Post-Traumatic Stress Disorder is a Psychiatric Diagnosis that Injured Workers can receive as a result of exposure to workplace stress. In the California Workers’ Compensation System, both Insurance Companies and Employers are well aware of the serious consequences with PTSD injuries.   This includes the fact, Workers’ Compensation Laws include several Labor Code Sections that support Injured Workers making PTSD claims.

This article will discuss PTSD, workplace causes of PTSD, risk management approaches to PTSD, and Labor Code Sections that impact to PTSD claims.

What is PTSD?

“Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event. It is natural to feel afraid during and after a traumatic situation. Fear triggers many split-second changes in the body to help defend against danger or to avoid it. This “fight-or-flight” response is a typical reaction meant to protect a person from harm. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems may be diagnosed with PTSD. People who have PTSD may feel stressed or frightened, even when they are not in danger.” – National Institute of Mental Health

The Specific and Cumulative Nature of Stressors?

Workplace stressors causing PTSD vary temporally. They can occur in a specific manner such as a robbery.   They can occur in a cumulative fashion such an Employee being continually bullied in the workplace.

What Are the Causes of PTSD in the Workplace?

Workplace causes of PTSD can be broken into two categories. There is Workplace Stress and Traumatic Stressful Events.

What Workplace Stress can give rise to PTSD?

Workplaces stressors that can give rise to PTSD include supervisor relations, group morale and cohesion, administrative procedures, workload, shift duties, resources and internal personal conflict Post-traumatic stress disorder in occupational settings: anticipating and managing the risk Alexander C. McFarlane, Richard A. Bryant Occupational Medicine, Volume 57, Issue 6, September 2007, Pages 404–410,

What Traumatic Stressful events can give rise to work-related PTSD?

Traumatic stressful events that can occur in the workplace include mass disasters, serious accidents, threats or death and injury, deaths of colleagues, witnessing deaths, suffering and injury and assault. Post-traumatic stress disorder in occupational settings: anticipating and managing the risk Post-traumatic stress disorder in occupational settings: anticipating and managing the risk Alexander C. McFarlane, Richard A. Bryant Occupational Medicine, Volume 57, Issue 6, September 2007, Pages 404–410,

Why are Insurance Companies and Employers concerned about PTSD cases?

First, in the event of an obvious stressful event, i.e. a shooting in the workplace, Insurance Companies and Employers realize that the chances of having any legal defense to defeat such a claim is minimum. Therefore, their goal is to minimize the risk.

In other words, the most important goal for Employers and Insurance Companies is to minimize the expenses on the claim. Costs that can be minimized include medical treatment, temporary and permanent indemnity, future medical treatment, and vocational rehabilitation.

How is the Risk Managed in PTSD Cases?

It has been suggested that PTSD risk management should include screening, observation, and treatment. Post-traumatic stress disorder in occupational settings: anticipating and managing the risk Alexander C. McFarlane, Richard A. Bryant Occupational Medicine, Volume 57, Issue 6, September 2007, Pages 404–410,

What is Screening?

As part of Risk Management, there will be an attempt to screen Workers who may be at risk for PTSD.  It is noted that “Screening for psychological disorders is an effective strategy in workers who are at significant risk because of their levels of trauma exposure. Such a strategy involves identifying individuals at risk and screening them in the immediate aftermath and again approximately 6 months later.”  Post-traumatic stress disorder in occupational settings: anticipating and managing the risk Alexander C. McFarlane, Richard A. Bryant Occupational Medicine, Volume 57, Issue 6, September 2007, Pages 404–410,

Note: Screening presents problems. Are the individuals screening trained to do so?  Will the Employees react negatively towards this screening? Is it better that such screening be done by a medical provider provided through a workers’ compensation claim by some other means such as an EAP program?

What is Observation?

Risk Management suggest that Managers observe Workers who are at risk for PTSD.  They will be looking for things such as increased alcohol use, interpersonal and or family conflict, social withdrawal, depression, somatic distress and performance deterioration.  Supra.

Note:  Observation can be very problematic for Injured Workers.   Having suffered through a psychiatric disturbance is certainly enough for one person.   The notion that Management is tantamount to spying on the individual can add additional unnecessary paranoia and psychiatric symptomology to the already existing PTSD symptoms.

What is Treatment?

“The aim of effective treatment is to minimize these disabilities before they emerge.” Supra. Per Labor Code Section 4600, Injured Workers are entitled to treatment subject to a utilization review schedule and Independent Medical Review.

Note: Minimizing disabilities translates to lower costs on cases.  Effective treatment reduces the need for temporary disability, permanent disability, need for future care and need for vocational rehabilitation services. In the Workers’ Compensation System, however, Insurance Companies are slow to act and often deny both treatment and claim.

Why Are Post-Trauma Factors Important in Managing Risk?

As much as what happened to cause the PTSD, events that happen post injury can shape the course an Injured Worker’s claim.

“In the aftermath of the event, a range of factors can modify the recovery or escalate distress such as social support and stress that emerge in the aftermath of the event such as continued exposure to the distress of the victims or critical legal investigations of the circumstances of the event where blame is involved.” Post-traumatic stress disorder in occupational settings: anticipating and managing the risk Alexander C. McFarlane, Richard A. Bryant Occupational Medicine, Volume 57, Issue 6, September 2007, Pages 404–410,

In sum, what happens in the workplace or elsewhere after the PTSD event can have a profound impact on the claim.  Therefore, Risk Management principles dictate that Management should continue to view the workplace as an ongoing site of injury. Post Injury events can push individuals who were functioning over the edge and create profound disability.

What Labor Code Sections specifically address PTSD issues?

There are two Labor Code Sections that I view as specifically related to PTSD.

The first is the PTSD Presumption which applies to certain law enforcement and safety offices.   This is Labor Code Section 3212.15. For more information concerning this Presumption, click here. 

The second is the Labor Code Section which lowers the causative burden for stress claims which involve violent acts.  Labor Code Section 3208.3(b)(2) which provides that “  in the case of employees whose injuries resulted from being a victim of a violent act or from direct exposure to a significant violent act, the employee shall be required to demonstrate by a preponderance of the evidence that actual events of employment were a substantial cause of the injury”.[emphasis added]

Note: This was included due to the fact that those events described have a significant possibility of resulting in PTSD.   This section lowers the burden of causation from predominant cause (greater than 50 percent) to 35 to 40 percent for the Injured Worker.

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.




Many Workers, in the open labor market, work closely with animals.   These workers are at risk for unique Animal-Related Injuries. Additionally, there are Workers who work in areas where they are exposed to either dead animals or animal biproducts such as dander, urine or feces.  These exposures place Workers at risk for injuries as well.

Animal-Related Work Injuries can range from very minor to very serious.   Some can even result in the Worker’s death.

This article will discuss Animal-Related Work Injuries, what type of Occupations that are at risk for Animal-Related Work Injuries, what type of Animals are the sources of Animal-Related Work Injuries,  the various mechanisms of injury from Animal-Related Work Injuries, Labor Code Sections that may relate to Animal-Related Work Injuries, and Caselaw concerning Animal-Related Work Injuries.

How Are Animals Harmful to Workers?

Animals are harmful to workers in many ways.   “Live” Animals can pose risk of injury to workers.  “Dead” Animals can pose a risk of injury to workers.  Animal biproducts, such as dander, feathers, feces, and urine, can pose a risk to workers.  As a result, Workers are capable of sustaining Animal-Related Work Injuries without ever seeing or coming in contact with an animal.

Note: for the purposes of this article, the term “Animals” refers to Live Animals, Dead Animals and Animal biproducts.

What Occupations are at Risk for Animal-Related Work Injuries?

Animal-related Work Injuries impact both the Public and Private Sector Employees.

There are many Public Sector Employees who are at risk for Animal-Related Work Injuries. They include Animal Control Officers, Firefighters, Forestry Workers, Meter Readers, Mosquito District Employees, Police Officers, Postal Officers, and Utility Workers.  Are Animals Animals Animals Occupational Hazards? Occupational Hazards? Compensation and Working Conditions Fall 2000, P. 15.

There are many Private Sector Employees who are at risk for Animal-Related Work Injuries. They include Animal Caretakers, Animal Trainers, Butchers, Cattle Workers, Construction Workers, Dog Walkers, Farm Workers, Fisherman, Food Processors, Gardeners, Groundskeepers, House Sitters, Janitors, Jockeys, Laboratory Workers, Laborers, Landscapers, Machine Operators, Meat Cutters, Rodeo Riders, Slaughterhouse Workers, Transportation Workers, and Veterinary Technicians, and Veterinarians. Supra.

What Animals Can Cause Work-Related Injuries?

Practically every species of animal can be a source of an Animal-Related Work Injury.  Animals that can be a cause of include Arachnids, Bees, Birds, Bovine, Cattle, Chickens, Dogs, Ducks, Fire Ants, Fish, Geese, Hornets, Horses, Insects, Mosquitos, Rats, Reptiles, Rodents, Scorpions, Sheep, Snakes, Spiders, Swine, Ticks, Turkeys, and Wasps.

What Types of Injures Can be Animal-Related?

There is a wide variety of mechanisms of injury that can involve Animals.

Allergic Reactions: This can include Cats, Dogs and Horses for dander, Fish, Shellfish and Insects

Attacks: This can include Cows, Cattle and Dogs.

Bites: This can be from Cats, Dogs, and Insects

These bites can include venom. Bites can cause illness such as Lyme disease or Rocky Mountain Spotted Fever.

Exposure/Inhalation: Workers can experience respiratory diseases as a result of exposure to animal products, dust, pathogens or chemicals(pesticides/disinfectants.)See Occupational Health (M Friesen and K Applebaum Section Editors) Published: 10 December 2019 Recent Research on Occupational Animal Exposures and Health Risks: A Narrative Review Caroline Dignard & Jessica H. Leibler Current Environmental Health Reports volume 6, pages236–246(2019)

Falls: Workers can fall off of ladders when being distracted by insects or fowl.

Goring: This can occur in the rodeo settling.

Interference: This can occur during transportation.   For example, Animals on roads causing drivers to swerve or stop.

 Lifting: Certain Job tasks involve the lifting of both live and dead animals

Mechanical Interference:  Animals getting into machinery causing dysfunction. For example, Birds getting sucked into jet turbines.

Scratches: Cats

Dogs versus Cats: An Interesting Fun Fact

Dogs are three times power of a work hazard for nonfatal injuries than cats. Are Animals Animals Animals Occupational Hazards?  Compensation and Working Conditions Fall 2000, P. 15.

Are there Any Statutes that Assist Injured Workers with Animal-Related Injuries?

Yes. There are a variety of Labor Code Sections that can assist Injured Workers with Animal-Related injuries.

These include

LYME DISEASE:  There is a Lyme Disease Presumption for certain individuals. See Labor Code Section Labor Code Section 3212.12, which applies to certain Law Enforcement Officers and California Conservation Corp Personnel.  For a detailed article on the Presumption, click here.

WEST NILE VIRUS: There is a Blood-Borne Disease Presumption for certain individuals. See Labor Code Section 3212.8, which applies to certain Law Enforcement and Safety Officers.   For a detailed article discussing the Labor Code Section, click here

Is there Caselaw Involving Animal-Related Work Injuries?

Horse Related Injury: Hanrahan vs. California Horsemen’s Alliance, 2012 Cal. Wrk. Comp. P.D. LEXIS 578 (An injury of a worker being struck in the head by a horse that was moving.   The eye injury was considered to be a high velocity eye injury which then allowed for up to 240 weeks of total temporary disability.)

Lyme Disease: Kuhl vs. Orange County Fire Authority, 2016 Cal. Wrk. Comp. P.D. LEXIS 642 (Injured Worker sustained burden of proving industrially caused Lyme Disease and received a 100 percent award.)

West Nile Virus: Leggette vs. CPS Security, 2020 Cal. Wrk. Comp. P. D. Lexis 3, 85 C.C.C. 321 (Applicant was found to have injury work-related when he contracted West Nile Virus as a result of being bitten by mosquitos)

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.


Hearing Loss, if there is industrial contribution, can be grounds for a workers’ compensation claim.  A workers’ compensation claim, if successful, would allow the Injured Worker to claim monetary benefits, medical care, and vocational rehabilitation benefits.   For Hearing Loss cases, if medically indicated, the Injured Worker would be entitled to be supplied Hearing Aids as long as they are deemed medically necessary pursuant to Labor Code Section 4600.

Hearing Loss can be caused for a variety of reasons.  One of the sources is noise.  Definitionally, it is called “Noise Induced Hearing Loss.” (NIHL)

This article will discuss “Noise Induced Hearing Loss”, how “Noise Induced Hearing Loss” can be work-related, what Occupations are susceptible to hearing loss, and other possible causes for industrial hearing loss.

Is there a Historical Legal Basis for Work-Related Hearing Loss?

Caselaw has supported work-related hearing loss.   In Messner vs. IAC, (1962) 27 Cal. Comp. Cases 226 (writ denied) it is quoted “[w]hile the distinction between the etiological mechanics of continuous trauma and disease may be elusive in its application to a particular set of facts, there is a considerable difference in the legal consequences flowing therefrom. The Commission has long taken the position that hearing loss is an occupational disease. We do not believe that we can alter the theory to fit the facts.” [emphasis added]

How is Noise Induced Hearing Loss (NIHL) Caused?

Noise-induced hearing loss (NIHL) occurs when loud noise causes an irreversible damage of the cochlear hair cells of the inner ear. This can occur by exposure to either intermittent or continuous hazardous sounds.  Hazardous noise sound levels can occur when they exceed 85 decibels.

What Type of Doctor Addresses Hearing Loss?

The field of medicine that addresses hearing loss is Otolaryngology.  Doctors within the specialty focus on the ears, nose and throat.  There are referred to as Otolaryngologists or also known as ENT (Ear, Nose, and Throat) Doctors.

Are There Controversies with Respect to Work-Related Hearing Loss?

Yes. There are controversies with respect to hearing loss claims.   They include causation and disability.


An excellent example of an analysis of causation comes from the case of Kaiser Cement vs. WCAB (1986) 51 Cal. Comp. Cases 232 (Opinion Not Published.) The doctor opining non-industrial causation went through the following analysis. Bear in mind that this is a long analysis. While the WCAB did not side with this doctor, it clearly shows the depth and the analysis that will be done when a doctor evaluates a NIHL claim.

“The audiology report submitted by Dr. Billings noted noise exposure consisting  of use of rifles and 22-millimeter guns without hearing protection while applicant was in the Navy from 1942 to 1945, as well as noise exposure on the job at Kaiser Cement. Dr. Billings described the occupational noise exposure at Kaiser Cement as “Mill noise about 20% of the time while employed as a laborer by Kaiser Cement from 1966 to 1968 and about 50% of the time while employed as an electrician/oiler by Kaiser Cement from 1973 to 1979. [Applicant] was also exposed to conveyor belt noise, motor noise and fan noise while employed as a cooler tender by Kaiser Cement from 1968 to 1973 and he was exposed to noise from dozers, graders, scrapers and loaders while employed as a heavy equipment operator by Kaiser Cement from 1979 to 1984. [Applicant] did not wear ear protection from 1966 to 1973 but he did wear ear plugs whenever exposed to intense noise from 1973 on. Cement mill noise, conveyor belts, motors, fans and heavy equipment such as dozers, graders, scrapers and loaders can generate noise levels that are hazardous to hearing without the use of ear protection.”

Dr. Billings further reported nonoccupational noise exposure consisting of applicant’s recreational use of shotguns, rifles and pistols approximately 15 times between 1946 and 1984. Dr. Billings further noted that presbycusis (hearing loss due to normal aging) usually begins at about 45 years of age in males. Because the applicant was 58 years of age at the time of evaluation, Dr. Billings reported presbycusis as a causative factor related to his hearing loss. Dr Billings concluded, “It is most probable that at least a portion of [applicant’s] present hearing loss was caused by all of the above factors and that his noise exposure at Kaiser Cement was the major causative factor of the noise causative factors. It is also most probable that some other unknown medical factor caused a significant portion of [applicant’s] present hearing loss. This opinion is based on the fact that [applicant’s] present hearing loss is considerably more severe than would be expected from his noise exposure and presbycusis …. [M]ost employees who are exposed to intense occupational noise all day every day during a working lifetime of 21 years without wearing ear protection will not incure a hearing loss at 1,000 Hz and lower frequencies. In addition, it is generally accepted that a noise-induced hearing loss will reach a maximum level of about 70 dB HL, regardless of the number of years of exposure. Since [applicant’s] hearing loss in both ears exceed these criteria considerably, it must be concluded that some other medical causative factor is responsible for a significant portion of [applicant’s] present hearing loss in addition to his noise exposure and presbycusis. It is recommended that [applicant’s] hearing loss due to noise exposure be calculated as being 0 dB HL at 500 and 1,000 Hz and as being the maximum noise-induced hearing loss of 70 dB HL at 2,000 and 3,000 Hz in both ears. Using these levels in the AAO method for calculating percent hearing handicap …, [applicant] would have a 15% hearing impairment of the right ear, a 15% hearing impairment of the left ear and a 15% binaural hearing handicap. Using these levels for calculation gives [applicant] the benefit of the doubt since these levels are based on 21 years of full-time exposure to intense occupational noise without wearing ear protection while [applicant] was only exposed to noise about 20% of the time from 1966 to 1968 without wearing ear protection, he was exposed to noise all of the time (including many 12 to 18 hour days) from 1968 to 1973 without wearing ear protection and although he was exposed to noise from 1973 on (including many 16 hour days from 1979 to 1984), he wore earplugs during all of his noise exposure from 1973 on and he reported that the earplugs were effective in reducing the background noise levels.””


Hearing Loss becomes a Permanent Disability when the testing reaches a certain level. Currently, the AMA Guides for Rating Permanent Impairment, 5th Edition apply.

The following is an analysis of hearing loss that was made under the old non-AMA Permanent Disability Schedule.  This case provides insight as to how a doctor will make a no Permanent Disability assessment.  In Fleming vs. WCAB (1975) 40 C.C.C. 642, “Dr. Charles Lebo in his reports dated August 17, 1973 and September 24, 1974 indicated that Fleming had a minor bilateral high frequency hearing loss and that noise induced hearing losses are permanent, non-progressive, untreatable and non-disabling. Dr. Lebo also stated that the “regular use of approved ear protectors” would let Fleming continue to work in his regular occupation “without the risk of further noise-induced ear damage.””

What Types of Industries/Occupations are Subject to Hearing Loss?

There are various industries that can be subject to hearing loss claims.  They include industries such as agriculture, airline, construction, law enforcement, mining, oil railroad, refining, safety, textile, and trucking. See Occupational Noise-induced Hearing Loss MH Azizi Int J Occup Environ Med Vol 1, No 3 (2010)

Further, there are occupations like Dentists, Professionals, and Trucking that are at risk of NIHL.

Besides NIHL, Are There Other Occupational Sources of Hearing Loss?

Yes. There are other Occupational Sources of Hearing Loss.  Hearing Loss can be caused by ototoxicity. “Ototoxicity is, quite simply, ear poisoning (oto = ear, toxicity = poisoning), which results from exposure to drugs or chemicals that damage the inner ear or the vestibulo-cochlear nerve.” Vestibular Disorders Organization. “Many chemicals have ototoxic potential, including over-the-counter drugs, prescription medications, and environmental chemicals.” 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.


“To File or Not To File? That is the Question”

It is common knowledge that there are many work-related injuries that are not reported.   The lack of reporting denies the Injured Worker the opportunity to claim workers’ compensation benefits which may include disability benefits, medical care, and vocational rehabilitation benefits.

This article will discuss why both Employees and Employers don’t report work injuries claims. This article will also discuss whether there are times in which a claim should not be filed.

Why Is the Reporting of Work Injuries Important?

Pursuant to Labor Code Section 5402, a reporting of an injury triggers the obligation of the carrier to investigate liability for the claim and make a determination within 90 days.   Further, if the claim is not denied, a presumption of injury can apply.   Further, during the period of delay, the Applicant is entitled to receive medical care paid for by the carrier up to $10,000.00.

How Significant is Under-Reporting?

In the study, “[a] questionnaire and interview survey was administered to 110 workers performing similar tasks and several managers, health, and safety personnel at each of three industrial facilities. Although less than 5% of workers had officially reported a work-related injury or illness during the past year, over 85% experienced work-related symptoms, 50% had persistent work-related problems, and 30% reported either lost time from work or work restrictions because of their ailment. Workers described several reasons for not reporting their injuries,” . Under-reporting of work-related disorders in the workplace: a case study and review of the literature Pransy, Snyder, Dembe & Himmestein Pages 171-182 | Published online: 06 Dec 2010

Note: In the study, significantly more Workers may have viable claims than those who report injuries.

Why Do Employees Under-Report Their Work-Related Injuries?

In a recent article, Employees reasons for not reporting injuries was discussed. Under-reporting of work-related disorders in the workplace: a case study and review of the literature Pransy, Snyder, Dembe & Himmestein Pages 171-182 | Published online: 06 Dec 2010 The reasons for the under-reporting were as follows: including fear of reprisal, a belief that pain was an ordinary consequence of work activity or ageing, lack of management responsiveness after prior reports, and a desire not to lose their usual job.

Fear of Reprisal: Note: Injured Workers are afraid that their Employers or Co-Workers can act in a negative fashion towards them if they report an injury.   Injured Workers are afraid that their pay, benefits, and work privileges and rights will be impacted.   Co-Workers can also be adversarial towards the Injured Worker if they are implicated in the injury claim. For example, they might be the cause of the injury claim as they may have stressed out or injured the worker.  Also, the Co-Workers may be a witness to the injury. The Co-Workers may not be happy that they are brought into the claim and have to make a statement against their Employer.   Note: Labor Code Section 132a protects Injured Workers and Employee Witnesses to claims.

A Belief that Pain was an Ordinary Consequence of Work Activity or Ageing: Note: Individuals with limited knowledge of medicine may not understand that certain medical conditions may be work-related.   This may be compounded by the fact that the Worker may not have sought treatment or medical care to be diagnosed with a condition.

Lack of Management Responsiveness After Prior Reports Note: Many times, injuries are reported and managers do nothing.  At that point, an Injured Worker just gives up.

 Desire Not to Lose Their Job Note: Certain Work Injury claims can impact one’s ability to work. Medical treatment or reporting may generate work restrictions that would preclude them from performing their job.   Also, there is the fear that they will be terminated for filing a claim.  Note: Labor Code Section 132a protects Workers against wrongful termination for reporting of a claim.

One reason not mentioned in the survey was

Worker not aware of their Rights to Claim Work Injury Note: Many workers are not aware of their workers’ compensation rights. Also, there are some injuries can be work-related that an Injured Worker would not know that they are work-related.

Why Do Employer’s Under Report Employees’ Work-Related Injuries?

In the article, it noted that “interviews with management representatives revealed administrative and other barriers to reporting, stemming from their desire to attain a goal of no reported injuries, and misconceptions about requirements for recordability.” Supra.

Desire to Attain a Goal of No Reported Injuries Note: Workers’ Compensation claims cost Employers money due to increased premiums.   For self-insured Employees,  there can be increased reserves because of claims.   In sum, work injuries cost Employers money.

Misconceptions about Requirements for Recordability Note: some Managers or Leads may not understand that what a work injury is and therefore not offer paperwork to the Injured Worker to file a claim.

Should an Injured Worker Report a Claim?

One should take thoughtful consideration when deciding whether to filing a claim.   They should think about whether it is worth filing the claim.  They should think about the implications in the workplace, and they should think about whether there is a medical/legal basis for filing the claim.  Consultation with an attorney is recommended to make the determination.   Further, a medical consultation might be of import as to whether there is industrial causation of the medical problem.

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.


Many occupations are susceptible to work injuries.  One of these occupations is that of a Dental Hygienist.  More specifically, Dental Hygienists are at risk for musculoskeletal disorders (MSDs.)  This has been recognized by the California Department of Public Health (CDPH.)

This article will discuss the occupation of Dental Hygienist, how Dental Hygienists are at risk for musculoskeletal disorders, and caselaw of interest.

What is a Dental Hygienist?

Per the American Dental Association(ADA), a Dental Hygienist is a licensed position which varies from state to state.  Note: The practice of dental hygiene in California is regulated by the Dental Hygiene Board of California.

The tasks of Dental Hygienists can include “patient screening procedures; such as assessment of oral health conditions, review of the health history, oral cancer screening, head and neck inspection, dental charting and taking blood pressure and pulse, taking and developing dental radiographs (x-rays), removing calculus and plaque (hard and soft deposits) from all surfaces of the teeth, applying preventive materials to the teeth (e.g., sealants and fluorides), teaching patients appropriate oral hygiene strategies to maintain oral health; (e.g., tooth brushing, flossing and nutritional counseling), counseling patients about good nutrition and its impact on oral health, making impressions of patients’ teeth for study casts (models of teeth used by dentists to evaluate patient treatment needs,)[and] performing documentation and office management activities.”

Dental Hygienists can work in a variety of locations.   This locations include Dental Offices.  This can include Dental Offices of General Practitioners as well a Specialty Practitioners’ Offices such as Periodontics and Pediatric Dentistry.

Dental Hygienists also may work at Public Health Agencies, Hospitals and Community Health Clinics. They can work for public school systems, dental schools and dental hygiene educational programs.  Dental hygiene services can be performed in hospitals, nursing homes, prisons and public health clinics.

Note: Activities of interest involve the activities in which the patient is in the dental chair and the Dental Hygienist is performing services upon them.

What Are Musculoskeletal Disorders (MSD)?

Per the Centers for Disease Control and Prevention (CDC), Musculoskeletal disorders (MSD) are injuries or disorders of the muscles, nerves, tendons, joints, cartilage, and spinal discs.

What Types of Musculoskeletal Injuries Do Dental Hygienists Sustain?

Dental Hygienists are susceptible to a multitude of musculoskeletal disorders.  Upper Extremity problems are common.  These upper extremity diseases or conditions include tendonitis, tennis elbow, and carpal tunnel syndrome.

Has There Been Any Caselaw Concerning Dental Hygienists with Cumulative Trauma Musculoskeletal Injuries?

Yes. In Barnes vs. WCAB (2013) 78 C.C.C. 1137 (writ denied), the case involved a Dental Hygienist who suffered a cumulative trauma musculoskeletal injury to her neck and back.  In the matter, there was a dispute as to whether there was also an aggravation of an underlying fibromyalgia and chronic fatigue syndrome.  In the case, there was a finding of industrial causation for those body parts.

Are Musculoskeletal Disorders for Dental Hygienists a Concern for the State of California?

Yes.  The State of California is concerned over the risk of injury for Dental Hygienists. The State recommends ergonomics programs in order to promoted a safe and efficient workplace.

What Are Ergonomics?

Per OSHA,  “ [w]orkers in many different industries and occupations can be exposed to risk factors at work, such as lifting heavy items, bending, reaching overhead, pushing and pulling heavy loads, working in awkward body postures and performing the same or similar tasks repetitively. Exposure to these known risk factors for MSDs increases a worker’s risk of injury.

Work-related MSDs can be prevented. Ergonomics — fitting a job to a person — helps lessen muscle fatigue, increases productivity and reduces the number and severity of work-related MSDs.”.

Are There Ergonomic Tools for Dental Hygienists?

Yes. The State of California offer videos designed for Dental Hygienists.  Here is the link.

There are videos which include topics such posturing and position, use and choice of instruments and body strengthening.

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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