HEALTH CARE WORKERS, SOCIAL SERVICES WORKERS, AND CALIFORNIA WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Work injuries are often studied based upon sector and occupation. Studies can impact how workers are trained and treated.  Health Care Workers and Social Assistance Workers were recently studied in the article “Occupational Injuries in California Health Care and Social Assistance Industry”  2009 to 2018.”  Kerri Wizner, Fraser W. Gaspar, Adriane Biggio, Steve Wiesner 06 June 2021 https: //doi.org/10.1002/hsr2.306

The study addressed a large variety of health care occupations including nurse, aides, assistances, service staff, administrative staff, and technicians. The study looked at the different healthcare facilities including hospitals, residential care sites, and social services providers.

The article will discuss the study’s data, conclusions and impact on Health Care Workers.

What Was the Study’s Purpose?

The study looked at injury prevention workforce health, and injury-related cost savings. Supra.

Thus, a typical risk management agenda was addressed.  In short, questions such as “what facilities have problems with work injuries?”, “what occupations have problems with work injuries?”, and “what type of work activities cause work injuries?” are addressed.

What Are the Injury Rates of Import in the Health Care and Services Fields?

Sex: Women sustain the majority of work injuries.   The data showed that “the majority of injuries were sustained by women (78.1%), with three-quarters of cases affecting individuals aged 32 to 53 years.”  Supra.  Note: This may relate to two factors.  A greater amount of women working in the field.  Also, women may have greater physical challenges of dealing with large or immobile patients.  As noted in the study, lifting was found to be a significant source of injury.

Facilities:  The injury rates differed in each industry subgroups.   Hospitals had the highest number of claims with Ambulatory Care, second, Nursing Care, third. The Social Assistance Group had the least claims.  Supra. Note: Hospitals are often less specialized that nursing care facilities.  Thus, there are more tasks and more activities performed in a non-ergonomic fashion in a hospital.  Likewise, there may be far more activity. Thus, the data is logical.

Occupation: Health care and social assistance settings each have a different proportion of job types, given the variety of health services offered. … Across all settings within California, nurses had the highest proportion of injuries (22.1%), followed by aides/assistants (20.4%), services staff (13.2%), administrative staff (11.0%), and technicians (10.3%). The highest proportion of injury occurred in nursing jobs in hospitals (32.2% vs 3.2%-20.6%), aides/assistants in nursing/residential care sites (40.2% vs 12.1%-16.7%), and social services in social assistance settings (40.6% vs 3.2%-8.0%).”  Supra. Note: This finding is not surprising as the largest percentage of injuries are reported within the most physically challenged positions.

Types of Injuries: There was an analysis of the types of Injuries reported. The study reported “[s]trains and tears (defined by the State of California as an injury of the muscle or the musculotendinous unit13), were the most common injury, representing 34.4% of all claims, followed by contusions (11.0%), sprains (injury to ligaments) (10.0%), other specific injuries (9.6%), and puncture wounds (7.7%). These injury types were similar across the industry sub-groups apart from ambulatory care, which had a higher proportion of puncture wounds than other settings (14.1% vs 3.4%-5.9%, respectively).”  Note: Most of the injuries were of a musculoskeletal nature.  The other concern in the healthcare setting is puncture wounds which can be caused by sharps and needles.

Activities Causing Injury: There was an analysis concerning what activities caused the work injuries.  The study found “[a]cross all settings, lifting injuries (10.8%) and strains NOC (9.1%) were the most common causes of injury, followed by miscellaneous NOC causes (6.6%), repetitive motion (6.0%), and injury due to being struck accidentally or on purpose by a fellow worker, patient, or other person (5.9%).”

Parts of the Body Injured:  There are an analysis concerning which body parts were most frequently injury.  Per the study, ”[t]he low back was the most frequently injured body part, representing 13.6% of all claims; followed by multiple body parts (12.8%), finger(s) (9.1%), shoulder(s) (6.8%), and knee(s) (6.1%). Nursing/residential care settings reported the highest proportion of both lifting injuries (15.8% vs 8.9%-9.9%) and low back injuries (16.9% vs 10.0%-13.1%) as compared to the other settings.” [emphasis added] Note: Most body parts injured are within the musculoskeletal systems.

Ambulatory care:

The rates for ambulatory care employee injuries were found to be increasing. Supra.  Note: Ambulatory care relates to outpatient centers.   Many hospital patients are moved to rehabilitation centers to begin the rehabilitation process.  These settings can require patients to begin performing physical activities in a weakened state.  Thus, there are significant injury risks for assisting workers.

What May Result from This Study?

The main findings were the high rates of injury in both the hospital setting as well as for ambulatory care employees.    Extra safety and training measures may likely be implemented to lower the injury rates with the setting and within the employee class.

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.

UTILIZATION REVIEW IN CALIFORNIA WORKERS’ COMPENSATION:  A PERSPECTIVE FOR INJURED WORKERS

For Injured Workers seeking medical treatment for their workers’ compensation claims, Utilization Review (UR) of their Physician’s Requests for Authorization for medical treatment is all too common.   Injured Workers often receive letters denying treatment, modifying treatment, deferring treatment authorization, requesting further information and certifying treatment.  These letters are generated by the Insurance Companies via their Utilization Review process.

This article will briefly discuss the history of Utilization Review, what is Utilization Review, why the workers’ compensation system employs UR, and how an Injured Workers should address UR.

What Is the History of Utilization Review?

“Background Utilization management has been defined by the Institute of Medicine as “a set of techniques used by or on behalf of purchasers of health benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision.”[1] Utilization management is used in an effort to discourage the use of unnecessary or inappropriate medical services, without jeopardizing necessary high-quality care.

The terms “utilization management” and “utilization review” (UR) are used interchangeably in this report. By the late 1980’s, UR had become ubiquitous in health care, effecting virtually everyone with any form of health insurance coverage in the U.S., and many workers’ compensation claims administrators had also begun to use UR as a cost-containment tool.” Utilization Review in California’s Workers’ Compensation System: A Preliminary Assessment July, 2001 Division of Workers’ Compensation Public Health Institute Department of Industrial Relations Berkeley, California State of California [emphasis added]

What is Utilization Review?

“Utilization management is a set of techniques used to manage health care costs through the assessment of the appropriateness of care in individual cases. The primary focus of utilization management is reduction of the use of unnecessary or inappropriate medical services.” Utilization Review in California’s Workers’ Compensation System: A Preliminary Assessment July, 2001 Division of Workers’ Compensation Public Health Institute Department of Industrial Relations Berkeley, California State of California

In layman’s term, managing health care costs saves Insurance Companies money by denying treatment.  Denying treatment leads to less bills. Less bills leads to less costs.

What are the Reasons for Utilization Review?

Medical costs within the workers’ compensation system are driven my multiple factors.  These can include fraud, overuse, and greed.

First, fraud in workers’ compensation could include prescriptions for expensive and unnecessary treatment.

Second, overuse in workers’ compensation involved Injured Workers who were enthusiastic about their treatment and had providers who would enable it. For example, before UR, there were individuals with minor back injuries with open medical awards that would seek chiropractic adjustments 3 days a week in perpetuity.

Third, greed and distrust of medical providers. There is a distrust by insurance Companies of medical providers.   Medical providers may be incentivized to provide treatment to make money versus providing the care that was needed.   For example, epidural injections, at one point in time, became increasingly used.  Arguably, they were done because they were profitable for the providers rather than helpful to the Injured Workers.

How Should Injured Workers Address Utilization Review?

Injured Workers need to address utilization review by choosing treating doctors who are responsive to the UR process.  Further, Injured Workers should be aware of UR denials and the need to file for Independent Medical Review.

An Injured Worker should choose the right treating doctor for UR processes. An Injured Worker should look for treating doctors who understand the utilization review process.   This means that the doctors should understand the forms that need to be filled out to get treatment approval.  This means that the doctors should understand the treatment utilization schedules as to what treatment can be approved and how to request it. Finally, the doctor should be responsive to inquiries from utilization review when they request peer to peer discussions as well as requests for supplemental reports.

Also, Injured Workers need to have treating doctors who will be responsive to the utilization review company’s requests for further information.

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.

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