim initiation to adjudication was 429 days (range 58-1,617). Mean time from physician request for any treatment and W CB authorization was 226 days (range 0-1,296). Mean time from physician req uest for surgery authorization and WCB authorization was 318 days (range 7- 595). Claims filed by non-whites, low-wage workers, and union members were significantly more likely than others to be challenged. Conclusions Patients with work-related carpal tunnel syndrome face frequent claim challenge by WC insurers in NY State, with attendant prolonged delay s in adjudication and treatment authorization. Likelihood of claim rejectio n was strongly related to ethnicity and socio-economic status. Am. J. Ind. Med. 35:335-342, 1999. (C) 1999 Wiley-Liss, Inc.