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

Posted on February 4, 2021 by Edward Singer

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., 2005; Wilhelm, 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, 2006; Sharpe & Heppner, 1991; Winkler 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., 2006; Kessler et al., 2005; Wilhelm et al., 2008; World 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, 2012; Hawton & van Heeringen, 2009; Levi et al., 2003; Moller-Leimkuhler, 2003; Rihmer, Belso, & Kiss, 2002; Statistics Canada, 2012a, 2012b; Wasserman, 2000; Wolfgang & 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.

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

Posted on January 25, 2021 by Edward Singer

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?

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

Posted on January 8, 2021 by Edward Singer

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?

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

Posted on January 6, 2021 by Edward Singer

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?

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

Posted on December 29, 2020 by Edward Singer

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?