Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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J.S. Pachman and B.P. Jacob
healing and repair incorporation, can reduce negative affect and improve
outcome perception [ 16 ].
Causality
Physicians treating patients with groin pain will occasionally be
asked by a workers’ compensation carrier to render an opinion regarding
causality. The issue here is whether the payer for the groin pain treatment
is more appropriately the workers’ compensation or the group health
carrier. There is often a motivation by patients to shift this responsibility
to the workers’ compensation system, given the absence of a deductible
or required co-pay. The rate of reimbursement to physicians and hospitals
in workers’ compensation can vary greatly from state to state.
In most jurisdictions, causality refers to the predominant cause of the
symptoms and findings, in this case, groin pain. Usually the question
relates to an estimation of causality as related to (greater than 50 %)
medical probability (i.e., is the groin pain, more likely than not, the
result of the workplace injury or the result of other unrelated processes?).
However, it is worth noting that the causation threshold in
different state workers’ compensation systems can vary.
The question of causality, i.e., whether or not an inguinal hernia may
be attributed to a single work-related strenuous lifting event, or even to
recurrent strenuous activity, is often a source of litigation. However,
despite the large number of claims in this area, there is little evidence to
support work- related causality [ 1 ]. There is increasing support for the
fact that inguinal hernias are more likely related to a congenital or
acquired connective tissue weakness [ 17 ]. For example, the available
evidence does not support an increased risk of developing an inguinal
hernia among laborers [ 18 ]. It is also interesting to note that inguinal
hernias are unusual occurrences in weight lifters [ 1 ]. As Hendry et al.
further point out, in the work setting, it is likely that when a hernia diagnosis
follows a specific lifting or strenuous event, “the event in question
has merely brought forward the occurrence of a hernia, and it would
most likely have occurred anyway around a similar time” (p. 362). In
this respect, the hernia is analogous to a myocardial infarction that happened
to occur at work, but was more likely than not the result of underlying
atherosclerosis, not the occupational related event. There is also no
evidence to support a relationship between a single or even recurrent
strenuous work-related (or nonwork-related) event and subsequent hernia
recurrence [ 1 ].