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.

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

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

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

What is the QBPDS?

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

Why are Surveys and Scales Used?

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

What are the QBPDS Questions Asked?

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

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

How Are the Responses Scored?

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

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

What Do the Scores Mean?

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

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

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

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

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

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

What if I Need Advice?

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.

 

 

 

 

UPPER EXTREMITY WORKERS’ COMPENSATION SURGERIES: WHAT YOU NEED TO KNOW

Studies about workers’ compensation as always of interest to Injured Workers.   A lot of these studies tell us how and why insurance companies, employers and doctors act in particular ways.   A study addressing upper extremity surgeries provides us such insight. The study compared the results of industrial versus non-industrial upper extremity surgeries.

This article will discuss, upper extremity surgeries, issues relating to upper extremity surgeries, and the results of the study.

What Are Upper Extremity Surgeries?

 With respect to upper extremities, there are a variety of surgeries that are done on an industrial basis.  Upper extremity surgeries can range from shoulders to finger tips. Parts operated on can include areas such as the shoulders, biceps, elbows, forearms, wrists, and fingers.

For shoulders and elbows, there operations can include fracture surgeries, total shoulder replacements, shoulder arthroscopies, rotator cuff repairs, tennis elbow, golfer’s elbow, and elbow arthroscopy.

For the wrist, operations can include fracture surgeries, carpal tunnel releases, wrist arthroscopies, wrist joint replacements and wrist fusions.

How Are Workers’ Compensation Upper Extremity Surgeries Different Than Non-Industrial Upper Extremity Surgeries?

Approval:  Unlike Health Insurance Company approval for surgeries, Workers’ Compensation surgeries are subject to utilization review and independent medical review. Thus, there are guidelines and algorithms that must be met in order for surgeries to get authorized.  This can lead to delays in getting approval.

Medical Providers:  For many Injured Workers, they are constrained to using hand surgeons and upper extremity surgeons within the workers’ compensation insurance medical provider networks. Thus, the quality of the surgeon is subject to the insurance company’s dedication to having good providers.

Total Temporary Disability Benefits: For Injured Workers, they receive benefits is they remain symptomatic. Therefore, it is necessary that the voice all of their problems.

Permanent Disability Benefits: For Injured Workers, they need to be critical of the results of the surgery and be able to describe them.  Therefore, the result is viewed with this mindset.

What Was the Study’s Conclusion?

 The study “found that patients receiving WC[workers’ compensation] had worse postsurgical results after upper extremity surgery and demonstrated less pre- vs postoperative improvement than uncompensated patients regardless of which outcomes were measured. However, this effect was not uniform among different types of outcomes. Functional measures, such as AOM or grip strength, were least likely to demonstrate a significant difference between compensated and uncompensated patients. The same was true in studies that measured pre- vs postoperative improvement rather than only assess patient postoperatively.” Fujihara Y, Shauver MJ, Lark ME, Zhong L, Chung KC. The Effect of Workers’ Compensation on Outcome Measurement Methods after Upper Extremity Surgery: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2017;139(4):923-933. doi:10.1097/PRS.0000000000003154. It was noted that this analysis was aware that compensated patients can result in artificial reduction of the therapeutic effect which may lead to incorrect conclusions. Supra.

The study noted that “.. the effect of WC on surgical outcome is not solely an issue of malingering Americans. Compensation systems that do not incentivise feigning impairment, also observe worse outcomes associated with WC. Rather, this may indicate that increased impairment among workers receiving WC may be a result of psychological effects on patients caused by a sense of victimization or injustice .” Fujihara Y, Shauver MJ, Lark ME, Zhong L, Chung KC. The Effect of Workers’ Compensation on Outcome Measurement Methods after Upper Extremity Surgery: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2017;139(4):923-933. doi:10.1097/PRS.0000000000003154

In sum, it would appear that Injured Workers have poorer post-operative results.   There are factors of income, malingering, psychological effects of victimhood and injustice may be the factors lead to a poorer workers’ compensation result.

Knowing these Results, How Will an Injured Worker Be Treated?

 Insurance Companies, knowing the surgery result may be poor, may want to avoid providing for it.  This can be done in two ways: one, settling the case before surgery, two, contesting the need for the surgery.

Doctors take pride in their work.  Doctors like to have good results.  Therefore, doctors may not thrilled with Injured Workers because there will be some level of dissatisfaction and representations that the surgical result was not optimal.

Employers, like Insurance Companies, may not be happy with surgeries with poor results.  For them, they are faced with a costlier claim as well as possible issues with respect to return to work.   Return to work issues would involve either qualified Injured worker status or the need to provide 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.

 

EVEN TREATERS GET INJURED AT WORK: OCCUPATIONAL AND PHYSICAL THERAPISTS SUSTAINING INDUSTRIAL INJURIES:  MEDICAL PROVIDERS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Occupational and Physical Therapists play a large role in helping Injured Workers recover from their industrial injuries.  In doing so, however, Occupational and Physical Therapists may be placing themselves at risk for sustaining a work injury. More specifically, both Occupational and Physical Therapist’s work activities can place them at risk for sustaining musculoskeletal disorders. These musculoskeletal disorders can include back problems, shoulder problems, and wrist problems.

The article will discuss Occupational and Physical Therapists, what activities they perform on the job that may be injurious to them, and the rates of injuries that occur for Occupational and Physical Therapists.

What is an Occupational Therapist (OT)?

Per the American Occupational Therapy Association, “occupational therapists …help people… participate in the things they want and need to do through the therapeutic use of everyday activities (occupations.)”

OT Programs can include “an individualized evaluation, during which the client/family and occupational therapist determine the person’s goals, [a] customized intervention to improve the person’s ability to perform daily activities and reach the goals, and an outcomes evaluation to ensure that the goals are being met and/or make changes to the intervention plan.”

What is a Physical Therapist (PT)?

Per the American Physical Therapy Association, “[p]hysical therapists are movement experts who improve quality of life through prescribed exercise, hands-on care, and patient education.”

“Physical therapists examine each person and then develops a treatment plan to improve their ability to move, reduce or manage pain, restore function, and prevent disability.”

What is the Difference Between an Occupational and Physical Therapists?

The Occupational Therapist focuses on the patient’s ability to perform work-related functions.  The Physical Therapist focuses on physical activities in general.

What Are The Work Activities That Are Injurious to OTs and PTs?

Transfers/Lifts and manual therapy have been found to be associated with musculoskeletal disorders. “Darragh AR, Campo M, King P. Work-related activities associated with injury in occupational and physical therapists. Work. 2012;42(3):373-84. doi: 10.3233/WOR-2012-1430. PMID: 22523031; PMCID: PMC3839086.  These activities have been found to impact the lumbar spine.  Supra.

Patient handling activities include (transfers, repositioning and patient lifting. Supra.

Manual therapy includes soft tissue work, joint mobilization, and orthopedic techniques. Supra.

Manual Therapy was found also found as a risk factor consistent risk factor for both injuries as well as gradual onset of WSMDs. Supra.  In workers’ compensation terms, this would be considered as a cumulative trauma injury.

With Respect to Musculoskeletal Disorders? Is There Any Difference Between OTs and PTs?

No. “Occupational (OTs) and physical therapists (PTs) have substantial and similar rates of work-related injury (WRI), musculoskeletal pain and musculoskeletal disorders (WMSD)” Darragh AR, Campo M, King P. Work-related activities associated with injury in occupational and physical therapists. Work. 2012;42(3):373-84. doi: 10.3233/WOR-2012-1430. PMID: 22523031; PMCID: PMC3839086.

“Darragh et al. reported an annual WRI incidence rate among OTs and PTs of 16.5 and 16.9 per 100 full-time workers, respectively.” Darragh AR, Campo M, King P. Work-related activities associated with injury in occupational and physical therapists. Work. 2012;42(3):373-84. doi: 10.3233/WOR-2012-1430. PMID: 22523031; PMCID: PMC3839086.

What Are Injury Rates for Activities?  What Do Therapists Think Are the Causes of Their Injuries?

“Manual therapy and transfers/lifts accounted for more than half of all injuries (54.0%), across all practice areas.” Supra.  “Manual therapy was the greatest proportion of injuries to the wrist and hand (69.1%).” Supra.  “Transfer and lifting activities were associated with 26.6% of injuries Over half of these injuries were to the low back (53.0%), followed by the shoulder (19.7%) and the head/neck (18.2%).” Supra.   “Other activities associated with injury included environmental and equipment interactions (10.9%), multiple activities (6.5%) and patient falls (5.7%)”

What Do Therapists Think of How They Get Hurt?

Therapists opine that force, awkward posture, repetitive motion, sustained posture, and fatigue were factors contributing to those type of injuries.  Supra.

For wrist and hand injuries, therapists opine that repetitive motion (experienced during joint mobilizations and range of motion activities), force (experienced during range of motion, soft tissue work, and joint mobilizations), awkward posture and sustained posture were factors contributing to those type of injuries. Supra.

For transfer and lifting activities, opined that “these injuries occurred both gradually because of repeated performance of transfers over time and more suddenly when a patient behaved in an unexpected way (grabbed the therapist, stumbled, or moved in an unexpected direction.) The majority of therapist identified force (72.7%;48/66), including overexertion and lifting, and awkward posture (54.5%; 36/66) as the primary contributing factors to their transfer injuries.” Supra.

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.

KNEE AND HIP INJURIES, OSTEOARTHRITIS, AND WORKERS’ COMPENSATION: PHYSICAL ACTIVITIES AS RISK FACTORS FOR WORK INJURIES: WHAT YOU NEED TO KNOW

There is no requirement that the causes of a work injury has to be 100 percent industrial.

There are some medical conditions that can have a work-related component to them.  In other words, they are only partially caused by job duties.   Osteoarthritis (OA) can be that type of industrial injury.  OA is a common form of arthritis that can impact a variety of parts of the body.  The parts of the body OA can impact includes the knees.

This article will discuss OA , who Treats OA,  and how OA can be work-related.

What is Osteoarthritis?

Per the CDC, “Osteoarthritis (OA) is the most common form of arthritis. Some people call it degenerative joint disease or “wear and tear” arthritis. It occurs most frequently in the hands, hips, and knees.”

“With OA, the cartilage within a joint begins to break down and the underlying bone begins to change. These changes usually develop slowly and get worse over time. OA can cause pain, stiffness, and swelling. In some cases,  it also causes reduced function and disability; some people are no longer able to do daily tasks or work.”

Note:  The term degenerative joint disease is a term that is frequently used.   It is commonly abbreviated to DJD.

What Are the Symptoms of OA?

Symptoms of OA can include pain or aching, stiffness, decreased range of motion, and swelling. CDC.

Who Treats OA, and What Treatments are Available?

OA is an interesting medical condition in that there are two medical specialties that can address the condition.   The two types of doctors are Orthopedists and Rheumatologists.

Orthopedists focus on the bones and the joints.   They can prescribe medications and perform operations.

Rheumatologists focus on internal medicine matters.  They can prescribe medications and prescribe non-surgical treatments.

How Is OA Work-Related?

OA is work-related with respect to some activities.   According to one study,  A synthesis of 69 studies from 23 countries yielded strong and moderate evidence for lifting, cumulative physical loads, full‐body vibration, and kneeling/squatting/bending as increasing the risks of developing osteoarthritis (OA) in men and women.”  Strong and moderate evidence existed for no increased risk of OA related to sitting, standing and walking (hip and knee OA), lifting and carrying (knee OA), climbing ladders (knee OA), [and] driving (knee OA.)” Men and Women’s Occupational Activities and the Risk of Developing Osteoarthritis of the Knee, Hip, or Hands: A Systemic Review and Recommendations for Further Research, Monique A.M. Gignac Emma Irvin Kim Cullen Dwayne Van Eerd Dorcas E Beaton Quenby Mahood Chris McLeod Catherine L. Backman 14 February 2019, https://doi.org/10.1002/acr.23855

Note: thus, there are activities that can increase the risk of OA and other activities which are not a causative risk factor.  Thus, an analysis of one’s work activities is important when considering to file a claim.

What is the Legal Theory for Industrial Causation?

An Injured Worker must prove that their work activities contributed to the development of the disease. South Coast Framing, Inc. v. Workers’ Comp. Appeals Bd. (2015) 61 Cal.4th 291 [188 Cal.Rptr.3d 46, 349 P.3d 141].)

What is the Analysis?

The fact that one engages in certain injurious activities does not guarantee a valid claim.  A medical opinion is required. Such a medical opinion should include a medical examination, testing, review of medical records, review of one’s past medical history, and an analysis of the physical activities the worker engaged in at 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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