Altered Medical States (AMS) is a medical condition of import within the Workers’ Compensation System.  Irrespective of whether the Injured Worker’s AMS is work-related or not, the fact that an Injured Worker has such a condition which may impact their ability to communicate and their ability to understand is of concern.

Workers’ Compensation is a medical-legal system.   An Injured Workers with an altered medical state raise both medical and legal concerns.  The Workers’ Compensation System requires Injured Workers to provide truthful and accurate information.   The System also allows for Injured Workers to enter into binding contracts and agreements.   Therefore, an Injured Worker’s mental state is important.

This article will discuss Altered Medical States, how Altered Medical States can impact medical treatment and reporting,  and how Altered Medical States can impact Workers’ Compensation Litigation.

What is an Altered Medical State?

Altered Medical State can range from “total loss of consciousness to extreme excitation.” Evaluation and treatment of altered mental status patients in the emergency department: Life in the fast lane Hai-yu XiaoYu-xuan WangTeng-da XuHua-dong ZhuShu-bin GuoZhong Wang, and Xue-zhong Yu World J Emerg Med. 2012; 3(4): 270–277 doi: 10.5847/wjem.j.issn.1920-8642.2012.04.006 PMCID: PMC4129809 PMID: 25215076

Altered Medical States include central nervous system inhibition which can include coma, drowsiness, and confusion.   It can include central nervous system stimulation including irritability and aggressiveness. It can include “abnormal behavior.” Supra.

What Are the Medical Causes of Altered Medical States?

There are many reasons as to why someone may have an Altered Medical State.  Many of these AMS conditions can be work-related.  Medical Causes of AMS include both Neurological and Non-Neurological Causes.

AMS causes differ based upon based upon age. Top causes of AMS for elderly patients can include cerebrovascular disease, systemic or organic failure and infection.   Top causes for non-elderly are drugs and toxic factors, systemic and organic failure, and metabolic and endocrine disorders.  Supra.

Various causes of AMS can include drugs and substance intoxication, infection, metabolic endocrine abnormalities, trauma, cancer, and system/organ dysfunction.  This can include acute alcoholism. It can also be caused by trauma, i.e. head trauma, and infection. Supra.

What are the Workers’ Compensation Concerns with respect to Injured Workers with AMS?

With respect to the Workers’ Compensation Claim, an Injured Worker with an altered medical state can have problems with respect to the medical-legal reporting to support the claim of injury.   If the work injury caused an altered medical state, then there is a likelihood that the immediate medical treatment may not have an accurate history as to how the injury/medical condition was work-related.    For example, there are times when an Injured Workers are found unconscious and is then sent for medical treatment.   In those circumstances, the initial medical providers may not be able to document any information that can support the work injury.

Altered Medical States can also be when an Injured Worker is attending workers’ compensation related medical appointments.   Injured Workers may be taking prescription medications that impact their abilities to comprehend and answer questions posed by medical providers.   This again can impact the quality of the medical-legal reporting as to both the history of injury and ongoing complaints.

An individual may be so intoxicated that evaluations may be terminated.   This problem does not only relate to prescription medications.   Injured Workers may consume alcohol or take street drugs that may impact their mental state.

In sum, there can be work-related and non-work related AMS issues which impact medical treatment and medical-legal reporting.

Additionally, there are some Injured Workers that suffer from severe mental health issues where they have problems being communicative.   Further, these Injured Workers may have such problems where the evaluators have serious doubt as to whether they can provide accurate information.

What are the Legal Concerns of Altered Medical States?

The Workers’ Compensation System is a legal system and statements made by Injured Workers are placed under a legal microscope.   False Statements can lead to allegations of Workers’ Compensation Fraud.   Criminal penalties can apply.

Thus, there is a concern as to whether an Injured Worker with an altered medical state is capable to speaking the truth.   For example, if the Injured Worker is having hallucinations, there may be some question as to whether they know what they are doing and saying.  Additionally, an Injured Worker may be taking medications when they are having their deposition taken.   The medications may impact on their ability to understand and answer questions in a truthful fashion.

Thus, if an Injured Worker has AMS issues, it is important that AMS be documented.  It may be needed to address accusation so fraud.  Note: there are three times in which reporting may be required: medical examinations and evaluations, the Injured Worker’s deposition, and the Injured Worker’s trial.

What Should Be Done with Respect to Injured Workers with AMS? Temporary versus Permanent AMS?

If an Injured Worker has a permanent AMS state, the use of a Guardian Ad Litem is indicated.   In other words, a trusted person, i.e. parent or spouse, should be appointed by the Workers’ Compensation Appeals Board to make decisions with respect to the case.

If the Injured Worker has a temporary AMS state, the parties should all take careful consideration that the Injured Worker is understanding what is going on and is making their decisions and statements in an unaltered state.   If there is some settlement, the fact that the individual is capable of entering into the agreement should be documented.

What If I Need Legal Advice?

If you would like a free consultation concerning any workers’ compensation case, 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 28 years. Contact us today for more information.

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