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What You Need To Know About Back Surgery, Return To Work, & Workers’ Compensation

Posted on April 23, 2021 by Edward Singer

Workers’ Compensation Medical Studies have been done on many topics. Studies have reported on surgeries performed within the workers’ compensation environment. Some studies have looked examined spinal surgeries.

Study results impact Injured Workers. Studies results can create insurance Company expectations concerning surgery success and recovery times. Insurance Company expectations from these studies can be imposed upon treating doctors concerning temporary and permanent disability.

This article will discuss back surgery, a study concerning back surgery, the back surgery study’s results. and what the study means for injured workers.

What Is Back Surgery?

The Spine has three segments: cervical, thoracic, and lumbar. The lumbar segment of the spine is usually referred to as back or low back. Back surgeries are generally on the area referred to as the lumbar spine. There are various types of surgeries. There are surgeries to address lumbar spine disks and there are other procedures that address the stability of the spine. Common surgeries are laminectomies, fusions and disc replacement.

Besides the problems being operated on, there is also issue of levels. The lumbar spine has multiple levels. Some surgeries operate on one level and others involve multiple levels.

There are a variety of reasons why a particular surgery may be indicated. This article will be addressing one of the reasons. A surgery to address a herniated lumbar disk. Specifically, a surgery to address a disk at only one level. This procedure is called a laminectomy.

Why Is Back Surgery a Significant Workers’ Compensation Issue?

Back Surgeries are expensive.T they cause periods of temporary disability and may result in findings of permanent disability. Back Surgeries can have complications that can be costly such as treatment for post-operative infections. Thus, Insurance Companies, in a risk management analysis, may wish to prevent surgery liability by either denying the treatment or settling the case.

What Were the Study’s Results?

The study addressed focused only on a single-level lumbar disk herniation surgery.

According to the study, “[p]atients receiving WC(workers; compensation) with shorter duration of radiculopathy before diskectomy had higher RTW(return to work) rates; fewer physical therapy, chiropractic, and psychotherapy sessions; and fewer postoperative diagnoses of psychological illnesses.” Ren BO, O’Donnell JA, Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Time to Surgery Affects Return to Work Rates for Workers’ Compensation Patients With Single-Level Lumbar Disk Herniation. Orthopedics. 2021 Jan 1;44(1):e43-e49. doi: 10.3928/01477447-20201202-06. Epub 2020 Dec 7. PMID: 33284984.

The study found that “within 12 weeks of injury, post-diskectomy patients do reasonably well, with a 70.0% (95% CI, 65.9%–74.1%) rate of RTW.”

The study also found that “[o]n the other hand, if a patient waited more than 2 years to have surgery for radiculopathy, RTW(return to work) rates decreased as low as 31.3% (95% CI, 26.3%–36.3%).” Ren BO, O’Donnell JA, Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Time to Surgery Affects Return to Work Rates for Workers’ Compensation Patients With Single-Level Lumbar Disk Herniation. Orthopedics. 2021 Jan 1;44(1):e43-e49. doi: 10.3928/01477447-20201202-06. Epub 2020 Dec 7. PMID: 33284984.

Note: the study’s results are confounding to Insurance Companies. The study suggests that acting promptly to approve a surgery can lead to more promising results. The study implies that a long drawn out battle for a back surgery can result in a poor result. Thus, acting quickly and spending a considerable amount of money for treatment leads to a better result in this circumstance. Thus, these types of cases are a true test for Adjusters.

Was There Anything Else Interesting from the Study?

Irrespective of surgery, the factors of legal representation, psychological co-morbidity and mean household income can negatively impact return to work. Ren BO, O’Donnell JA, Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Time to Surgery Affects Return to Work Rates for Workers’ Compensation Patients With Single-Level Lumbar Disk Herniation. Orthopedics. 2021 Jan 1;44(1):e43-e49. doi: 10.3928/01477447-20201202-06. Epub 2020 Dec 7. PMID: 33284984.

Is There Anything an Injured Worker Should Do?

Injured Workers with spinal problems should get appropriate medical care at the onset of injury. In the case of severe back pain and in cases with radiculopathy, they should seek out an orthopedic surgeon to have their condition assessed.

Per the study, if surgery is truly indicated, surgery it suggests that it be done promptly. Each individual’s medical condition and recovery, however, is different. Thus, the treatment course should be done on an individual basis and not per a study.

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 over 28 years. Contact us today for more information.

THE QUEBEC BACK PAIN DISABILITY SCALE AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Posted on December 24, 2020 by Edward Singer

For both workers’ compensation treatment and evaluation, Injured Workers are frequently asked to fill out surveys concerning their medical conditions. The Quebec Back Pain Disability Scale (QBPDS) is one of those surveys.

This article will discuss how and why such scales are used within the workers’ compensation system, what is the Quebec Back Pain disability Scale, what questions are asked within the scale, how the scale is scored? and what it can mean to a workers’ compensation claim.

What is the QBPDS?

This questionnaire is one that addresses back pain. It inquires as to the daily activities that impacted by Back Pain.

Why are Surveys and Scales Used?

Surveys and Scales which ask the Injured Worker to self-report on their conditions are helpful to both treating doctors and evaluators. First, they are a cheap quick method of getting some insight into the Injured Worker’s complaints. Second, they can give the doctor or evaluator a sense of how serious the worker perceives their injury. Third, they can give some insight as to whether someone is exaggerating with respect to the complaints. Fourth, if the same scale is administered over time, it can reveal some insight as to the course of the injured Worker’s condition. Repeated testing may show whether the Injured Worker sees their pain improving, staying the same, or getting worse.

What are the QBPDS Questions Asked?

There are twenty questions asked within the inventory. The questions are about getting out of bed, sleeping through the night, turning over in bed, riding in a car, standing up for 20-30 minutes, sitting in a chair for several hours, climbing one slight of stairs, walking a few blocks, walking several kilometers, reaching up to high shelves, throwing a ball, running one block, taking food out of the refrigerator, making your bed, putting socks or pantyhose on, bending over to clean the bathtub, moving a chair, pulling or pushing heavy doors, carrying two bags or groceries, and lifting and carrying a heavy suit case.

Note: The questions are interesting in that they include activities that an individual may rarely or never participate in. For example, there are some people who do not throw balls or handle suit cases.

How Are the Responses Scored?

There are five responses that can be made. They are not difficult at all, minimally difficult, somewhat difficult, fairly difficult, very difficult, and unable to do. They are scored from 0-5.

Note: The responses address ability to perform activities as opposed to the individual’s pain experience.

What Do the Scores Mean?

A higher score represents a greater level of perceived functional disability. A lower score represents a lower level of perceived functional disability.

Is The QBPDS Helpful for Treating Evaluators and Physicians With Respect to Permanent Disability Assignment?

In California Workers’ Compensation Law, Activities of Daily Living are a basis for making impairment assessments. Impairment assessments render a Whole Person Impairment which then translates into a Permanent Disability Percentage. The QBPDS can be helpful to an evaluator on their assessment. The Activities of Daily Living based upon the AMA Guides 5^th Edition are Self-care: urinating, defecating, brushing teeth, personal hygiene combing hair, bathing, dressing oneself, and eating, Communication: writing, typing, seeing, hearing, and speaking, Physical activity: standing, sitting, reclining, walking, and climbing stairs, Sensory Function: hearing, seeing, tactile feeling, tasting, smelling, Nonspecialized Hand Activities: grasping, lifting, tactile discrimination, Travel: riding, driving, flying, Sexual Function: orgasm, ejaculation, lubrication, erection, and Sleep: restful and nocturnal sleep pattern.

The QBPDS does not explore self-care and sexual function. Therefore, it is not fully comprehensive to render an ADL assessment.

As an Injured Worker, What Should I Do When I Fill Out These Scales?

When fill out these scales, try to be accurate as possible. Sometimes, I personally roll my eyes when I see scales in which every answer is the highest.

What if I Need Advice?

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

Posted on November 9, 2020 by Edward Singer

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?

BODY ARMOR, WORK INJURIES AND LAW ENFORCEMENT: POLICE OFFICERS, SHERIFFS AND INJURIES DUE TO EQUIPMENT: WHAT YOU NEED TO KNOW

Posted on October 11, 2020 by Edward Singer

Law Enforcement Officers are required to carry various items as part of their job duties. Equipment, such as Duty Belts, have been recognized as being damaging to the lumbar spine. Due to that fact, the State of California has enacted a Back Injury Presumption for with respect to Law Enforcement Officers who wear duty belts.

Besides Duty Belts, there is other Law Enforcement equipment that has become implicated as to causing physical injury. One of these items is Body Armor. Body Armor has become popular for Law Enforcement to wear to protect them. Body Armor, however, can be physically restrictive. This restrictiveness can be a source of musculoskeletal injury. It should be noted that this Body Armor can be life saving for officers. Police Officers: Surviving a real life-threatening incident while wearing body armor Xiong, Houawa 2014 May URI: https://scholarworks.csustan.edu/handle/011235813/703 (in thesis data, all 24 officers studied survived life-threatening incidents and were able to to return to full duty after the incidents.)

This article will discuss Law Enforcement Officers’ use of Body Armor, the problems with respect to such equipment, and whether it has been found to cause physical problems.

What Is Body Armor?

There are different types of body armor. There is body amor that is designed for military use. Also, there is a different body armor that is designed with respect to Law Enforcement. This different body armor is called Light Armor. The armors of the light variety care called Individual Light Armor Vests or ILAVs.

Are There Any Studies Concerning Light Armor Vests?

Yes. A recent study compared ILVAs versus Normal Station Wear.

What are the Problems with Light Body Armor?

“Wearing body armour has also been found to compromise trunk posture (Phillips et al., 2016) and reduce range of motion in multiple planes (Lenton et al., 2016). Axial trunk rotation has been shown to be reduced by up to 12° when wearing military-styled body armour (Lenton et al., 2016). A generalized increase in trunk and hip forward flexion during tasks has also been associated with wearing body armour (Lenton et al., 2016; Phillips et al., 2015). The effects of both a forward trunk posture and any compromise in trunk or shoulder mobility may further affect an officer’s ability to compensate for any balance compromise and put them at greater risk of falls and subsequent injury (Dempsey et al., 2013).” The effects of body armour on mobility and postural control of police officers Ben Schram Robin Orr Ben Hinton Geoff Norris Rodney Pope https://doi.org/10.1016/j.jbmt.2020.03.001

What Were The Findings of the Study?

The study found “[s]ignificant differences were found between ILAV or N conditions in various components of the FMS, including right Straight Leg Raise, left shoulder mobility, and both right and left quad rotary stability. No significant differences were found in any of the balance measures between these conditions.” Supra.

The conclusions made were that the “ILAVs can significantly affect police officer mobility and therefore may contribute to injury risk and decreased ability to complete occupational tasks, though this should be weighed against protective benefits. ILAVs should therefore be carefully selected to minimise injury risk without detracting from occupational performance.” Supra. [emphasis added]

Are There Any Issues of Controversy with Respect to Body Armor?

Yes. One matter that can become an issue with respect Body Armor is the fact that there are multiple types of body armor which have different styles. There was a study that compared different ILAV and found that there were differences in the comfort and performance. The perceived effects and comfort of various body armour systems on police officers while performing occupational tasks B. Schram1* , B. Hinton2 , R. Orr , R. Pope and G. Norris Schram et al. Annals of Occupational and Environmental Medicine (2018) 30:15 https://doi.org/10.1186/s40557-018-0228-x.

In sum, there are different brands that may have different impacts on the officers wearing them.

What Does Caselaw Say with Respect to Body Armor?

A search review was done with respect to this article. As the writing of this article, there have been no reported cases concerning injury related to the use of body armor. This caselaw search does not reveal as to whether such claims have been made and have been accepted as legitimate injury claims. Rather, the search indicates that there has been no controversy to the point that there has been any noteworthy or reported litigation involving body armor.

What Is the Future?

Many Law Enforcement Departments have received grants and funds to provide body armor to their departments. As a result, there will be more increased use of body armor. This increased use may likely cause musculoskeletal problems which may give rise to a physical injury. This type of physical injury would be the basis for filing a workers’ compensation claim.

What if I Need Advice?