Workers’ Compensation In the News, Episode # 3: Even Super Heroes Get Hurt: What You Need to Know

Holy Cow Batwoman! Pow, Kabam! Ouch!

Ruby Rose, who played Batwoman, on the CW Television Show reported that she sustained two injuries while working on the program.

While wearing a latex Batwoman Mask, she developed an allergic reaction.  She also had an accident on the set which required back surgery. foxnew.com

Can An Allergic Reaction Be An Industrial Injury? 

Yes. Allergic reactions can be work-related injuries.  If so, the Injured Worker will receive medical treatment paid for by the insurance company as well as monetary compensation.

Allergic Contact Dermatitis (ACD) is an inflammation of the skin caused by an immunologic reaction triggered by dermal contact to a skin allergen. For ACD to occur, a worker must be first sensitized to the allergen. Subsequent exposures of the skin to the allergenic agent may elicit an immunologic reaction resulting in inflammation of the skin. The reaction is not confined to the site of contact and may result in systemic responses. ACD may be caused by industrial compounds (i.e. metals, epoxy and acrylic resins, rubber additives, chemical intermediates), agrochemicals (i.e. pesticides and fertilizers), and commercial chemicals.

A common allergic reaction is latex allergies. Per the CDC, Latex Gloves have proved effective in preventing transmission of many infectious diseases. But for some workers, exposures to latex may result in allergic reactions. Reports of such reactions have increased in recent years–especially among Health Care Workers.

Can An Accident at Work Be An Industrial Injury? 

Yes. Workers’ Compensation is “no fault.”  Thus,  if Ruby Rose had hurt her back by an accidental trip, she would still be able to have a valid claim.  The claim would have paid for her back surgery, paid her compensation for her time off of work as well as provided her additional benefits.

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 over 27 years. Contact us today for more information.

CALIFORNIA BACK INJURIES AND TREATMENT GUIDELINES: EVIDENCE BASED MEDICINE (EBM) AND WORKERS’ COMPENSATION:  WHAT YOU NEED TO KNOW

California Workers’ Compensation has embraced Evidence Based Medicine (EBM) to dictate industrial medical care authorization.

Thus, when a EBM study is published, the Workers’ Compensation Community looks to its conclusions. The community looks to see the results are aligned with the Labor Code’s mandate to provide treatment to cure or relieve from the effects of an industrial injury.

Back Injury treatment was assessed in a recent EBM study.  They looked to see if  guidelines treatment achieved favorable results.  The results of such a study can shape both insurance company and medical office policy.

This article will discuss the study which looked at California back injury treatment in light of EBM-related guidelines.

What Is Evidence Based Medicine?

Evidence Based Medicine “…integrates medical research with clinical expertise and patient values to support decision making based on the best available evidence.” Gaspar FW, Thiese MS, Wizner K, Hegmann K. Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system. PLoS One. 2021 Jun 17;16(6):e0253268. doi: 10.1371/journal.pone.0253268. PMID: 34138937; PMCID: PMC8211224.

In other words, an Injured Worker’s treatment is geared more towards past research and study results. The Injured Worker’s treating physician’s clinical impressions are viewed as secondary. Thus, EBM-like treatment is provided in an algorithmic or formulaic fashion.

What Was the Study’s Purpose?

“The aim of this study was to determine the influence of adherence to guideline recommendations on lost workdays for workers with acute LBP(low back pain) claims in California’s WC system.” Gaspar FW, Thiese MS, Wizner K, Hegmann K. Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system. PLoS One. 2021 Jun 17;16(6):e0253268. doi: 10.1371/journal.pone.0253268. PMID: 34138937; PMCID: PMC8211224.

In other words, treatment currently can be in a number of modality forms.  Some are within guidelines, some treatment which is not recommended by guidelines and some others.  During an accepted claim, Injured Workers’ treatment are usually authorized.  Sometimes, authorized treatment can be ones that are outside of the guidelines.

What Is Guideline Treatment?   

Guideline treatment is based upon the “American College of Occupational and Environmental Medicine (ACOEM)’s Low Back Disorders Practice Guideline was used as the source of guideline recommendations [16]. ACOEM’s treatment guidelines have been adopted in California’s Medical Treatment Utilization Schedule (MTUS), which determines what is reasonable and necessary medical care.” Gaspar FW, Thiese MS, Wizner K, Hegmann K. Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system. PLoS One. 2021 Jun 17;16(6):e0253268. doi: 10.1371/journal.pone.0253268. PMID: 34138937; PMCID: PMC8211224.

What Is the Criticism of the Study? 

The study did not look at every back condition.  The study limited itself to very specific back conditions.  Thus, the results are very limited.  The danger of such a study it will be interpreted to apply to back conditions that were not part of the study.

As noted in the study, “to focus on the treatment of uncomplicated LBP claims, claims were removed if they had an inpatient admission during the claim or a “red flag” diagnosis that may indicate treatment outside of guideline recommendations, such as fracture, cancer, infection, aortic aneurysm, and paralysis (S1 Table). Claims were excluded with stenosis diagnoses if they also had an accompanying surgical procedure (i.e., decompression, fusion, or adhesiolysis). Claims were also excluded if there had been a prior LBP claim to remove complicated clinical presentations due to LBP recurrences.” Gaspar FW, Thiese MS, Wizner K, Hegmann K. Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system. PLoS One. 2021 Jun 17;16(6):e0253268. doi: 10.1371/journal.pone.0253268. PMID: 34138937; PMCID: PMC8211224. [emphasis added]

Thus, the study should not be considered one that should be viewed in an expansive nature.   It was limited as many back problems were not addressed.  It only address uncomplicated back pain complaints.

What Did the Study Look at?

The workers were placed into categories concerning whether or not they received guideline treatment.   Likewise, there were categories in which they received no guideline treatment or no treatment at all. Gaspar FW, Thiese MS, Wizner K, Hegmann K. Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system. PLoS One. 2021 Jun 17;16(6):e0253268. doi: 10.1371/journal.pone.0253268. PMID: 34138937; PMCID: PMC8211224.

What Were the Study’s Results?

The results of the study were that “[w]hen workers received guideline-recommended interventions, they typically returned to work in fewer days. The majority of workers received at least one non-recommended intervention, demonstrating the need for adherence to guideline recommendations. Fewer lost workdays and improved quality care are outcomes that strongly benefit injured workers.”

The other result of interest was that “workers who received either no intervention or other medical interventions experienced more favorable outcomes than those who received non-recommended interventions”  This result suggests that alternative treatment or no treatment is better than non-recommended interventions.

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

Injured Workers are both evaluated and treated within the Workers’ Compensation System for their work-related complaints.  Workers suffering from back injuries will be physically examined in order to determine a proper diagnosis.

Lumbar Spine Physical Examinations require that the physician or examiner perform a variety of 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?

Physical Examinations are done by medical professionals 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 common 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 in a supine position. 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/

In sum, when an Injured Worker is sitting, 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 aborts 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 and not with 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 the process of making a comprehensive diagnosis.  Thus, the Injured Worker may be requested to participate in additional testing which can include 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, 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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