MEDICAL TREATMENT

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WORKERS’ COMPENSATION IN THE NEWS, EPISODE #2, A RESTAURANT COOKING UP STRESS: WHAT YOU NEED TO KNOW

Posted on July 19, 2021 by Edward Singer

A Restaurant closed for a “day of kindness” after enduring customers’ abuse. Nypost.com Restaurant Employee stress is real. Some of the story’s restaurant’s employees were reduced to tears from customers swearing, threatening, arguing, and yelling.

The story illustrated multiple stressors that restaurant employees experience. Customer abuse was the highlight. There were management problems as well. The Employer noted that they “.. have had to make adjustments due to the increase in business volume, size of kitchen, product availability and staffing availability.”

Can Work Stress Be the Basis for a Workers’ Compensation Claim?

Yes. Work stress can be a source of psychiatric injury claim. it can be the source of other stress related conditions.

Do The Restaurant Employees From the Story Have a Claim?

In California, the predominant cause of a psychiatric claim of injury arise from actual events of employment. Further, good-faith personnel action which is substantial (35-40%) can defeat a claim.

In the story, the stressors did not come from employer discipline or write-ups. Rather it came from Customers and Management organizational issues. Thus, it can be argued that 100 percent of the work stressors do not fall within the personnel action defense.

Are Stressed Out Employees Eligible for Time off From Work?

Work stress can cause employees to go out sick. Mental Health Practitioners may take stressed out employee off of work. This may entitle the Injured Worker to obtain benefits during their time off. It should be noted that in the story, the workers, technically, never received a day off. Instead, they spent the day cleaning the restaurant.

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 27 years. Contact us today for more information.

UPPER EXTREMITY SURGERY, POST-OPERATIVE VISITS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Posted on June 7, 2021 by Edward Singer

Workers’ Compensation Studies will often provide Injured Workers insight as to Insurance Companies’ and Medical Providers’ tactics. Injured Workers often feel like there is an agenda working against them. A recent study about post-operative visits for Upper Extremity Surgery raises concerns.

This article will discuss Upper Extremity Surgery, the Study’s results and the Study’s implications for Injured Workers.

What Are Upper Extremity Surgeries?

In the workers’ compensation system, upper extremities can fit into two categories.

First, there are traumatic injuries which require surgeries. A skill saw accident involving amputation is one which may require extensive and specific procedures.

Second, there are surgeries that are due to Occupational Illness. These surgeries are most likely related to repetitive trauma.

One common occupational illness surgery is carpal tunnel.

What Are Typical Workers’ Compensation Upper Extremity Surgeries?

Typical workers’ compensation surgeries, which were also the subject to the Study, are Carpal Tunnel Release, Trigger Finger Release, Cubital Tunnel Release, and De Quervains.

With respect to these surgeries, sometimes two or more of these procedures can be done at the same time.

What Did the Study Find?

The study found that workers’ compensation patients have more post-operative visits after surgery than non-industrial surgeries. Henry TW, Townsend CB, Beredjiklian PK. Workers’ Compensation Status Confers a Greater Number of Postoperative Visits After Common Upper Extremity Surgeries. Cureus. 2021;13(4):e14629. Published 2021 Apr 22. doi:10.7759/cureus.14629

The study viewed these additional visits as being an additional cost which could be targeted for saving. Telehealth appointments were suggested as a means of lowering costs. Also, there is the concern overburdening the providers with additional appointments.

Comment: Workers’ compensation claims have reporting obligations. Therefore, there is a greater need for appointments. Likewise, there are return to work issues which may also cause the need for additional post-operative appointments.

Further, non-industrial patients, if they are satisfied with their result, may be inclined to cancel or not follow through with post-operative appointments. Thus, there are a number of drivers in the workers’ compensation system which cause more appointments than non-industrial patients. The notion of telehealth evaluations, however, may be of value. In matters where there is excellent post-surgery healing, an actual appointment with the provider may not be so important. A telehealth evaluation may suffice.

Besides Costs, What Are Other Concerns in the Workers’ Compensation System Claims involving Upper Extremities?

Risk Management concerns on post-operative cases include the Injured Worker’s compliance with treatment, their functional outcome, their symptom relief, their return to work and their satisfaction. Henry TW, Townsend CB, Beredjiklian PK. Workers’ Compensation Status Confers a Greater Number of Postoperative Visits After Common Upper Extremity Surgeries. Cureus. 2021;13(4):e14629. Published 2021 Apr 22. doi:10.7759/cureus.14629

What If I Need Advice?

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

Posted on May 24, 2021 by Edward Singer

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.

DUPUYTREN’S DISEASE(DD) AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Posted on May 18, 2021 by Edward Singer

Dupuytren’s Disease (DD) is an upper extremity disorder. DD has been a source of controversy with respect to whether it should be considered as an industrial injury. If DD is considered an industrial injury, then the Injured Worker suffering from the disorder would be entitled to workers’ compensation benefits. These would include medical treatment and disability compensation. A recent study addressed industrial causation of the condition and made interesting findings.

This article will discuss Dupuytren’s Disease (DD), industrial causation for DD, the study’s results, and what it means to Injured Workers.

What Is Dupuytren’s Disease (DD)?

Dupuytren’s disease (DD) results in “the chronic contracture of the fourth and/or fifth finger of the hand towards the palm and is usually accompanied by a thickening of the palmar skin. These clinical manifestations significantly impair and restrict hand functioning.” Murínová L, Perečinský S, Jančová A, Murín P, Legáth Ľ. Is Dupuytren’s disease an occupational illness? Occup Med (Lond). 2021 Feb 6;71(1):28-33. doi: 10.1093/occmed/kqaa211. PMID: 33420499.

Why is Dupuytren’s Disease Important for Workers’ Compensation?

Per mayoclinic.org, “Dupuytren’s contracture can make it difficult to perform certain functions using your hand. .. as Dupuytren’s contracture progresses, it can limit your ability to fully open your hand, grasp large objects or to get your hand into narrow places.” These activities are both labor disabling and can impact the performance of activities of daily living. Thus, DD can be the basis for impairment within workers’ compensation and would therefore translate into a permanent disability percentage.

In sum, if DD is work-related, it is likely an injury for which a permanent disability award is possible.

What Work Activities Did the Study Find That Impact DD?

There are two types of work activities that have been implicated as a source of causation for industrially-related DD. They are working with vibrating tools and performing heavy manual labor.

There are many tools used in the work force that vibrate. For example, jackhammers and power saws. The study used involved workers who used hand-held pneumatic rock drills.

Heavy manual labor can take place in various occupations. Heavy labor that was used in the study was working involving “prolonged, heavy, physical labour that required strength and energy, and included lifting, lowering, pulling, pushing or carrying a load.”

The theory behind these two types of activities is that they can cause cumulative micro-traumas which then can cause impairment of the micro-circulation in the hands. Murínová L, Perečinský S, Jančová A, Murín P, Legáth Ľ. Is Dupuytren’s disease an occupational illness? Occup Med (Lond). 2021 Feb 6;71(1):28-33. doi: 10.1093/occmed/kqaa211. PMID: 33420499.

It was noted that risk was 4-fold for vibrating tools and 3-fold for heavy manual labor compared to controls. Supra.

“A significant independent association was found between DD and HTVs (OR 4.59; 95% CI 2.05–10.32) and HMW (OR 3.10; 95% CI 1.21–7.91).” Supra.

In the Study, Was the Length of Time Performing the Injurious Activities Significant?

Yes. They study found the length of exposure to be significant. This was especially the case when there was at least 15.5 years of employment. “Exposures that lasted for more than 15.5 years were sensitive and specific predictors for the presence of DD.” Murínová L, Perečinský S, Jančová A, Murín P, Legáth Ľ. Is Dupuytren’s disease an occupational illness? Occup Med (Lond). 2021 Feb 6;71(1):28-33. doi: 10.1093/occmed/kqaa211. PMID: 33420499.

In the Study, Did Age Matter?

Yes. The study noted “[w]hile DD was more common in older patients, it was much more frequent in exposed subjects compared to controls across all age categories.” Murínová L, Perečinský S, Jančová A, Murín P, Legáth Ľ. Is Dupuytren’s disease an occupational illness? Occup Med (Lond). 2021 Feb 6;71(1):28-33. doi: 10.1093/occmed/kqaa211. PMID: 33420499.

Is There Any Limitation to the Study?

Yes. The study was limited to only men. Thus, additional studies beyond this one would assist is a female injured worker making a DD claim. Murínová L, Perečinský S, Jančová A, Murín P, Legáth Ľ. Is Dupuytren’s disease an occupational illness? Occup Med (Lond). 2021 Feb 6;71(1):28-33. doi: 10.1093/occmed/kqaa211. PMID: 33420499.

What If I Need Advice?

STRESSED OUT WORKERS: SOCIAL MEDIA, UNSYMPATHETIC CUSTOMERS, AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Posted on May 13, 2021 by Edward Singer

A TikTok trend, is stressing out Starbucks Baristas. The NyPost reports that customers who are TikTok fans are essentially harassing workers with outlandish orders. One famous order is from an Edward. Edward’s drink is a double blended drink containing 13 ingredients. nypost. Unless a commensurate tip is provided for time consuming orders, it is understandable why these customized drinks can be a source of Barrista stress, anxiety and upset. Further, too many of these orders simultaneously ordered could place a real grind on the fulfillment of regular orders.

Customer stress can a valid basis for a Workers’ Compensation “Stress” or “Psyche” claim. Should the stress from being inundated by these ridiculous time consuming orders give rise to an emotional disorder, a Barrista could consider filing a workers’ compensation claim to seek medical attention and benefits.

Are There Any Requirements to File Such a Claim?

Before filing a workers’ compensation claim, it is important for an Injured Worker to have some understanding as to whether they will prevail.

The “Six-Month” Rule

Given a claim relating to excessive order, an employee must have six months of employment that need not be continuous. If you have issues as to whether you worked six months, an attorney consultation is indicated.

“Predominant Cause”

The employee must provide by a preponderance of the evidence that the injury was caused by work. There is a defense of good faith personnel action. If there are various sources of work stress such as write-ups or discipline, an attorney consultation is indicated.

What If I Need Advice?