‘Bottom up’ biomechanics takes active role in evaluation of workplace injury claims
By Ian M. Zeller
Does biomedical engineering have a potential role in the insurance industry when it comes to gauging the cause of injuries?
Current trends point to yes.
This application of engineering principles to problems in medicine and biology has a long-evolving history that has come into the spotlight in the past 15 years with its progress in bio-fabrication of artificial organs and surgical robotics and can be particularly valuable for use in the evaluation of bodily injury claims in such industry segments as workers compensation, where injury causation can come into question.
There are several facets to what is collectively referred to as biomedical engineering, including that which explores the understanding and applications of electrical signals in the body, that which seeks to understand and apply the healing and growth properties of human tissue, and that which explores the actions and reactions of the human body, especially as pertains to forces and movements that can lead to injuries.
Despite this inherent value in such industries as workers compensation, involving the concepts of math and physics coupled with the novelty of the field of injury biomechanics for the analysis of personal injuries makes such analysis an often-overlooked part of the claims process. Encompassing a broad field that includes sports science, human performance engineering and medical device design, the most relevant aspect of this discipline to claims evaluation is injury biomechanics.
This is a sub-discipline centered on understanding the relationship between the forces and movements acting upon the body as a result of an incident and the consistency of injuries that would be expected to result from such an event. It is important to distinguish that this is different from the role of a physician whose purpose is to diagnose and treat reported injuries. As such, the physician would treat the injuries regardless of their origin. To highlight this difference, it can be said that a physician uses a “top down” approach where an injury diagnosis is determined on the basis of observations from an examination as well as the history as reported by the patient. This is contrasted by a biomechanics approach that can be described as “bottom up,” basing injury potential on the event itself.
Biomechanics is based on the evaluation of the dynamics from an incident, identification of associated injury mechanisms, and a determination whether the forces and motions from the incident would facilitate the mechanical failure of tissue diagnosed by a physician as an injury. Between these two processes, the biomechanics technique is uniquely qualified as a means of evaluating the link between an incident and a claimed injury as it quantifies the mechanics of the incident.
The scope of a biomechanical analysis is not to dispute a diagnosis, as that is within the purview of a physician, but rather to identify which rendered diagnoses are related to an incident and which are not consistent with the forces and motions associated with an incident. In other words, the analysis attached to biomechanics serves as an evaluation as to whether a particular diagnosed injury is consistent with the mechanics that would have been in effect given the physics of the accident.
The scientific methodology of a biomechanical injury consistency analysis revolves around several basic steps, which include quantifying the forces and movements associated with a particular incident and establishing the known injury mechanisms associated with a claimed injury.
This analysis can include a calculation of the speed change and associated forces involved in a vehicle accident, the motions resulting from a trip and fall, and the forces resulting from contact with a falling object.
The methodology of examining biomechanics is particularly suitable for identifying injuries that resulted from a particular set of traumatic circumstances in addition to identifying which are more likely the result of degenerative processes or predated an incident.
In many cases, injury mechanisms have been extensively published in the peer-reviewed scientific literature and made available in textbooks for teaching purposes. It is understood that some injuries have significantly more complex mechanisms requiring an analysis of multiple forces, moments and possibly abnormal body positioning.
One of the final steps in biomechanical analysis is determining whether each known injury mechanism of the reported injury was consistent with the dynamics of an incident.
While biomechanics generally focuses on the consistency of injuries, it is also possible to use a well-documented injury as evidence to validate the claimed incident as reported. For injury reconstruction, this strategy can sometimes be used to determine the order of events and determine body positioning and orientation prior to an incident.
The role of biomechanics in claims evaluations is sometimes not well understood, and for that reason this type of analysis is often underutilized in claims evaluations. The overall goal of a biomechanical analysis is to evaluate the evidence from an incident, determine the associated forces and movements from that particular event, evaluate the motions, orientations and mechanisms associated with the claimed injuries, and finally compare those claimed injuries with the mechanisms that dictate how they occur. The end result is an evaluation as to whether an injury is consistent with a particular event based on the evidence available.
Specifically, biomechanics is not about making diagnoses; rather it is about determining the root cause that led to the diagnoses given by physicians in the context of a mechanical event.