ARE INJURED WORKERS SATISIFIED WITH THEIR INDUSTRIAL MEDICAL TREATMENT?  QUALITY WORK-RELATED MEDICAL CARE AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

“I Can’t Get No, Satisfaction”

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California Industrial Medical Treatment is controlled by the Labor Code. Thus, it differs from both traditional Private Medical Care as well as Government Programs such as Medicare and Medicaid.

Industrial medical care is part of a risk management system designed to provide cost-cutting elements with respect to providing the service.

Researches have looked into Injured Workers’ satisfaction with respect to their treatment.

This article will discuss Injured Worker’s satisfaction with their medical treatment.

What is Industrial Medical Care?

In California, Industrial Medical Treatment is guided by the Labor Code.   The Labor Code contains various treatment limitations.

Medical Control is one limitation. Insurance Company Managed Provider Networks limit the doctors that Injured Workers can choose.

Medical treatment is limited by utilization review of medical treatment requests.  These utilization reviews can deny treatment that does not follow the set algorithms and schedules.

What Is Private Medical Care?

Private Medical Care can come from a variety of sources. There is cash payment in where there is a direct provider patient relationship.  There are personal insurance policies for which the individual purchases the policy directly from the medical insurance company.  Finally, there is employer provided health insurance policies.

What is Medicare?

Per the SSA, “Medicare is [the U.S]… health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare, too, including those with disabilities and those who have permanent kidney failure.

The program helps with the cost of health care, but it does not cover all medical expenses.”

What Is Medicaid?

Per Medicaid.gov, Medicaid programs [are] designed to provide health coverage for low-income people. This program is separate from Medicaid.

Can Injured Workers have Multiple Insurance Coverages?

Yes. Injured Workers can have multiple coverages at the same time.   It is possible that an Injured Worker can have private coverage, medicare and workers’ compensation at the same time.  For Injured Workers with low income and are on social security disability, they may have medicare, medicaid, and workers’ compensation at the same time.

What was the Study’s Overall Finding? Were There Other Findings?

The study found that “that Workers’ Compensation status is independently associated with dissatisfaction with health care compared with other primary payer groups.” Compton J, Glass N, Fowler T. The Effect of Workers’ Compensation Status on the Patient Experience. JB JS Open Access. 2019;4(2):e0003. Published 2019 Jun 11. doi:10.2106/JBJS.OA.19.00003

The study, however, had other findings of interest as well.

Workers’ Compensation treatment rated lower than Private Insurance and Medicaid.   It did, however, rate at about the same level of satisfaction as Medicare. Compton J, Glass N, Fowler T. The Effect of Workers’ Compensation Status on the Patient Experience. JB JS Open Access. 2019;4(2):e0003. Published 2019 Jun 11. doi:10.2106/JBJS.OA.19.00003.

With respect to mental health issues, workers’ compensation treatment, satisfaction was rated lower than private insurance.   It was however comparable to both Medicare and Medicaid patients. Compton J, Glass N, Fowler T. The Effect of Workers’ Compensation Status on the Patient Experience. JB JS Open Access. 2019;4(2):e0003. Published 2019 Jun 11. doi:10.2106/JBJS.OA.19.00003.

There was one area in which there was some higher level of satisfaction with respect  to industrial medical treatment.   This was when the treatment included surgical authorization.  Patients with Workers’ Compensation who were scheduled for a surgical procedure were more likely to be satisfied with their care.  Patients with surgical authorization have higher levels of satisfaction.  Compton J, Glass N, Fowler T. The Effect of Workers’ Compensation Status on the Patient Experience. JB JS Open Access. 2019;4(2):e0003. Published 2019 Jun 11. doi:10.2106/JBJS.OA.19.00003

What Can Be Done to Improve Care Injured Workers’ Satisfaction?

This author believes that the following items may improve the level of satisfaction of industrial medical care.   First, expanded Managed Provider Networks with more doctors to choose from.  Second, improvement of the utilization review process to allow for greater authorization of treatment.

As noted above, Injured Workers are happy when there are results that occur as part of the treatment.  This is shown in their level of satisfaction with respect to surgical authorization.

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.

MEN, DEPRESSION, SUICIDE, AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Stress impacts Men and Women differently.   Studies show there are differences in the workplace.  The findings are both significant and complicated.

This article will discuss depression, suicide, the differences between men and women, and the implications with respect to workers’ compensation cases.

What Is the Psychological Diagnosis of Depression?  

 Per the American Psychiatric Association, Depression (major depressive disorder) is an illness that negatively affects how you feel, the way you think and how you act.

”Depression symptoms can include: Feeling sad or having a depressed mood, Loss of interest or pleasure in activities once enjoyed, Changes in appetite — weight loss or gain unrelated to dieting, Trouble sleeping or sleeping too much, Loss of energy or increased fatigue, Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing) or slowed movements or speech (these actions must be severe enough to be observable by others), Feeling worthless or guilty, Difficulty thinking, concentrating or making decisions, Thoughts of death or suicide.” APA

A depression diagnosis requires these symptoms last for an extended period of time. “Symptoms must last at least two weeks and must represent a change in your previous level of functioning for a diagnosis of depression.” APA

Which Sex Is Diagnosed Most with Depression?

 Studies show that women are diagnosed at twice the rate as men. “[c]omparatively, in Western countries, men are formally diagnosed with depression at approximately half the rate of women” (Kessler et al., 2005Wilhelm, Parker, Geerligs, & Wedgwood, 2008).” 1. Oliffe JL, Han CSE. Beyond Workers’ Compensation: Men’s Mental Health In and Out of Work. American Journal of Men’s Health. January 2014:45-53. doi:10.1177/1557988313490786

Note: These findings raise questions.  There is the issue of “men’s reluctance to express concerns about their mental health and reticence to seek professional health care (Emslie, Ridge, Ziebland, & Hunt, 2006Sharpe & Heppner, 1991Winkler et al., 2006).” 1. Oliffe JL, Han CSE. Beyond Workers’ Compensation: Men’s Mental Health In and Out of Work. American Journal of Men’s Health. January 2014:45-53. doi:10.1177/1557988313490786

In other words, men may not seek mental health treatment. Thus, there would be fewer depression diagnosis for men.

Is There a Connection Between Depression and Suicide?

Severe depression can … significantly increase the risk for suicide.  (Emslie et al., 2006Kessler et al., 2005Wilhelm et al., 2008World Health Organization, n.d.), 1. Oliffe JL, Han CSE. Beyond Workers’ Compensation: Men’s Mental Health In and Out of Work. American Journal of Men’s Health. January 2014:45-53. doi:10.1177/1557988313490786

Which Sex is at Most Risk of Suicide?

Men have been found to have higher rates of suicide. “[S]uicide rates are approximately four times higher in Western men than in women (Centers for Disease Control and Prevention, 2012Hawton & van Heeringen, 2009Levi et al., 2003Moller-Leimkuhler, 2003Rihmer, Belso, & Kiss, 2002Statistics Canada, 2012a2012bWasserman, 2000Wolfgang & Zoltan, 2007).” 1. Oliffe JL, Han CSE. Beyond Workers’ Compensation: Men’s Mental Health In and Out of Work. American Journal of Men’s Health. January 2014:45-53. doi:10.1177/1557988313490786

Thus, there is the question as to why men’s suicide rates are higher when their depression rates are lower.

Are There Suicidal Issues Related to Occupation?

The issue of suicide has multiple issues.  There is suicidal thought or ideation.  There is the act of suicide.

Studies have found high suicide rates in male-dominated workgroups. This included manual workers, farming, military and nursing.” 1. Oliffe JL, Han CSE. Beyond Workers’ Compensation: Men’s Mental Health In and Out of Work. American Journal of Men’s Health. January 2014:45-53. doi:10.1177/1557988313490786

Suicidal ideation is also an issue for men. Being a failed breadwinner can have an impact on suicidal thoughts. “Linkages between men’s work, depression, and suicide have also been described. Self-perceptions of being a “failed breadwinner” led older men with a history of depression to think about suicide (Oliffe, Han, Ogrodniczuk, Phillips, & Roy, 2011), whereas some middle-aged men countered suicidal ideations by focusing on work as a means of providing for their family (Oliffe, Ogrodniczuk, Bottorff, Johnson, & Hoyak, 2012. 1. Oliffe JL, Han CSE. Beyond Workers’ Compensation: Men’s Mental Health In and Out of Work. American Journal of Men’s Health. January 2014:45-53. doi:10.1177/1557988313490786

Is There a Connection Between Depression and Retirement?

Depressed workers are more likely to retire than nondepressed workers (Doshi, Cen, & Polsky, 2008) 1. Oliffe JL, Han CSE. Beyond Workers’ Compensation: Men’s Mental Health In and Out of Work. American Journal of Men’s Health. January 2014:45-53. doi:10.1177/155798831349078

What Does This Information Mean with Respect to Workers’ Compensation Claims?

These studies impact workers’ compensation cases in that they provide insight into the injured worker.

There studies show that there is some uniqueness for a man to file a claim for depression. These studies provide “red flags” as to certain occupations that men perform and their risk for suicide.  These studies may give some insight to employers as to whether depressed male  injured workers are going retire or return to work.  These studies show that working may assist a man’s mental state.

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.

 

ROTATOR CUFF SHOULDER SURGERIES AND WORKERS’ COMPENSATION: INDUSTRIAL VS. NON-INDUSTRIAL SURGERY RESULTS: WHAT YOU NEED TO KNOW  

In the US, annually, almost 2 million adults visit doctors for rotator cuff injuries. AAOS. A number of these individuals seeking this shoulder treatment on a work-related basis.  If conservative care does not resolve the issues, surgery is indicated.

With all types of surgeries, medical researchers like to compare the results of the Industrially provided versus those done on a non-industrial basis.  A study was done with respect to Rotator Cuff Surgeries.

This article will discuss the Rotator Cuff, Rotator Cuff Injuries, Causes of Rotator Cuff Injuries, Rotator Cuff Surgeries, and the Study’s Findings.

What is a Rotator Cuff?

The rotator cuff is a group of four muscles that come together as tendons to form a covering around the head of the humerus in the shoulder. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm. AAOC

How Does a Rotator Cuff Get Injured?

 A rotator cuff injury can occur when one or more of the tendons are torn.  Tears can range from  partial to full-thickness(complete.) AAOC

What Are Symptoms of Rotator Cuff Injuries?

 The symptoms for rotator cuff tears can include pain at rest and at night, pain when lifting and lowering your arm, pain with specific movements, weakness when lifting or rotating your arm and cracking when moving your shoulder. AAOC

 What Is Rotator Cuff Surgery?

A rotator cuff surgery will  attempt to repair the torn tendons.   This can include re-attaching them to the bone. AAOC

What Work Activities Can Cause an Industrial Rotator Cuff Injury?

There are a number of factors that have been identified as causative towards industrial shoulder problems.   These factors that are considered as occupational risk factors for shoulder tendinopathy, impingement, and rotator cuff tears include: the combination of risk factors (eg force and repetition, force and posture); some evidence, highly repetitive work alone or in combination with other factors, some evidence, and awkward postures: strong evidence ( sustained shoulder postures with more than 60 degrees of flexion or abduction) AMA Guides to the Evaluation of Disease and Injury Causation, 2nd Edition,  P. 320

Thus, painters, carpenters, and others who do overhead work also have a greater chance for tears. They can also be caused by a traumatic injury such as a fall. AAOC

What are the Factors that Can Impact the Results of a Rotator Cuff Surgery?

There are a number of factors that can impact the recovery from a rotator cuff surgery.   This factors affecting postoperative outcomes include age, gender, and smoking status. Other factors that can impact the outcome include the number of surgeons, tear size, operation method, and surgical technique.  Kim KC, Lee WY, Shin HD, Han SC, Yeon KW. Do patients receiving workers’ compensation who undergo arthroscopic rotator cuff repair have worse outcomes than non-recipients? Retrospective case-control study. J Orthop Surg (Hong Kong). 2018 May-Aug;26(3):2309499018802507. doi: 10.1177/2309499018802507. PMID: 30270747.

Also, factors most commonly believed to affect postoperative outcomes also include fatty degeneration and diabetes mellitus. Kim KC, Lee WY, Shin HD, Han SC, Yeon KW. Do patients receiving workers’ compensation who undergo arthroscopic rotator cuff repair have worse outcomes than non-recipients? Retrospective case-control study. J Orthop Surg (Hong Kong). 2018 May-Aug;26(3):2309499018802507. doi: 10.1177/2309499018802507. PMID: 30270747.

What Were the Results of the Study?

 The study found thatAlthough workers’ compensation recipients who undergo arthroscopic rotator cuff repair had worse outcomes before the end of WCB(Workers’ Compensation) benefits, the outcomes became similar after WCB(Workers’ Compensation) benefits ended” Kim KC, Lee WY, Shin HD, Han SC, Yeon KW. Do patients receiving workers’ compensation who undergo arthroscopic rotator cuff repair have worse outcomes than non-recipients? Retrospective case-control study. J Orthop Surg (Hong Kong). 2018 May-Aug;26(3):2309499018802507. doi: 10.1177/2309499018802507. PMID: 30270747.

The data supported “the hypothesis that patients with workers’ compensation claims would have worse outcomes.” Kim KC, Lee WY, Shin HD, Han SC, Yeon KW. Do patients receiving workers’ compensation who undergo arthroscopic rotator cuff repair have worse outcomes than non-recipients? Retrospective case-control study. J Orthop Surg (Hong Kong). 2018 May-Aug;26(3):2309499018802507. doi: 10.1177/2309499018802507. PMID: 30270747.

 As an Attorney, Why Do You Believe That An Injured Worker Have Worse Results?

As an attorney, I will express my opinion as to what could be the cause of poor results for industrial rotator cuff surgeries.

First, industrial medicine treatment, versus non-industrial treatment, may have more delay and denials in getting the treatment and surgery authorized.  Additionally, there may delays and denials in getting treatment authorized.

Second,  workers’ compensation claims determine impairment and dysfunction as part of a disability award.  Thuys, an injured worker may be focused on recalling their dysfunction as opposed to a non-industrial surgery in which there is no reward for a poor result.

Third, if there was dissatisfaction with the workers’ compensation process, an injured worker may have lingering emotional unhappiness with respect to the result.

Fourth, if the case was settled with a Compromise and Release Buy-Out of future medical care, the Injured Worker may not  access to follow up medical treatment needed for their shoulder.

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.

 

 

 

 

 

CALIFORNIA VIRUS-21? COVID-19, CALIFORNIA HOMEGROWN VIRUS MUTATION, AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Is There Something New with Respect to COVID-19?

Yes. There is a new strain of Coronavirus which is a B1429 strain.  This may be unique to California.

“Health officials are still determining if the new variant shares is more contagious than the regular strain” NY Post,  “We’re concerned that it [B1429] attaches to the human cell a little more than the natural virus the one we’ve been dealing with. That might make it more contagious, we aren’t sure yet, we’re looking at it,” said Mark Ghaly, California Health and Human Services Secretary. Supra.

Is This Important for Workers?

For Workers’ Compensation purposes, the information about the new strain is important.  It may provide some explanation as to the severity of a COVID-19 infection.  Further, this new strain may be used to determine industrial causation.  For example, if co-workers have the same strain of COVID-19, this information may assist in finding industrial causation.

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.

 

WHY IS MY WORKERS’ COMPENSATION CLAIM DELAYED?  INJURED WORKERS, OUTSTANDING CLAIMS, AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Many Injured Workers have their workers’ compensation claims delayed.

This article will discuss why claims are delayed and what Insurance Company activities occur during the delay period.

Why Are Claims Delayed?

Insurance Companies delay claims in order to verify that there is a legitimate claim.  Per the Labor Code, they are afforded this opportunity to investigate.

As part of their investigation, Insurance Companies will investigate the following matters.

Coverage: Insurance Companies need to verify that they actually insure the Employer for the date of the injury.

Employment Verification: Insurance Companies need to verify the Injured Worker actually worked for the Insured Employer.

Date of Injury:  Insurance Companies need to verify the date of injury.

Employer Injury Knowledge:  Insurance Companies need to know if the Employer knows about the work injury.  They need to know the details how the injury happened, whether there were witnesses,  and whether it was reported to management.

Medical Verification: Insurance Companies will seek to obtain the medical reporting from the Industrial Clinic or the Medical Provider who treated the worker.

Statements: Insurance Companies may seek the use of an investigator to take statements of the injured worker, other employees of the company, or witnesses,  to verify the injury.  Investigations can be done by Attorney who may take depositions.

Records:  Insurance Companies may seek records from prior employers, insurance companies or medical providers

Qualified Medical Evaluation: An Insurance Company may seek a Panel Evaluator from the State of California to obtain a medical opinion on causation. .

What is the Authority for Delaying a Workers’ Compensation Claim?

Labor Code Section 5402(b) provides for a 90 day period upon which Insurance Companies have to deny a claim.  Thus, there is a 90 day period to delay the claim and investigate.  This 90 days is from the knowledge of the claim.

The date of knowledge is per LC 5402(a) which provides that “ [k]nowledge of an injury, obtained from any source, on the part of an employer, his or her managing agent, superintendent, foreman, or other person in authority, or knowledge of the assertion of a claim of injury sufficient to afford opportunity to the employer to make an investigation into the facts, is equivalent to service under Section 5400.” Thus, employer knowledge can trigger the start of the insurance company’s delay period

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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