“Baby, it’s Cold Outside!”

Many Injured Workers who are exposed to Cold on the job. Cold Exposure can be a source of work injuries. Cold Exposure can take many forms. Cold Exposure can be the result of outdoor work as well as indoor work. Cold Exposure can be the result of cold weather.

Cold Exposure can be the result of working in a refrigerated work environment. Cold Exposure can be the result of working in an environment for which there is an air conditioning system. Work Environments that have poor insulation or lack of a heating system for workers also expose workers to cold.

Work-Related Cold Exposure Injuries can entitle workers to obtain medical treatment for these medical conditions and obtain workers’ compensation benefits.

This article will discuss Cold Exposure and Cold-Related Medical Conditions. Further, case law concerning cold-related injuries will be discussed.


How Cold is Cold?

A Cold Environment is one that is near-freezing temperatures. This is considered “Extreme Cold.” A Cold Environment causes the body to work harder to maintain its temperature. Both Cold and Wind Chill can impact the degree of coldness.

Extreme Cold can drive down the skin and the internal temperature of the body. This is what is known as the core temperature. Extreme Cold can cause the body to shift blood flow from the extremities and outer skin of the core. When this occurs, it can lead to serious health problems, tissue damage, and death.

According to the American Conference of Governmental Industrial Hygienists (ACGIH®) Threshold Limit Values (TLV®), workers should be protected from exposure to cold so that the deep core temperature does not fall below 96.8°F (36°C) and to prevent frostbite to body extremities [ACGIH 2019]. DHH(NIOSH) Publication Number 2019-113


Are there Risk Factors When Dealing with Cold Exposure?

Yes. There are some risk factors that make for a greater chance of injury when exposed to cold. These risk factors include wetness, dampness, being improperly dressed as well as exhaustion.

These risk factors can also include workers who have pre-existing health conditions such as hypertension, hypothyroidism, and diabetes. Also, a worker with poor physical conditioning is also at risk.


What Types of Occupations are at Risk for Cold Exposure?

There are a variety of workers who are at risk for cold-exposure related injuries. These occupations include Snow Cleanup Crews, Sanitation Workers, Police Officers, and Emergency Response Personnel such as Firefighters and Emergency Medical Technicians.

Further, other occupations include an individual who works in refrigerated areas or manufacturing facilities that require cold temperatures. Additionally, Long Haul Truck Drivers are at risk for cold exposure.


Was are Cold-Related Medical Conditions?

Cold-Related Medical Conditions include Chiliblains, Trenchfoot aka Immersion Foot, Frostbite, and Hypothermia.

Besides Cold-Related conditions, Cold Exposure can also have an impact on other medical conditions. Cold-related conditions aggravate a Worker’s pre-existing musculoskeletal injuries and vascular disorders.


What is Chiliblains?

“Chilblains are the painful inflammation of small blood vessels in the skin that occur in response to repeated exposure to cold but nonfreezing temperatures. Small blood vessels in the skin may become permanently damaged by cold temperatures, resulting in redness and itching during additional exposures.

Symptoms of chilblains include redness, itching, possible blistering, inflammation, and possible ulceration in severe cases..” DHH(NIOSH) Publication Number 2019-113.


What is Trendfoot aka Immersion Foot?

“Trench foot is an injury of the feet after prolonged exposure to wet and cold-related conditions. Trench foot occurs because wet feet lose heat faster than dry feet. To prevent heat loss, the body constricts blood vessels in the feet, and then the skin tissue begins to die.

Symptoms of trench foot include reddening of the skin, numbness, leg cramps, swelling, tingling pain, blisters or ulcers, bleeding under the skin, and gangrene (e.g., foot turns purple, blue, or gray).” DHH(NIOSH) Publication Number 2019-113

This condition can occur at temperatures as high as 60°F


What is Frostbite?

“Frostbite is an injury caused by freezing of the skin and deeper tissues, resulting in the loss of feeling and color in the affected areas. Frostbite can permanently damage body tissues, and severe cases can lead to amputation.

Examples of risk factors for frostbite include contact with metal or water, dehydration, diabetes, smoking, alcohol abuse, sedating or judgment impairing medications, and prior history of frostbite. Symptoms of frostbite include numbness; tingling or stinging; aching; and bluish or pale, waxy skin.” DHH(NIOSH) Publication Number 2019-113.


What is Hypothermia?

Hypothermia is another cold-related illness. “[w]hen exposed to cold temperatures, the body loses heat faster than it can be produced. Prolonged exposure to cold causes internal body temperature to drop, resulting in a condition called hypothermia. Hypothermia affects brain function, making the victim unable to think clearly or move well (i.e., they may be unable to protect themselves from hazards, or experience slips, trips, and falls). This makes hypothermia particularly dangerous because a person may not recognize the symptoms and will be unable to make life-preserving decisions.

Symptoms of hypothermia can depend on how long a person has been exposed to cold temperatures and individual variability. Hypothermia Symptoms and First Aid Early symptoms include shivering, fatigue, loss of coordination, confusion, and/or disorientation. Late symptoms include no shivering, blue skin, dilated pupils, slowed pulse and breathing, and/or loss of consciousness. If hypothermia is suspected, medical assistance should be requested immediately (e.g., call 911).” DHH(NIOSH) Publication Number 2019-113.

Hypothermia occurs when the normal body temperature of 98.6 degrees drops to less than 95 degrees. It can occur even at cool temperatures above 40 degrees.


Has there been Caselaw concerning Cold Exposure?

Yes. There have been several cases of interest concerning Cold Exposure.

Nature and Extent of Cold Exposure: In a case involving a partial lower extremity amputation, the applicant claimed cold exposure as a causative element that caused the necessity for the amputation to be required. The Court of Appeal discussed the fact that there was an issue concerning the duration and degree of cold exposure.

In sum, the applicant and applicant’s medical evidence was not found to be convincing as to bring it to the level of substantial evidence on the issue. The applicant’s claim was not found to be industrial. Cigna vs. WCAB (1996) 61 Cal. Comp. Cases 1378.

The take away from the case is that evidence of nature, i.e. the temperature and elements exposed to, and the amount of time of the exposure are important facts that the Injured Worker should obtain in order to prove up their case.

Exposure to Cold Aggravating Pre-Existing Medical Conditions: In this case, applicant claimed that her exposure to cold air in her employment aggravated her underlying bronchial disease and caused chronic pulmonary disease. Applicant prevailed. Aetna vs. WCAB (1976) 41 C.C.C. 252.


Can Cold Injuries Be Prevented?

Yes. There are countless efforts that Employers and Workers can take to reduce the risk of cold-related illness and injury.

Prevention measures include planning, education, reducing cold exposure, allowance for breaks to be in heated environments, proper clothing and the allowance for changing out wet clothing. There are many additional measures that can be taken to prevent cold-related injury.


What If I Need Advice?

If you would like a free consultation regarding your workers’ compensation claim, or if you feel you have medical mismanagement claims, please contact the Law Offices of Edward J. Singer, A Professional Law Corporation.

They have been helping people in Central and Southern California deal with their workers’ compensation cases for 26 years. Contact us today for more information.


Image Credit: Shutterstock/Avatar_023


California Workers’ Compensation Law provides for a treatment for work-related dental injuries. Some industrial Dental conditions can include Orofacial Pain Conditions. This article will discuss the Orofacial Pain Conditions and the treatment indicated for them.

There are a variety of Orofacial Pain Dental Conditions. These conditions include Orofacial Pain, Craniofacial Spasticity, TMJ Disorders, Atypical Toothaches, and Snoring & Sleep Apnea.


Are there any Limitations on Workers’ Compensation Dental Treatment?

The answer is “yes” and “no.” With respect to the answer of “yes,” treatment is subject to both Utilization Review and Independent Medical Review.

Therefore, the treatment must be approved in order to be provided. With respect to the answer of “no,” treatment has no monetary limit. Therefore, treatment will not be denied based upon the fact that it may be costly in nature.


What is Orofacial Pain?

Per the American Academy of Orofacial Pain, “[t]he field of Orofacial Pain is concerned with the prevention, evaluation, diagnosis, treatment, and rehabilitation of orofacial pain disorders.

Such disorders may have pain and associated symptoms arising from a discrete cause, such as postoperative pain or pain associated with a malignancy, or may be syndromes in which pain constitutes the primary problem, such as TMJ disorder pain, neuropathic pains or headaches.”


What Types of conditions are considered Orofacial Pain?

Per the AAOP, “[a]t the present time the orofacial pain encompasses: Temporomandibular Joint disorders, Masticatory Musculoskeletal Pain, Cervical Musculoskeletal Pain, Neurovascular Pain, Neuropathic Pain, Sleep Disorders related to Orofacial Pain, Orofacial Dystonias, Headaches, Intraoral, Intracranial, Extracranial, and systemic disorders that cause orofacial pain.”


What Treatments are indicated for Orofacial Pain?

Orofacial Pain treatments can include anti-spasticity drugs, bruxism counter-conditioning and protective appliances, and botulinum toxin injections.


What is Craniofacial Spasticity?

Craniofacial dyskinesias involve abnormal spontaneous craniofacial movements.


What Treatments are indicated for Craniofacial Spasticity?

Craniofacial Spasticity treatments can include trigger point therapy, corticosteroid, and sodium hyaluronate joint injections, arthrocentesis and mobilization, pharmacological treatment and physical therapy.


What are TMJ Disorders?

TMJ Disorders relate to problems with respect to the joint that connects the jaw to the skull.

TMJ disorders have been known to have been caused or aggravated by stress. Therefore, work stress can be considered as a causative factor to a TMJ Disorder claim.


What are the Treatments for TMJ Disorders?

TMJ Disorder treatments include trigger point therapy, corticosteroid, and sodium hyaluronate injections, arthrocentesis and mobilization, pharmacologic and physical therapy.


What are Atypical Toothaches?

Atypical Toothaches are also referred to as Atypical Odontalgia. This relates to atypical facial pain, phantom tooth pain or neuropathic orofacial pain.

These conditions could be work-related in that they arise in connection with prior industrial work-related dental treatment. Also, there is some association that can be made with work-related stress causing depression or anxiety.


What are the Treatments for Atypical Toothaches?

Treatments can include diagnostic and therapeutic anesthetic blocks, topical desensitization medications, neurosensory stents, nerve desensitizing injections and sympathetic nerve blocks.


What is Snoring & Sleep Apnea?

Snoring is noisy breathing that occurs during sleeping. Sleep Apnea is a condition in which breathing repeatedly stops and starts which someone is sleeping.

Sleep Apnea is associated with weight gain. There are many times that Injured Workers, as a result of their inactivity post-injury, gain weight. As a result of this weight gain, they can develop Sleep Apnea.


What are the Treatments for Snoring & Sleep Disorders?

The treatments for Snoring & Sleep Apnea include anterior mandibular positioning devices such as a Herbst or TAP. Surgery via a maxillofacial surgery, laser-U3P, non-surgical treatment including weight loss, exercise programs, polysomnography, and home monitoring.


What are Oral Lesions/ Burning Mouth?

Burning Mouth Syndrome involves an individual feeling burning scalding or tingling feelings in the mouth that may occur every day for a month or longer.

Oral Lesions are ulcers that occur on the mucous membrane of the oral cavity.

These conditions can be work-related in that they can be caused by industrial trauma, treatment for industrial injuries such as radiotherapy or chemotherapy, job-related stress, or industrially-related gastrointestinal conditions.


What is the Treatment for Oral Lesions/Burning Mouth?

Treatments include medications, laser therapy, oral stents, and cryotherapy.


What is Need Advice?

If you would like a free consultation regarding your workers’ compensation claim, or if you feel you have medical mismanagement claims, please contact the Law Offices of Edward J. Singer, A Professional Law Corporation.

They have been helping people in Central and Southern California deal with their workers’ compensation cases for 26 years. Contact us today for more information.


Image Credit: Shutterstock/YAKOBCHUK VIACHESLAV

Onecall and Workers’ Compensation: Injured Workers obtaining services and testing through one call: What You Need to Know

In the California Workers’ Compensation System, Insurance Companies have the obligation to provide Injured Workers medical treatment to cure or relieve from the effects of their industrial injury.

In order to fulfill their obligation to provide medical care and other services, Insurance Companies utilize vendors. Vendors are businesses that provide various services. For example, a pharmacy that fills a prescription for medications would be considered a vendor.

One of these vendors that Insurance Companies use to fulfill their workers’ compensation related obligations is Onecall.

This article will discuss Onecall. Many Injured Workers have encountered Onecall during the course and scope of their treatment. They or their treating physicians may be directed to Onecall to provide services. This article will discuss the role of Onecall in workers’ compensation.


Why Is Onecall Unique?

Some vendors in workers’ compensation lend themselves to provide very specific services. For example, an Interpreting Services may provide only foreign Language Interpreters. Onecall, however, is unique in that it holds itself as a vendor which can provide a large variety of services to Insurance Companies.


What is Onecall?

As a vendor, Onecall, according to their website, provides “convenient, efficient and cost-effective healthcare for injured workers so they can get back to work and life faster.” Their goal for injured workers is to deliver care when they need it. Further, their goal is to provide the Injured Worker the right resources to help the Injured Worker navigate down the road to recovery.


What Type of Services Does Onecall Provide?

Onecall provides for a variety of services. These services include Physical Therapy, Diagnostics, Durable Medical Equipment, Home Health, Complex Care, Transport Services, Language Services, and Dental Services.


Who Contracts with Onecall? Why?

Companies that contract with Onecall include Insurance Companies, Third Party Administrators, State Funds, Adjusters, Employers, Providers, and Physicians.

Onecall, because of the large variety of services it provides, makes it a convenient vendor for Insurance Companies when they are required to provide a wide range of necessary services. In sum, it is a “one-stop” shop for Insurance Companies.


What Individuals does Onecall Deal with?

Onecall interacts with practically everybody involved in a workers’ compensation claim. This interaction includes Injured Workers, Adjusters, Nurse Case Managers, Carriers, Third Party Administrators, Self-Insured Employers, and Physicians.

For Injured Workers, Onecall makes efforts to assist with respect to upcoming appointments. Their website contains information to assist Injured Workers with respect to their upcoming appointments.


What Types of Services Can an Injured Worker get from Onecall? Is there a limit?

Injured Workers can obtain a variety of services from Onecall. These services include Acupuncture, Aqua Therapy, Certified Hand Therapy, Chiropractic Treatment, Functional Capacity Evaluations, Massage Therapy, Occupational Therapy, Physical Therapy, Tele-Rehabilitation, and Work Hardening.

Please note, however, that under California Workers’ Compensation Law, there are limitations with respect to the types of medical services that can be provided. Further, any services requested are subject to Utilization Review by the Insurance Company.

As a result, if Onecall is offered as a provider, the services were most likely authorized by the Insurance Company.

Further, an Insurance Company using Onecall may not contract for all of their services they offer. They may contract with Onecall to provide a specific service such as dentistry.


What is Your Experience with Onecall?

My experience with Onecall is mixed. In certain circumstances, I have been very happy with the result of using Onecall. I was able to get a good provider for my client. Further, my client was happy with the results. He got the treatment that he needed.

In other circumstances, there were some problems. The problems that I encountered was with respect to some of the vendors that Onecall utilized to perform services. There was some disappointment with respect to the facilities they were referred to.

In sum, I have no problem with using or working with Onecall on claims. I do, however, monitor the situation to make sure that the provision of services was done successfully.


What If I Need Advice?

If you would like a free consultation regarding your workers’ compensation claim, or if you feel you have medical mismanagement claims, please contact the Law Offices of Edward J. Singer, A Professional Law Corporation.

They have been helping people in Central and Southern California deal with their workers’ compensation cases for 26 years. Contact us today for more information.


Image Credit: Shutterstock/Elnur

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Many times, Injured Workers wonder why certain things are happening on their claim.

Common questions are:

• “Why is my Employer treating me differently now that I am injured?”

• “Why is the Insurance Company not trying to help me?”

• Why is my Employer or Carrier acting this Way?

There are reasons that can explain your Employer’s and Insurance Company’s behavior. Continue reading

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