AMPUTATIONS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Amputations can be a life-changing event for a Worker.  Workers may lose their ability to perform their job as well as perform activities of daily living.

The Workers’[ Compensation Community is concerned about amputation cases as they involve  extensive medical costs and missed time from work.

This article will discuss amputations, special laws concerning amputations, and interesting data derived from a recent study.

What Is an Amputation?

The Workers’ Compensation Appeals Board defined amputation.  In Cruz vs. Mercedes Benz, 72 C.C.C. 1281 (Panel Decision), the WCAB indicated “ Defining amputation as the severance or removal of a limb, part of a limb, or other body appendage comports with the ordinary meaning, and includes the range of potentially compensable scenarios, including both traumatic loss of a body part in an industrial injury and surgical removal during treatment. This definition conforms to our understanding of the common meaning of the term “amputation,” which encompasses external projecting body parts, not internal parts, even if they include bone. It is also consistent with the definitions in the International Dictionary of Medicine and Biology, Dorland’s Illustrated Medical Dictionary, and Stedman’s Medical Dictionary. To the extent that some definitions refer to organs, appear to encompass all body parts, or include an equivocal “etc.,” we reject them or interpret them in a manner consistent with our understanding of the term “amputation.”

Thus, surgery on a lumbar disc was found not to constitute an amputation.

Why Is an Amputation Important in California Workers’ Compensation?

An amputation in a workers’ compensation case triggers entitlement to additional periods of total temporary disability. 240 weeks is allowed in the case of amputations. Labor Code Section 4656.  In these cases, there is no requirement that the temporary disability period be connected to the amputation. Jon Van Ness, Applicant v. Barbara Herzstein, 2007 Cal. Wrk. Comp. P.D. LEXIS 239 (Panel Decision)

How Do Amputations Occur on an Industrial Basis?

Occupationally related amputations can occur for many reasons.  The accident itself can be the source of the amputation, i.e. a skill saw cutting off a finger.  They can result of a crush injury which necessitates an amputation. They can be the result of post-surgical infection.  They can be the result of an industrially related disease process such as diabetes.

Interesting Amputation Facts Are:  

Males vs. Females

Men sustain most of the work-related amputations.  (84.8%) Gomez NG, Gaspar FW, Thiese MS, Merryweather AS. Trends in incidence and correlation between medical costs and lost workdays for work-related amputations in the State of California from 2007 to 2018. Health Sci Rep. 2021 Jul 1;4(3):e319. doi: 10.1002/hsr2.319. PMID: 34250271; PMCID: PMC8247939.

Full-Time vs. Part-Time Employees

Full-Time Employees were more likely to sustain amputation versus Part-Time Workers. (71.7%.) Supra.

Most Amputated Parts

Most claims consisted of partial-hand amputations (82.0%).  Most of those were partial-hand amputations, 66.7% were fingers without the loss of the thumb. Following partial-hand amputations, partial-foot amputations were the next most common claim  at 5.9%.  Supra.

Type of Business

Manufacturing is the industry with the highest number of claims (24.1%.) Supra.

What Should an Injured Worker Take from This Study?

The study noted that “[a]mputations represent high medical costs and number of lost workdays.” Gomez NG, Gaspar FW, Thiese MS, Merryweather AS. Trends in incidence and correlation between medical costs and lost workdays for work-related amputations in the State of California from 2007 to 2018. Health Sci Rep. 2021 Jul 1;4(3):e319. doi: 10.1002/hsr2.319. PMID: 34250271; PMCID: PMC8247939.

Due to the increased medical expense and missed time from work, Insurance Companies will make efforts to control the costs.  They may do so by employing a Defense Counsel as well as a Nurse Case Manager.

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.

HEALTH CARE WORKERS, SOCIAL SERVICES WORKERS, AND CALIFORNIA WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Work injuries are often studied based upon sector and occupation. Studies can impact how workers are trained and treated.  Health Care Workers and Social Assistance Workers were recently studied in the article “Occupational Injuries in California Health Care and Social Assistance Industry”  2009 to 2018.”  Kerri Wizner, Fraser W. Gaspar, Adriane Biggio, Steve Wiesner 06 June 2021 https: //doi.org/10.1002/hsr2.306

The study addressed a large variety of health care occupations including nurse, aides, assistances, service staff, administrative staff, and technicians. The study looked at the different healthcare facilities including hospitals, residential care sites, and social services providers.

The article will discuss the study’s data, conclusions and impact on Health Care Workers.

What Was the Study’s Purpose?

The study looked at injury prevention workforce health, and injury-related cost savings. Supra.

Thus, a typical risk management agenda was addressed.  In short, questions such as “what facilities have problems with work injuries?”, “what occupations have problems with work injuries?”, and “what type of work activities cause work injuries?” are addressed.

What Are the Injury Rates of Import in the Health Care and Services Fields?

Sex: Women sustain the majority of work injuries.   The data showed that “the majority of injuries were sustained by women (78.1%), with three-quarters of cases affecting individuals aged 32 to 53 years.”  Supra.  Note: This may relate to two factors.  A greater amount of women working in the field.  Also, women may have greater physical challenges of dealing with large or immobile patients.  As noted in the study, lifting was found to be a significant source of injury.

Facilities:  The injury rates differed in each industry subgroups.   Hospitals had the highest number of claims with Ambulatory Care, second, Nursing Care, third. The Social Assistance Group had the least claims.  Supra. Note: Hospitals are often less specialized that nursing care facilities.  Thus, there are more tasks and more activities performed in a non-ergonomic fashion in a hospital.  Likewise, there may be far more activity. Thus, the data is logical.

Occupation: Health care and social assistance settings each have a different proportion of job types, given the variety of health services offered. … Across all settings within California, nurses had the highest proportion of injuries (22.1%), followed by aides/assistants (20.4%), services staff (13.2%), administrative staff (11.0%), and technicians (10.3%). The highest proportion of injury occurred in nursing jobs in hospitals (32.2% vs 3.2%-20.6%), aides/assistants in nursing/residential care sites (40.2% vs 12.1%-16.7%), and social services in social assistance settings (40.6% vs 3.2%-8.0%).”  Supra. Note: This finding is not surprising as the largest percentage of injuries are reported within the most physically challenged positions.

Types of Injuries: There was an analysis of the types of Injuries reported. The study reported “[s]trains and tears (defined by the State of California as an injury of the muscle or the musculotendinous unit13), were the most common injury, representing 34.4% of all claims, followed by contusions (11.0%), sprains (injury to ligaments) (10.0%), other specific injuries (9.6%), and puncture wounds (7.7%). These injury types were similar across the industry sub-groups apart from ambulatory care, which had a higher proportion of puncture wounds than other settings (14.1% vs 3.4%-5.9%, respectively).”  Note: Most of the injuries were of a musculoskeletal nature.  The other concern in the healthcare setting is puncture wounds which can be caused by sharps and needles.

Activities Causing Injury: There was an analysis concerning what activities caused the work injuries.  The study found “[a]cross all settings, lifting injuries (10.8%) and strains NOC (9.1%) were the most common causes of injury, followed by miscellaneous NOC causes (6.6%), repetitive motion (6.0%), and injury due to being struck accidentally or on purpose by a fellow worker, patient, or other person (5.9%).”

Parts of the Body Injured:  There are an analysis concerning which body parts were most frequently injury.  Per the study, ”[t]he low back was the most frequently injured body part, representing 13.6% of all claims; followed by multiple body parts (12.8%), finger(s) (9.1%), shoulder(s) (6.8%), and knee(s) (6.1%). Nursing/residential care settings reported the highest proportion of both lifting injuries (15.8% vs 8.9%-9.9%) and low back injuries (16.9% vs 10.0%-13.1%) as compared to the other settings.” [emphasis added] Note: Most body parts injured are within the musculoskeletal systems.

Ambulatory care:

The rates for ambulatory care employee injuries were found to be increasing. Supra.  Note: Ambulatory care relates to outpatient centers.   Many hospital patients are moved to rehabilitation centers to begin the rehabilitation process.  These settings can require patients to begin performing physical activities in a weakened state.  Thus, there are significant injury risks for assisting workers.

What May Result from This Study?

The main findings were the high rates of injury in both the hospital setting as well as for ambulatory care employees.    Extra safety and training measures may likely be implemented to lower the injury rates with the setting and within the employee class.

What If I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

THE “STRAIGHT LEG” TEST: INJURED WORKERS BEING EXAMINED FOR WORK INJURIES AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

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

Lumbar Spine Physical Examinations require that the physician or examiner perform a variety of physical tests.  One of these tests is the “straight leg.”

This article will discuss the “straight leg” test, what it means for a back condition, and what it means for Industrially Injured Workers.

Who Conducts Lumbar Spine Physical Examinations?

Physical Examinations are done by medical professionals in the capacity of Treaters,  Qualified Medical Evaluators, and Agreed Medical Evaluators.

Specialties conducting physical examinations for the spine may include Chiropractors, Neurologists, Neurosurgeons, Nurse Practitioners, Occupational Medicine Doctors, Orthopedic Surgeons, Physical Medicine Doctors, Physician Assistants, Osteopaths, Primary Care Physicians, and Sports Medicine Doctors.

What is the Common Back Complaint Relevant to the “Straight Leg” Test?

The common back complaint, relevant to the straight leg test, is back pain which radiates down one or both lower extremities.  The symptoms can include numbness in the lower extremities.

Are There Other Names for the” Straight Leg” Test?

Yes. The straight leg test has different names.   This includes the names “Lasegue Test” and the “Straight Leg Raise Test.”

How is the Straight Leg Test Performed?

“The straight leg raise test is performed with the patient in a supine position. The examiner gently raises the patient’s leg by flexing the hip with the knee in extension, and the test is considered positive when the patient experiences pain along the lower limb in the same distribution of the lower radicular nerve roots (usually L5 or S1).” Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539717/

In sum, when an Injured Worker is sitting, the examiner will take the worker’s leg and raise it upward.

What Makes a Positive Straight Leg Test?

“[A] positive straight leg raise test is determined when pain is elicited by lower limb flexion at an angle lower than 45 degrees. During the test, if the pain is reproduced during the leg straightening, patients usually request that the examiner aborts the maneuver and by flexing the patient’s knee, the buttock pain is usually relieved(Figure 1).”  Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539717/

Based upon a review of many medical reports, I have seen Injured Workers have positive straight leg findings with one examiner and not with others.  Thus, in my opinion there is some variability concerning results.

What Is the Aim of the Straight Leg Test?

The straight leg test may indicate whether there is a “sciatic compromise due to lumbosacral nerve root irritation.” Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539717/

It should be noted, however, that “there are multiple causes of a positive test such as facet joint cyst or hypertrophy.” Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539717/

If the Test is Positive, What Will Happen?

If a test is positive, there is the possibility of nerve root irritation and possible entrapment.  The positive straight leg test is simply the beginning of the process of making a comprehensive diagnosis.  Thus, the Injured Worker may be requested to participate in additional testing which can include MRI testing, CT scans, X-Rays, and Nerve Conduction Studies.

In sum, a positive finding suggests the need for additional testing to rule out a herniated disc.

What Does a Positive Straight Leg Test Mean for Injured Workers?

For Injured Workers, a positive straight leg test will trigger the examiner to consider ruling out the possibility of a herniated disc injury in the lumbar spine. Thus, a thorough assessment will require additional testing to occur via imaging studies and nerve testing. A positive test may trigger a referral to an orthopedic surgeon or neurosurgeon.

What If I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

 

DUPUYTREN’S DISEASE(DD) AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Dupuytren’s Disease (DD) is an upper extremity disorder.   DD has been a source of controversy with respect to whether it should be considered as an industrial injury. If DD is considered an industrial injury, then the Injured Worker suffering from the disorder would be entitled to workers’ compensation benefits. These would include medical treatment and disability compensation.  A recent study addressed industrial causation of the condition and made interesting findings.

This article will discuss Dupuytren’s Disease (DD), industrial causation for DD, the study’s results, and what it means to Injured Workers.

What Is Dupuytren’s Disease (DD)?

Dupuytren’s disease (DD) results in “the chronic contracture of the fourth and/or fifth finger of the hand towards the palm and is usually accompanied by a thickening of the palmar skin. These clinical manifestations significantly impair and restrict hand functioning.” Murínová L, Perečinský S, Jančová A, Murín P, Legáth Ľ. Is Dupuytren’s disease an occupational illness? Occup Med (Lond). 2021 Feb 6;71(1):28-33. doi: 10.1093/occmed/kqaa211. PMID: 33420499.

Why is Dupuytren’s Disease Important for Workers’ Compensation?

Per mayoclinic.org, “Dupuytren’s contracture can make it difficult to perform certain functions using your hand. .. as Dupuytren’s contracture progresses, it can limit your ability to fully open your hand, grasp large objects or to get your hand into narrow places.”  These activities are both labor disabling and can impact the performance of activities of daily living. Thus, DD can be the basis for impairment within workers’ compensation and would therefore translate into a permanent disability percentage.

In sum, if DD is work-related, it is likely an injury for which a permanent disability award is possible.

What Work Activities Did the Study Find That Impact DD?

There are two types of work activities that have been implicated as a source of causation for industrially-related DD.   They are working with vibrating tools and performing heavy manual labor.

There are many tools used in the work force that vibrate.   For example, jackhammers and power saws. The study used involved workers who used hand-held pneumatic rock drills.

Heavy manual labor can take place in various occupations. Heavy labor that was used  in the study was working involving “prolonged, heavy, physical labour that required strength and energy, and included lifting, lowering, pulling, pushing or carrying a load.”

The theory behind these two types of activities is that they can cause cumulative micro-traumas which then can cause impairment of the micro-circulation in the hands. Murínová L, Perečinský S, Jančová A, Murín P, Legáth Ľ. Is Dupuytren’s disease an occupational illness? Occup Med (Lond). 2021 Feb 6;71(1):28-33. doi: 10.1093/occmed/kqaa211. PMID: 33420499.

It was noted that risk was 4-fold for vibrating tools and 3-fold for heavy manual labor compared to controls. Supra.

“A significant independent association was found between DD and HTVs (OR 4.59; 95% CI 2.05–10.32) and HMW (OR 3.10; 95% CI 1.21–7.91).” Supra.

In the Study, Was the Length of Time Performing the Injurious Activities Significant?

Yes.  They study found the length of exposure to be significant.   This was especially the case when there was at least 15.5 years of employment. “Exposures that lasted for more than 15.5 years were sensitive and specific predictors for the presence of DD.” Murínová L, Perečinský S, Jančová A, Murín P, Legáth Ľ. Is Dupuytren’s disease an occupational illness? Occup Med (Lond). 2021 Feb 6;71(1):28-33. doi: 10.1093/occmed/kqaa211. PMID: 33420499.

In the Study, Did Age Matter?

Yes.  The study noted “[w]hile DD was more common in older patients, it was much more frequent in exposed subjects compared to controls across all age categories.” Murínová L, Perečinský S, Jančová A, Murín P, Legáth Ľ. Is Dupuytren’s disease an occupational illness? Occup Med (Lond). 2021 Feb 6;71(1):28-33. doi: 10.1093/occmed/kqaa211. PMID: 33420499.

Is There Any Limitation to the Study?

Yes. The study was limited to only men.  Thus, additional studies beyond this one would assist is a female injured worker making a DD claim.  Murínová L, Perečinský S, Jančová A, Murín P, Legáth Ľ. Is Dupuytren’s disease an occupational illness? Occup Med (Lond). 2021 Feb 6;71(1):28-33. doi: 10.1093/occmed/kqaa211. PMID: 33420499.

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.

 

HOME HEALTHCARE WORKERS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Home Healthcare is an important field in California.  Many individuals require in-home services for a variety of medical conditions.  Home Healthcare Workers (HHCW) can be employed in a variety of ways including through the State.

This article will discuss Home Healthcare Workers, their tasks, and the occupational risks of HHCWs.

What Are Home Healthcare Workers? 

Per the United States Department of Labor, “[h]ome healthcare workers provide hands-on long-term care and personal assistance to clients with disabilities or other chronic conditions. These workers, who may be home health aides, personal/home care aides, companions, nursing assistants or home health nurses, are employed in patients’ homes and in community-based services such as group homes.”

What Tasks Do They Perform?

“Depending on their training and job duties, they help patients with activities of daily living such as meals, bathing, dressing and housekeeping, and may perform clinical tasks such as medication administration, wound care, blood pressure readings and range of motion exercises.”  USDL

What are The Home Healthcare Hazards?

Home Healthcare Workers are subject to a large variety of hazards.  They include bloodborne and biological pathogens, latex sensitivities, ergonomic hazards, violence, hostile animals, dangerous conditions and unhygienic conditions.

How Do These Problems Occur?

Bloodborne and Biological Pathogens: This can include saliva, urine and feces.  These can occur while performing injections or changing bags such as urostomy bags.

Latex Sensitivity: This can arise out of the use of gloves. Glove use can result in contact dermatitis.

Ergonomic Hazards:  This can arise from working at a patient’s home which is not set up in an ergonomic fashion.  For example, lifting may be required in an awkward position.

Violence: This most commonly arises in patients that suffer from dementia.  They have the capacity to act out in a violent fashion.  This can include being bitten, kicked, pinched, punched, scratched, or shoved.

Hostile Animals: This most commonly relates to aggressive family pets who may bite or jump on workers.  Additionally, they can be tripping hazards as well.

Dangerous Conditions: These conditions can arise from physical defects on the premises as well as exposures to drug residues, infectious agents and cleaning chemicals..

Unhygienic Conditions: Unlike hospitals, home settings may not have proper disposal of biological waste. This can result in transmission of pathogens.

Travel: Home Healthcare Worker may service more than one patient in a day.  Thus, there duties may include travel from one location to another

Environmental Hazards: This can include second-hand smoke, exposure to asbestos, exposure to lead paint and exposure to allergens such as dust and mold.

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 28 years. Contact us today for more information.

 

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