YOUNGER WORKERS AND WORK INJURIES:  YOUTHFUL WORKERS, SPECIAL CONCERNS FOR YOUNGER WORKERS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

“When I was young, it seemed that life was so wonderful”

Supertramp

Does Age matter?  Yes.  Younger Workers get injured at different rates than Older Workers.  A recent study brought light onto the issue of Age as a factor with respect to Work Injuries.

Younger Workers make up a significant number of the workforce.  Adolescents and Young Adults represent approximately 13% of the U.S. workforce. Guerin RJ, Reichard AA, Derk S, Hendricks KJ, Menger-Ogle LM, Okun AH. Nonfatal Occupational Injuries to Younger Workers — United States, 2012–2018. MMWR Morb Mortal Wkly Rep 2020;69:1204–1209. DOI: https://dx.doi.org/10.15585/mmwr.mm6935a3external icon.

As a result of this, like all workers, they sustain work-related injuries. Per a study, it was estimated that “3.2 million nonfatal injuries to young workers were treated in hospital emergency departments, with the highest rates among workers aged 18–19 years. Data from 2018 indicate that the leisure and hospitality industry [i.e. food service such as McDonalds hotels, and amusement parks] contributed the highest percentage of injuries to workers aged 15–17 years requiring at least 1 day away from work.” Guerin RJ, Reichard AA, Derk S, Hendricks KJ, Menger-Ogle LM, Okun AH. Nonfatal Occupational Injuries to Younger Workers — United States, 2012–2018. MMWR Morb Mortal Wkly Rep 2020;69:1204–1209. DOI: https://dx.doi.org/10.15585/mmwr.mm6935a3external icon.

This article will discuss the rates of injury for Younger Workers, the implications for Younger Workers who sustain work injuries, the special concerns a Workers’ Compensation Attorney has with respect to these claims, and how the Workers’ Compensation Systems addresses Younger Workers’ Permanent Disability.

What Was the Study?

The study  that was done looked into nonfatal occupational injuries of Younger Workers within the United States during the years 2012 to 2018.  Guerin RJ, Reichard AA, Derk S, Hendricks KJ, Menger-Ogle LM, Okun AH. Nonfatal Occupational Injuries to Younger Workers — United States, 2012–2018. MMWR Morb Mortal Wkly Rep 2020;69:1204–1209. DOI: https://dx.doi.org/10.15585/mmwr.mm6935a3external icon.

How Does Age Make a Difference?

Yes. It was found that Younger Workers, aged 15-24, experienced a higher rate of job-related injury versus Adult Workers, aged 25-44.  Supra.

Are There Any Interesting Facts Concerning the Injury Rates?

AGE RANGE WITH HIGHEST RATE OF INJURY: The highest injury rate (404 per 10,000 FTE) occurred among workers aged 18–19 years.

MALE VERSUS FEMALE: Within each of the four age categories, the rate of injury was 1.4 to 1.5 times higher among males than among females.

YOUNGER VERSUS MIDDLE AGED WORKERS:  Annual rates of injuries among young workers aged 15–24 years were 1.2–2.3 times higher than those for workers aged 25–44 years. Guerin RJ, Reichard AA, Derk S, Hendricks KJ, Menger-Ogle LM, Okun AH. Nonfatal Occupational Injuries to Younger Workers — United States, 2012–2018. MMWR Morb Mortal Wkly Rep 2020;69:1204–1209. DOI: https://dx.doi.org/10.15585/mmwr.mm6935a3external icon.

How Do Young People Get Hurt?

Younger Workers can get injured in a variety of ways.  One of the reasons why Younger Workers get injured is that they are often learning on the job. This makes them more susceptible to injuries.

For example,

“Contact with objects and equipment was the leading cause of occupational ED-treated injuries among all age groups examined, with rates of injuries ranging from 64 per 10,000 FTE among workers aged 25–44 years to 182 per 10,000 FTE among workers aged 18–19 years.” Supra.

“Lacerations and punctures were the most common type of ED-treated injuries reported among workers aged <25 years, with injury rates ranging from 66 to 99 per 10,000 FTE, “ Supra.

To the contrary, it should be noted that

“strains and sprains were most common among workers aged 25–44 years (injury rate of 47 per 10,000 FTE).” Supra.

Why are Work Injuries to Younger Workers a Concern?

One of the big concerns with respect to Younger Workers in California is the issue of lifetime medical care.   Young Workers, to some extent, are more able to recover from injuries versus Older Workers.

Some injuries that have long term implications.   There are injuries which can cause arthritis.   Arthritis can take decades to become a problem for the worker. Therefore, Younger Worker may need medical care decades after the injury happened.  Many Young Workers do not understand or appreciate this fact.   This is an issue of discussion concerning settlement of their case.

How Does the California Workers’ Compensation System View Younger Workers’ Permanent Disability?

Younger Workers’ Permanent Disability is not viewed as significant as older workers’ permanent disability.  For the same injury, a Younger Worker will receive less money than an Older Worker.

How is a Younger Worker’s Age Factored into Permanent Disability?

In the SCHEDULE FOR RATING PERMANENT DISABILITIES UNDER THE PROVISIONS OF THE LABOR CODE OF THE STATE OF CALIFORNIA (2005) , there is a provision for adjusting with respect to the Injured Worker’s age.

One of the steps in the permanent disability rating formula is to make an age adjustment.  Using a Table, a Younger Worker’s Permanent Disability is lowered via the rating adjustment.   See Schedule at P. 1-9.

In sum, the Schedule has a specific table that is used in a permanent disability rating formula to lower the disability rating. The disability rating being lowered translates into less money for the Injured Worker.

What If I Need Legal Advice?

If you would like a free consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years. Contact us today for more information.

 

THE OWESTRY DISABILITY INDEX(ODI) AND WORKERS’ COMPENSATION: BACK INJURIES, EVALUATIONS, TREATMENT AND INDEXES: WHAT YOU NEED TO KNOW

Injured Workers are frequently given questionnaires and indexes to fill out as part of their workers’ compensation treatment and evaluations.   These questionnaires and indexes can play an important role with respect to workers’ compensation benefits.

One of the indexes that an Injured Worker may encounter is the Owestry Disability Index. This article will discuss the Owestry Disability Index (ODI), what it is used for, how is it scored, problems with scoring, and how it is used for in the workers’ compensation setting.

Why Are Indexes Used?

Indexes are a quick way of address one’s disability state.  Sometimes,  simple questions can provide an accurate picture as to an Individual’s physical state and their capabilities. In Workers’ Compensation, due to the employment of the American Medical Association Guide to the Evaluation of Permanent Impairment, 5th Edition, there is a focus on an Individual’s “Activities of Daily Living.” For an article on Activities of Daily Living, click here.

What is the Oswestry Disability Index?

“The Oswestry Disability Index (ODI) is one of the most commonly used outcome measures for individuals with low back pain (LBP)”Psychometric properties and clinical usefulness of the Oswestry Disability Index, Michael Vianin J Chiropr Med. 2008 Dec; 7(4): 161–163.

doi: 10.1016/j.jcm.2008.07.001 PMCID: PMC2697602 PMID: 19646379

“The ODI is a self-administered questionnaire that requires 5 minutes to complete and 1 minute to score. Scores are associated with degree of disability ranging from minimal to bedbound. The ease of administering, scoring, and interpreting renders the ODI a potentially meaningful tool in clinical practice.” Supra.

What is the Owestry Disability Index Used For?

As noted above, the Owestry Disability Index is used to make assessments for Low Back Injuries. Essentially, it is the self-reporting of the Patient.

For workers’ compensation purposes, functional status is important in assessing a variety of workers’ compensation issues. These issues can include disability status- temporary total, permanent and stationary, permanent total disability, and credibility.  Credibility can speak towards the truthfulness of the Injured Worker’s complaints versus possible malingering. A physician encountering malingering may use that finding as a basis to cut-off temporary disability benefits or assign a low level of impairment/permament disability.

“The ODI is a valid, reliable, and responsive condition-specific assessment tool that has withstood the test of time and scrutiny.3 So far, it has been used mostly in chronic and severely disabled populations, but shows good indicators for the assessments of less severe complaints.” Supra.  

How Does Owestry Approach Back Injuries?

The Owestry Disability Index looks at the Injured Worker’s ability to perform Activities of Daily Living.   The Index focuses on 10 sections designed to make such an assessment.  Each section is scored with a 0-5 number.   0 being the least disability and 5 being the greatest.

What Are The Questions Asked in the Owestry Disability Index?

  1. PAIN INTENSITY

I can tolerate the pain I have without having to use pain killers

The pain is bad but I manage without taking pain killers

Pain killers give complete relief from pain

Pain killers give moderate relief from pain

Pain killers give very little relief from pain … Pain killers have no effect on the pain and I do not use them

  1. PERSONAL CARE (e.g. Washing, Dressing)

I can look after myself normally without causing extra pain

I can look after myself normally but it causes extra pain

It is painful to look after myself and I am slow and careful

I need some help but manage most of my personal care

I need help every day in most aspects of self care

I don’t get dressed, I was with difficulty and stay in bed

  1. LIFTING

I can lift heavy weights without extra pain

I can lift heavy weights but it gives extra pain

Pain prevents me from lifting heavy weights off the floor, but I can manage if they are conveniently positioned, i.e. on a table

Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positioned

I can lift very light weights

I cannot lift or carry anything at all

  1. WALKING

Pain does not prevent me walking any distance

Pain prevents me walking more than one mile

Pain prevents me walking more than ½ mile

Pain prevents me walking more than ¼ mile

I can only walk using a stick or crutches

I am in bed most of the time and have to crawl to the toilet

  1. SITTING

I can sit in any chair as long as I like

I can only sit in my favorite chair as long as I like

Pain prevents me from sitting more than one hour

Pain prevents me from sitting more than ½ hour

Pain prevents me from sitting more than 10 minutes

Pain prevents me from sitting at all

  1. STANDING

I can stand as long as I want without extra pain

I can stand as long as I want but it gives me extra pain

Pain prevents me from standing for more than one hour

Pain prevents me from standing for more than 30 minutes

Pain prevents me from standing for more than 10 minutes

Pain prevents me from standing at all

  1. SLEEPING

Pain does not prevent me from sleeping well

I can sleep well only by using medication

Even when I take medication, I have less than 6 hrs sleep

Even when I take medication, I have less than 4 hrs sleep

Even when I take medication, I have less than 2 hrs sleep

Pain prevents me from sleeping at all

  1. SOCIAL LIFE

My social life is normal and gives me no extra pain

My social life is normal but increases the degree of pain

Pain has no significant effect on my social life apart from limiting my more energetic interests, i.e. dancing, etc.

Pain has restricted my social life and I do not go out as often

Pain has restricted my social life to my home

I have no social life because of pain

  1. TRAVELLING

I can travel anywhere without extra pain

I can travel anywhere but it gives me extra pain

Pain is bad, but I manage journeys over 2 hours

Pain restricts me to journeys of less than 1 hour

Pain restricts me to short necessary journeys under 30 minutes

Pain prevents me from traveling except to the doctor or hospital

  1. EMPLOYMENT/ HOMEMAKING

My normal homemaking/ job activities do not cause pain.

My normal homemaking/ job activities increase my pain, but I can still perform all that is required of me.

I can perform most of my homemaking/ job duties, but pain prevents me from performing more physically stressful activities (e.g. lifting, vacuuming)

Pain prevents me from doing anything but light duties.

Pain prevents me from doing even light duties.

Pain prevents me from performing any job or homemaking chores.

See Fairbank JC, Pynsent PB. “The Oswestry Disability Index.” Spine 2000: 25(22):2940-2952;  Fairbank JCT, Couper J, Davies JB. “The Oswestry Low Back Pain Questionnaire.” Physiotherapy 1980; 66:271-273

How It is Scored? Is There a Problem With Scoring?

 “The index is calculated by dividing the summed score by the total possible score, which is then multiplied by 100 and expressed as a percentage. Thus, for every question not answered, the denominator is reduced by 5. If a patient marks more than one statement in a question, the highest scoring statement is recorded as a true indication of disability.” Oswestry Disability Index Scoring Made Easy A MehraD BakerS Disney, and PB Pynsent Ann R Coll Surg Engl. 2008 Sep; 90(6): 497–499. doi: 10.1308/003588408X300984

Scoring of the test can be problematic.  First, the individual may not understand the questions asked and answer them incorrectly. There can be language or literacy issues that can come into play.  Second, the individuals scoring the test may not use the highest score or may calculate the result appropriately. See Oswestry Disability Index Scoring Made Easy A MehraD BakerS Disney, and PB Pynsent Ann R Coll Surg Engl. 2008 Sep; 90(6): 497–499. doi: 10.1308/003588408X300984  (re: Issues concerning staff scoring tests accurately and their training)

What Does the Score Mean?

 The scores of ODI are as follow:

0 – 4                 No disability

5 – 14               Mild disability

15 – 24             Moderate disability

25 – 34             Severe disability

35 – 50             Completely disabled

See Fairbank JC, Pynsent PB. “The Oswestry Disability Index.” Spine 2000: 25(22):2940-2952  Fairbank JCT, Couper J, Davies JB. “The Oswestry Low Back Pain Questionnaire.” Physiotherapy 1980; 66:271-273

What Do These Disability Terms Mean?

No disability The patient can cope with most living activities. Usually no treatment is indicated apart from advice on lifting, sitting and exercise.

Mild disability The patient experiences more pain and difficulty with sitting, lifting and standing. Travel and social life are more difficult and they may be disabled from work. Personal care, sexual activity and sleeping are not grossly affected and the patient can usually be managed by conservative means.

Moderate disability Pain remains the main problem in this group but activities of daily living are affected. These patients require a detailed investigation.

Severe disability Back pain impinges on all aspects of the patient’s life. Positive intervention is required.

Completely disabled These patients are either bed-bound or are exaggerating their symptoms.

Supra.

What Does This Mean In Workers’ Compensation?

The Index can help address the credibility of the Injured Worker. Is the scoring commensurate with the pathology? For example, if someone scores “Completely Disabled” but has a minor back sprain, malingering comes into question.  If someone post-back surgery scores as “Moderate”, they would most likely be viewed as credible. In sum, an ODI score can either raise a “red flag” concerning an Injured Work or be a confirmatory basis for assigning impairment, disability status or permanent disability.

What If I Need Legal Advice?

If you would like a free consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years. Contact us today for more information. Click Here.

 

POST TRAUMATIC STRESS DISORDER (PTSD), OCCUPATIONAL CAUSES, & EMPLOYER ASSESSMENT AND REACTION: WORKERS’ COMPENSATION AND PTSD: WHAT YOU NEED TO KNOW

Post-Traumatic Stress Disorder is a Psychiatric Diagnosis that Injured Workers can receive as a result of exposure to workplace stress. In the California Workers’ Compensation System, both Insurance Companies and Employers are well aware of the serious consequences with PTSD injuries.   This includes the fact, Workers’ Compensation Laws include several Labor Code Sections that support Injured Workers making PTSD claims.

This article will discuss PTSD, workplace causes of PTSD, risk management approaches to PTSD, and Labor Code Sections that impact to PTSD claims.

What is PTSD?

“Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event. It is natural to feel afraid during and after a traumatic situation. Fear triggers many split-second changes in the body to help defend against danger or to avoid it. This “fight-or-flight” response is a typical reaction meant to protect a person from harm. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems may be diagnosed with PTSD. People who have PTSD may feel stressed or frightened, even when they are not in danger.” – National Institute of Mental Health

The Specific and Cumulative Nature of Stressors?

Workplace stressors causing PTSD vary temporally. They can occur in a specific manner such as a robbery.   They can occur in a cumulative fashion such an Employee being continually bullied in the workplace.

What Are the Causes of PTSD in the Workplace?

Workplace causes of PTSD can be broken into two categories. There is Workplace Stress and Traumatic Stressful Events.

What Workplace Stress can give rise to PTSD?

Workplaces stressors that can give rise to PTSD include supervisor relations, group morale and cohesion, administrative procedures, workload, shift duties, resources and internal personal conflict Post-traumatic stress disorder in occupational settings: anticipating and managing the risk Alexander C. McFarlane, Richard A. Bryant Occupational Medicine, Volume 57, Issue 6, September 2007, Pages 404–410, https://doi.org/10.1093/occmed/kqm070

What Traumatic Stressful events can give rise to work-related PTSD?

Traumatic stressful events that can occur in the workplace include mass disasters, serious accidents, threats or death and injury, deaths of colleagues, witnessing deaths, suffering and injury and assault. Post-traumatic stress disorder in occupational settings: anticipating and managing the risk Post-traumatic stress disorder in occupational settings: anticipating and managing the risk Alexander C. McFarlane, Richard A. Bryant Occupational Medicine, Volume 57, Issue 6, September 2007, Pages 404–410, https://doi.org/10.1093/occmed/kqm070

Why are Insurance Companies and Employers concerned about PTSD cases?

First, in the event of an obvious stressful event, i.e. a shooting in the workplace, Insurance Companies and Employers realize that the chances of having any legal defense to defeat such a claim is minimum. Therefore, their goal is to minimize the risk.

In other words, the most important goal for Employers and Insurance Companies is to minimize the expenses on the claim. Costs that can be minimized include medical treatment, temporary and permanent indemnity, future medical treatment, and vocational rehabilitation.

How is the Risk Managed in PTSD Cases?

It has been suggested that PTSD risk management should include screening, observation, and treatment. Post-traumatic stress disorder in occupational settings: anticipating and managing the risk Alexander C. McFarlane, Richard A. Bryant Occupational Medicine, Volume 57, Issue 6, September 2007, Pages 404–410, https://doi.org/10.1093/occmed/kqm070

What is Screening?

As part of Risk Management, there will be an attempt to screen Workers who may be at risk for PTSD.  It is noted that “Screening for psychological disorders is an effective strategy in workers who are at significant risk because of their levels of trauma exposure. Such a strategy involves identifying individuals at risk and screening them in the immediate aftermath and again approximately 6 months later.”  Post-traumatic stress disorder in occupational settings: anticipating and managing the risk Alexander C. McFarlane, Richard A. Bryant Occupational Medicine, Volume 57, Issue 6, September 2007, Pages 404–410, https://doi.org/10.1093/occmed/kqm070

Note: Screening presents problems. Are the individuals screening trained to do so?  Will the Employees react negatively towards this screening? Is it better that such screening be done by a medical provider provided through a workers’ compensation claim by some other means such as an EAP program?

What is Observation?

Risk Management suggest that Managers observe Workers who are at risk for PTSD.  They will be looking for things such as increased alcohol use, interpersonal and or family conflict, social withdrawal, depression, somatic distress and performance deterioration.  Supra.

Note:  Observation can be very problematic for Injured Workers.   Having suffered through a psychiatric disturbance is certainly enough for one person.   The notion that Management is tantamount to spying on the individual can add additional unnecessary paranoia and psychiatric symptomology to the already existing PTSD symptoms.

What is Treatment?

“The aim of effective treatment is to minimize these disabilities before they emerge.” Supra. Per Labor Code Section 4600, Injured Workers are entitled to treatment subject to a utilization review schedule and Independent Medical Review.

Note: Minimizing disabilities translates to lower costs on cases.  Effective treatment reduces the need for temporary disability, permanent disability, need for future care and need for vocational rehabilitation services. In the Workers’ Compensation System, however, Insurance Companies are slow to act and often deny both treatment and claim.

Why Are Post-Trauma Factors Important in Managing Risk?

As much as what happened to cause the PTSD, events that happen post injury can shape the course an Injured Worker’s claim.

“In the aftermath of the event, a range of factors can modify the recovery or escalate distress such as social support and stress that emerge in the aftermath of the event such as continued exposure to the distress of the victims or critical legal investigations of the circumstances of the event where blame is involved.” Post-traumatic stress disorder in occupational settings: anticipating and managing the risk Alexander C. McFarlane, Richard A. Bryant Occupational Medicine, Volume 57, Issue 6, September 2007, Pages 404–410, https://doi.org/10.1093/occmed/kqm070

In sum, what happens in the workplace or elsewhere after the PTSD event can have a profound impact on the claim.  Therefore, Risk Management principles dictate that Management should continue to view the workplace as an ongoing site of injury. Post Injury events can push individuals who were functioning over the edge and create profound disability.

What Labor Code Sections specifically address PTSD issues?

There are two Labor Code Sections that I view as specifically related to PTSD.

The first is the PTSD Presumption which applies to certain law enforcement and safety offices.   This is Labor Code Section 3212.15. For more information concerning this Presumption, click here. 

The second is the Labor Code Section which lowers the causative burden for stress claims which involve violent acts.  Labor Code Section 3208.3(b)(2) which provides that “  in the case of employees whose injuries resulted from being a victim of a violent act or from direct exposure to a significant violent act, the employee shall be required to demonstrate by a preponderance of the evidence that actual events of employment were a substantial cause of the injury”.[emphasis added]

Note: This was included due to the fact that those events described have a significant possibility of resulting in PTSD.   This section lowers the burden of causation from predominant cause (greater than 50 percent) to 35 to 40 percent for the Injured Worker.

What If I Need Legal Advice?

If you would like a free consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years. Contact us today for more information. Click Here.

 

 

HEARING LOSS AND WORKERS’ COMPENSATION: NOISE EXPOSURE AND INDUSTRIAL INJURY: WHAT YOU NEED TO KNOW

Hearing Loss, if there is industrial contribution, can be grounds for a workers’ compensation claim.  A workers’ compensation claim, if successful, would allow the Injured Worker to claim monetary benefits, medical care, and vocational rehabilitation benefits.   For Hearing Loss cases, if medically indicated, the Injured Worker would be entitled to be supplied Hearing Aids as long as they are deemed medically necessary pursuant to Labor Code Section 4600.

Hearing Loss can be caused for a variety of reasons.  One of the sources is noise.  Definitionally, it is called “Noise Induced Hearing Loss.” (NIHL)

This article will discuss “Noise Induced Hearing Loss”, how “Noise Induced Hearing Loss” can be work-related, what Occupations are susceptible to hearing loss, and other possible causes for industrial hearing loss.

Is there a Historical Legal Basis for Work-Related Hearing Loss?

Caselaw has supported work-related hearing loss.   In Messner vs. IAC, (1962) 27 Cal. Comp. Cases 226 (writ denied) it is quoted “[w]hile the distinction between the etiological mechanics of continuous trauma and disease may be elusive in its application to a particular set of facts, there is a considerable difference in the legal consequences flowing therefrom. The Commission has long taken the position that hearing loss is an occupational disease. We do not believe that we can alter the theory to fit the facts.” [emphasis added]

How is Noise Induced Hearing Loss (NIHL) Caused?

Noise-induced hearing loss (NIHL) occurs when loud noise causes an irreversible damage of the cochlear hair cells of the inner ear. This can occur by exposure to either intermittent or continuous hazardous sounds.  Hazardous noise sound levels can occur when they exceed 85 decibels.

What Type of Doctor Addresses Hearing Loss?

The field of medicine that addresses hearing loss is Otolaryngology.  Doctors within the specialty focus on the ears, nose and throat.  There are referred to as Otolaryngologists or also known as ENT (Ear, Nose, and Throat) Doctors.

Are There Controversies with Respect to Work-Related Hearing Loss?

Yes. There are controversies with respect to hearing loss claims.   They include causation and disability.

CAUSATION

An excellent example of an analysis of causation comes from the case of Kaiser Cement vs. WCAB (1986) 51 Cal. Comp. Cases 232 (Opinion Not Published.) The doctor opining non-industrial causation went through the following analysis. Bear in mind that this is a long analysis. While the WCAB did not side with this doctor, it clearly shows the depth and the analysis that will be done when a doctor evaluates a NIHL claim.

“The audiology report submitted by Dr. Billings noted noise exposure consisting  of use of rifles and 22-millimeter guns without hearing protection while applicant was in the Navy from 1942 to 1945, as well as noise exposure on the job at Kaiser Cement. Dr. Billings described the occupational noise exposure at Kaiser Cement as “Mill noise about 20% of the time while employed as a laborer by Kaiser Cement from 1966 to 1968 and about 50% of the time while employed as an electrician/oiler by Kaiser Cement from 1973 to 1979. [Applicant] was also exposed to conveyor belt noise, motor noise and fan noise while employed as a cooler tender by Kaiser Cement from 1968 to 1973 and he was exposed to noise from dozers, graders, scrapers and loaders while employed as a heavy equipment operator by Kaiser Cement from 1979 to 1984. [Applicant] did not wear ear protection from 1966 to 1973 but he did wear ear plugs whenever exposed to intense noise from 1973 on. Cement mill noise, conveyor belts, motors, fans and heavy equipment such as dozers, graders, scrapers and loaders can generate noise levels that are hazardous to hearing without the use of ear protection.”

Dr. Billings further reported nonoccupational noise exposure consisting of applicant’s recreational use of shotguns, rifles and pistols approximately 15 times between 1946 and 1984. Dr. Billings further noted that presbycusis (hearing loss due to normal aging) usually begins at about 45 years of age in males. Because the applicant was 58 years of age at the time of evaluation, Dr. Billings reported presbycusis as a causative factor related to his hearing loss. Dr Billings concluded, “It is most probable that at least a portion of [applicant’s] present hearing loss was caused by all of the above factors and that his noise exposure at Kaiser Cement was the major causative factor of the noise causative factors. It is also most probable that some other unknown medical factor caused a significant portion of [applicant’s] present hearing loss. This opinion is based on the fact that [applicant’s] present hearing loss is considerably more severe than would be expected from his noise exposure and presbycusis …. [M]ost employees who are exposed to intense occupational noise all day every day during a working lifetime of 21 years without wearing ear protection will not incure a hearing loss at 1,000 Hz and lower frequencies. In addition, it is generally accepted that a noise-induced hearing loss will reach a maximum level of about 70 dB HL, regardless of the number of years of exposure. Since [applicant’s] hearing loss in both ears exceed these criteria considerably, it must be concluded that some other medical causative factor is responsible for a significant portion of [applicant’s] present hearing loss in addition to his noise exposure and presbycusis. It is recommended that [applicant’s] hearing loss due to noise exposure be calculated as being 0 dB HL at 500 and 1,000 Hz and as being the maximum noise-induced hearing loss of 70 dB HL at 2,000 and 3,000 Hz in both ears. Using these levels in the AAO method for calculating percent hearing handicap …, [applicant] would have a 15% hearing impairment of the right ear, a 15% hearing impairment of the left ear and a 15% binaural hearing handicap. Using these levels for calculation gives [applicant] the benefit of the doubt since these levels are based on 21 years of full-time exposure to intense occupational noise without wearing ear protection while [applicant] was only exposed to noise about 20% of the time from 1966 to 1968 without wearing ear protection, he was exposed to noise all of the time (including many 12 to 18 hour days) from 1968 to 1973 without wearing ear protection and although he was exposed to noise from 1973 on (including many 16 hour days from 1979 to 1984), he wore earplugs during all of his noise exposure from 1973 on and he reported that the earplugs were effective in reducing the background noise levels.””

PERMANENT DISABILITY

Hearing Loss becomes a Permanent Disability when the testing reaches a certain level. Currently, the AMA Guides for Rating Permanent Impairment, 5th Edition apply.

The following is an analysis of hearing loss that was made under the old non-AMA Permanent Disability Schedule.  This case provides insight as to how a doctor will make a no Permanent Disability assessment.  In Fleming vs. WCAB (1975) 40 C.C.C. 642, “Dr. Charles Lebo in his reports dated August 17, 1973 and September 24, 1974 indicated that Fleming had a minor bilateral high frequency hearing loss and that noise induced hearing losses are permanent, non-progressive, untreatable and non-disabling. Dr. Lebo also stated that the “regular use of approved ear protectors” would let Fleming continue to work in his regular occupation “without the risk of further noise-induced ear damage.””

What Types of Industries/Occupations are Subject to Hearing Loss?

There are various industries that can be subject to hearing loss claims.  They include industries such as agriculture, airline, construction, law enforcement, mining, oil railroad, refining, safety, textile, and trucking. See Occupational Noise-induced Hearing Loss MH Azizi Int J Occup Environ Med Vol 1, No 3 (2010)

Further, there are occupations like Dentists, Professionals, and Trucking that are at risk of NIHL.

Besides NIHL, Are There Other Occupational Sources of Hearing Loss?

Yes. There are other Occupational Sources of Hearing Loss.  Hearing Loss can be caused by ototoxicity. “Ototoxicity is, quite simply, ear poisoning (oto = ear, toxicity = poisoning), which results from exposure to drugs or chemicals that damage the inner ear or the vestibulo-cochlear nerve.” Vestibular Disorders Organization. “Many chemicals have ototoxic potential, including over-the-counter drugs, prescription medications, and environmental chemicals.” Supra.

What If I Need Legal Advice?

If you would like a free consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years. Contact us today for more information. Click Here.

“WET-WORK” EXPOSURE AND SKIN-RELATED INJURIES: DERMATITIS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

 Some occupations require workers to perform tasks involving liquids.  Some occupations involve workers immersing their hands in liquids throughout the day.   This exposure to liquid is referred to in literature and in occupational studies as “Wet Work.”

“Wet Work” Exposure encompasses activities of frequent contact with liquids. This “Wet Work” Exposure can lead to the development of Skin Disorders.   Since these activities are work-related, the Injured Worker suffering from “wet work” skin disorder can make a workers’ compensation claim.  A workers’ compensation claim may entitle the Injured Worker to obtain monetary disability benefits, medical treatment, and vocational retraining.

Occupational Skin Disorders constitute a large portion of work injuries.  They rank only second to musculoskeletal disorders.  They represent greater than 45 percent of occupational illnesses. Wet-work Exposure: A Main Risk Factor for Occupational Hand Dermatitis  Ali Behroozy1 Tessa G. Keegel https://doi.org/10.1016/j.shaw.2014.08.001  Contact Dermatitis makes up 80 percent of all occupational skin disorders. Supra.

This article will discuss “Wet-Work,” industrial “Wet Work” Skin Disorders, Occupations that are at risk for “Wet Work” Skin Disorders , and Permanent Disability as a result of such “Wet Work” Skin Disorders.

What Is Wet Work?

Wet Work becomes a problem with respect to Worker’s skin when there is significant frequency and duration of activities that involve liquids.  Researchers have defined the criteria as to how much frequency and duration constitutes “Wet Work.” Wet-Work has been “defined as activities where workers have to immerse their hands in liquids for >2 hours per shift, or wear waterproof (occlusive) gloves for a corresponding amount of time, or wash their hands >20 times per shift.” Supra.

How Is Wet Work Harmful to Workers?

Long or repeated exposure to water, along with the simultaneous effects of washing and cleaning agents, disenfectants, solvents, alkalis, and acids can damage the barrier properties of stratum corneum and underlying skin layers (living epidermis). Working with gloves also can cause injury as well to the skin.  Supra.

In sum, liquid exposure essentially compromises the dermis. This can lead to irritation of the skin. This irritation can continue to fester if the acts of performing “Wet Work” continued.   This continued irritation can lead to skin diseases and disorders.

Also, implicated within “Wet Work” is not only the use of the liquids.   The frequently drying off the hands is also part of the harmful process to the skin.

What Skin Conditions Can Arise from “Wet Work?”

There are a variety of Skin Conditions that can arise from “Wet Work.” They include Acneiform Dermatitis, Allergic Contact Dermatitis, Cumulative Irritant Dermatitis, Eczema, Frictional Dermatitis, Hyperkeratotic Hand Dermatitis, Irritant Contact Dermatitis, Maceration, Pustular Dermatitis, and Traumatic Irritant Contact Dermatitis.

Contact Dermatitis, the AMA Guide for Rating Permanent Impairment, 5th Edition, describes the condition as an “inflammatory skin reaction induced by exposure to an external agent and is the most frequent cause of occupational skin disease.”  It notes that the two common types of contact dermatitis is irritant which is 80 percent of the cases.   This represents direct tissue damage.  The Allergic Contact Dermatitis involves delayed cellular hypersensitivity.

There are many substances that can irritate with respect to being an allergen agent  Per the AMA Guides, it is noted that “[m]any cutaneous allergens, such as chromates, nickel salts, epoxy resins, and preservatives, are also primary irritants. Allergy can be induced or maintained by chemicals in concentrations insufficient to irritate nonallergic skin. Allergen

cross-sensitivity is an important phenomenon in which an individual who is allergic to one chemical (eg, urushiol in poison ivy or poison oak) also will react to structurally related chemicals (eg, in Japanese lacquer, mango, and cashew nutshell oil).”

What Occupations Engage in Wet Work?

There are many occupations that involve “Wet Work.” This includes agriculture, beautician services, catering, construction, dish washing, domestic workers, engine serving, flower arranging, food preparation and processing, hairdressing, healthcare workers, household cleaning, leather work, machine tool operation, manufacturing, metal machining, metal plating, metal treatment, metal work, nursing, painting,  and printing.

Do “Wet Work” Injuries Translate Into Permanent Disability?

Yes.

The AMA Guides for Rating Permanent Impairment, 5th Edition, notes that the “[a]ccurate diagnosis is the key to proper management of contact dermatitis. If the specific agent(s) can be identified … and successfully avoided, full recovery usually is anticipated; but if contact continues, the dermatitis may become chronic and disabling, and it may prevent the individual from performing some activities of daily living.” AMA Guides at P. 177. [emphasis added]

 The concept of “Wet Work” injuries resulting permanent disability is longstanding within California Workers’ Compensation Law.  Prior to the adoption of the AMA Guides to determine impairment, the 1997 Schedule for Rating Permanent Disabilities Under the Provisions of the Labor Code Section of the State of California, 1997, provided for a permanent disability relating to “wet work.”  At the time, permanent disability was rated by actual or prophylactic work restrictions.  In the Schedule, under the Skin Condition Section, 6.2, there was work restriction “Precluding Wet Work.”  It was defined as a restriction that “contemplate[d] [that] the individual must avoid more than incidental contact with water, and/or other liquids provide for a 25% standard disability.  Page 2-6.  Note: This illustrates that Workers’ Compensation Law recognized the value the ability of an Individual to be able to perform “wet work” activities in the open labor market.

Under the current law, the AMA Guides apply. Under the current Rating Schedule, the AMA Guides for Rating Permanent impairment, 5th Edition, on P. 178, has a table that can be used to address a skin impairment caused by “wet work.”  There is a table which is entitled the “Criteria for Rating Permanent Impairment Due to Skin Disorders,” Table 8-2, which is one table that can apply to assigning whole person impairment to “wet work” skin injuries.

Under the AMA Guides, Table 8-2, the table requires the evaluating physician will look at three items of import.  First, the presence of skin disorder signs and symptoms, second, the effect that the skin disorder has on the performance of activities of daily living, and third, the need for treatment in terms of nature, extent and duration.

In sum, permanent disability, for these skin conditions, will be assessed on an individual basis.   Generally speaking, a Physician who specialized in Dermatology should be making the assessment.

What If I Need Legal Advice?

If you would like a free consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years. Contact us today for more information. Click Here.

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