FINGERTIP INJURIES AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Upper Extremity Injuries are very common in an occupational setting.  Upper Extremity Injuries can include injuries to the fingertip.  Fingertip injuries can involve an amputation.

In the general population, “[i]t is estimated that as many as 45,000 finger amputations are performed in the US per year with an incidence rate of 7.5/100,000 people.” Kawaiah A, Thakur M, Garg S, Kawasmi SH, Hassan A. Fingertip Injuries and Amputations: A Review of the Literature. Cureus. 2020;12(5):e8291. Published 2020 May 26. doi:10.7759/cureus.8291

This article will discuss Fingertip Injuries, causes of fingertip injuries, treatment for fingertip injuries, a special workers’ compensation law with respect to amputation cases, and issues relating permanent disability.

What is the Fingertip? Why is It Unique?

 Fingertips are unique. “The tip of the digit comprises virtually all tissue components present elsewhere in the body: skin, bone, joint, synovial membrane, ligaments, tendons, tendon sheaths, arteries, veins, lymphatic channels, nerves, and advanced nervous end organs.” Kawaiah A, Thakur M, Garg S, Kawasmi SH, Hassan A. Fingertip Injuries and Amputations: A Review of the Literature. Cureus. 2020;12(5):e8291. Published 2020 May 26. doi:10.7759/cureus.8291

Thus, a traumatized tip can experience a variety of symptoms.  These symptoms and factors of impairment can include tenderness, sensitivity to cold, discoloration, and deformity.   Kawaiah A, Thakur M, Garg S, Kawasmi SH, Hassan A. Fingertip Injuries and Amputations: A Review of the Literature. Cureus. 2020;12(5):e8291. Published 2020 May 26. doi:10.7759/cureus.8291

What Are Common Causes of Fingertip Injuries?

Many occupational hand injuries involve metal items.  The metal items can include hand tools which include blades.  On a personal note, I have had fingertip injuries occur on table saws in which safeties have been removed.  Also, I  have had fingertip injuries in which the hand accidentally went into a piece of moving machinery.

Fingertip injuries can also occur as a result of sharps.   Sharps are devices that are used to cut.  These include many items used in the medical field such as auto injectors, connection needles and sets, infusion sets, lancets, needles, and syringes.

Sharp injuries can result in lacerations, amputations, or neurovascular injuries. Kawaiah A, Thakur M, Garg S, Kawasmi SH, Hassan A. Fingertip Injuries and Amputations: A Review of the Literature. Cureus. 2020;12(5):e8291. Published 2020 May 26. doi:10.7759/cureus.8291

 What Are Goals of Treatment?

 Treatment goals for fingertip injuries include restoration of sensation of the tip, improving the durability of the tip, and providing for proper bone support to allow for nail growth. Kawaiah A, Thakur M, Garg S, Kawasmi SH, Hassan A. Fingertip Injuries and Amputations: A Review of the Literature. Cureus. 2020;12(5):e8291. Published 2020 May 26. doi:10.7759/cureus.8291

What Problems Can Arise from a Fingertip Injury?

Problems arising from fingertip injuries can include deformities, intolerance to cold, skin tenderness, stiffness, and long-term functional loss. Kawaiah A, Thakur M, Garg S, Kawasmi SH, Hassan A. Fingertip Injuries and Amputations: A Review of the Literature. Cureus. 2020;12(5):e8291. Published 2020 May 26. doi:10.7759/cureus.8291

How Is a Fingertip Injury Treated?

Due to the complexity and importance of the fingertip, there are many issues that can present.  There are concerns with respect to psychological factors that can present with such injuries.

Also, there may be issues of pain syndromes that can occur as a result of a fingertip injury.  These pain syndromes can even occur in the case of minor contusion. Approach to Fingertip Injuries Patricia Martin-Playa, MD, Anthony Foo, MD* Clin Plastic Surg 46 (2019) 275–283 https://doi.org/10.1016/j.cps.2019.02.001

Treatment can include repairing the skin by stiches or glue, skin grafting, reconstruction, composite grafts, flap reconstruction, bone graft, nail complex reconstruction.

Are There Psycho-Social Factors Issues with Fingertip Injuries?

Yes.  Fingertips are an extremely important part of the body.  They are used frequently during the day for a variety of tasks. Fingertip injuries can impact one’s occupation and their participation in hobbies.  For example, a fingertip injury may impact on one’s ability to perform a musical instrument.

Fingertips are usually visible to the public.  Therefore, there can be an emotional impact on the patient.

Fingertip injuries that are part of a workers’ compensations have secondary motivation issues. For instance, the patient may have concerns about disability status and impairment.

Fingertip injuries can be subject to clinical bias. For example, medical practitioners may view the severity of the injury differently from the patient. Approach to Fingertip Injuries Patricia Martin-Playa, MD, Anthony Foo, MD* Clin Plastic Surg 46 (2019) 275–283 https://doi.org/10.1016/j.cps.2019.02.001

Is There a Special Law for Amputation Cases?

Yes. In the case of amputations, total temporary disability benefits are extended out to 240 weeks from 104 weeks.  This is pursuant to Labor Code Section 4565(c)(3)(c.)

What Type of Permanent Impairment Can Arise from A Fingertip Injury?

Fingertip injuries can cause many types of impairments.  There are impairments that relate to amputations, there are impairments that relate to skin conditions, there are impairments that relate to nerve damage, there are impairments which relate to loss of function such as range of motion.  Also, there may be a pain impairment add-on.

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.

 

OCCUPATIONAL PNEUMONITIS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

There are a variety of lung diseases that may have occupational components.   One of these lung diseases is Pneumonitis.  If a Worker succumbs to Pneumonitis, and there is an occupational component as to its cause, they would be able to file and pursue a workers’ compensation claim to obtain medical treatment and monetary benefits for their lung condition.

This article will discuss Pneumonitis, how it can be work-related, and a discussion of various caselaw that addressed issues relating to the disease.

What Pneumonitis? Is It the Same as Pneumonia?

Pneumonitis is a medical condition which involves the inflammation of lung tissue.

The medical disease Pneumonia is essentially a subset of Pneumonitis.  It is an inflammation of the lungs caused by an infection.

What Are the Symptoms of Pneumonitis?

Symptoms of Pneumonitis can include difficulty breathing and a dry, nonproductive, cough. If the condition progresses to Chronic Pneumonitis, symptoms can also include fatigue, loss of appetite and unintentional weight loss. Mayo Clinic.

Are There Degrees of Pneumonitis?

Yes. There are varying degrees of Pneumonitis.  The degrees are Acute, Subacute and Chronic.

Pneumonitis is very serious.  If it goes unnoticed or untreated can cause irreversible lung damage.

What Tests and Treatments are there for Pneumonitis?

Pneumonitis is a complex medical condition. Therefore, a thorough evaluation by a specialist is recommended.  This specialist will conduct the physical examination and order testing.

The testing with respect to Pneumonitis can include blood tests, bronchoalveolar lavage (BAL), chest x-rays, computed tomography (CT), inhalation challenge tests lung biopsies, lung function tests, and precipitin tests.  Mayo Clinic.

How Is Pneumonitis Diagnosed?

Diagnosis of the condition can be complicated. It can take a long time to diagnose. In writing this blog, this matter must be deferred to a specialist without further comment.

The diagnosis of HP in general remains often challenging as there is no gold standard test and the diagnosis is made from a combination of procedures. In addition, the diagnosis of OHP requires ascertaining the work relatedness of the disease with a high level of confidence. A multidisciplinary approach, including clinicians, radiologists, pathologists, and occupational physicians/hygienists, is strongly recommended to improve the diagnosis of OHP, as demonstrated for IPF  Quirce S, Vandenplas O, Campo P, Cruz MJ, de Blay F, Koschel D, Moscato G, Pala G, Raulf M, Sastre J, Siracusa A, Tarlo SM, Walusiak-Skorupa J, Cormier Y. Occupational hypersensitivity pneumonitis: an EAACI position paper. Allergy. 2016 Jun;71(6):765-79. doi: 10.1111/all.12866. Epub 2016 Mar 11. PMID: 26913451.

What is Occupational Hypersensitivity Pneumonitis (OHP)?

“Based on the key features of the disease that were outlined by previous authors 411 and the EAACI nomenclature for allergic diseases 12, the following consensus definition is proposed: ‘OHP is an immunologic lung disease with variable clinical presentation and outcome resulting from lymphocytic and frequently granulomatous inflammation of the peripheral airways, alveoli, and surrounding interstitial tissue which develops as the result of a non‐IgE‐mediated allergic reaction to a variety of organic or low molecular weight agents that are present in the work environment’. Quirce S, Vandenplas O, Campo P, Cruz MJ, de Blay F, Koschel D, Moscato G, Pala G, Raulf M, Sastre J, Siracusa A, Tarlo SM, Walusiak-Skorupa J, Cormier Y. Occupational hypersensitivity pneumonitis: an EAACI position paper. Allergy. 2016 Jun;71(6):765-79. doi: 10.1111/all.12866. Epub 2016 Mar 11. PMID: 26913451.

What Is the Treatment for the Condition?

Treatment for some medical conditions is not just medical care.

In the case of Pneumonitis, one of the forms of treatment is avoidance of harmful exposure.   This can include the removal of causative substances, the replacement of products that have the causative substances, changes in work that will avoid exposures to the causative substances, and avoidance in general of known sources of the causative substances.

Treatments can include corticosteroids or other immunosuppressants. Treatment can include oxygen therapy, bronchodilators, opioids, and lung transplants.  Mayo Clinic.

In viewing the range and scope of treatments, it is fair to say that Pneumonitis should be viewed as a serious medical condition.

What Are the Causes of Pneumonitis? What Are Occupational Causes of Pneumonitis?

Common causes of pneumonitis include airborne irritants at your job or from your hobbies. In addition, some types of cancer treatments and dozens of drugs can cause pneumonitis.

With respect to work-related exposure, “A large number of occupational agents/antigens have been described as potential causative agents of HP in a wide variety of occupations. These offending agents can be classified into six broad categories that include bacteria, fungi, animal (glyco) proteins, plant (glyco) proteins, low molecular weight chemicals, and metals (Table 2). Using a quantitative structure–activity relationship (QSAR) model, it was found that chemicals causing OHP tend to have a higher predicted asthma hazard, are more lipophilic, and are more likely to be protein cross‐linkers than those causing occupational asthma .” Quirce S, Vandenplas O, Campo P, Cruz MJ, de Blay F, Koschel D, Moscato G, Pala G, Raulf M, Sastre J, Siracusa A, Tarlo SM, Walusiak-Skorupa J, Cormier Y. Occupational hypersensitivity pneumonitis: an EAACI position paper. Allergy. 2016 Jun;71(6):765-79. doi: 10.1111/all.12866. Epub 2016 Mar 11. PMID: 26913451.

What Types of Occupations That Are At Risk of Pneumonitis?

The following are occupations that may be at risk for the disease: aircraft industry, animal feeding, bagasse workers [slaughterhouse], bird breeders, ceramic workers, cheese workers, chemical and polyurethane industry, compost workers, cork workers, cosmetic industry, dental technicians,  farmers, florists, food processors, hard metal workers, humidifiers, laboratory workers, maple bark strippers, malt workers, mushroom workers, painters, paprika slicers, pearl industry, peat moss processors, pharmaceutical industry, plastic industry, plastic workers, potato riddlers, seaweed workers, smelters, stucco workers, textile workers, tobacco growers, wine makers, wood workers, and yacht manufacturing. Quirce S, Vandenplas O, Campo P, Cruz MJ, de Blay F, Koschel D, Moscato G, Pala G, Raulf M, Sastre J, Siracusa A, Tarlo SM, Walusiak-Skorupa J, Cormier Y. Occupational hypersensitivity pneumonitis: an EAACI position paper. Allergy. 2016 Jun;71(6):765-79. doi: 10.1111/all.12866. Epub 2016 Mar 11. PMID: 26913451.

Is There An Alternative Theory of Industrial Causation for Pneumonitis?

Yes.  Radiation treatment has been considered as a source of this disease.

Treatment for an industrial injury can give rise to a work injury claim.   Thus, if there is a work-related medical condition that involves radiation treatment, they may possibly be able to pursue a claim.   This may be the case with cancers such as lung or breast.

Is There Any Caselaw Concerning Pneumonitis?

Yes.  There have been a variety of cases with respect to the disease.

The pneumonia presumption for safety and law enforcement officers was found to not apply in the case of pneumonitis.  As noted above, pneumonia is a subset of the disease.

Pneumonitis was found work-related for a meat cutter.  The WCAB panel determined that the applicant developed compensable hypersensitivity pneumonitis while working as a meat cutter. See Costco Wholesale Corp vs. WCAB (2010) 75 C.C.C. 1187 (writ denied.)

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 JOINT POWERS INSURANCE AUTHORITY: WORKERS’ COMPENSATION INSURANCE COVERAGE FOR GOVERNMENT AGENCIES: WHAT YOU NEED TO KNOW

The State of California provides for Private industry and Government Entities a variety of ways in which they can fulfill their commitment to maintain workers’ compensation coverage for their workers.  One of the entities that assists Government Entities provide workers’ compensation coverage is the Joint Powers insurance Authority (JPIA.)

While Injured Workers are entitled to benefits in accordance with workers’ compensation law, it is important to know who is providing the coverage.  This knowledge provides insight as to how the claim will be managed and how a settlement may occur.

This article with discuss what is the Joint Powers insurance Authority and how the JPIA is involved with workers’ compensation coverage.

What is the Joint Powers Insurance Authority?

The Joint Powers Insurance Authority is a Risk Management Entity.  The JPIA was formed to fill the needs for public agencies to handle their risk obligations.  For public agencies with employees, one of their risk obligations is workers’ compensation.

In addition to the Authority, the Joint Powers members have associations which may lobby on their behalf to impact workers’ compensation legislation.

How Does the Joint Powers insurance Authority Provide Workers’ Compensation Coverage?

Per the JPIA, “[t]he California JPIA provides workers’ compensation coverage that offers members two options: the primary workers’ compensation program and the excess workers’ compensation program.”

What Is a Primary Workers’ Compensation Program?

A primary workers’ compensation program would provide coverage and administration in the adjustment of workers’ compensation claims. JPIA members will generally use a third-party administrator to adjuster their claims.

What is An Excess Workers’ Compensation Program?

Excess Workers’ Compensation Insurance is coverage that covers costs that exceed a set point.   This set point of excess is to be determined by the insurance.  It can be for payments exceeding $500,000.00 or $1,000,000.00.   The coverage can be capped. The coverage can even be unlimited.  Excess coverage protects the employer in the event of a catastrophic case.  Additionally, an employer can purchase multiple policies to cover various levels of excess amounts.

Note: My personal experience is that excess carriers can be difficult and resist in contributing to settlements of cases.   There have been many times in which the employer is at odds with their excess carrier on the issues of settlement.

How Extensive is the JPIA?

JPIA is quite extensive. There are a number of agencies which employ their services.   JPIA indicates that they have more than 100 public agencies have partnered with them.  Also, the agencies employing JPIA include small, single-purpose entities to cities to special districts.

What Are The Core Values of JPIA?

Per their website, there core values are “Integrity: We hold ourselves to the highest ethical and professional standards. We pledge to fulfill our duties and deliver on our commitments; Excellence: We pursue distinction with a passion. We proactively assess our performance and strive to continuously improve programs, services, and work product;  Innovation: We foster creativity as we explore opportunities and meet challenges; Teamwork: We pursue productive relationships through communication, collaboration, understanding, and respect.”

Note:  The Core Values are all about risk management.  There is no mention of any values directly related to workers’ compensation and the treatment of injured workers.

How Do I Know My Claim Is Being Handled via JPIA?

If you work for a government agency, there is the possibility that JPIA may be involved in your case.   Further, JPIA may not be administering the claim.   It will most likely be a third-party administrator.   On your claim correspondence, however, there may be a reference to JPIA.

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.

 

 

HIGH-HEELED SHOES AND MUSCULOSKELETAL INJURIES AT WORK: CLOTHING APPAREL CAUSING ORTHOPEDIC INJURIES: WHAT YOU NEED TO KNOW

On the Job, Workers can get injured as a result of their attire. High-Heeled Shoes have long been considered as a possible source of work place injuries.  Injuries from High-Heeled Shoes can occur in a variety of ways and impact a multitude of parts of the body.

This article will discuss High-Heeled Shoes, the theories of industrial causation of High-Heeled Shoe related injuries, and injuries caused by High-Heeled Shoes.

What Are High Heeled Shoes?

High-Heeled Shoes are footwear in which the heel is farther off of the ground in comparison with the toe. They are considered aesthetically appealing and are commonly worn in professional settings.   As a result, many women wear them in the workplace. The alternative type of shoe is called a “flat.”

What Types of Medical Conditions Can High Heeled Shoes Cause?

There are High Heeled Shoe injuries which relate to those wearing them.  With these type of shoes,  there are issues concerning falls, issues concerning the impact on the prolonged use on the foot, and issues concerning the biomechanics of gait on other parts of the body.  Thus, physical injuries from shoes can range from toe to head.  Specific conditions caused by the footwear usage include hallux valgus and osteoarthritis.  Barnish MS, Barnish J High-heeled shoes and musculoskeletal injuries: a narrative systematic review BMJ Open 2016;6:e010053. doi: 10.1136/bmjopen-2015-010053

Many pathologies are associated with wearing high heel shoes mainly in the lower extremity including blisters, callosities, heel spur, bunions (hallux valgus) in the feet which is mainly due to the altered ankle joint axis and altered arch angle, pain in the calf muscle, knee and hip joint. Younus SM, Ali T, Memon WA, Qazi A, Ismail F. High heel shoes; outcome of wearing in young generation: a cross sectional study. Professional Med J 2014;21(4): 798-803.

Also,  similarly the spine is also adversely affected resulting in back pain which is mainly due to exaggerated spinal flexion. Younus SM, Ali T, Memon WA, Qazi A, Ismail F. High heel shoes; outcome of wearing in young generation: a cross sectional study. Professional Med J 2014;21(4): 798-803.

There has been study concerning women wearing high heel shoes in department store in which hallux valgus deformity was found more common in those workers than those who wore flat shoes. Soemarko DS, Rahmasari F, Kamal AF, Cahayadi SD. Hallux valgus among sales promotion women wearing high heels in a department store. Journal of Orthopaedic Surgery. January 2019. doi:10.1177/2309499019828456  It was noted that “The long duration of work with wearing high heels puts more pressure on the metatarsal, which increases the risk of HV” Supra.

What is the Legal Theory That Makes High Heel Injuries Industrial?

The legal theory behind most High Heel injury claims is that workers’ compensation is a “no-fault” system. Thus, a person’s decision to wear high heels at work is not necessarily of import.  The issue is more that the high heels were in fact worn and work and it was the wearing at work which was the cause of the physical condition.  Thus, the work activities which wearing the shoes is of import. See US Airways vs. WCAB (2002) 67 C.C.C. 1243 (writ denied.) Applicant was found to have left foot injury due to continuous trauma of having to wear high heels on the job. Applicant had a medical-legal opinion that supported it.

Secondary High Heel Injuries? Bystander Injuries?

Besides injuries to the workers wearing high heels, This can include being injured as a result of a first party fall, being stepped on by a high heel shoe, and being assaulted by a pair of high heels. Barnish MS, Barnish J High-heeled shoes and musculoskeletal injuries: a narrative systematic review BMJ Open 2016;6:e010053. doi: 10.1136/bmjopen-2015-010053

What Would be the Controversies in Such Injuries?

In matters involving High Heels, case analysis will focus on the usage of the shoes in the workplace.   If a cumulative trauma injury is alleged, an analysis will be done as to the nature and extent of the shoe usage in the workplace.   Likewise, there will be an inquiry as to the nature and extent of the usage of the shoes outside of work.

What Is I am Having Problems?

It is recommended that you seek medical attention.  An opinion indicating that the usage of the shoes in the workplace is a causative factor towards one’s musculoskeletal disorder, then a workers’ compensation clam should be considered.

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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