Subsequent Injuries Fund & Workers’ Compensation: Additional Benefits for Seriously Disabled Injured Workers with Pre-Existing Disabilities: What You Need To Know

The State of California has a Special Program for Injured Workers who have pre-existing labor disabling conditions. It is called the Subsequent Injuries Fund. It is commonly referred to by the abbreviation “SIF”. This Special Program allows for Injured Workers who are seriously disabled to obtain additional compensation beyond their ordinary workers’ compensation case.

What is the Subsequent Injuries Benefits Trust Fund?

Per the Department of Industrial Relations, “[t]he Subsequent Injuries Benefits Trust Fund (SIBTF) is a source of additional compensation to injured workers who already had a disability or impairment at the time of injury. For benefits to be paid from the SIBTF, the combined effect of the injury and the previous disability or impairment must result in a permanent disability of at least 70 percent. The fund enables employers to hire disabled workers without fear of being held liable for the effects of previous disabilities or impairments.” In sum, ratings of an Injured Worker’s overall disability, regardless of it being industrial, must be 70 percent or more to qualify. Continue reading

QME Specialties & Your Qualified Medical Evaluation: The Choice Of QME Specialties & Your Workers’ Compensation Case: What You Need To Know

California Workers’ Compensation Law provides for the employment of Qualified Medical Evaluators (QMEs) to assist in resolving disability and medical disputes between Injured Workers and Insurance Companies.

The Department of Industrial Relations (DIR) Medical Unit is responsible for the assignment of the QMEs to the parties. As part of this process, the Medical Unit also provides for a Medical Specialty choice with respect to the assignment of a QME Panel.

This article is intended to discuss the various QME medical specialties available.

What is a Qualified Medical Evaluator?

Per the DIR, “Qualified medical evaluators (QMEs) are qualified physicians who are certified by the Division of Workers’ Compensation – Medical Unit to examine injured workers to evaluate disability and write medical-legal reports. The reports are used to determine an injured worker’s eligibility for workers’ compensation benefits. “

The DIR believes that typically doctors with Medical Specialties have “typically gained through education, experience, and demonstrated competency.”

The DIR notes that a “QME physician certified by the DWC in a particular specialty characteristically has the knowledge to perform QME evaluations that fall within that specialty’s range of expertise. It is important to be aware that individual physicians vary in their specific knowledge, skills, and expertise.” [NOTE: The DIR acknowledges that not all QME are equal. Some are more competent than others.]

What is a Medical Specialty?

The practice of medicine has many different areas of concern. A specialty means that the physician has taken steps to have an increased proficiency with respect to a certain area of medicine. Certain physicians, after graduating medical school, enter into residency programs. These programs can include specialties such as urology and surgery. Further, there is additional specialty and subspecialty training in the form of fellowships. For example, there are doctors who focus their practice to treating people with musculoskeletal problems; there are doctors who practice performing surgery on bones and joints. There are doctors who focus their practice treating patients with cardiovascular disease.

How Do Medical Specialties Impact QME Evaluations?

Injured Workers generally have specific injured body parts and body systems that need to be evaluated. Injured Workers, as part of their evaluation, need to have a QME who will examine and render medical opinions with respect to these body parts and body systems. Therefore, it is very important for an injured worker to choose a medical specialty in which the body part or body systems will be addressed. Therefore, it is important to understand the medical specialties that are available and what areas each specialty covers.

What If My Medical Injuries Involve Multiple Specialties?

QMEs are allowed to consult with other doctors concerning the generation of the QME report. They may reach out to your treating physicians for consultation. Further, frequently, QMEs note in their reporting that they defer evaluations of certain conditions outside their medical specialty to other evaluators. Sometimes, the QMEs will report that an additional QME Panel for other medical specialties.

What are the QME Medical Specialties Available?

The QME Medical Specialties include Allergy and Immunology, Dermatology, Emergency Medicine, Family Practice, General Preventative Medicine, Hand Surgery, Internal Medicine, Internal Medicine-Cardiovascular Disease, Internal Medicine-Endocrinology, Diabetes and Metabolism, Internal Medicine-Gastroenterology, Internal Medicine-Hematology, Internal Medicine-Infectious Disease, Oncology, Nephrology, Pulmonary Disease, Rheumatology, Neurological, Neurological Surgery, Obstetrics and Gynecology, Occupational Medicine, Orthopedic Surgery, Otolaryngology, Pain Medicine, Pathology, Physical Medicine & Rehabilitation, Psychiatry, Spine, Surgery, Surgery-General Vascular, Thoracic Surgery, Medical Toxicology, and Urology.

Are there additional QME Medical Specialties Available?

Yes. The Medical Unit also provides for non-physician specialties. These non-physician specialties include:

  • Acupuncture
  • Dentistry
  • Optometry
  • Podiatry
  • Psychology

Descriptions of all the QME Specialties:


What is the Acupuncture QME Specialty?

Per the DIR, “An acupuncturist may be consulted for specific symptoms and conditions such as pain, anxiety, arthritis, asthma, migraine, menstrual disorders, intestinal disorders, addiction, and other conditions. The World Health Organization (WHO) has listed the above conditions as being responsive to acupuncture treatment. Acupuncture is generally categorized as alternative medicine or complementary medicine. Acupuncturists complete at least three years of study beyond their college education and receive a master’s or doctoral degree.”

What is the Allergy and Immunology(MAI) QME Specialty?

Per the DIR, “An allergist/immunologist (commonly referred to as an allergist) is a physician specially trained to diagnose, treat and manage allergies, asthma and immune system diseases including primary immunodeficiency disorders. These conditions range from the very common to the very rare, spanning all ages and encompassing various organ systems.”

What is a Chiropractic QME Specialty?

Per the DIR, “Doctors of Chiropractic (chiropractors) care for patients of all ages, with a variety of health conditions. Chiropractors are especially well known for their expertise in caring for patients with back pain, neck pain, and headaches. They may use manipulations or mobilizations (chiropractic adjustments). They also care for patients with a wide range of injuries and disorders of the musculoskeletal system, involving the muscles, ligaments and joints. Chiropractors also counsel patients on diet,

nutrition, exercise, healthy habits, and occupational and lifestyle modification. Chiropractors receive a Doctor of Chiropractic (DC) degree after four to five years of education following their college education.”

What is the Dermatology (MDE) QME Specialty?

Per the DIR, “Dermatology involves the evaluation and management of patients with benign and malignant disorders of the skin, hair, nails and adjacent mucous membranes. A dermatologist has had training and experience in the following:

The diagnosis and Treatment of Skin Cancers

  • melanomas
  • moles
  • other tumors of the skin
  • The management of contact dermatitis and other inflammatory skin disorders
  • The recognition of systemic and infectious diseases that manifest on the skin
  • Dermatopathology, the microscopic diagnosis of diseases of the skin
  • Surgical techniques used in dermatology

The management of cosmetic disorders of the skin, including:

  • hair loss
  • scars
  • the skin changes associated with aging.”

What is an Emergency Medicine(MEM) QME Specialty?

Per the DIR, “Emergency medicine is the specialty concerned with the stabilization, management, diagnosis, and disposition of individuals with acute illness and injury. It also includes the management of trauma resuscitation, advanced cardiac life support, advanced airway management, poisonings, pre-hospital care and disaster preparedness. Emergency medicine encompasses a large amount of general medicine but involves the technical and cognitive aspects of virtually all fields of medicine and surgery including the surgical sub-specialties.

Emergency medicine physicians have a broad knowledge base and possess the skills of many specialists and have the ability to:

  • Manage a difficult airway (Anesthesia)
  • Suture a complex laceration (Plastic Surgery)
  • Reduce a fractured bone or dislocated joint (Orthopedic Surgery)
  • Treat a heart attack (Internal Medicine)
  • Delivery a baby (Obstetrics and Gynecology)
  • Stop a bad nosebleed (ENT)
  • Manage suicide attempts and complex overdoses (Psychiatry & Toxicology)
  • Tap a septic joint (Rheumatology)
  • Protect an abused child (Pediatrics)
  • Place a chest tube (Cardiothoracic Surgery.)”

What is a Family Practice QME Specialty?

Per the DIR, “A family practice physician has been trained in: Providing continuing, comprehensive health care and a specialty in breadth that integrates the biological, clinical and behavioral sciences.

The scope of family practice medicine encompasses all ages, both sexes, each organ system and every disease entity.”

What is General Preventative Medicine (MPM) QME Specialties?

Per the DIR, “General preventive medicine focuses on: The health of individuals and defined populations to protect, promote, and maintain health and well-being and prevent disease, disability, and premature death; Control and prevention of occupational and environmental factors that may adversely affect health; Clinical preventive medicine activities, including measures to promote health and prevent the occurrence, progression, and disabling effects of disease and injury; and Assessment of social, cultural, and behavioral influences on health.”

What is a Hand Surgery (MHH) QME Specialties?

Per the DIR, “Hand surgeons focus on surgical and non-surgical assessment of problems of the hand, wrist, and forearm. Many hand surgeons are also experts in diagnosing and caring for shoulder and elbow problems. Hand surgeons are orthopedic, plastic, or general surgeons who have additional training in surgery of the hand. Because many hand surgeons devote most of their time to examining, treating and studying the hand, they are specialists in hand care, including:

  • Carpal tunnel syndrome
  • Wrist pain
  • Cuts on the fingers and hand
  • Fractures
  • Dislocations
  • Contractures
  • Amputations
  • Creating fingers from toes and other joints
  • Vascular injuries
  • Prosthetics
  • Orthotics.”

What is an Internal Medicine (MMM) QME Specialty?

Per the DIR,” Internal medicine physicians, or internists, specialize in adult health care. They spend at least three years of medical training learning how to prevent, find and treat illness in adults. Internists have a broad knowledge base and possess the skills of many internal medicine specialists. They care for any adult sickness, including those involving:

  • Blood (Hematology)
  • Cancer (Oncology)
  • Diabetes (Endocrinology)
  • Digestion (Gastrointestinal)
  • Heart and blood vessels (Cardiovascular Disease)
  • Hormones (Endocrinology)
  • Infections (Infectious Disease)
  • Kidneys (Renal)
  • Liver (Gastrointestinal)
  • Rheumatoid arthritis (Rheumatology)

Internists take care of people from their teen years through old age and manage their care even when other doctors are involved.”

What is the Internal Medicine-Cardiovascular Disease (MMV) QME Specialty?

Per the DIR, “Cardiovascular disease, or cardiology, is the subspecialty of internal medicine that focuses on prevention, diagnosis, and treatment of conditions of the heart, blood vessels and circulation system in adult patients.

Cardiology is the subspecialty of internal medicine concerned with the functioning of the heart, blood vessels and circulation of blood throughout the body. It may also encompass evaluation of the lungs.”

What is the Internal Medicine-Endocrinology, Diabetes & Metabolism (MME) Qualified Medical Evaluator Specialty?

Per the DIR, “Endocrinology, diabetes, and metabolism (endocrinology) is the subspecialty of internal medicine that specializes in conditions specific to the endocrine system and major endocrine glands, including the pituitary, pineal, thyroid, parathyroids, thymus, adrenals, pancreas, ovaries, and testes. Endocrinologists provide treatment for a wide range of functions and disorders of the human body – diabetes, thyroid disorders, infertility, metabolism, glandular cancers, growth hormone deficiency, genetic dysfunction, heart disease, osteoporosis, obesity and hormonal imbalances. The skills of an endocrinologist are necessary for complicated disorders, such as uncontrolled diabetes, thyroid cancer, pituitary dysfunction, familial endocrine and auto-immune disease.”

What is the Internal Medicine-Gastroenterology(MMG) Qualified Medical Evaluator Specialty?

Per the DIR, “Gastroenterology is the subspecialty of internal medicine involving the management of diseases of the gastrointestinal tract (esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts) and liver. It includes common and important conditions such as colon polyps and cancer, hepatitis, gastroesophageal reflux (heartburn), peptic ulcer disease, colitis, gallbladder and biliary tract disease, nutritional problems, Irritable Bowel Syndrome (IBS), and pancreatitis. In essence, all normal activity and disease of the digestive organs are part of the field of Gastroenterology.”

What is the Internal Medicine Hematology (MMH) Qualified Medical Evaluator Specialty?

Per the DIR, “Hematology is the subspecialty of internal medicine concerned with disorders of the blood, bone marrow and lymphatic systems. These include disorders of red and white blood cells and platelets, bone marrow failures, such as aplastic anemia, abnormal clotting, and bleeding, Hodgkin’s disease and blood malignancies such as leukemia, lymphoma, multiple myeloma, hairy cell leukemia and related problems. Hematologists coordinate total patient care, working, where needed, with surgeons, radiation therapists, gynecologists or other specialists. Treatments may include therapeutic phlebotomy, bone marrow aspiration, core bone marrow biopsy, and chemotherapy or other special therapy.”

What is the Internal Medicine Infectious Disease(MMI) Qualified Medical Evaluator Specialty?

Per the DIR, “Infectious disease is the subspecialty of internal medicine that focuses on the diagnosis and treatment of infectious diseases. Infectious disease specialists have expertise in infections of the sinuses, heart, brain, lungs, urinary tract, bowel, bones, and pelvic organs. Their extensive training focuses on all kinds of infections, including those caused by bacteria, viruses, fungi, and parasites. Many infectious disease physicians specialize in treating patients with infections due to human immunodeficiency virus (HIV), the cause of acquired immunodeficiency syndrome (AIDS). Infectious disease specialists have specialized knowledge about the use of antibiotics and their potential adverse effects. They also have additional training in immunology (how the body fights infection), epidemiology (how infections spread) and infection control.”

What is the Internal Medicine Medical Oncology(MMO) QME Specialty?

Per the DIR, “Medical oncology is the subspecialty of internal medicine that focuses on the diagnosis and management of cancer. Medical oncologists are broadly trained in all areas of treating cancer. Some medical oncologists also further specialize in specific types of cancer, such as breast cancer, lung cancer, prostate cancer, leukemia, or lymphoma.”

What is the Internal Medicine Nephrology(MMN) QME Specialty?

Per the DIR,” Nephrology is the subspecialty of internal medicine concerned with kidney diseases. Nephrologists diagnose and treat kidney diseases, including both the conditions these diseases can produce — such as hypertension — as well as diseases that can cause kidney failure — such as diabetes mellitus and polycystic kidney disease. Nephrologists evaluate patients in cases of protein or blood found in the urine, severe high blood pressure, kidney stones, renal insufficiency or kidney failure.”

What is the Internal Medicine-Pulmonary Disease (MMP)/Pulmonology QME Specialty?

Per the DIR, “Pulmonology is the subspecialty of internal medicine concerned with diseases of the lungs and bronchial tubes, which often involves evaluation of the upper respiratory tract (nose, pharynx, and throat) as well as the heart.

Pulmonologists are specially trained in diseases and conditions of the chest, such as pneumonia, asthma, tuberculosis, emphysema, or complicated chest infections. Pulmonologists have expertise in complex pulmonary problems, such as emphysema, tuberculosis, asthma, complicated infections of the chest, the pulmonary complications of AIDS, injury, and complications of respiratory diagnostic and therapeutic procedures.”

What is the Internal Medicine-Rheumatology(MMR) QME Specialty?

Per the DIR, “Rheumatology is the subspecialty of internal medicine concerned with joints, muscles and bones and their roles in health and disease.

Rheumatologists study conditions specific to the musculoskeletal system – arthritis, certain autoimmune diseases, pain disorders, and osteoporosis. Rheumatologists are specially trained to do the detective work necessary to discover the cause of swelling and pain. This may include diseases such as rheumatoid arthritis, osteoarthritis, gout, lupus, back pain, osteoporosis, fibromyalgia or tendonitis.”

What is the Neurology(MPN) QME Specialty?

Per the DIR, “Neurologists diagnose and manage disorders of the nervous system (brain, spinal cord, and nerves) and muscles. These disorders include: Stroke ,Brain and spinal cord tumors, Muscular dystrophy, Headache and other pain, Meningitis, Encephalitis, Epilepsy (seizures), Parkinson disease, Alzheimer disease and other memory disorders, Multiple sclerosis, and Effects of systemic diseases, like high blood pressure and diabetes, on the nervous system.”

What is Neurological Surgery(MNS) QME Specialty?

Per the DIR, “[a] neurological surgeon specializes in operative and non-operative management (prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of patients with disorders of the brain, spinal cord, spinal column, and peripheral nerves, including their support structures and blood supply. They also evaluate and manage disorders that affect the function of the nervous system and the operative and non-operative management of certain types of pain. Common conditions managed by neurologic surgeons include disorders of the brain, meninges (membranes covering the brain and spinal cord), skull, spinal cord, and vertebral column. This also includes the carotid and vertebral arteries, the pituitary gland, spinal fusion or instrumentation, and disorders of the cranial and spinal nerves. Pediatric neurosurgeons manage children with head injuries, brain and spinal tumors, vascular malformation, seizure disorders, and hydrocephalus.”

What is the Obstetrics and Gynecology(MOG) QME Specialty?

Per the DIR, “Obstetrician/gynecologists have specialized knowledge of medical and surgical care of the female patient, with a focus on the female reproductive system. This includes surgical procedures, managing the care of pregnant women, delivering babies, and rendering gynecologic care, oncology care, and primary health care for women.”

What is the Occupational Medicine (MPO) QME Specialty?

Per the DIR, “Occupational medicine physicians have knowledge in a number of clinical areas and expertise in a wide variety of disciplines. Occupational medicine focuses on comprehensively preventing and managing illness and injury among workers. An occupational medicine physician typically has expertise in The harmful effects of chemicals, metals, gases, and pesticides) and other workplace hazards, such as radiation and noise (Toxicology); Fitting the job to a person (Ergonomics); Musculoskeletal injuries including back, neck, and extremities; Hearing loss; Disorders of the lung, such as asbestosis, silicosis, and work-related asthma (Pulmonary); Work-related cancers (Oncology); Infectious diseases in the workplace, including bloodborne pathogen exposures and tuberculosis; and Preventing illness and promoting wellness (Preventive Medicine)”

What is the Optometry QME Specialty?

Per the DIR, “Dentistry involves the evaluation, diagnosis, prevention, and treatment (nonsurgical, surgical, or related procedures) of diseases, disorders, and/or conditions of the oral cavity (mouth and related structures), maxillofacial area (jaws and face), and adjacent areas. Dentists receive a doctoral degree (DDS or DMD) in dentistry after attending dental school for four years following their college degree.”

What is the Orthopedic Surgery(MOS) QME Specialty?

Per the DIR, “Orthopaedics is the broad-based medical and surgical specialty dedicated to the prevention, diagnosis, and treatment of diseases and injuries of the musculoskeletal system. The frequency and impact of these diseases and injuries combined with recent advances in their diagnosis and treatment make orthopedics a critical part of health care. Areas of orthopedic surgery include:

  • Sports Medicine.
  • Care of injuries related to athletic activities
  • Joint Replacement and Surgery in Arthritis
  • Care of patients with advanced arthritis including medical treatment, joint replacement, and other procedures.
  • Foot and Ankle
  • Care of patients with injury and diseases of the foot and ankle
  • Shoulder and Elbows
  • Care of diseases and injuries of the shoulder and elbow
  • Trauma and Fractures
  • Treatment of injuries to the bones, joints, muscles, tendons, nerves, and vessels of the arms, legs, back, and neck.
  • Musculoskeletal Oncology
  • Treatment of benign and malignant tumors of bones, joints, and muscles.
  • Rehabilitation
  • Short and long-term programs to improve strength and mobility and optimize recovery.
  • Arthroscopy and Arthroscopic Surgery
  • Diagnosis and treatment of joint diseases and injuries using arthroscopic methods.”

What is the Otolaryngology (Ear, Nose, and Throat, or ENT)(MTO) QME Specialty?

Per the DIR, “Otolaryngology or ENT surgery focuses on the comprehensive medical and surgical care of patients with diseases and disorders that affect the ears, the respiratory and upper alimentary systems and related structures of the head and neck. This includes: Knowledge of audiology and speech-language pathology; the chemical senses and allergy/immunology, endocrinology and neurology as they relate to the head and neck; Medical and/or surgical therapy or prevention for diseases, neoplasms, deformities, disorders and/or injuries of the ears, the respiratory and upper alimentary.”

What if I need advice?

If you would like a free consultation regarding your workers’ compensation claim, 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.


Job Analysis

Job Analysis and Workers’ Compensation: What You Need to Know

Job Analyses are used within the California Workers’ Compensation System for a variety of reasons.  Job Analyses can be used to determine industrial causation.  Job Analyses can be used to determine Qualified Injured Worker status.   Qualified Injured Worker status relates to whether the Injured Worker is able to return to their usual and customary occupation.

Within Workers’ Compensation, Treating and Evaluating Physicians are requested to provide work restrictions or limitations as part of their workers’ compensation reporting.  These work restrictions or limitations are often compared to the Injured Worker’s Job Analysis to see if the worker is able to return to their usual and customary employment.   Continue reading

Substantial Justice

Is There Justice in The Workers’ Compensation System? Justice, Substantial Justice & Workers’ Compensation: What You Need to Know

“No, you can’t always get what you want
You can’t always get what you want
You can’t always get what you want
And if you try sometimes you find
You get what you need”

Rolling Stones

A frequent question asked by clients and prospective clients concerning their work injuries is:

“Will I get justice when I pursue my workers’ compensation case?”

The answer to their question is:

“no, you will not get justice.”  however “you are entitled to substantial justice.”

This article will discuss the concept of “substantial justice” and why it applies to injured workers within the workers’ compensation system.

The Workers’ Compensation “No Fault” Trade-Off

California Workers’ Compensation Law is premised upon bargaining between employers and employees.   In exchange for giving up access to the regular civil litigation laws of the State of California concerning their employers and injuries that occur in the workplace,  the California Constitution provides that the State provides “[a] complete system of workers’ compensation includes adequate provisions for the comfort, health and safety and general welfare of any and all workers and those dependent upon them for support to the extent of relieving them from the consequences of any injury or death incurred or sustained by workers in the course of their employment, irrespective of the fault of any party.” Cal Const, Art. XIV § 4

What is Justice?

Per Black’s Law Dictionary Fifth Edition, “Justice” is defined as the proper administration of laws. In Jurisprudence, the constant and perpetual disposition of legal matters or disputes to render every man his due.”

What is Substantial Justice?

Substantial Justice has a variety of meanings.  Substantial Justice includes that a matter is done in an expeditious manner.  Substantial Justice includes that a matter is done inexpensively.  Substantial Justice includes that the process is done without incumbrance of any character.  See Associated Construction vs. WCAB (1978) 43 C.C.C. 1333; Dubon v. World Restoration, Inc., 79 Cal. Comp. Cases 313, 2014 Cal. Wrk. Comp. LEXIS 21 (W.C.A.B. February 27, 2014)

Substantial Justice also has some meaning with respect to Trial proceedings before a Workers’ Compensation Appeals Board.  There is a line of cases in which Substantial Justice includes the need for the Judge to decide cases based upon an adequate record.   See Tyler v. Workers’ Comp. Appeals Bd., supra, 56 Cal.App.4th at pp. 392–394McClune v. Workers’ Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117, 1120 [72 Cal. Rptr. 2d 898, 63 Cal. Comp. Cases 261]M/A Com-Phi v. Workers’ Comp. Appeals Bd., supra, 65 Cal.App.4th at p. 1025.)

Also, see Labor Code Sections 5701 and 5906, as interpreted by a long line of cases, that the Appeals Board has both the authority and the duty to further develop the record when necessary to accomplish substantial justice by obtaining additional evidence, including medical evidence, at any time during the proceedings. (Lundberg v. Workmen’s Comp. Appeals Bd. (1968) 69 Cal.2d 436, 440 [445 P.2d 300, 71 Cal. Rptr. 684]  That authority and duty, however, is not absolute. In San Bernardino Community Hospital v. Workers’ Comp. Appeals Bd. (McKernan) (1999) 74 Cal.App.4th 928, 935–937 [88 Cal. Rptr. 2d 516] [64 Cal.Comp.Cases 986, 991–993], the Court held that the power of the Appeals Board or of a WCJ to further develop the record under sections 5701 and 5906 cannot be used to circumvent the clear intent and language of section 5502(d)(3) [now section 5502(e)(3)].

Where Does Substantial Justice Come From?

In Workers’ Compensation, the concept of “Substantial Justice” comes from the California State Constitution.   Workers’ Compensation Law is derived from the Constitution. Cal Const, Art. XIV § 4 provides the basis for the workers’ compensation system within California. The stated goal of the workers’ compensation system is to “accomplish substantial justice in all [workers’ compensation] cases expeditiously, inexpensively, and without incumbrance of any character; all of which matters are expressly declared to be the social public policy of this State, binding upon all departments of the State government.”[emphasis added]

As an Injured Worker, Why Should I be concerned that I am getting Substantial Justice rather than Justice?


As an Injured Worker, there should be some concern over substantial justice.   Substantial Justice, many times, works in favor of the injured worker.   Substantial Justice allows for expeditious, inexpensive and litigation which does not encumber the character of an individual.  Further, the Judge deciding the case is required to make an adequate record when deciding a case. Substantial Justice also provides for a “no fault” system to collect benefits. Substantial Justice, however, does not provide for the full accouterment of discovery and law and motion that is available in a Civil Court.  Also, the matters are heard in an Administrative Law Court and there will be no jury to render a decision. Finally, worker’s compensation benefits are capped per the Labor Code.

In a System Guided by Substantial Justice, What Should I Expect? 

Substantial Justice means that an Injured Worker will move through the workers’ compensation in an expeditious fashion. A determination for liability will be made within 90 days from the employer knowledge of the claim. An Injured Worker, under general circumstances, will be entitled to one Qualified Medical Evaluator who can make medical opinions on whether the injury is work-related.  The Injured Worker will have access to the Workers’ Compensation Appeal Board to have their claim adjudicated.   Their claim, unlike civil cases in which there is the entitlement to a jury, will be heard and decided by an Administrative Law Judge.  Further, the Workers’ Compensation Judge will make efforts to ensure that there is an adequate record developed.

What if I Need Advice?

If you would like a free consultation regarding your workers’ compensation claim, 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 worker’s compensation cases for 26 years. Contact us today for more information.



different types of pain

The Difference Between Pain & Chronic Pain Within Workers’ Compensation- Why Is It Important?: What You Need To Know

Within California Workers’ Compensation, Injured Workers are frequently given labels or diagnoses to describe their industrial injuries. Physicians, who either treat or evaluate Injured Workers, frequently describe different types of pain that injured workers experience. The description of pain provided by the physician can have a significant impact on an Injured Worker’s entitlement to workers’ compensation benefits.

In some circumstances, “pain” may become part of the injury diagnosis. For some Injured Workers, physicians will describe their pain as “chronic.” Further, in some circumstances, the physician will provide a diagnosis of “chronic pain.”

This article is meant to explore the meanings of “Pain” and “Chronic Pain” within the workers’ compensation system and how it has an impact on treatment. It will also discuss its impact on permanent disability impairment.

The State of California propounded a MEDICAL TREATMENT UTILIZATION SCHEDULE (MTUS) CHRONIC PAIN MEDICAL TREATMENT GUIDELINES Part 1: Introduction July 28, 2016, which discusses the challenges of treating Injured Workers with Chronic Pain. This text will be referenced in the article as “MTUS Intro.”primary physicians in workers comp cases

What Is Pain?

Per the MTUS Intro, “[d]efinitions: Pain: The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” (Merskey, 1994) This definition describes the pain as a subjective experience; therefore, unlike hypertension or diabetes, there is no objective measurement for pain. Analysis of the objective data (history, psychosocial assessment, physical findings, imaging results, lab tests, etc.) Is needed to evaluate the patient’s subjective report of pain.”

Note: This statement recognizes the fact that pain is a subjective experience and that it varies differently with each individual. The goal within workers’ compensation is to have a uniform assessment of pain in order to provide compensation and benefits based upon it.

Are There Different Types Of Pain?

Yes. There are different types of Pain.

Per the MTUS Intro, “ Types of Pain (Acute vs Chronic): Pain comes in many forms. Understanding which kind or kinds of pain a person is experiencing is a first step toward treatment. Although acute and chronic pain is considered separately below, an individual can experience them simultaneously. Furthermore, current research shows that pain exists more on a continuum than in discrete categories of “acute” or “chronic” pain. This means that, for some patients, the mechanisms responsible for pain persistence are engaged early in the injury process. Therefore, it is important to identify persons at risk for the development of chronic pain and to establish preventative measures to reduce the likelihood of pain persistence.”

What Is Acute Pain?

Per the MTUS Intro, “Acute pain, by definition, is of sudden onset and expected to be of short duration. It can usually be linked to a specific event, injury, or illness—a muscle strain, a bone fracture, severe sunburn, or a kidney stone, for example. People can self-manage many types of acute pain with over-the-counter medications or a short course of stronger analgesics and rest. Acute pain usually subsides when the underlying cause resolves, such as when a fracture heals, or kidney stone or diseased tooth is removed. In the “MTUS Opioids Treatment Guidelines,” acute pain is defined as pain lasting up to one month and subacute pain as pain last between one and three months.”

In sum, Acute Pain is the pain of short duration. It does not last too long.

What Is Chronic Pain?

Per the MTUS Intro, “Chronic pain is any pain that lasts three (3) or more months from the initial onset of pain (i.e., over 12 weeks) and can be frustratingly difficult to treat.”

Note: Based upon this definition, it is important that the Injured Worker makes sure that the reporting physicians document the initial reporting of the pain.

Are There Conditions That Involve Chronic Pain?

Yes. There are a variety of medical conditions that can be considered as a chronic pain disease. These include such conditions/diseases as fibromyalgia, irritable bowel syndrome, vulvodynia, chronic headaches, and temporomandibular joint disorder (TMJ or TMD).

How Does A Physician Make A Chronic Pain Determination?

Per the MTUS Intro, “the physician begins by assessing the presenting complaint and determining whether there is a “red flag for a potentially serious condition” that would trigger an immediate intervention. Upon ruling out a potentially serious condition, the physician should provide conservative management, that is, a treatment approach designed to avoid surgical and other medical and therapeutic measures with higher risk of harm compared to benefit.(Singh, 2013). If the complaint persists, the physician needs to reconsider the diagnosis and decide whether a specialist evaluation is necessary.”

Chronic Pain can be complicated. Physicians can employ a biopsychosocial model of pain. In using this model, physicians will look at pathophysiology, psychological state, cultural background, and belief systems. It can also involve relationships and interactions with the environment. This can include interactions with the workplace, home, the disability system, and the health care providers.

How Does One Get Treatment For Chronic Pain Within The Workers’ Compensation System?

All medical treatment within California Workers’ Compensation is determined by the Labor Code. Labor Code Section 4600(a) which provides that

“(a) Medical, surgical, chiropractic, acupuncture, and hospital treatment, including nursing, medicines, medical and surgical supplies, crutches, and apparatuses, including orthotic and prosthetic devices and services, that is reasonably required to cure or relieve the injured worker from the effects of his or her injury shall be provided by the employer. In the case of his or her neglect or refusal reasonably to do so, the employer is liable for the reasonable expense incurred by or on behalf of the employee in providing treatment. (b) As used in this division and notwithstanding any other law, medical treatment that is reasonably required to cure or relieve the injured worker from the effects of his or her injury means treatment that is based upon the guidelines adopted by the administrative director pursuant to Section 5307.27.”’’

Further, treatment is subject to Utilization Review. If Utilization Review is denied, Injured Workers can appeal via the Independent Medical Review process.

As noted above, if there is persistent pain and such pain fits within the Guidelines, then special Chronic Treatment Guidelines are applicable.

What Type Of Physician Treats Chronic Pain?

Per the American Society of Regional Anesthesia and Pain Medicine, “ [a] pain management specialist is a physician with special training in evaluation, diagnosis, and treatment of all different types of pain. Pain is actually a wide spectrum of disorders including acute pain, chronic pain and cancer pain and sometimes a combination of these. Pain can also arise for many different reasons such as surgery, injury, nerve damage, and metabolic problems such as diabetes. Occasionally, pain can even be the problem all by itself, without any obvious cause at all.”

The specialty that usually treats chronic pain patients is Anesthesiology.

With respect to treatment, Chronic Pain Physicians can provide such treatment as medications, trigger point injections, and epidural injections.

What Are The Problems With Chronic Pain?

There are many problems with Injured Workers with Chronic Pain. One of the biggest concerns is the impact of Chronic Pain on the Injured Worker’s life. Injured Workers with chronic pain patients can become dysfunctional with respect to many aspects of both life and work. Chronic Pain, due to the pain or the pain medications, can prevent the injured worker from engaging in a variety of activities.

As a result of Chronic Pain, Injured Workers can be prevented from performing activities of daily living. For example, if they are taking narcotics, they may be precluded from driving a car. Sometimes, the Chronic Pain sufferers can be so debilitated that they can no longer clean their house or do their laundry. In addition, Chronic Pain may impact the quality of their relationships with family and friends.

Chronic Pain may prevent Injured Workers from returning to their usual and customary occupation or the labor market in general. As noted above, an Injured Worker may be taking narcotic medication that may prevent them from performing work activities such as driving a car. Further, Chronic Pain may prevent them from concentrating at a level to perform cognitive tasks.

How Does Chronic Pain Impact Permanent Disability?

To access Permanent Disability, California Workers’ Compensation Law uses the AMA Guides for the Evaluation of Permanent Impairment, 5th Edition. Within the Guides, there is a Chapter dedicated to Pain.

Chapter 18 of the Guides is the Pain Chapter. Chapter 18, “provides information that ..[to] enable physicians to understand pain and develop a method to distinguish pain that accompanies illnesses and injuries from the pain that has become an autonomous process, and provide physicians with a qualitative method for evaluating permanent impairment due to chronic pain.” AMA Guides, 5th Edition, at P. 565. In sum, Pain, in and of itself, may take on a life of itself beyond that of the pain that ordinarily emanates to the underline injury or illness. In those circumstances, there may be the basis for assigning additional impairment.

In sum, the diagnosis of Chronic Pain may allow for an assessment of Whole Person Impairment to the Injured Worker based upon this condition. This can occur when the pain is considered in addition to the ordinary underline illness or injury. This Chronic Pain Whole Person Impairment is then placed into a rating formula to determine the Injured Worker’s Permanent Disability Percentage

What If I Need Advice?

If you would like a free consultation regarding your workers’ compensation claim, 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 worker’s compensation cases for 26 years. Contact us today for more information.