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.

WORK-RELATED ROTATOR CUFF SHOULDER INJURIES, SURGERY, AND RETURN TO WORK: SHOULDERS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Shoulders are at risk of industrial injury and are subject to many workers’ compensation claims.  The shoulder is a complex body part. As a result, there are variety of medical treatments that can be applied.  One type of shoulder injury is to the rotator cuff.  Rotator cuff tears account for over 4.5 million annual physician visits due to rotator cuff tears in the United States .Rotator cuff tears are one of the most common forms of upper extremity injury in the workers’ compensation population. Gutman M J, Patel M S, Katakam A, et al. (March 31, 2021) Understanding Outcomes and the Ability to Return to Work After Rotator Cuff Repair in the Workers’ Compensation Population. Cureus 13(3): e14213. doi:10.7759/cureus.14213.  One form a treatment for rotator cuff injuries is surgery.

This article will discuss shoulders, rotator cuff surgeries, and a recent study concerning rotator cuff surgeries.

What Types of Surgeries Can Be Performed on Shoulders?

 There are a variety of shoulder surgeries that are available.   Shoulder surgeries include rotator cuff tear, total shoulder arthropathy and reverse shoulder arthropathy.  Surgery choice is based upon the nature of the injury and what needs to be repaired.

What is the 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

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

Does Occupation Matter with Respect to Rotator Cuff Surgeries?

Per the study, “the majority of patients with workers’ compensation claims have excellent outcomes from rotator cuff repair. Those patients that returned to work were more likely to work as non-laborers, had better functional scores and greater satisfaction with their treatment. Patients with three tendon tear repairs demonstrated worse functional outcomes than small full-thickness tendon repairs.” Gutman M J, Patel M S, Katakam A, et al. (March 31, 2021) Understanding Outcomes and the Ability to Return to Work After Rotator Cuff Repair in the Workers’ Compensation Population. Cureus 13(3): e14213. doi:10.7759/cureus.14213.

In sum, occupations such as clerical staff will have better results and happiness from the surgery versus physical laborers.  Generally, laborers are individuals that work in the construction field, do warehouse work, and do heavy work.

What Were the Study Results with Respect to Dominant versus Non-Dominant Hand?

Yes. The study “found that patients who did not RTW [return to work] had a higher frequency of rotator cuff tear in the dominant arm. This was especially evident when looking at patients who held labor-intensive occupations that required use of their upper extremities. In general, laborers were less likely to return to work than non-laborers (p = 0.032), but when they had sustained a dominant arm injury, the ability to RTW [return to work) was decreased even further in 90% of laborers with non-dominant cuff tears able to return to work compared to only 54% of laborers with dominant arm cuff tears.” Gutman M J, Patel M S, Katakam A, et al. (March 31, 2021) Understanding Outcomes and the Ability to Return to Work After Rotator Cuff Repair in the Workers’ Compensation Population. Cureus 13(3): e14213. doi:10.7759/cureus.14213.

Is Rotator Cuff Surgery Generally Successful with Respect to Injured Workers’ Return to Work?

The study found “the majority of patients achieved excellent functional outcomes and the ability to return to work. Gutman M J, Patel M S, Katakam A, et al. (March 31, 2021) Understanding Outcomes and the Ability to Return to Work After Rotator Cuff Repair in the Workers’ Compensation Population. Cureus 13(3): e14213. doi:10.7759/cureus.14213.

Is Pain a Factor?

Yes, per the study, “shoulder function and shoulder pain scores were highly predictive of ability to RTW [return to work.] Patients who returned to work had significantly higher shoulder satisfaction and shoulder function.” Gutman M J, Patel M S, Katakam A, et al. (March 31, 2021) Understanding Outcomes and the Ability to Return to Work After Rotator Cuff Repair in the Workers’ Compensation Population. Cureus 13(3): e14213. doi:10.7759/cureus.14213.

Do the Number of Tears Operated on Matter?

Yes. Per the study, “three tendon tears have been shown to have the highest rate of re-tear rate and worse functional outcomes. In the current study, while size of tear (p = 0.12) was not predictive of ability to RTW [return to work], patients with three torn tendons experienced the lowest rates of returning to work and the worst functional outcomes.” Gutman M J, Patel M S, Katakam A, et al. (March 31, 2021) Understanding Outcomes and the Ability to Return to Work After Rotator Cuff Repair in the Workers’ Compensation Population. Cureus 13(3): e14213. doi:10.7759/cureus.14213.

What Does This Study Mean for Injured Workers?

Insurance Companies may use this study to make assessments on an injured Workers’ ability to return to work.  Specifically, Injured Workers who are laborers who injured had their dominant shoulder operated on will likely have return to work difficulties.

Insurance Companies may be encouraged to authorize additional post-surgical therapy if there are signs of functional improvement.  Functional improvement plays an important factor on   return to work issues.

Insurance Companies will be concerned in rotator cuff shoulder surgeries involving three tears.  Carriers may approach these cases with the view that they may be problematic for both return to work issues and for future medical care needs.

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.

ARE INJURED WORKERS SATISIFIED WITH THEIR INDUSTRIAL MEDICAL TREATMENT?  QUALITY WORK-RELATED MEDICAL CARE AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

“I Can’t Get No, Satisfaction”

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California Industrial Medical Treatment is controlled by the Labor Code. Thus, it differs from both traditional Private Medical Care as well as Government Programs such as Medicare and Medicaid.

Industrial medical care is part of a risk management system designed to provide cost-cutting elements with respect to providing the service.

Researches have looked into Injured Workers’ satisfaction with respect to their treatment.

This article will discuss Injured Worker’s satisfaction with their medical treatment.

What is Industrial Medical Care?

In California, Industrial Medical Treatment is guided by the Labor Code.   The Labor Code contains various treatment limitations.

Medical Control is one limitation. Insurance Company Managed Provider Networks limit the doctors that Injured Workers can choose.

Medical treatment is limited by utilization review of medical treatment requests.  These utilization reviews can deny treatment that does not follow the set algorithms and schedules.

What Is Private Medical Care?

Private Medical Care can come from a variety of sources. There is cash payment in where there is a direct provider patient relationship.  There are personal insurance policies for which the individual purchases the policy directly from the medical insurance company.  Finally, there is employer provided health insurance policies.

What is Medicare?

Per the SSA, “Medicare is [the U.S]… health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare, too, including those with disabilities and those who have permanent kidney failure.

The program helps with the cost of health care, but it does not cover all medical expenses.”

What Is Medicaid?

Per Medicaid.gov, Medicaid programs [are] designed to provide health coverage for low-income people. This program is separate from Medicaid.

Can Injured Workers have Multiple Insurance Coverages?

Yes. Injured Workers can have multiple coverages at the same time.   It is possible that an Injured Worker can have private coverage, medicare and workers’ compensation at the same time.  For Injured Workers with low income and are on social security disability, they may have medicare, medicaid, and workers’ compensation at the same time.

What was the Study’s Overall Finding? Were There Other Findings?

The study found that “that Workers’ Compensation status is independently associated with dissatisfaction with health care compared with other primary payer groups.” Compton J, Glass N, Fowler T. The Effect of Workers’ Compensation Status on the Patient Experience. JB JS Open Access. 2019;4(2):e0003. Published 2019 Jun 11. doi:10.2106/JBJS.OA.19.00003

The study, however, had other findings of interest as well.

Workers’ Compensation treatment rated lower than Private Insurance and Medicaid.   It did, however, rate at about the same level of satisfaction as Medicare. Compton J, Glass N, Fowler T. The Effect of Workers’ Compensation Status on the Patient Experience. JB JS Open Access. 2019;4(2):e0003. Published 2019 Jun 11. doi:10.2106/JBJS.OA.19.00003.

With respect to mental health issues, workers’ compensation treatment, satisfaction was rated lower than private insurance.   It was however comparable to both Medicare and Medicaid patients. Compton J, Glass N, Fowler T. The Effect of Workers’ Compensation Status on the Patient Experience. JB JS Open Access. 2019;4(2):e0003. Published 2019 Jun 11. doi:10.2106/JBJS.OA.19.00003.

There was one area in which there was some higher level of satisfaction with respect  to industrial medical treatment.   This was when the treatment included surgical authorization.  Patients with Workers’ Compensation who were scheduled for a surgical procedure were more likely to be satisfied with their care.  Patients with surgical authorization have higher levels of satisfaction.  Compton J, Glass N, Fowler T. The Effect of Workers’ Compensation Status on the Patient Experience. JB JS Open Access. 2019;4(2):e0003. Published 2019 Jun 11. doi:10.2106/JBJS.OA.19.00003

What Can Be Done to Improve Care Injured Workers’ Satisfaction?

This author believes that the following items may improve the level of satisfaction of industrial medical care.   First, expanded Managed Provider Networks with more doctors to choose from.  Second, improvement of the utilization review process to allow for greater authorization of treatment.

As noted above, Injured Workers are happy when there are results that occur as part of the treatment.  This is shown in their level of satisfaction with respect to surgical authorization.

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.

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

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, 2nd 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 thatAlthough 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?

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.

 

 

 

 

 

INJURED WORKERS WAKE UP! CARRIERS AND EMPLOYERS HAVE OTHER GOALS THAN YOU: RISK MANAGEMENT AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Injured Workers need to know that the workers’ compensation system is a risk management system. Therefore, it is important to understand the nature of a risk management system.  Insurance Companies and Employers may take actions on your claim and your employment.  Therefore, understanding risk management may allow you take measures to protect yourself.

Risk Managers compile information and techniques which allow them to limit costs with respect to workers’ compensation claims.

Injured Workers and Workers should have a general understanding risk management within a work injury context. Risk Managers’ approaches in workers’ compensation claims may unfortunately impact an Injured Worker’s treatment or benefits.

This article will discuss the various factors that Risk Managers consider as important and what areas that they will address as cost-savings measures.

What Is Workers’ Compensation?  How Is It Related To Risk Management?

Workers’ Compensation was created to be insurance program that manages work injury losses or costs for employers.  The system is designed with the context that businesses and employers can be able to cover the employee injury risk and no go broke.  In other words, a work injury claim should be something that can be affordable and not bankrupt a business.

Work Injury losses and costs include indemnity payments, transactional costs such as adjusting and legal costs, and medical treatment costs.  Further, employers and insurers are also concerned with respect to reserves. Reserves are monies that are set aside to pay the expected costs on a claim.

What Is Risk Management?

Risk Management is a field which addresses aspects of insurance and loss.   Thus, with respect to industrial injuries, Risk Managers focus on both injury reduction and injury prevention.

Part of the injury reduction component includes limiting the nature and extent of injuries as well as the attending costs for the claim. This can include reducing indemnity payments as well as medical treatment.

Part of Risk Management is the ability to predict outcomes.   Therefore, knowledge of past claims and past results lays the foundation as to how to approach future claims.

What Are the Methods of Risk Management?

Risk Management methods include safety training, control banding, protective equipment safety guards, safety mechanisms on machinery, and safety barriers. Also, analyzing causes by using root cause analysis may help reduce future injury. Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Some aspect of risk management can include workplace inspection.

What Is Risk Management’s View of the Sources of Occupational Injuries?

Risk Managers need to know what can cause injuries in the workplace.  Occupational injuries can result from physical, biological, chemical, or psychosocial hazards. Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Thus, Risk Managers may have a goal of controlling these hazards.  In doing so, this can lead to loss prevention with respect to work injury claims.

Thus, Risk Managers may implement workplace training, rules, and regulations.

What Is Risk Management’s View as to the Types of Work Exposures That Can Cause Injury?  

Risk Managers see a variety of exposures that workers encounter in the workplace that are causative towards injuries.  Unlike sources of injury, exposures are ones that are in fact injurious in nature.  These include “noise, temperature, insect or animal bites, aerosols, blood-borne pathogens, hazardous chemicals, radiation, and occupational burnout.” Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Thus, Risk Managers may control the amount of worker’s exposure to these items or events to prevent work injury claims.

What is Risk Management’s View as to Common Sources of Injury?

“Many injuries still occur due to poor ergonomics, manual handling of heavy loads, misuse of equipment, general hazards, and inadequate safety training.” Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Thus, Risk Managers, to prevent injury, may implement of ergonomic work stations, training and rules for properly lifting and safety training.

What is Risk Management’s View as to the Common Types of Injuries?

“Slipping or tripping, which causes a fall are common work-related injuries, accounting for 20% to 40% of disabling occupational injuries.”  Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Further, it should be noted that orthopedic injuries tend to be the most common medical specialty that is employed to treat industrial injuries.

What is Risk Management’s View as to the Parts of the Body Get Injured?

The most common injury is to the Upper Extremities.  They represent 50 percent of workplace injuries.   Hearing Loss also accounts for a significant amount of occupational injury claims.  Further, needle sticks are also a source of injuries as well. Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Thus, Risk Managers may impose rest breaks, ergonomics, hearing testing, hearing protections, and proper disposal of needles to prevent work injuries.

What Is Risk Managements’ View of Age?

A Worker’s age can statistically have value to Risk Managers.

Statically, “[a]ge is perhaps the most common personal factor that predisposes a person to an increased risk of work-related injury. Workers aged 65 years and older are more likely to suffer from occupational injuries compared to their younger occupational counterparts.” Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Additionally, older workers can make them ”at higher risk for hearing loss, visual impairment, and the use of multiple prescription medications that are linked to higher rates of work-related injuries.”

In sum, Risk Management, although there are laws against age discrimination, may be focused on the tasks that older workers perform.

Does Risk Management Have a Concern with Respect to Occupations?

Yes.  Certain occupations for which there are higher rates of work injuries.  In particular, the occupations with high rates of include farming, fishing, forestry, construction and manufacturing.  Supra.

What is Risk Management’s View with Respect to Testing Proving or Disproving Claims?

Risk Managers rely on traditional work-ups by medical providers to assess work injury claims.

The work-ups include the taking of a comprehensive history and a physical examination. Also,  a diagnostic workup should be considered. This diagnostic work-up can include, but is not limited to, radiographs, ultrasound, and advanced imaging modalities.

Risk Managers, however, have concerns with respect to MRIs.  It is noted that “while the use of magnetic resonance imaging (MRI) is often helpful in delineating the actual clinical pathology, providers should remain cognizant of the potential for overdiagnosis and the potential for treating a potentially incidental finding that is not the primary source of a patient’s current debilitating condition.” [emphasis added]

Note: This passage shows notes that allowing for medical testing can open a Pandora’s Box of liability.  An incidental finding on a MRI can lead to a claim being amended for additional body parts.

Further, it is noted that “MRI has been demonstrated previously in the literature to its known limitations in the appropriate clinical setting. For example, a 2010 study reported on the inconsistent diagnostic accuracy of wrist MRIs being obtained to identify the potential source(s) of ulnar-sided wrist pain.” Supra.

Further, “a 2017 study analyzing work-related injuries consistent with unilateral knee or shoulder injury and subsequent bilateral MRI studies being performed during the diagnostic evaluation reported that less than half of patients had degenerative and/or pathologic findings that would be considered worse than the contralateral, asymptomatic, “normal” side.”

Note: This research is Risk Management propaganda concerning MRIs.  The issue is treating symptomatic disabling body parts.  The fact that an asymptomatic body part with pathology is present should not create excuse.

What Is Risk Management’s View on Treatment?

Risk Managers view treatment with a two-fold perspective.  In the treatment setting, there is the opportunity to treat the injury. Also, there is the opportunity to analyze the work-relatedness of the claim. This can include an assessment as to the value of the claim.

“Each work-related injury is different. Thus, providers should first establish whether the injury is preexisting, directly or indirectly related to the patient’s occupational requirements and if the claim is considered to fall under the workers’ compensation system.” Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Risk Managers note that “[t]reatment is specific to the specific condition and may include pain management modalities, physical therapy, NSAIDs, injections, and surgery.  It is important to recognize that each patient presenting with occupational-related injuries should be managed on an individual basis as not all conditions are created equal.”   This is position is true.   This position is not however adhered to during the course of workers’ compensation treatment.

Risk Managers limit claims exposure by asking providers to limit their evaluations and treatment.  This can be done by limiting authorization to treat certain body parts or what treatment will be authorized.

What Is Risk Management’s View on Surgery?

Surgeries are not necessarily viewed as beneficial from a Risk Management perspective.

“The literature supports many different types of clinical encounters the potential disparity with respect to postoperative outcomes comparing work-related injury patients compared to their non-work counterparts.”

“For example, total joint replacements are, in general, consistently reproducible procedures that yield excellent outcomes in the vast majority of patients. However, when comparing occupational-based (or workers’ compensation) patients to non-workers’ compensation control patients via matched cohort or comparative studies, the literature demonstrates the potential for a comparably inferior outcome in the former.” Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238.

Thus, Risk Managers may have some fear and trepidation as to authorizing surgeries due to the fact that there is the anticipation that the results may not be optimum.  As a result, Risk Managers may scrutinize and resist requests for surgery.

What Is the Risk Management’s View of Case Settlement?

Risk Managers have a concern with respect to the future medical costs. This is especially the cases with respect to older workers. It is noted that “the synergistic combination of the older population falling at work, in addition to the older population’s predisposition to these low-energy injuries, sets up the potential for an overall devastatingly morbid effect on the entire healthcare system.” Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238. The Risk Management perspective to include nurse practitioners as part of the diagnosis progress.

This perspective indicates that there may be an increased sense of urgency to settle older workers’ case.   This is due to the fact of the possible high medical exposure costs.   Further, Risk Managers may desire to avoid placing older workers in work setting in which they may be subject to trip and fall injuries.

What Is Risk Management’s View on Obtaining a Medical Diagnosis?

“All healthcare providers are encouraged to manage these patients individually in order to ensure the best possible outcomes.”  Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. 2020 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29262238. Nurse practitioners were included as part of the providers who could make the medical diagnosis. Supra.

As a representative of Injured Workers, it is my contention that diagnosis and treatment of Injured Worker should be the purview of medical doctors.  They should be the one making the diagnosis and not nurse practitioners.   The reliance on nurse practitioners is solely a cost savings measure, Improper or inadequate diagnosis by a nurse practitioner can lead to delay in a achieving a proper medical diagnosis.  This improper or inadequate diagnosis can lead to delays in both proper treatment and return to work. Therefore, while reliance on lower level practitioners for diagnosis of a condition may be perceived as cost-cutting, it may not actually be more costly in the long run.

What Is Risk Management’s View Concerning “Return-to-Work?”

Yes. Risk Managers recognize that there are “return to work” issues for Injured Workers. I attended a lecture on this issue.  The speaker noted that every day that an Injured Worker missed as a result of their injury impacted on the probability that the worker would return to their usual and customary job.

Thus, Risk Managers acknowledge that an Injured Worker returning to work can have a profound impact on both their workers’ compensation case and the Injured Worker’s employment.

Thus, there may be some instances where Insurance Companies and Employers may encourage early return to the workplace.  This can be done via offers of alternative or modified work.

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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