COVID-19, HEALTHCARE WORKERS, AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

A recent Occupational COVID-19, Study addressed Coronavirus Work Injury Claims for Health Care Workers.  The study was done in Germany.  Nienhaus A. COVID-19 among Health Workers in Germany-An Update. Int J Environ Res Public Health. 2021 Aug 31;18(17):9185. doi: 10.3390/ijerph18179185. PMID: 34501773; PMCID: PMC8431697.

Healthcare Workers, being on the front line of medical care, are at significant risk for industrial COVID-19 infection injuries.  Infection rates appear to be different for each particular Healthcare Occupation.   Infection risk differs from support staff workers to nurses to doctors.  Likewise, the Healthcare Worker’s workplace can impact the infection risk. Facility types, i.e. hospital, nursing home, etc, can play a role in infection rates.

This article will discuss the study which addresses Healthcare Workers and their industrial COVID-19 infection rates.

What Health Care Facilities Are Impacted?

The study showed that “most claims concern inpatient and outpatient nursing (39.5%) or clinics (37.6%).” Supra.

In contrast, medical practices are not subject to as many claims.  It was reported that “As few as 3.2% of the claims concern medical practices.” Supra.

In other words, it appears that facilities which address extended patient care have greater rates than mere evaluations or examinations.

What Was the Claims Acceptance Rate for Occupational Injury?

 It was reported that “.. 77.5% of all claims were assessed, and in 81.4% of these, the OD(Occupational Disease) was confirmed.” Supra.

Thus, it appears in Germany that there is wide acceptance of industrial claims of injury for COVID-19.

How Are Healthcare Workers Impacted?

Nursing is the profession most impact with 68.8% of the cases. Supra.

Hospitals had the highest claims rates with 41.3 claims per 1000 full time workers. Supra.

What Was Treatment Severity?

It was reported seventy-seven workers died (0.09%) and three hundred and seventy-five (0.4%) were hospitalized. Supra.

The majority of workers got treatment clinics (52.3%) and inpatient and outpatient care facilities (28.0%)  Supra.

What Percent Claims Considered as Industrial?

 A total of 65,693 (77.5%) claims were assessed, and for 81.4% of these claims, the Occupational Disease was confirmed. Supra.

Where Was the Highest Frequency of Claims?

The Occupational Disease rate per 1000 full time workers highest in clinics, followed by inpatient and outpatient care (28.9 and 20.8). Supra.

Where Were the Highest Claims Rates?

The Occupational Disease rate per 1000 full time workers was highest in clinics, followed by inpatient and outpatient care (28.9 and 20.8). Supra.

The hospital breakdown was  per 100,000 full time workers highest for clinics (25.4), followed by inpatient and outpatient care (10.5) and medical practices (8.7). Supra.

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.

THE “STRAIGHT LEG” TEST: INJURED WORKERS BEING EXAMINED FOR WORK INJURIES AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Injured Workers are evaluated and treated within the Workers’ Compensation System for work-related complaints.  Workers suffering from back injuries will be physically examined to determine a proper diagnosis.

Lumbar Spine Physical Examinations require the physician or examiner to perform various physical tests.  One of these tests is the “straight leg.”

This article will discuss the “straight leg” test, what it means for a back condition, and what it means for Industrially Injured Workers.

Who Conducts Lumbar Spine Physical Examinations?

Medical professionals do Physical Examinations in the capacity of Treaters,  Qualified Medical Evaluators, and Agreed Medical Evaluators.

Specialties conducting physical examinations for the spine may include Chiropractors, Neurologists, Neurosurgeons, Nurse Practitioners, Occupational Medicine Doctors, Orthopedic Surgeons, Physical Medicine Doctors, Physician Assistants, Osteopaths, Primary Care Physicians, and Sports Medicine Doctors.

What is the Common Back Complaint Relevant to the “Straight Leg” Test?

The typical back complaint relevant to the straight leg test is back pain, which radiates down one or both lower extremities.  The symptoms can include numbness in the lower extremities.

Are There Other Names for the” Straight Leg” Test?

Yes. The straight leg test has different names.   This includes the names “Lasegue Test” and the “Straight Leg Raise Test.”

How is the Straight Leg Test Performed?

“The straight leg raise test is performed with the patient supine. The examiner gently raises the patient’s leg by flexing the hip with the knee in extension, and the test is considered positive when the patient experiences pain along the lower limb in the same distribution of the lower radicular nerve roots (usually L5 or S1).” Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539717/

When an Injured Worker sits, the examiner will take the worker’s leg and raise it upward.

What Makes a Positive Straight Leg Test?

“[A] positive straight leg raise test is determined when pain is elicited by lower limb flexion at an angle lower than 45 degrees. During the test, if the pain is reproduced during the leg straightening, patients usually request that the examiner abort the maneuver, and by flexing the patient’s knee, the buttock pain is usually relieved(Figure 1).”  Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539717/

Based upon a review of many medical reports, I have seen Injured Workers have positive straight leg findings with one examiner, not others.  Thus, in my opinion, there is some variability concerning results.

What Is the Aim of the Straight Leg Test?

The straight leg test may indicate whether there is a “sciatic compromise due to lumbosacral nerve root irritation.” Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539717/

It should be noted, however, that “there are multiple causes of a positive test such as facet joint cyst or hypertrophy.” Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539717/

If the Test is Positive, What Will Happen?

If a test is positive, there is the possibility of nerve root irritation and possible entrapment.  The positive straight-leg test is simply the beginning of making a comprehensive diagnosis.  Thus, the Injured Worker may be requested to participate in additional testing, including MRI testing, CT scans, X-rays, and Nerve Conduction Studies.

In sum, a positive finding suggests the need for additional testing to rule out a herniated disc.

What Does a Positive Straight Leg Test Mean for Injured Workers?

For Injured Workers, a positive straight leg test will trigger the examiner to consider ruling out the possibility of a herniated disc injury in the lumbar spine. Thus, a thorough assessment will require additional testing to occur via imaging studies and nerve testing. A positive test may trigger a referral to an orthopedic surgeon or neurosurgeon.

What If I Need Advice?

If you would like a free consultation regarding workers’ compensation, don’t hesitate to 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 LOWER EXTREMITY FUNCTIONAL SCALE (LEFS) AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

In Workers’ Compensation, Doctors and Medical Evaluators, in order to address matters of disability and impairment, frequently use testing. Testing can be in the form of self-reporting questionnaires filled out by Injured Workers.

Many Injured Workers have injuries to their lower extremities.  Lower extremity injuries can include the hips, knees, ankles and feet.

This article will describe the Lower Extremity Functional Scale (LEFS), what the questions are asked, how it is scored, and what it means to an Injured Worker.

What is the Lower Extremity Functional Scale?

“The Lower Extremity Functional Scale (LEFS) is a questionnaire containing 20 questions about a person’s ability to perform everyday tasks.” Honorhealth.com

What is the Purpose of the LEFS?

“The LEFS can be used by clinicians as a measure of patients’ initial function, ongoing progress and outcome, as well as to set functional goals. The LEFS can be used to evaluate the functional impairment of a patient with a disorder of one or both lower extremities. It can be used to monitor the patient over time and to evaluate the effectiveness of an intervention.” Honorhealth.com

How Are You to Answer the Questions?

When provided the LEFS, there is language on the form. It provides as follows: “We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your lower limb problem for which you are currently seeking attention. Please provide an answer for each activity.”  Honorhealth.com

“Today, do you or would you have any difficulty at all with:”

What Are the Activities That Are to Be Assessed?

There are twenty activities that are to be addressed within the LEFS:

Usual work, housework or school activities

Usual hobbies, recreational or sporting activities.

Walking between rooms

Getting into or out of the bath

Walking between rooms

Putting on shoes or socks

Squatting

Lifting an object, like a bag of groceries from the floor

Performing light activities around a home

Performing heavy activities around a home

Getting into or out of a car

Walking 2 blocks

Walking a mile.

Going up or down 10 stairs (about 1 flight of stairs)

Standing for 1 hour

Sitting for 1 hour

Running on even ground

Running on uneven ground

Making sharp turns while running fast

Hopping

Rolling over in bed

How Are the Questions Answered?

The questions are answered with respect to a level of difficulty.  The levels of difficulty are as follows: extreme difficulty or inability to perform activity, quite a bit of difficulty, moderate difficulty, a little bit of difficulty, and no difficulty.

How Is It Scored?

Each level of difficulty is assigned a number from 0 to 4.  The range being from “O” for being extreme difficulty or inability to perform to “4” being able to perform with no difficulty.

Extreme Difficulty or Unable to Perform Activity (0)

Quite a Bit of Difficulty (1)

Moderate Difficulty (2)

A Little Bit of Difficulty (3)

No difficulty (4)

What Is the Total Score?

The total score can range from 0 to 80.  The lower the score implies the greater the disability.

How Can This Scale Be Used in Workers’ Compensation?

In California, the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th Edition, employs the use of “activities of daily living” (ADL) to address impairment.   “Activities of daily living” include the following items

Per the AMA Guides 5th Edition, Table 1-2, See Page 599, the following are the definitions of each ADL. These ADLs include standing, sitting, walking, climbing stairs, lifting, dressing oneself and bathing.

Thus, the LEFS may assist doctors and examiners as to the nature and extent of the injury’s impact on the ADLs.   The ADL assessment can impact the assignment of the permanent impairment number.

Are There Any Concerns with Respect to LEFS?

The LEFS presents problems with respect to workers’ compensation.

First, the scale is to be filled out with respect to the individual’s perception as of the day of the evaluation.  Thus, if someone’s condition gets worse during the day from prolonged weight bearing, their answer in the morning may be different from that in the afternoon. Likewise, there is the issue of the Injured Worker having good days versus bad days. Further, there is the issue of whether the assessment is made with respect to one being medicated or not.  For example, an Injured Worker may be able to perform well on activities while on narcotics but have problems without.

Second, the scale may be used for credibility issues.  Since the scale documents activities on a particular day, contemporaneous sub rosa film may show the Injured Worker performing activities either consistent or inconsistent with their answers.

Third, the scale asks a “would” question concerning the activities.  To some extent, the Injured Worker is being asked to speculate as to their ability to perform certain functions.  In workers’ compensation, speculation cannot be used as a basis for an award and is therefore problematic.

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.

 

What You Need To Know About The Cage-aid Questionnaire And Workers’ Compensation

Workers’ Compensation Medical Treatment can employ various questionnaires to assess an Injured Workers’ need for treatment.  One of these questionnaires is called CAGE-AID.

This article will discuss the purpose of the CAGE-AID questionnaire, how it is used in an industrial treatment setting, and how it may impact an injured worker’s treatment.

What is the CAGE-AID Questionnaire? 

The CAGE-Aid questionnaire is a substance abuse screening tool.  Substance abuse applies to alcohol, legal drugs and street drugs.

Why is Substance Abuse a Problem with Workers’ Compensation Treatment?

Substance abuse is a multi-factorial problem in workers’ compensation.  There are workers who, prior to their injury, have histories of either substance or alcohol abuse.  Further, there are workers, as a result of their injuries, begin to abuse drugs or alcohol.   This abuse can either be with prescription drugs, alcohol, or street drugs.  Finally, there are injured workers who, not as a result of their work injuries, engage in substance abuse.

Why is The Questionnaire  Called CAGE?

The abbreviation refers to some of the terms within the questions. The terms are cut, annoyed, guilty and eye opener.

What are the Questions Asked?

There are four questions.  They are:

Have you ever felt that you ought to cut down on your drinking or drug use?

Have people annoyed your by criticizing your drinking or drug use?

Have you ever felt bad or guilty about your drinking or drug use?

Have you ever had a drink or used drugs first thing in the morning to steady your nerves or get rid of a hangover (eye opener)?

How is it Scored?  

It is scored one for yes and zero for no.

How is The Score Interpreted? 

If one or more responses is yes, then it is regarded as a positive screening test.  Thus, possible substance abuse is something that the medical provider should explore with the partient.

How Should Injured Workers Answer the Questions?

These questions may impact medical treatment decisions.  Medical providers need accurate information in order to provide appropriate treatment.  Substance abuse, when combined with prescription drugs, can lead to harmful and deadly drug interactions.   Therefore, it is important to be honest when answering the questions.

Additionally, if an injured worker has a substance abuse problem that is preventing their recovery from a work injury, it is possible that the workers’ compensation medical system may provide some assistance with respect to substance abuse treatment.  This, however,  would be subject to the limitations within Labor Code Section 4600.

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.

 

VISUAL ANALOG PAIN SCALE (VAPS) AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

In the Workers’ Compensation System, Doctors and Medical Evaluators ask Injured Workers to fill out various scales and questionnaires. One of these scales is the Visual Analog Pain Scale (VAPS.)

Scales and questionnaires can impact an Injured Worker’s ability to get treatment and disability payments. Therefore, Injured Worker should understand how to answer them properly.

This article will discuss the Visual Analog Pain Scale(VAPS), how the VAPS is administered, how VAPS is to be answered, how VAPS is graded, and how VAPS can be used within the workers’ compensation setting.

What is VAPS? What Is it Designed to Measure?

The Visual Analog Pain Scale is “a unidimensional measure of pain intensity, which is utilized in diverse adult populations.”  Measure of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP) Gillian A. Hawker, Samra Mian, Tetyana Kendzerska Melissa French 07 November 2011 https: //doi.org/10.1002/acr.20543

The VAPS is intended to explore the issue of pain.

What Does VAPS Look Like?

The VAP Scale can be set up either horizontally or vertically. Supra.

This is an example of a scale:    0 “no pain”   |————————————————–| 100 “worst imaginable pain.”

How Many Questions Are There in VAPS?

One. It is the simple answering of one’s pain level.  This is done by marking a spot on the spectrum to describe the pain. Supra.  The spot can be measured and assigned a number.  See below.  Some scales allow for the patient to assign a number.

How is the Score Interpreted?

“A higher score indicates greater pain intensity. Based on the distribution of pain VAS scores in post surgical patients (knee replacement, hysterectomy, or laparoscopic myomectomy) who described there postoperative pain intensity as none, mild, moderate, or severe, the following cut points on the pain VAS have been recommended: no pain (0-4mm), mild pain (5-44mm), moderate pain (45-74 mm) , and severe pain (75-100 mm) ” Supra.

Why Are These Terms important?

In workers’ compensation, the evaluators look at pain. Pain is often characterized by the terms of slight, moderate or severe.

The definitions for slight, moderate and severe are different in the field of industrial medicine. California used to use them to assign permanent disability.  In order to do so, they defined the terms.  The 1997 Permanent Disability Rating Schedule defined the terms as follows: “Pain is not always disabling. It becomes disabling when its degree affects function. Regulations define four degrees of subjective pain – minimal, slight, moderate and severe. By definition, minimal (mild) pain is not disabling because it causes no handicap in the activity precipitating the pain. However, slight, moderate and severe pain reflect increasingly greater degrees of handicap on work activity, and are ratable factors of disability.” P.1-7.  While these terms are no longer used for permanent disability purposes, they are frequently documented in medical reports.

Pain’s nature and extent, in certain circumstances, can be a factor in assessing whole person impairment. Whole person impairment is then translated into permanent disability.

How Can Testing Impact Injured Workers’ Claims?

Testing creates credibility issues.  When an Injured Worker provides a 100 score, it means either that they are in severe pain, they are exaggerating, or that they are making a cry for help.  In cases with minor injuries, high scores will impact the credibility of the pain reporting.

Also, an injured Worker may wish to ask how the question should be answered. Pain level when medicated or pain level during a certain period of time, i.e. this moment or this week, are legitimate questions.

What Is the Problem with this VAP Scale?

Pain assessments can be confounded with respect to an individual’s “pain reference.”

Some individuals have never experienced severe pain in their life.  For women who have experienced childbirth and for those who have passed a kidney stone, their pain references, however, can be in the severe range.  Thus, an individual’s past medical conditions is important to review as a reference.

It is quite conceivable that they have experienced pain in the 90s up to 100.   Some individuals also have strong pain tolerances.  A 70 to them would be a 95 to others Thus, these individual’s reporting may only be relevant when compared to other  assigned scores provided on different dates of evaluation or treatment.

How Should an Injured Worker Answer the VAPS?

An Injured Worker should make their best effort to accurately describe their pain.

If there is any confusion concerning how to answer or mark the scale, you should clarify with the evaluator. For instance, you could be a 50 on medications and a 70 without.  Thus, it is important that the doctor or evaluator understand your reason for assigning a particular level of pain.

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.

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