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OPERATING ROOM PERSONNEL AND ORTHOPEDIC WORK INJURIES: MEDICAL PROFESSIONALS SUFFERING MUSCULOSKELETAL DISORDERS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Posted on September 15, 2020 by Edward Singer

There is some irony to the fact that Operating Room Personnel, who help repair and treat patients with workers’ compensation injuries, are at risk of work injuries in doing so. Operating Room Personnel perform vital services in our society’s medical delivery system. Their hard work is appreciated by all. The Operating Room, however, is a difficult place to work.

This article will discuss Operating Room Personnel, the mechanisms of injury that occur as a result of the Operating Room, and the various musculoskeletal injuries that Operating Room Personnel are at risk for sustaining.

Who Are Operating Room Personnel?

Operating Room Personnel include Surgeons, Nurses, Scrub Nurses and Surgical Technicians.

What are the Mechanisms of Injury for Operating Room Personnel?

There are a variety of mechanisms of injury for Operating Room Personnel. These mechanisms include manipulation, standing and static stress.

What is Manipulation?

“Manual activities are another risk factor for work-related physical activity among operating room personnel. Manual activities mean the manual movement and transfer of surgical instruments and devices that require special attention. Pulling, pushing or lifting surgical instruments, heavy and specialized surgical equipment and patient displacement are the most common manual activities of operating room personnel.” J Multidiscip Healthc. 2020; 13: 735–741. Published online 2020 Jul 31. doi: 10.2147/JMDH.S259245 PMCID: PMC7402850 PMID: 32801736 A Multidisciplinary Focus Review of Musculoskeletal Disorders Among Operating Room Personnel Reza Tavakkol, Ashkan Karimi, Soheil Hassanipour, Ali Gharahzadeh, and Reza Fayzi.

Some of the problems with respect to manipulation is that some of these activities may not be performed in an ergonomic fashion. Supra.

One study found the abnormal posture with respect to nurses. The study noted that “in most cases nurses were at high risk level and needed urgent and prompt change in their working posture.” Health Promot Perspect. 2016; 6(1): 17–22. Published online 2016 Mar 31. doi: 10.15171/hpp.2016.03 PMCID: PMC4847110 PMID: 27123432 Working posture and its predictors in hospital operating room nurses Farahnaz Abdollahzade,Fariba Mohammadi,Iman Dianat, Elnaz Asghari,Mohammad Asghari-Jafarabadi, and Zahra Sokhanvar.

What is “Standing?”

“[T]the team members are in a standing position throughout the surgery.25,26 Standing up for a long time is one of the most important risk factors for musculoskeletal disorders.27 Andersen et al found that prolonged standing may increase back pain and leg pain J Multidiscip Healthc. 2020; 13: 735–741. Published online 2020 Jul 31. doi: 10.2147/JMDH.S259245 PMCID: PMC7402850 PMID: 32801736 A Multidisciplinary Focus Review of Musculoskeletal Disorders Among Operating Room Personnel Reza Tavakkol, Ashkan Karimi, Soheil Hassanipour, Ali Gharahzadeh, and Reza Fayzi.

What Is “Static Stress?”

“Static stress is one of the risk factors that cause musculoskeletal disorders in operating room personnel. Static stress includes activities such as prolonged standing and constant physical posture during surgery and holding equipment such as retractors during surgery.” J Multidiscip Healthc. 2020; 13: 735–741. Published online 2020 Jul 31. doi: 10.2147/JMDH.S259245 PMCID: PMC7402850 PMID: 32801736 A Multidisciplinary Focus Review of Musculoskeletal Disorders Among Operating Room Personnel Reza Tavakkol, Ashkan Karimi, Soheil Hassanipour, Ali Gharahzadeh, and Reza Fayzi.

What Body Parts that Can Be Injured by Operating Room Work?

Practically every orthopedic body part is susceptible for injury in the Operating Room. “Operating room personnel are most affected by musculoskeletal pain (58–90%) due to difficult working conditions.20 Musculoskeletal disorders can occur in different parts of the body. The most common areas of involvement include the neck, shoulder, elbows, wrists, and hands, upper and lower back, hip and thighs, knees, ankles, and feet. Among the musculoskeletal disorders, low back pain has the highest prevalence.” 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.

HOTEL WORKERS AND WORKERS’ COMPENSATION: HOTEL WORKERS SUSTAINING INDUSTRIAL INJURIES AND WORKERS COMPENSATION: WHAT YOU NEED TO KNOW

Posted on September 2, 2020 by Edward Singer

Hotel Workers are at risk for injury. They have demanding jobs that are time sensitive. There are many tasks that they perform that can cause musculoskeletal disorders. In addition, some workers use tools and materials which can place them at risk for skin and respiratory injuries.

There was a study awhile ago which analyzed work injuries in the Hotel Industry. Moving forward from the study, you can see how the industry has dealt with the problem of their high rate of workers’ compensation claims. At the time, the study found that the Hotel Industry was at high risk when compared to others. Disparities in the US Hotel Industry Susan Buchanan, MD, MPH, * Pamela Vossenas, MPH, Niklas Krause, MD, PhD, Joan Moriarty, MS, Eric Frumin, MA, Jo Anna M. Shimek, MS, Franklin Mirer, PhD, CIH, Peter Orris, MD, MPH, and Laura Punnett, AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 53:116–125 (2010)

This article will discuss Hotel Workers, their tasks, their rates of work injuries and the tactics that Risk Management has used to address the high rate of work injuries.

Why Should Hotel Employees Be Concerned?

Any time an Industry is subject to significant amounts of work injuries, Risk Management will take measures to reduce work injuries. These measures may impact Hotel Employees and how they perform their work assignments. Additionally, it may impact how Injured Workers will be treated after claims have been reported.

Why Are Work Injuries in the Hotel Industry Important?

When the study was done, it was noted that “[w]ithin the US hospitality industry, hotels, and motels employ 1.8 million workers [USBLS, 2007b].” Supra.

At the time, the study reported the significant number of work injuries that occur at Hotels. “In the United States, hotel workers are nearly 40% more likely to be injured on the job than all other service sector workers. Hotel workers also sustain more severe injuries resulting in more days off work, more job transfers, and more medically restricted work compared to other employees in the hospitality industry [USBLS, 2005]. Supra.

What is the Service Industry?

The Service Industry is part of the employment/business sector that provides customer services and occasionally provides goods. The Service Industry does not manufacture products.

Examples of the Service Industry include food services: i.e., McDonalds, Starbucks, and Taco Bell, retail, i.e. Target, Walmart and Food-4-Less, transport, i.e. Greyhound and Southwest Airlines, and distribution, i.e. Fed-Ex, UPS and DHL.

Manufacturing and Raw Materials are the other employment/industrial sectors.

What is the Hotel Industry?

The Hotel Industry is considered as part of the “Hospitality Industry”. The term “Hospitality Industry” includes additional employers such as food service, drink service, event planning, theme parks and transportation.

Who are Hotel Workers? What Do They Do? What Types of Labor Makes Them at Risk for Injury?

Hotel Workers have many titles and perform various tasks. Hotel Workers have many job titles such as bartender, banquet server, cashier, chef, cook, dishwasher, door person, host, hostess, housekeeper, lobby attendant, pot washer, room attendant, and stewards.

Hotel tasks can be broken down into five distinct categories. These are Housekeepers, Banquet Servers, Stewards/Dishwasher, Cooks/Kitchen Workers and Other.

What Tasks Do Housekeepers Perform?

”Housekeepers perform guest room cleaning including making beds, vacuuming floors, cleaning shower walls and bathroom fixtures, dusting furniture, and pushing carts.” Occupational Injury Disparities in the US Hotel Industry Susan Buchanan, MD, MPH, * Pamela Vossenas, MPH, Niklas Krause, MD, PhD, Joan Moriarty, MS, Eric Frumin, MA, Jo Anna M. Shimek, MS, Franklin Mirer, PhD, CIH, Peter Orris, MD, MPH, and Laura Punnett, AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 53:116–125 (2010)

NOTE: Housekeepers perform physically arduous work.

What Tasks Do Banquet Servers Perform?

“Banquet servers provide food service such as carrying plated food from the kitchens to the customers, dispensing drinks, and supplying food to cafeteria and buffet services.” Supra.

NOTE: Banquet Servers perform physical activities which are time sensitive.

What Tasks Do Stewards/Dishwashers Perform?

“Stewards retrieve, sort, load/lift, unload, and return dishes, glasses, pots, utensils and silverware, and provide these items by pushing carts to cafeteria and buffet lines. In addition, stewards maintain cleanliness in food preparation areas.” Supra.

NOTE: Stewards/Dishwashers, like the Banquet Servers, perform physical activities which are time sensitive.

What Tasks Do Cooks/Kitchen Workers Perform?

Cooks lift, weigh, measure, mix, cut and grind food ingredients; they cook these ingredients and compose salads and other food for serving Supra.

NOTE: Cooks/Kitchen, like the Banquet Servers, perform physical activities which are time sensitive. Likewise, they may also be involved in shift work.

What Tasks Do Others Perform?

All remaining jobs were categorized as “other.” Jobs classified as “other” were those that did not share similar job tasks or exposures with the other four key job categories. These included lobby attendant, cashier, door person, host/hostess, among others. Supra.

NOTE: Other work may involve various physical activities as well as perform shift work.

What Are the General Types of Injuries that Hotel Workers Can Sustain?

Most commonly, Hotel Workers are subject to musculoskeletal injuries.

The study cited that “[a]mong Las Vegas hotel room cleaners, the prevalence of self-reported pain associated with work was 75% during the previous year [Scherzer et al., 2005]; 63% had had severe or very severe low back pain just in the prior month [Krause et al., 2005].” Supra.

Additionally, Hotel Workers who work with water or other liquids or who use gloves as subject to “wet-work” injuries. These injuries are to the skin, i.e. contact dermatitis. For an article discussing “wet work,” click here. Further Hotel workers may work with products that contain fragrances. These products may cause respiratory injuries such as “occupational asthma.” For an article discussing “fragrance-related injuries,” click here.

What Did the Study Tell Us About Hotel Workers? As an Injured Worker, Should It Matter?

The study found that with respect to certain Hotel Employees that women had a greater rate of work injuries than men. It found that there were some racial differences in that certain ethnic groups had greater injury rates than whites.

NOTE: With respect to these rates, it is this writer’s opinion that more data should be explored. Non-English-Speaking workers may stay with a work position that is physically harming them longer than English Speaking workers. One reason for them remaining on such as a job is that that their lack of English Fluency may limit their ability to obtain less physical employment. As a result of this, they may at a greater risk of injury. Thus, the ethnic group itself may not really be the issue. It may be more the ability of worker to seek other employment that is less injurious in nature.

How Does the High Rate of Work Injuries Impact Hotels?

Industries with high rates of workers’ compensation claims will seek to reduce their injury rates. Since the study, Hotel Risk Management has already taken steps to reduce injuries. For those who visit hotels, it is apparent that what has been done. Reducing staff hours and tasks translates into lower rates of injuries. Many Hotels, under the auspices of being “green” encourage patrons to reuse towels and decline daily “room service.” In doing so, labor time of laundry service and housekeeping is reduced. Long term, if staff hours are reduced, staffing may in turn be reduced. In sum, less employees.

With respect to food service workers, many catered events feature buffets and no longer offer table service. Further, beverage stations are offered so that attendees can get their own coffee, juice, etc.. Again, less labor hours translates to less risk of injury. In sum, less labor hours, less employees.

Additionally, Risk Management may engage in more surveillance of their employees via cameras to prove or disprove work injuries. NOTE: This may be most effective with respect to specific injuries and not so much with respect to cumulative trauma injury claims.

What If I Need Legal Advice?

MEDICARE SET-ASIDES (MSA), LIFE CARE PLANS, FUTURE TREATMENT PLANS AND WORKERS’ COMPENSATION: WORKERS’ COMPENSATION, COMPROMISE AND RELEASE SETTLEMENTS, AND MEDICARE: WHAT YOU NEED TO KNOW

Posted on August 26, 2020 by Edward Singer

There are many Injured Workers who are on Medicare or are considered as Medicare-Eligible. Many of these Injured Workers wish to settle their workers’ compensation cases via a “Compromise and Release” settlement. This type of a settlement is generally considered as a “buy out” of the claims and as a “buy out” of the Injured Workers entitlement to “lifetime medical” care paid for by the workers’ compensation insurance. In these circumstances, Medicare’s interests need to be addressed when there is a settlement. Medicare Set-Asides is the means upon which the interests of Medicare are considered.

This article is a Part II, of a prior article on Medicare Set-Asides. This article discusses the “nuts and bolts” that are to be contained within the MSA. To achieve this goal, Life Care Plans, Future Medical Care Plans, Prescriptions Drugs, and Life Expectancy will be discussed. If you are interested in the Part I of the article, click here.

What is a “Life Care Plan” for MSA Purposes?

“A “Life Care Plan” is a dynamic document based on published standards of practice, comprehensive assessment, data analysis, and research that provides an organized concise plan for current and future needs with associated costs for individuals who have experienced catastrophic injury or have chronic health needs. A life care plan is appropriate when the claimant’s injury or disease is extensive and serious, e.g., paraplegia, quadriplegia, brain damage. Although submission of a life care plan is optional, you are required to include drug and dosage lists. Include all pricing charts, cost projections, pricing information, and explanatory narratives and analyses.” [emphasis added] Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide Version 3.1 May 11, 2020 COBR-Q2-2020-v3.1

Note: Irrespective of the Medicare Issue, the parties in catastrophic injury or chronic health need case may utilize Life Care Plans to assist in resolving cases. They are not exclusive to the development of a MSA.

What Types of Reporting is included in a “Life Care Plan”?

“When the parties to a WC settlement present CMS with “life care plans” or similar evaluations prepared by non-treating physicians to support and justify their proposed WCMSAs,

Medicare will consider accepting such evaluations if the physician does all of the following: Examines the claimant; Reviews the claimant’s medical records; Contacts any of the claimant’s treating physicians (if applicable); Is available to answer CMS’ questions; Prepares a report that summarizes the above; and Offers a written medical opinion as to all of the reasonably anticipated future medical needs of the claimant related to the claimant’s work injury or illness/disease. Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide Version 3.1 May 11, 2020 COBR-Q2-2020-v3.1 [emphasis added]

Note: Non-physicians frequently draw up “Life Care Plans.”

What is a “Future Medical Care” Plan?

In cases where there is not a catastrophic injury or one with chronic health needs, there is still the need to provide a Future Medical Care Plain.

“A Future Treatment Summary lists all expected care by type, level, frequency, cost per event, and total for all expected future medical and pharmacy care. A Future Treatment Plan is required in the absence of a Life-Care Plan. Future Treatment Summaries do not require the same stringent evaluation as a Life Care Plan; however, they delineate the treatment care pricing expectations by the submitter for the purpose of WCMSA calculation. The Future Treatment Summary gives the WCRC some insight into the pricing methods used by the submitter, and should not be construed to carry the same weight as treatment records or Life Care Plans.” Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide Version 3.1 May 11, 2020 COBR-Q2-2020-v3.1 [emphasis added]

Note: These Plans address “expected” care. This may not be a realistic picture of the individual. For example, no one would expect a post-surgical infection and need for hospitalization. This can be a large cost but would not be considered as expected. Also, someone with comorbidities, i.e. diabetes, which may complicate treatment. This may not be considered within this framework as expected as well. In sum, the MSA may not be an “accurate” assessment of one’s care cost. Rather, it is merely an “expected” assessment.

Does CMS Accept MSA Plans on Face Value?

No. CMS will not necessarily accept a plan based upon the fact that it was prepared and is in the correct format

“Please note that such a life care plan or evaluation is not automatically conclusive. The CMS may not credit the report if there is information that calls the evaluation or plan into question for some reason, such as contrary evidence, internal conflicts, or if the plan is not credible on its face.” Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide Version 3.1 May 11, 2020 COBR-Q2-2020-v3.1 [emphasis added]

Note: Either by mistake or intentionally, there may be some intent to skew a MSA to lower the amount. These attempts may be flagged by CMS and there may be a need to increase the MSA amount. To be fair, there have been times where carriers have provided for treatment monies beyond which may have been required. This is done where they have provided for treatment which was not necessarily to be considered as “expected.”

Should MSAs also Address Applicant’s “Current Treatment” for Their Industrial Injury?

Yes. Current treatment information needs to be provided within a MSA.

“Current Treatment Provide the treatment/services that the claimant regularly receives. The current treatment should give an indication that the work-related condition is stable (or at least is not getting worse).” .” Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide Version 3.1 May 11, 2020 COBR-Q2-2020-v3.1

“The summary of current treatment should be supported by a minimum of two years of medical documentation and a comprehensive payment history from the WC Carrier (including indemnity payments). See Section 10.7 for details on medical records submission. If the work-related injury occurred less than two years from the date of the WCMSA submission, supporting medical documentation should date back to the date of the work-related injury. Also note any relevant past treatment, such as surgery, that the claimant may have undergone.” .” Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide Version 3.1 May 11, 2020 COBR-Q2-2020-v3.1 [emphasis added]

Note: The “two years” part of this statement is important. In order to complete and get an MSA approved, the gathering of an Injured Workers treatment and pharmacy records from all providers, industrial and non-industrial, is important to get a MSA completed and approved.

How Is Future Treatment Determined?

Future Treatment is determined as follows: “[d]etermine the cost of future medical expenses and prescription drugs that are directly related to the injury or illness suffered by the worker. This amount can be determined by reviewing medical records and past medical and prescription expenditures. The WCMSA must show the amount of money that should be invested to provide for the yearly expenses for the worker’s life expectancy.” Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide Version 3.1 May 11, 2020 COBR-Q2-2020-v3.1

Is “Life Expectancy” an Issue with MSAs? Why is “Life Expectancy” Important?

“Life Expectancy” is a term frequently used by individuals in the “actuarial” community. There are segments of the medical and business world that makes calculations as to when someone is expected to die. This is then reduced to a number. So, an a Female 65 years of age may have a 21.6 year life expectancy. These numbers were taken from a Life Expectancy Table generated from statistics from the U.S. Government. This calculation is based upon the general population. Those in the medical and business worlds will do further analysis. They will look at whether the individual has morbidities such as diabetes, hypertension or kidney disease. There are medical conditions that can impact one’s life expectancy. In sum, “Life Expectancy” can have a base which is calculated on the general population. It can then be lowered based upon the individual’s morbidities. By shortening the “Life Expectancy,” the cost of the MSA can be reduced. Therefore, insurance companies will want to get a lower life expectancy to save money.

Note: In order to protect Medicare’s interests, a Workers’ Compensation Medicare Set-Aside (WCMSA) should be funded based on the life expectancy of the claimant unless state law specifically limits the length of time that WC covers work-related conditions.

What is the Philosophy of the MSA Calculation and the Amount?

“The key is that both the principal amount that is to be set aside and the anticipated interest that it will earn must be sufficient to provide for the worker’s future medical treatment and administration fees for the worker’s lifetime.” .” Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide Version 3.1 May 11, 2020 COBR-Q2-2020-v3.1

What Should MSAs Document?

The MSA should “[i]dentify specific types of medical services or items, the frequency and duration of the medical services or items, and the projected costs of the medical services or items related to the work injury or disease that are expected in the future in light of the claimant’s condition; Include ICD-9 or ICD-10 diagnosis codes if available. Do not use ICD-9 codes for submissions with a DOI on or after 10/1/2015; do not mix ICD-9 and ICD-10 codes in one submission. (ICD-9 codes will continue to be allowed on submissions with a DOI of 9/30/2015 or earlier.) ; Appropriately identify the information by both Medicare-covered services and services not covered by Medicare. • Future treatment must be based on the evaluation and recommendation of a physician(s), e.g., the primary care physician, orthopedic surgeon, or other specialist (if applicable). An independent medical examination (IME) may be sufficient under certain circumstances, e.g., claimant has not received treatment in several years, and there is no primary care physician. The claimant’s condition and medical care required in the future must be documented in written evaluations, reports, and/or letters from a physician(s). Living arrangements that affect the medical benefits of the settlement should be noted, such as nursing homes or assisted living facilities.” Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide Version 3.1 May 11, 2020 COBR-Q2-2020-v3.1

How Do MSAs Address Prescription Drugs?

“Prescription drugs must be included even if the claimant is not yet a Medicare Part D beneficiary, if the current treatment records or future care plan support the use of drugs in treating the claimant’s WC injury.

What is an Example of a MSA Breakdown?

“ Example: The primary care physician states that during the claimant’s life expectancy of 30 years, it is estimated that he or she will need the following Medicare-covered services.

A physician visit every 6 months with an estimated cost of $75 per visit.
Physical therapy (PT) – 12 sessions per year for only the next 3 years with estimated cost of $50 per session
An x-ray every 3 years with an estimated cost of $100 per x-ray (including interpretation)
An MRI every 5 years with an estimated cost of $1,500 per MRI (including interpretation)
Maintenance dose of prescription pain medication at $8 per month for 12 months per year
Inpatient hospitalization every 10 years with an estimated cost $10,000 per hospitalization
The projected total costs in this case are $49,180 as listed below; Physician visits @ $4,500 ($75 x 2 x 30) ; PT @ $1,800 ($50 x 12 x 3) ; X-rays @ $1,000 ($100 x 10); MRIs @ $9,000 ($1,500 x 6); Medication @ $2,880 ($8 x 12 x 30); Hospitalizations @ $30,000 ($10,000 x 3)” Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide Version 3.1 May 11, 2020 COBR-Q2-2020-v3.1

What If I Need Legal Advice?

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

Posted on August 14, 2020 by Edward Singer

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, 5^th 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?

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

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

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

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

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

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

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

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

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

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 Mehra, D Baker, S 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 Mehra, D Baker, S 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?

Workers’ Compensation Back Injuries: What You Need to Know

Posted on August 16, 2017 by Edward Singer

How can Industrial Back Injuries occur?

In California, Workers’ Compensation Back Injuries can occur in many ways. Injuries can be the result of a specific incident, a cumulative trauma, a presumptive injury, or a compensable consequence arising out of an injury to other body parts or systems. A Back Injury can also be an aggravation of a pre-existing back condition. This article discusses the types of industrial back injuries, the testings that are available, an the treatments that are available.

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