EVEN TREATERS GET INJURED AT WORK: OCCUPATIONAL AND PHYSICAL THERAPISTS SUSTAINING INDUSTRIAL INJURIES:  MEDICAL PROVIDERS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Occupational and Physical Therapists play a large role in helping Injured Workers recover from their industrial injuries.  In doing so, however, Occupational and Physical Therapists may be placing themselves at risk for sustaining a work injury. More specifically, both Occupational and Physical Therapist’s work activities can place them at risk for sustaining musculoskeletal disorders. These musculoskeletal disorders can include back problems, shoulder problems, and wrist problems.

The article will discuss Occupational and Physical Therapists, what activities they perform on the job that may be injurious to them, and the rates of injuries that occur for Occupational and Physical Therapists.

What is an Occupational Therapist (OT)?

Per the American Occupational Therapy Association, “occupational therapists …help people… participate in the things they want and need to do through the therapeutic use of everyday activities (occupations.)”

OT Programs can include “an individualized evaluation, during which the client/family and occupational therapist determine the person’s goals, [a] customized intervention to improve the person’s ability to perform daily activities and reach the goals, and an outcomes evaluation to ensure that the goals are being met and/or make changes to the intervention plan.”

What is a Physical Therapist (PT)?

Per the American Physical Therapy Association, “[p]hysical therapists are movement experts who improve quality of life through prescribed exercise, hands-on care, and patient education.”

“Physical therapists examine each person and then develops a treatment plan to improve their ability to move, reduce or manage pain, restore function, and prevent disability.”

What is the Difference Between an Occupational and Physical Therapists?

The Occupational Therapist focuses on the patient’s ability to perform work-related functions.  The Physical Therapist focuses on physical activities in general.

What Are The Work Activities That Are Injurious to OTs and PTs?

Transfers/Lifts and manual therapy have been found to be associated with musculoskeletal disorders. “Darragh AR, Campo M, King P. Work-related activities associated with injury in occupational and physical therapists. Work. 2012;42(3):373-84. doi: 10.3233/WOR-2012-1430. PMID: 22523031; PMCID: PMC3839086.  These activities have been found to impact the lumbar spine.  Supra.

Patient handling activities include (transfers, repositioning and patient lifting. Supra.

Manual therapy includes soft tissue work, joint mobilization, and orthopedic techniques. Supra.

Manual Therapy was found also found as a risk factor consistent risk factor for both injuries as well as gradual onset of WSMDs. Supra.  In workers’ compensation terms, this would be considered as a cumulative trauma injury.

With Respect to Musculoskeletal Disorders? Is There Any Difference Between OTs and PTs?

No. “Occupational (OTs) and physical therapists (PTs) have substantial and similar rates of work-related injury (WRI), musculoskeletal pain and musculoskeletal disorders (WMSD)” Darragh AR, Campo M, King P. Work-related activities associated with injury in occupational and physical therapists. Work. 2012;42(3):373-84. doi: 10.3233/WOR-2012-1430. PMID: 22523031; PMCID: PMC3839086.

“Darragh et al. reported an annual WRI incidence rate among OTs and PTs of 16.5 and 16.9 per 100 full-time workers, respectively.” Darragh AR, Campo M, King P. Work-related activities associated with injury in occupational and physical therapists. Work. 2012;42(3):373-84. doi: 10.3233/WOR-2012-1430. PMID: 22523031; PMCID: PMC3839086.

What Are Injury Rates for Activities?  What Do Therapists Think Are the Causes of Their Injuries?

“Manual therapy and transfers/lifts accounted for more than half of all injuries (54.0%), across all practice areas.” Supra.  “Manual therapy was the greatest proportion of injuries to the wrist and hand (69.1%).” Supra.  “Transfer and lifting activities were associated with 26.6% of injuries Over half of these injuries were to the low back (53.0%), followed by the shoulder (19.7%) and the head/neck (18.2%).” Supra.   “Other activities associated with injury included environmental and equipment interactions (10.9%), multiple activities (6.5%) and patient falls (5.7%)”

What Do Therapists Think of How They Get Hurt?

Therapists opine that force, awkward posture, repetitive motion, sustained posture, and fatigue were factors contributing to those type of injuries.  Supra.

For wrist and hand injuries, therapists opine that repetitive motion (experienced during joint mobilizations and range of motion activities), force (experienced during range of motion, soft tissue work, and joint mobilizations), awkward posture and sustained posture were factors contributing to those type of injuries. Supra.

For transfer and lifting activities, opined that “these injuries occurred both gradually because of repeated performance of transfers over time and more suddenly when a patient behaved in an unexpected way (grabbed the therapist, stumbled, or moved in an unexpected direction.) The majority of therapist identified force (72.7%;48/66), including overexertion and lifting, and awkward posture (54.5%; 36/66) as the primary contributing factors to their transfer injuries.” Supra.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

KNEE AND HIP INJURIES, OSTEOARTHRITIS, AND WORKERS’ COMPENSATION: PHYSICAL ACTIVITIES AS RISK FACTORS FOR WORK INJURIES: WHAT YOU NEED TO KNOW

There is no requirement that the causes of a work injury has to be 100 percent industrial.

There are some medical conditions that can have a work-related component to them.  In other words, they are only partially caused by job duties.   Osteoarthritis (OA) can be that type of industrial injury.  OA is a common form of arthritis that can impact a variety of parts of the body.  The parts of the body OA can impact includes the knees.

This article will discuss OA , who Treats OA,  and how OA can be work-related.

What is Osteoarthritis?

Per the CDC, “Osteoarthritis (OA) is the most common form of arthritis. Some people call it degenerative joint disease or “wear and tear” arthritis. It occurs most frequently in the hands, hips, and knees.”

“With OA, the cartilage within a joint begins to break down and the underlying bone begins to change. These changes usually develop slowly and get worse over time. OA can cause pain, stiffness, and swelling. In some cases,  it also causes reduced function and disability; some people are no longer able to do daily tasks or work.”

Note:  The term degenerative joint disease is a term that is frequently used.   It is commonly abbreviated to DJD.

What Are the Symptoms of OA?

Symptoms of OA can include pain or aching, stiffness, decreased range of motion, and swelling. CDC.

Who Treats OA, and What Treatments are Available?

OA is an interesting medical condition in that there are two medical specialties that can address the condition.   The two types of doctors are Orthopedists and Rheumatologists.

Orthopedists focus on the bones and the joints.   They can prescribe medications and perform operations.

Rheumatologists focus on internal medicine matters.  They can prescribe medications and prescribe non-surgical treatments.

How Is OA Work-Related?

OA is work-related with respect to some activities.   According to one study,  A synthesis of 69 studies from 23 countries yielded strong and moderate evidence for lifting, cumulative physical loads, full‐body vibration, and kneeling/squatting/bending as increasing the risks of developing osteoarthritis (OA) in men and women.”  Strong and moderate evidence existed for no increased risk of OA related to sitting, standing and walking (hip and knee OA), lifting and carrying (knee OA), climbing ladders (knee OA), [and] driving (knee OA.)” Men and Women’s Occupational Activities and the Risk of Developing Osteoarthritis of the Knee, Hip, or Hands: A Systemic Review and Recommendations for Further Research, Monique A.M. Gignac Emma Irvin Kim Cullen Dwayne Van Eerd Dorcas E Beaton Quenby Mahood Chris McLeod Catherine L. Backman 14 February 2019, https://doi.org/10.1002/acr.23855

Note: thus, there are activities that can increase the risk of OA and other activities which are not a causative risk factor.  Thus, an analysis of one’s work activities is important when considering to file a claim.

What is the Legal Theory for Industrial Causation?

An Injured Worker must prove that their work activities contributed to the development of the disease. South Coast Framing, Inc. v. Workers’ Comp. Appeals Bd. (2015) 61 Cal.4th 291 [188 Cal.Rptr.3d 46, 349 P.3d 141].)

What is the Analysis?

The fact that one engages in certain injurious activities does not guarantee a valid claim.  A medical opinion is required. Such a medical opinion should include a medical examination, testing, review of medical records, review of one’s past medical history, and an analysis of the physical activities the worker engaged in at work. .

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

THE JOINT POWERS INSURANCE AUTHORITY: WORKERS’ COMPENSATION INSURANCE COVERAGE FOR GOVERNMENT AGENCIES: WHAT YOU NEED TO KNOW

The State of California provides for Private industry and Government Entities a variety of ways in which they can fulfill their commitment to maintain workers’ compensation coverage for their workers.  One of the entities that assists Government Entities provide workers’ compensation coverage is the Joint Powers insurance Authority (JPIA.)

While Injured Workers are entitled to benefits in accordance with workers’ compensation law, it is important to know who is providing the coverage.  This knowledge provides insight as to how the claim will be managed and how a settlement may occur.

This article with discuss what is the Joint Powers insurance Authority and how the JPIA is involved with workers’ compensation coverage.

What is the Joint Powers Insurance Authority?

The Joint Powers Insurance Authority is a Risk Management Entity.  The JPIA was formed to fill the needs for public agencies to handle their risk obligations.  For public agencies with employees, one of their risk obligations is workers’ compensation.

In addition to the Authority, the Joint Powers members have associations which may lobby on their behalf to impact workers’ compensation legislation.

How Does the Joint Powers insurance Authority Provide Workers’ Compensation Coverage?

Per the JPIA, “[t]he California JPIA provides workers’ compensation coverage that offers members two options: the primary workers’ compensation program and the excess workers’ compensation program.”

What Is a Primary Workers’ Compensation Program?

A primary workers’ compensation program would provide coverage and administration in the adjustment of workers’ compensation claims. JPIA members will generally use a third-party administrator to adjuster their claims.

What is An Excess Workers’ Compensation Program?

Excess Workers’ Compensation Insurance is coverage that covers costs that exceed a set point.   This set point of excess is to be determined by the insurance.  It can be for payments exceeding $500,000.00 or $1,000,000.00.   The coverage can be capped. The coverage can even be unlimited.  Excess coverage protects the employer in the event of a catastrophic case.  Additionally, an employer can purchase multiple policies to cover various levels of excess amounts.

Note: My personal experience is that excess carriers can be difficult and resist in contributing to settlements of cases.   There have been many times in which the employer is at odds with their excess carrier on the issues of settlement.

How Extensive is the JPIA?

JPIA is quite extensive. There are a number of agencies which employ their services.   JPIA indicates that they have more than 100 public agencies have partnered with them.  Also, the agencies employing JPIA include small, single-purpose entities to cities to special districts.

What Are The Core Values of JPIA?

Per their website, there core values are “Integrity: We hold ourselves to the highest ethical and professional standards. We pledge to fulfill our duties and deliver on our commitments; Excellence: We pursue distinction with a passion. We proactively assess our performance and strive to continuously improve programs, services, and work product;  Innovation: We foster creativity as we explore opportunities and meet challenges; Teamwork: We pursue productive relationships through communication, collaboration, understanding, and respect.”

Note:  The Core Values are all about risk management.  There is no mention of any values directly related to workers’ compensation and the treatment of injured workers.

How Do I Know My Claim Is Being Handled via JPIA?

If you work for a government agency, there is the possibility that JPIA may be involved in your case.   Further, JPIA may not be administering the claim.   It will most likely be a third-party administrator.   On your claim correspondence, however, there may be a reference to JPIA.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

 

 

HIGH-HEELED SHOES AND MUSCULOSKELETAL INJURIES AT WORK: CLOTHING APPAREL CAUSING ORTHOPEDIC INJURIES: WHAT YOU NEED TO KNOW

On the Job, Workers can get injured as a result of their attire. High-Heeled Shoes have long been considered as a possible source of work place injuries.  Injuries from High-Heeled Shoes can occur in a variety of ways and impact a multitude of parts of the body.

This article will discuss High-Heeled Shoes, the theories of industrial causation of High-Heeled Shoe related injuries, and injuries caused by High-Heeled Shoes.

What Are High Heeled Shoes?

High-Heeled Shoes are footwear in which the heel is farther off of the ground in comparison with the toe. They are considered aesthetically appealing and are commonly worn in professional settings.   As a result, many women wear them in the workplace. The alternative type of shoe is called a “flat.”

What Types of Medical Conditions Can High Heeled Shoes Cause?

There are High Heeled Shoe injuries which relate to those wearing them.  With these type of shoes,  there are issues concerning falls, issues concerning the impact on the prolonged use on the foot, and issues concerning the biomechanics of gait on other parts of the body.  Thus, physical injuries from shoes can range from toe to head.  Specific conditions caused by the footwear usage include hallux valgus and osteoarthritis.  Barnish MS, Barnish J High-heeled shoes and musculoskeletal injuries: a narrative systematic review BMJ Open 2016;6:e010053. doi: 10.1136/bmjopen-2015-010053

Many pathologies are associated with wearing high heel shoes mainly in the lower extremity including blisters, callosities, heel spur, bunions (hallux valgus) in the feet which is mainly due to the altered ankle joint axis and altered arch angle, pain in the calf muscle, knee and hip joint. Younus SM, Ali T, Memon WA, Qazi A, Ismail F. High heel shoes; outcome of wearing in young generation: a cross sectional study. Professional Med J 2014;21(4): 798-803.

Also,  similarly the spine is also adversely affected resulting in back pain which is mainly due to exaggerated spinal flexion. Younus SM, Ali T, Memon WA, Qazi A, Ismail F. High heel shoes; outcome of wearing in young generation: a cross sectional study. Professional Med J 2014;21(4): 798-803.

There has been study concerning women wearing high heel shoes in department store in which hallux valgus deformity was found more common in those workers than those who wore flat shoes. Soemarko DS, Rahmasari F, Kamal AF, Cahayadi SD. Hallux valgus among sales promotion women wearing high heels in a department store. Journal of Orthopaedic Surgery. January 2019. doi:10.1177/2309499019828456  It was noted that “The long duration of work with wearing high heels puts more pressure on the metatarsal, which increases the risk of HV” Supra.

What is the Legal Theory That Makes High Heel Injuries Industrial?

The legal theory behind most High Heel injury claims is that workers’ compensation is a “no-fault” system. Thus, a person’s decision to wear high heels at work is not necessarily of import.  The issue is more that the high heels were in fact worn and work and it was the wearing at work which was the cause of the physical condition.  Thus, the work activities which wearing the shoes is of import. See US Airways vs. WCAB (2002) 67 C.C.C. 1243 (writ denied.) Applicant was found to have left foot injury due to continuous trauma of having to wear high heels on the job. Applicant had a medical-legal opinion that supported it.

Secondary High Heel Injuries? Bystander Injuries?

Besides injuries to the workers wearing high heels, This can include being injured as a result of a first party fall, being stepped on by a high heel shoe, and being assaulted by a pair of high heels. Barnish MS, Barnish J High-heeled shoes and musculoskeletal injuries: a narrative systematic review BMJ Open 2016;6:e010053. doi: 10.1136/bmjopen-2015-010053

What Would be the Controversies in Such Injuries?

In matters involving High Heels, case analysis will focus on the usage of the shoes in the workplace.   If a cumulative trauma injury is alleged, an analysis will be done as to the nature and extent of the shoe usage in the workplace.   Likewise, there will be an inquiry as to the nature and extent of the usage of the shoes outside of work.

What Is I am Having Problems?

It is recommended that you seek medical attention.  An opinion indicating that the usage of the shoes in the workplace is a causative factor towards one’s musculoskeletal disorder, then a workers’ compensation clam should be considered.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

 

 

FIREFIGHTERS AND THEIR MOST REPORTED CAUSE OF INJURY: OVEREXERTION, WORK INJURIES FOR SAFETY OFFICERS, AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Firefighters play a vital role in society.  Each Firefighter represents a significant investment by a community.  Therefore, there is significant study into how and why Firefighters are injured.  Researchers use the term overexertion to describe mechanisms of injury.

This type of research is important for Firefighters.  When a Firefighter is injured and the mechanism of injury is of a certain nature, there will be a certain reaction from Management and Risk Management.   If Management and Risk Management is aware that a particular type of injury is common, it may be viewed with less scrutiny. Likewise, Firefighters claiming injury that are unique in nature may be subject to greater scrutiny.

This article will discuss overexertion, the results of a recent study and what Firefighter should be concerned about concerning the results of the study.

What Is Overexertion?

The Study noted that   “according to the Occupational Safety and Health Administration (OSHA), the term “overexertion” is sometimes used synonymously or interchangeably with “bodily reaction” Strains can be defined as injury to the muscle or musculotendinous joint, and sprains are an injury to the ligament.” Firefighter Overexertion: A Continuing Problem Found in an Analysis of Non-Fatal Injury Among Career Firefighters Int. J. Environ. Res. Public Health 2020, 17(21), 7906; https://doi.org/10.3390/ijerph17217906 Published: 28 October 2020

Note: essentially, overexertion injuries are orthopedics injuries. For example, back injuries which are usually lumbar sprains/strains, or cervical sprains/strains.   It can include injuries to both the upper and lower extremities such as shoulder sprains/strains and knee sprains/strains.

Why Is Overexertion Injuries Significant With Respect to Workers’ Compensation?

Per the Study, Overexertion.. is the leading cause of non-fatal injury across ten industry categories and accounts for 35% of non-fatal injuries and illnesses resulting in days away from work per year.” .” Firefighter Overexertion: A Continuing Problem Found in an Analysis of Non-Fatal Injury Among Career Firefighters Int. J. Environ. Res. Public Health 2020, 17(21), 7906; https://doi.org/10.3390/ijerph17217906 Published: 28 October 2020

Work Injuries can be costly to both private and government positions.  The study noted that the “resultant sprain and strain injuries cost U.S. businesses and organizations an estimated USD 13.8 billion a year in direct costs, which include medical and lost-wage payments.” .” Firefighter Overexertion: A Continuing Problem Found in an Analysis of Non-Fatal Injury Among Career Firefighters Int. J. Environ. Res. Public Health 2020, 17(21), 7906; https://doi.org/10.3390/ijerph17217906 Published: 28 October 2020

Note: with respect to any industry, including Fire Departments, there is a need to contain risk management costs by having injury reduction.

What Did the Overexertion Study Tells Us About Firefighter Injuries?

The study found that despite the fact that the occupation deals with fire and its destructive properties to a human body, it is the overexertion which is the greatest source of injury to for firefighting personnel. .” Firefighter Overexertion: A Continuing Problem Found in an Analysis of Non-Fatal Injury Among Career Firefighters Int. J. Environ. Res. Public Health 2020, 17(21), 7906; https://doi.org/10.3390/ijerph17217906 Published: 28 October 2020

Note: with respect to this study, it important to note that the Departments appear to do an excellent job with respect to safety equipment to prevent fire and burn-related injuries.   Thus, orthopedic injuries then emerge as the most common source of injury.

Another study provided additional data of interest. “Leading injury events were fires and explosions (36%) and overexertion and bodily reactions (20%). A majority (38%) of injuries occurred during firefighting activities, 7% occurred during training, and 7% occurred during patient care. Sprains and strains accounted for the largest proportion of injuries in all three of these activities: 28% firefighting activities, 32% training, and 36% patient care. Nonfatal Injuries to Firefighters Treating in U.S. Emergency Departments, 2003-2014, Suzanne M. Marsch, MPA, Melody Gwilliam MPH Srinivas Konda MPH Hope M.Tiesman PhD Rita Fahy Phd, American Journal of Preventative Medicine Volume 55, Issue 3, September 2018, P. 353-360.

Does Age Have an Impact with Respect to What Injuries Firefighters Have?

Yes.  The study found that younger firefighters have different injuries than older firefighters.  The study found that  “FF personnel aged less than 39 experienced higher levels of injury as a result of fires and explosions, transportation incidents, and contact with objects and equipment, relative to those aged 40 and above. Those aged 40 and above experienced falls, slips and trips, as well as overexertion and bodily reactions at a higher prevalence than their younger counterparts.” .” Firefighter Overexertion: A Continuing Problem Found in an Analysis of Non-Fatal Injury Among Career Firefighters Int. J. Environ. Res. Public Health 2020, 17(21), 7906; https://doi.org/10.3390/ijerph17217906 Published: 28 October 2020

What will Department Do about This?

The study recommended a focus on fitness and ergonomics.  Firefighter Overexertion: A Continuing Problem Found in an Analysis of Non-Fatal Injury Among Career Firefighters Int. J. Environ. Res. Public Health 2020, 17(21), 7906; https://doi.org/10.3390/ijerph17217906 Published: 28 October 2020.

Note: the challenges to this issue is that a significant amount of firefighting activity is performed in conditions in which ergonomics may not be able to be practiced.  Thus, this is a significant challenge.  Also, in the other study, overexertion injuries appear to be spread about evenly across the many task performed.  Therefore, an overall approach may be taken by Departments as opposed to any particular job task.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

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