JANITORS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

A large part of the labor market is the occupation of Professional Cleaners.  They are also referred to as Commercial Janitors.  The Janitorial Occupation is susceptible for a variety of work injuries and occupational illnesses. Janitorial work presents unique risks for work injuries for those within the field.

This article will discuss Janitors, Janitorial Tasks, Industrial injuries and Occupational Illnesses that are prevalent within the Occupation, and the barriers that Janitors have with respect to filing claims.

What are Janitors?

Janitors perform a variety of maintenance tasks a variety of facilities. They use a multitude of tools and chemicals to perform their jobs.  They can engage in a large variety of repetitive physical tasks, ie. sweeping or mopping.

Janitors can work at institutions such as schools, hospitals, parks, and prisons.

Janitors can work in commercial buildings such as shopping malls, and they can work in residential properties.

What Are Janitor’s Risks of Industrial Injury?

Each type of facility can present unique risks of work injury for Janitors.

For example, hospitals and medical facilities can have significant amounts of potentially infectious biological material present.  Schools can have issues relating to mold exposure.

Further, the physical activities of being a Janitor may cause work injury.

What Types of Injuries Do Janitors Sustain?

There are a variety of work-related orthopedic injuries. These injuries relate, in part, due to the fact that “Janitorial work is repetitive and requires bending, twisting, and other motions that can lead to or exacerbate musculoskeletal disorders, such as arthritis” Using Behavioral Risk Factor Surveillance System Data as an Occupational Health Profile Washington State Janitors, 2011 to 2017 Anderson, Naomi J. MPH; Marcum, Jennifer L. DrPH Journal of Occupational and Environmental Medicine: September 2019 – Volume 61 – Issue 9 – p 747-753 doi: 10.1097/JOM.0000000000001652

Also, Janitors may sustain respiratory injuries relating to the cleaning chemicals that they use.  Further, they may sustain dermatological injuries due to wet work.

What Are the Injury Rates for Janitors?

In a Washington State Study, it was noted that “[t]he prevalence of self-reported work-related injuries in the past year was higher than that of all others …. Analyses of WC data indicate that work-related injury risk may be higher for the industry group containing Janitors than other industries2 overall and in several injury types, with women at particularly high risk.” Using Behavioral Risk Factor Surveillance System Data as an Occupational Health Profile Washington State Janitors, 2011 to 2017 Anderson, Naomi J. MPH; Marcum, Jennifer L. DrPH

Journal of Occupational and Environmental Medicine: September 2019 – Volume 61 – Issue 9 – p 747-753 doi: 10.1097/JOM.0000000000001652

Thus, the workers’ compensation industry both has a concern over janitorial injuries as well as an understanding that work injuries are common.  Thus, Risk Management handling Janitorial claims will work hard to manage these claims.  This can be done with respect to reporting requirements.  It can also be done with respect to return to work issues which can include modified work.

Do Janitors Have Emotional Issues?

Yes. Janitors, in the study, reported “being diagnosed with a depressive disorder ..significantly higher and has been reported previously.    Using Behavioral Risk Factor Surveillance System Data as an Occupational Health Profile Washington State Janitors, 2011 to 2017 Anderson, Naomi J. MPH; Marcum, Jennifer L. DrPH Journal of Occupational and Environmental Medicine: September 2019 – Volume 61 – Issue 9 – p 747-753 doi: 10.1097/JOM.0000000000001652

While this finding did not address work-relatedness, it is possible that the depressive disorder may be in party work-related in nature and give rise to a workers’ compensation claim.

Can Shift Work Impact Janitors?

Yes. Shiftwork has been connected to various medical conditions.

Shiftwork can cause issues of inadequate sleep.  Inadequate sleep can lead to other health issues.

Do Janitors Have Barriers in Filing Workers’ Compensation Claims?

Yes. There is some concern as to whether all janitor work injury claims are filed.  As noted in the study, “[l]ow-wage, immigrant, and/or Hispanic worker populations, including many Janitors, may also not be aware of the WC system (or how to navigate the system, if they lack internet access) or of their right to seek medical care for an occupational injury or illness. Janitors may also face barriers to reporting an injury to their employer, such as fear of consequences.    Using Behavioral Risk Factor Surveillance System Data as an Occupational Health Profile Washington State Janitors, 2011 to 2017 Anderson, Naomi J. MPH; Marcum, Jennifer L. DrPH Journal of Occupational and Environmental Medicine: September 2019 – Volume 61 – Issue 9 – p 747-753 doi: 10.1097/JOM.0000000000001652

If a Janitor is concerned about their employment situation if they claim a work injury, it is important for them to seek legal counsel to discuss their concerns to make a determination as to whether they should file the claim.

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’S TOTAL TEMPORARY DISABLITY RATES FOR 2021: INJURED WORKERS, WORKERS’ COMPENSATION, AND DISABILITY PAYMENTS: WHAT YOU NEED TO KNOW

The State of California Department of Industrial Relations announced the total temporary disability rates for 2021 (See DIR Release Number: 2020-95, November 2, 2020.)

The current maximum rate is now $1,356.31, per week.  The current minimum rate is to be $203.44.

Thus, total temporary disability payments that are due for dates of injury occurring on 1/1/21, and thereafter in 2021, are to be at these rates.  For prior injury dates, if the total temporary disability payments are made two years after the date of injury, then they are to be paid out at these new amounts as well.

Generally, total temporary disability payments are calculated by 2/3rds of the Injured Worker’s Average Weekly Wage at the time of the injury.

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.

 

FINGERTIP INJURIES AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Upper Extremity Injuries are very common in an occupational setting.  Upper Extremity Injuries can include injuries to the fingertip.  Fingertip injuries can involve an amputation.

In the general population, “[i]t is estimated that as many as 45,000 finger amputations are performed in the US per year with an incidence rate of 7.5/100,000 people.” Kawaiah A, Thakur M, Garg S, Kawasmi SH, Hassan A. Fingertip Injuries and Amputations: A Review of the Literature. Cureus. 2020;12(5):e8291. Published 2020 May 26. doi:10.7759/cureus.8291

This article will discuss Fingertip Injuries, causes of fingertip injuries, treatment for fingertip injuries, a special workers’ compensation law with respect to amputation cases, and issues relating permanent disability.

What is the Fingertip? Why is It Unique?

 Fingertips are unique. “The tip of the digit comprises virtually all tissue components present elsewhere in the body: skin, bone, joint, synovial membrane, ligaments, tendons, tendon sheaths, arteries, veins, lymphatic channels, nerves, and advanced nervous end organs.” Kawaiah A, Thakur M, Garg S, Kawasmi SH, Hassan A. Fingertip Injuries and Amputations: A Review of the Literature. Cureus. 2020;12(5):e8291. Published 2020 May 26. doi:10.7759/cureus.8291

Thus, a traumatized tip can experience a variety of symptoms.  These symptoms and factors of impairment can include tenderness, sensitivity to cold, discoloration, and deformity.   Kawaiah A, Thakur M, Garg S, Kawasmi SH, Hassan A. Fingertip Injuries and Amputations: A Review of the Literature. Cureus. 2020;12(5):e8291. Published 2020 May 26. doi:10.7759/cureus.8291

What Are Common Causes of Fingertip Injuries?

Many occupational hand injuries involve metal items.  The metal items can include hand tools which include blades.  On a personal note, I have had fingertip injuries occur on table saws in which safeties have been removed.  Also, I  have had fingertip injuries in which the hand accidentally went into a piece of moving machinery.

Fingertip injuries can also occur as a result of sharps.   Sharps are devices that are used to cut.  These include many items used in the medical field such as auto injectors, connection needles and sets, infusion sets, lancets, needles, and syringes.

Sharp injuries can result in lacerations, amputations, or neurovascular injuries. Kawaiah A, Thakur M, Garg S, Kawasmi SH, Hassan A. Fingertip Injuries and Amputations: A Review of the Literature. Cureus. 2020;12(5):e8291. Published 2020 May 26. doi:10.7759/cureus.8291

 What Are Goals of Treatment?

 Treatment goals for fingertip injuries include restoration of sensation of the tip, improving the durability of the tip, and providing for proper bone support to allow for nail growth. Kawaiah A, Thakur M, Garg S, Kawasmi SH, Hassan A. Fingertip Injuries and Amputations: A Review of the Literature. Cureus. 2020;12(5):e8291. Published 2020 May 26. doi:10.7759/cureus.8291

What Problems Can Arise from a Fingertip Injury?

Problems arising from fingertip injuries can include deformities, intolerance to cold, skin tenderness, stiffness, and long-term functional loss. Kawaiah A, Thakur M, Garg S, Kawasmi SH, Hassan A. Fingertip Injuries and Amputations: A Review of the Literature. Cureus. 2020;12(5):e8291. Published 2020 May 26. doi:10.7759/cureus.8291

How Is a Fingertip Injury Treated?

Due to the complexity and importance of the fingertip, there are many issues that can present.  There are concerns with respect to psychological factors that can present with such injuries.

Also, there may be issues of pain syndromes that can occur as a result of a fingertip injury.  These pain syndromes can even occur in the case of minor contusion. Approach to Fingertip Injuries Patricia Martin-Playa, MD, Anthony Foo, MD* Clin Plastic Surg 46 (2019) 275–283 https://doi.org/10.1016/j.cps.2019.02.001

Treatment can include repairing the skin by stiches or glue, skin grafting, reconstruction, composite grafts, flap reconstruction, bone graft, nail complex reconstruction.

Are There Psycho-Social Factors Issues with Fingertip Injuries?

Yes.  Fingertips are an extremely important part of the body.  They are used frequently during the day for a variety of tasks. Fingertip injuries can impact one’s occupation and their participation in hobbies.  For example, a fingertip injury may impact on one’s ability to perform a musical instrument.

Fingertips are usually visible to the public.  Therefore, there can be an emotional impact on the patient.

Fingertip injuries that are part of a workers’ compensations have secondary motivation issues. For instance, the patient may have concerns about disability status and impairment.

Fingertip injuries can be subject to clinical bias. For example, medical practitioners may view the severity of the injury differently from the patient. Approach to Fingertip Injuries Patricia Martin-Playa, MD, Anthony Foo, MD* Clin Plastic Surg 46 (2019) 275–283 https://doi.org/10.1016/j.cps.2019.02.001

Is There a Special Law for Amputation Cases?

Yes. In the case of amputations, total temporary disability benefits are extended out to 240 weeks from 104 weeks.  This is pursuant to Labor Code Section 4565(c)(3)(c.)

What Type of Permanent Impairment Can Arise from A Fingertip Injury?

Fingertip injuries can cause many types of impairments.  There are impairments that relate to amputations, there are impairments that relate to skin conditions, there are impairments that relate to nerve damage, there are impairments which relate to loss of function such as range of motion.  Also, there may be a pain impairment add-on.

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.

 

 

 

 

DOCTORS’ ATTITUDES TOWARDS WORKERS’ COMPENSATION TREATMENT: INJURED WORKERS, THEIR TREATING DOCTORS, AND THEIR MEDICAL TREATMENT: WHAT YOU NEED TO KNOW

Doctors, as much as Injured Workers, can be frustrated with the administrative process controlling work injury treatment. This frustration is in large part due to the rules, regulations and statutes which govern industrial medical treatment.

California Workers’ Compensation System medical treatment rules for authorization are different than regular health insurance. Thus, treatments that are may be authorized under regular health insurance without difficulty may not be authorized as part of treatment for a workers’ compensation claim.

Part of the difference in treatment between workers’ compensation and regular health insurance is that Workers’ Compensation Law has adopted  Evidence Based Medicine (EBM) as a means of determine what treatment should be authorized. Labor Code 5307.27. adopted a medical treatment utilization schedule which is to incorporate evidence-based, peer-reviewed, and nationally recognized standards of care

This article will discuss Evidence Based Medicine (EBM), how medical providers view EBM, and what an Injured Worker can do to address their workers’ compensation treatment.

What Is Evidence Based Medicine (EBM)?

Evidence Based Medicine looks towards science to determine whether treatment helpful.  Thus, they will look at scientific studies as a basis for treatment.  These studies could include ones in which they look at the benefits of a particular mode of therapy within a population.

For example, if 90 percent of the individuals in a study report a significant benefit from a form of therapy, then, there would be a likelihood that therapy would be recommended in an EBM format.

Also, EBM will look at the quality or strength of studies to determine which ones should be followed.  This determination is made by experts who are qualified to make such an assessment. Benjamin Djulbegovic, Gordon H Guyatt, Progress in evidence-based medicine, The Lancet, Volume 390, Issue 10092, 2017, Pages 415-423, ISSN 0140-6736, https://doi.org/10.1016/S0140-6736(16)31592-6.

Note: My criticism of EBM is that each patient responds differently towards treatment. Thus, while a treatment may not be considered effective with respect to the general population, it may be something that is effective toward on an individual basis.

An individual may have a history with a particular form of treatment, i.e. chiropractic, which had been effective in the past for the individuals.   Thus, a general scientific study is being chosen against real data concerning the real patient.  It is important to note that it is the real patient who is going to get the treatment and not a statistical patient.  It can be argued that a small scientific study based upon the individual’s success with a treatment is more valuable than a broader study.  Arguably, it is far more relevant.

What Is Workers’ Compensations’ Interest In EBM?

In an article, the following was the commentary with respect to this issue: “[t]he workers’ compensation scheme expects that such a tool (EBM) could reduce the uncertainty about the appropriateness and effectiveness of a treatment. Reducing the uncertainty could speed up the decision-making process and reduce the need to seek second opinions from medical examiners. Health care practitioners would no longer have to complete additional paperwork for those evidence-based treatments. In general, it could facilitate a common understanding across those requesting treatment/services and those reviewing the services requested.” Elbers, N.A., Chase, R., Craig, A. et al. Health care professionals’ attitudes towards evidence-based medicine in the workers’ compensation setting: a cohort study. BMC Med Inform Decis Mak 17, 64 (2017). https://doi.org/10.1186/s12911-017-0460-2

Note: While this was the view in the study, this was not an assessment of the California Workers’ Compensation scheme concerning medical treatment.  Despite the EBM approach, doctors are still subjected to considerable amount of paperwork to get treatment authorized.  Further, EBM requests for treatment are still subject to a Utilization Review process and are not automatically authorized.  Further, there is a training problem in that not all medical providers are adequately versed with respect to EBM. As a result, requests for treatment from certain providers may be denied as being improper.

What Is Insurance Companies’ Interest in Evidence Based Medicine?

In an article, it is noted that “[t]he tool is primarily developed to be used by claims managers. However, the treatment approval process is an interaction between claims managers and health care professionals.” Elbers, N.A., Chase, R., Craig, A. et al. Health care professionals’ attitudes towards evidence-based medicine in the workers’ compensation setting: a cohort study. BMC Med Inform Decis Mak 17, 64 (2017). https://doi.org/10.1186/s12911-017-0460-2

Thus, EBM is a means upon which Insurance Companies can assert control of medical treatment away from doctors.  They can use EBM to dictate to providers as to what treatment will be authorized. Thus, Insurance Companies have supplanted doctors with decades of experience to determine necessary treatment.

What Are the Criticisms of EBM?

There are a variety of criticisms for EBM.

Cookbook Medicine:  This term has the implication as to whether a doctor is needed.   Thus, all one needs to administer medical care is look at the guidelines.  Thus, who needs training, experience and expertise to provide treatment?

Decreased Professional Freedom:  The profession of medicine is referred to as both a practice and an art.  EBM takes away a doctor’s experience, knowledge and acquired skills from being employed to treat patients.  When I treat for my industrial injuries, I want to go to an experienced and talented doctor.  I do not necessarily want to go to a doctor who knows EBM.

What are the Visions and Problems for EBM?

It may provide guidance to clinicians in that they would know what they can request for authorization.

It may limit over-servicing or over-prescription of a particular medicine or treatment.

It may work as a basis to guide patients’ expectations as to what they can receive and how long their course of treatment will last pending return to work.

It may cause problems in that treatment will be insurance company formulaic as opposed to being dictated by the provider.

It may conflict with patient’s concerns about their treatment and as to what would benefit them.  Sometimes, they are confronted with a doctor wanting to perform surgery and an insurance company denying the authorization.  Also, patients come in conflict with their doctors when they wish to try treatment which is not within EBM guidelines.

There are questions as to the quality and quantity of the evidence that is used. Studies can be generated to produce results favorable to insurance companies’ positions and then adopted within the EBM guidelines.

The article indicated that there may be more timeliness on approval of treatment.   In California, however, as long as treatment requests are sent to UR, there will be delays in providing industrial treatment even if they fall within EBM based guidelines.  Some claims departments have taken an approach of pre-authorizing some forms of treatment to eliminate this process. This has been helpful.

There are concerns with respect to those analyzing the data and recommendations within an EBM setting. There may be some bias involved which may relate to countries, legal systems and forms of medical delivery or insurance.

There are concerns that the Insurance Industry will use EBM as a tool to dictate medical treatment at the expense of the Injured Worker.   There are medical providers who will reject EBM and discontinue treating cases on an industrial basis.  This will leave the field of medical providers as ones who will simply comply with EBM rather than fight for patient’s medical treatment needs.

EBM creates problems.  It creates distrust in medical providers who want to do their job.  It throws out the window medical expertise from providers with decades of experience.   It discourages Injured Workers who simply wish to get their treatment provided on a timely basis. It emboldens Insurance Companies and their representatives to tell Injured Workers that they are better off getting their treatment elsewhere.   This is offensive in that the industrial treatment is mandated to be done through this system.   It is unfair to force injured Workers to treat within a broken or ineffective system.

What are Doctors’ View of Evidence Based Medicine?

Per the study on doctor’s attitude, they noted that “Overall, HCP[health care providers] are supportive of EBM, but have strong concerns about implementation of EBM based decision making in the workers’ compensation setting.

The participants felt that an EBM tool should not be applied rigidly and should take into account clinical judgement and patient variability and preferences.

In general, the treatment approval process in the workers’ compensation insurance system is a sensitive area, in which the interaction between HCP and claims managers can be improved.” Elbers, N.A., Chase, R., Craig, A. et al. Health care professionals’ attitudes towards evidence-based medicine in the workers’ compensation setting: a cohort study. BMC Med Inform Decis Mak 17, 64 (2017). https://doi.org/10.1186/s12911-017-0460-2

What Should an Injured Worker Do?

It is very important that an Injured Worker find medical providers that both understanding the paperwork needed to be placed in for treatment requests as well as understand the treatment guidelines which are in part based upon Evidence Based Medicine concepts.

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.

INJURED WORKERS WAKE UP! CARRIERS AND EMPLOYERS HAVE OTHER GOALS THAN YOU: RISK MANAGEMENT AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Injured Workers need to know that the workers’ compensation system is a risk management system. Therefore, it is important to understand the nature of a risk management system.  Insurance Companies and Employers may take actions on your claim and your employment.  Therefore, understanding risk management may allow you take measures to protect yourself.

Risk Managers compile information and techniques which allow them to limit costs with respect to workers’ compensation claims.

Injured Workers and Workers should have a general understanding risk management within a work injury context. Risk Managers’ approaches in workers’ compensation claims may unfortunately impact an Injured Worker’s treatment or benefits.

This article will discuss the various factors that Risk Managers consider as important and what areas that they will address as cost-savings measures.

What Is Workers’ Compensation?  How Is It Related To Risk Management?

Workers’ Compensation was created to be insurance program that manages work injury losses or costs for employers.  The system is designed with the context that businesses and employers can be able to cover the employee injury risk and no go broke.  In other words, a work injury claim should be something that can be affordable and not bankrupt a business.

Work Injury losses and costs include indemnity payments, transactional costs such as adjusting and legal costs, and medical treatment costs.  Further, employers and insurers are also concerned with respect to reserves. Reserves are monies that are set aside to pay the expected costs on a claim.

What Is Risk Management?

Risk Management is a field which addresses aspects of insurance and loss.   Thus, with respect to industrial injuries, Risk Managers focus on both injury reduction and injury prevention.

Part of the injury reduction component includes limiting the nature and extent of injuries as well as the attending costs for the claim. This can include reducing indemnity payments as well as medical treatment.

Part of Risk Management is the ability to predict outcomes.   Therefore, knowledge of past claims and past results lays the foundation as to how to approach future claims.

What Are the Methods of Risk Management?

Risk Management methods include safety training, control banding, protective equipment safety guards, safety mechanisms on machinery, and safety barriers. Also, analyzing causes by using root cause analysis may help reduce future injury. Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Some aspect of risk management can include workplace inspection.

What Is Risk Management’s View of the Sources of Occupational Injuries?

Risk Managers need to know what can cause injuries in the workplace.  Occupational injuries can result from physical, biological, chemical, or psychosocial hazards. Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Thus, Risk Managers may have a goal of controlling these hazards.  In doing so, this can lead to loss prevention with respect to work injury claims.

Thus, Risk Managers may implement workplace training, rules, and regulations.

What Is Risk Management’s View as to the Types of Work Exposures That Can Cause Injury?  

Risk Managers see a variety of exposures that workers encounter in the workplace that are causative towards injuries.  Unlike sources of injury, exposures are ones that are in fact injurious in nature.  These include “noise, temperature, insect or animal bites, aerosols, blood-borne pathogens, hazardous chemicals, radiation, and occupational burnout.” Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Thus, Risk Managers may control the amount of worker’s exposure to these items or events to prevent work injury claims.

What is Risk Management’s View as to Common Sources of Injury?

“Many injuries still occur due to poor ergonomics, manual handling of heavy loads, misuse of equipment, general hazards, and inadequate safety training.” Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Thus, Risk Managers, to prevent injury, may implement of ergonomic work stations, training and rules for properly lifting and safety training.

What is Risk Management’s View as to the Common Types of Injuries?

“Slipping or tripping, which causes a fall are common work-related injuries, accounting for 20% to 40% of disabling occupational injuries.”  Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Further, it should be noted that orthopedic injuries tend to be the most common medical specialty that is employed to treat industrial injuries.

What is Risk Management’s View as to the Parts of the Body Get Injured?

The most common injury is to the Upper Extremities.  They represent 50 percent of workplace injuries.   Hearing Loss also accounts for a significant amount of occupational injury claims.  Further, needle sticks are also a source of injuries as well. Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Thus, Risk Managers may impose rest breaks, ergonomics, hearing testing, hearing protections, and proper disposal of needles to prevent work injuries.

What Is Risk Managements’ View of Age?

A Worker’s age can statistically have value to Risk Managers.

Statically, “[a]ge is perhaps the most common personal factor that predisposes a person to an increased risk of work-related injury. Workers aged 65 years and older are more likely to suffer from occupational injuries compared to their younger occupational counterparts.” Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Additionally, older workers can make them ”at higher risk for hearing loss, visual impairment, and the use of multiple prescription medications that are linked to higher rates of work-related injuries.”

In sum, Risk Management, although there are laws against age discrimination, may be focused on the tasks that older workers perform.

Does Risk Management Have a Concern with Respect to Occupations?

Yes.  Certain occupations for which there are higher rates of work injuries.  In particular, the occupations with high rates of include farming, fishing, forestry, construction and manufacturing.  Supra.

What is Risk Management’s View with Respect to Testing Proving or Disproving Claims?

Risk Managers rely on traditional work-ups by medical providers to assess work injury claims.

The work-ups include the taking of a comprehensive history and a physical examination. Also,  a diagnostic workup should be considered. This diagnostic work-up can include, but is not limited to, radiographs, ultrasound, and advanced imaging modalities.

Risk Managers, however, have concerns with respect to MRIs.  It is noted that “while the use of magnetic resonance imaging (MRI) is often helpful in delineating the actual clinical pathology, providers should remain cognizant of the potential for overdiagnosis and the potential for treating a potentially incidental finding that is not the primary source of a patient’s current debilitating condition.” [emphasis added]

Note: This passage shows notes that allowing for medical testing can open a Pandora’s Box of liability.  An incidental finding on a MRI can lead to a claim being amended for additional body parts.

Further, it is noted that “MRI has been demonstrated previously in the literature to its known limitations in the appropriate clinical setting. For example, a 2010 study reported on the inconsistent diagnostic accuracy of wrist MRIs being obtained to identify the potential source(s) of ulnar-sided wrist pain.” Supra.

Further, “a 2017 study analyzing work-related injuries consistent with unilateral knee or shoulder injury and subsequent bilateral MRI studies being performed during the diagnostic evaluation reported that less than half of patients had degenerative and/or pathologic findings that would be considered worse than the contralateral, asymptomatic, “normal” side.”

Note: This research is Risk Management propaganda concerning MRIs.  The issue is treating symptomatic disabling body parts.  The fact that an asymptomatic body part with pathology is present should not create excuse.

What Is Risk Management’s View on Treatment?

Risk Managers view treatment with a two-fold perspective.  In the treatment setting, there is the opportunity to treat the injury. Also, there is the opportunity to analyze the work-relatedness of the claim. This can include an assessment as to the value of the claim.

“Each work-related injury is different. Thus, providers should first establish whether the injury is preexisting, directly or indirectly related to the patient’s occupational requirements and if the claim is considered to fall under the workers’ compensation system.” Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Risk Managers note that “[t]reatment is specific to the specific condition and may include pain management modalities, physical therapy, NSAIDs, injections, and surgery.  It is important to recognize that each patient presenting with occupational-related injuries should be managed on an individual basis as not all conditions are created equal.”   This is position is true.   This position is not however adhered to during the course of workers’ compensation treatment.

Risk Managers limit claims exposure by asking providers to limit their evaluations and treatment.  This can be done by limiting authorization to treat certain body parts or what treatment will be authorized.

What Is Risk Management’s View on Surgery?

Surgeries are not necessarily viewed as beneficial from a Risk Management perspective.

“The literature supports many different types of clinical encounters the potential disparity with respect to postoperative outcomes comparing work-related injury patients compared to their non-work counterparts.”

“For example, total joint replacements are, in general, consistently reproducible procedures that yield excellent outcomes in the vast majority of patients. However, when comparing occupational-based (or workers’ compensation) patients to non-workers’ compensation control patients via matched cohort or comparative studies, the literature demonstrates the potential for a comparably inferior outcome in the former.” Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Thus, Risk Managers may have some fear and trepidation as to authorizing surgeries due to the fact that there is the anticipation that the results may not be optimum.  As a result, Risk Managers may scrutinize and resist requests for surgery.

What Is the Risk Management’s View of Case Settlement?

Risk Managers have a concern with respect to the future medical costs. This is especially the cases with respect to older workers. It is noted that “the synergistic combination of the older population falling at work, in addition to the older population’s predisposition to these low-energy injuries, sets up the potential for an overall devastatingly morbid effect on the entire healthcare system.” Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238. The Risk Management perspective to include nurse practitioners as part of the diagnosis progress.

This perspective indicates that there may be an increased sense of urgency to settle older workers’ case.   This is due to the fact of the possible high medical exposure costs.   Further, Risk Managers may desire to avoid placing older workers in work setting in which they may be subject to trip and fall injuries.

What Is Risk Management’s View on Obtaining a Medical Diagnosis?

“All healthcare providers are encouraged to manage these patients individually in order to ensure the best possible outcomes.”  Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238. Nurse practitioners were included as part of the providers who could make the medical diagnosis. Supra.

As a representative of Injured Workers, it is my contention that diagnosis and treatment of Injured Worker should be the purview of medical doctors.  They should be the one making the diagnosis and not nurse practitioners.   The reliance on nurse practitioners is solely a cost savings measure, Improper or inadequate diagnosis by a nurse practitioner can lead to delay in a achieving a proper medical diagnosis.  This improper or inadequate diagnosis can lead to delays in both proper treatment and return to work. Therefore, while reliance on lower level practitioners for diagnosis of a condition may be perceived as cost-cutting, it may not actually be more costly in the long run.

What Is Risk Management’s View Concerning “Return-to-Work?”

Yes. Risk Managers recognize that there are “return to work” issues for Injured Workers. I attended a lecture on this issue.  The speaker noted that every day that an Injured Worker missed as a result of their injury impacted on the probability that the worker would return to their usual and customary job.

Thus, Risk Managers acknowledge that an Injured Worker returning to work can have a profound impact on both their workers’ compensation case and the Injured Worker’s employment.

Thus, there may be some instances where Insurance Companies and Employers may encourage early return to the workplace.  This can be done via offers of alternative or modified 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.

 

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