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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?

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 “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.

What You Need To Know About Back Surgery, Return To Work, & Workers’ Compensation

Posted on April 23, 2021 by Edward Singer

Workers’ Compensation Medical Studies have been done on many topics. Studies have reported on surgeries performed within the workers’ compensation environment. Some studies have looked examined spinal surgeries.

Study results impact Injured Workers. Studies results can create insurance Company expectations concerning surgery success and recovery times. Insurance Company expectations from these studies can be imposed upon treating doctors concerning temporary and permanent disability.

This article will discuss back surgery, a study concerning back surgery, the back surgery study’s results. and what the study means for injured workers.

What Is Back Surgery?

The Spine has three segments: cervical, thoracic, and lumbar. The lumbar segment of the spine is usually referred to as back or low back. Back surgeries are generally on the area referred to as the lumbar spine. There are various types of surgeries. There are surgeries to address lumbar spine disks and there are other procedures that address the stability of the spine. Common surgeries are laminectomies, fusions and disc replacement.

Besides the problems being operated on, there is also issue of levels. The lumbar spine has multiple levels. Some surgeries operate on one level and others involve multiple levels.

There are a variety of reasons why a particular surgery may be indicated. This article will be addressing one of the reasons. A surgery to address a herniated lumbar disk. Specifically, a surgery to address a disk at only one level. This procedure is called a laminectomy.

Why Is Back Surgery a Significant Workers’ Compensation Issue?

Back Surgeries are expensive.T they cause periods of temporary disability and may result in findings of permanent disability. Back Surgeries can have complications that can be costly such as treatment for post-operative infections. Thus, Insurance Companies, in a risk management analysis, may wish to prevent surgery liability by either denying the treatment or settling the case.

What Were the Study’s Results?

The study addressed focused only on a single-level lumbar disk herniation surgery.

According to the study, “[p]atients receiving WC(workers; compensation) with shorter duration of radiculopathy before diskectomy had higher RTW(return to work) rates; fewer physical therapy, chiropractic, and psychotherapy sessions; and fewer postoperative diagnoses of psychological illnesses.” Ren BO, O’Donnell JA, Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Time to Surgery Affects Return to Work Rates for Workers’ Compensation Patients With Single-Level Lumbar Disk Herniation. Orthopedics. 2021 Jan 1;44(1):e43-e49. doi: 10.3928/01477447-20201202-06. Epub 2020 Dec 7. PMID: 33284984.

The study found that “within 12 weeks of injury, post-diskectomy patients do reasonably well, with a 70.0% (95% CI, 65.9%–74.1%) rate of RTW.”

The study also found that “[o]n the other hand, if a patient waited more than 2 years to have surgery for radiculopathy, RTW(return to work) rates decreased as low as 31.3% (95% CI, 26.3%–36.3%).” Ren BO, O’Donnell JA, Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Time to Surgery Affects Return to Work Rates for Workers’ Compensation Patients With Single-Level Lumbar Disk Herniation. Orthopedics. 2021 Jan 1;44(1):e43-e49. doi: 10.3928/01477447-20201202-06. Epub 2020 Dec 7. PMID: 33284984.

Note: the study’s results are confounding to Insurance Companies. The study suggests that acting promptly to approve a surgery can lead to more promising results. The study implies that a long drawn out battle for a back surgery can result in a poor result. Thus, acting quickly and spending a considerable amount of money for treatment leads to a better result in this circumstance. Thus, these types of cases are a true test for Adjusters.

Was There Anything Else Interesting from the Study?

Irrespective of surgery, the factors of legal representation, psychological co-morbidity and mean household income can negatively impact return to work. Ren BO, O’Donnell JA, Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Time to Surgery Affects Return to Work Rates for Workers’ Compensation Patients With Single-Level Lumbar Disk Herniation. Orthopedics. 2021 Jan 1;44(1):e43-e49. doi: 10.3928/01477447-20201202-06. Epub 2020 Dec 7. PMID: 33284984.

Is There Anything an Injured Worker Should Do?

Injured Workers with spinal problems should get appropriate medical care at the onset of injury. In the case of severe back pain and in cases with radiculopathy, they should seek out an orthopedic surgeon to have their condition assessed.

Per the study, if surgery is truly indicated, surgery it suggests that it be done promptly. Each individual’s medical condition and recovery, however, is different. Thus, the treatment course should be done on an individual basis and not per a study.

What If I Need Advice?

ROTATOR CUFF SHOULDER SURGERIES AND WORKERS’ COMPENSATION: INDUSTRIAL VS. NON-INDUSTRIAL SURGERY RESULTS: WHAT YOU NEED TO KNOW

Posted on January 27, 2021 by Edward Singer

In the US, annually, almost 2 million adults visit doctors for rotator cuff injuries. AAOS. A number of these individuals seeking this shoulder treatment on a work-related basis. If conservative care does not resolve the issues, surgery is indicated.

With all types of surgeries, medical researchers like to compare the results of the Industrially provided versus those done on a non-industrial basis. A study was done with respect to Rotator Cuff Surgeries.

This article will discuss the Rotator Cuff, Rotator Cuff Injuries, Causes of Rotator Cuff Injuries, Rotator Cuff Surgeries, and the Study’s Findings.

What is a Rotator Cuff?

The rotator cuff is a group of four muscles that come together as tendons to form a covering around the head of the humerus in the shoulder. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm. AAOC

How Does a Rotator Cuff Get Injured?

A rotator cuff injury can occur when one or more of the tendons are torn. Tears can range from partial to full-thickness(complete.) AAOC

What Are Symptoms of Rotator Cuff Injuries?

The symptoms for rotator cuff tears can include pain at rest and at night, pain when lifting and lowering your arm, pain with specific movements, weakness when lifting or rotating your arm and cracking when moving your shoulder. AAOC

What Is Rotator Cuff Surgery?

A rotator cuff surgery will attempt to repair the torn tendons. This can include re-attaching them to the bone. AAOC

What Work Activities Can Cause an Industrial Rotator Cuff Injury?

There are a number of factors that have been identified as causative towards industrial shoulder problems. These factors that are considered as occupational risk factors for shoulder tendinopathy, impingement, and rotator cuff tears include: the combination of risk factors (eg force and repetition, force and posture); some evidence, highly repetitive work alone or in combination with other factors, some evidence, and awkward postures: strong evidence ( sustained shoulder postures with more than 60 degrees of flexion or abduction) AMA Guides to the Evaluation of Disease and Injury Causation, 2^nd Edition, P. 320

Thus, painters, carpenters, and others who do overhead work also have a greater chance for tears. They can also be caused by a traumatic injury such as a fall. AAOC

What are the Factors that Can Impact the Results of a Rotator Cuff Surgery?

There are a number of factors that can impact the recovery from a rotator cuff surgery. This factors affecting postoperative outcomes include age, gender, and smoking status. Other factors that can impact the outcome include the number of surgeons, tear size, operation method, and surgical technique. Kim KC, Lee WY, Shin HD, Han SC, Yeon KW. Do patients receiving workers’ compensation who undergo arthroscopic rotator cuff repair have worse outcomes than non-recipients? Retrospective case-control study. J Orthop Surg (Hong Kong). 2018 May-Aug;26(3):2309499018802507. doi: 10.1177/2309499018802507. PMID: 30270747.

Also, factors most commonly believed to affect postoperative outcomes also include fatty degeneration and diabetes mellitus. Kim KC, Lee WY, Shin HD, Han SC, Yeon KW. Do patients receiving workers’ compensation who undergo arthroscopic rotator cuff repair have worse outcomes than non-recipients? Retrospective case-control study. J Orthop Surg (Hong Kong). 2018 May-Aug;26(3):2309499018802507. doi: 10.1177/2309499018802507. PMID: 30270747.

What Were the Results of the Study?

The study found that “Although workers’ compensation recipients who undergo arthroscopic rotator cuff repair had worse outcomes before the end of WCB(Workers’ Compensation) benefits, the outcomes became similar after WCB(Workers’ Compensation) benefits ended” Kim KC, Lee WY, Shin HD, Han SC, Yeon KW. Do patients receiving workers’ compensation who undergo arthroscopic rotator cuff repair have worse outcomes than non-recipients? Retrospective case-control study. J Orthop Surg (Hong Kong). 2018 May-Aug;26(3):2309499018802507. doi: 10.1177/2309499018802507. PMID: 30270747.

The data supported “the hypothesis that patients with workers’ compensation claims would have worse outcomes.” Kim KC, Lee WY, Shin HD, Han SC, Yeon KW. Do patients receiving workers’ compensation who undergo arthroscopic rotator cuff repair have worse outcomes than non-recipients? Retrospective case-control study. J Orthop Surg (Hong Kong). 2018 May-Aug;26(3):2309499018802507. doi: 10.1177/2309499018802507. PMID: 30270747.

As an Attorney, Why Do You Believe That An Injured Worker Have Worse Results?

As an attorney, I will express my opinion as to what could be the cause of poor results for industrial rotator cuff surgeries.

First, industrial medicine treatment, versus non-industrial treatment, may have more delay and denials in getting the treatment and surgery authorized. Additionally, there may delays and denials in getting treatment authorized.

Second, workers’ compensation claims determine impairment and dysfunction as part of a disability award. Thuys, an injured worker may be focused on recalling their dysfunction as opposed to a non-industrial surgery in which there is no reward for a poor result.

Third, if there was dissatisfaction with the workers’ compensation process, an injured worker may have lingering emotional unhappiness with respect to the result.

Fourth, if the case was settled with a Compromise and Release Buy-Out of future medical care, the Injured Worker may not access to follow up medical treatment needed for their shoulder.

What If I Need Advice?

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

Posted on December 18, 2020 by Edward Singer

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?