Body shop workers in Great Britain are being encouraged to do more to protect themselves when paint spraying, as new research suggests some are putting themselves at risk of developing asthma.

A report by the Health and Safety Executive (HSE) into the use of two-pack paints containing isocyanates has identified that, while practices have improved greatly in recent years, there are still a number of areas of concern. (WCxKit)

HSE estimates that vehicle spray painters are 80 times more likely to develop occupational asthma than the average worker in the UK because they fail to take the correct precautions.

Visits to 30 motor vehicle repair body shops and telephone surveys with 500 body shops found some sprayers and managers remain unaware of the link between breathing in isocyanates contained within the invisible spray mist and developing occupational asthma.

"Occupational asthma destroys careers and lives. We appreciate that sprayers work to tight deadlines and time pressures, but they should not be gambling with their health. We will use this research to ensure we're working with industry in the most effective way to help reduce the risk to workers." (WCxKit)

Posted in Medical Cost Containment & Managed Care, WC in Other Countries (International) |

The lawsuit, according to the EEOC,  says the hospital prohibits Filipino staff from speaking Tagalog (or other Filipino languages) while allowing non-Filipino employees to speak other languages, such as Spanish. (WCxKit)

The lawsuit was filed in the U.S. District Court, Eastern District of California (EEOC v. Central California Foundation for Health d/b/a Delano Regional Medical Center, Case No. 10-CV-01492-LJO-JLT ), after efforts to reach a pre-litigation settlement failed. The suit seeks monetary relief in the form of compensatory and punitive damages, and an injunction against future discrimination. (WCxKit)

Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with industry employers to reduce workers compensation costs. Her clients includes airlines, healthcare, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: RShafer@ReduceYourWorkersComp.com  or 860-553-6604.
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Posted in California Workers Comp, EEOC Discrimination Laws |

 

 

 

Posted in Litigation Management |

When workers compensation injuries result in damage to the musculoskeletal parts of the body, it is often necessary for the treating physician to send the injured employee to a physical therapist. Physical therapy, also known as physiotherapy, is a type of medical service design to develop, maintain or restore the employee's normal body movements.

 

When an employee injures a limb or joint, or has surgery on a limb or joint, the treating physician will often recognize the employee's range of motion is limited, or the functioning of the limb or joint is below what it was prior to the accident or surgery. The injury has created an abnormal condition within the employee's body making it difficult for the employee to do normal tasks. The goal of the physical therapist is to assist the employee in regaining prior functioning level. A side benefit of this is often a reduction in pain from the injured body part.

 

With workers compensation claims, the injured employee is normally dealing with a physical therapist who specializes in working with muscles, tendons, ligaments, bones and joints. Other physical therapist specialist who could treat workers comp injuries may specialize in skin problems resulting from burns or wounds, or nerve injuries and related muscles, or breathing and lung problems.

The primary treating physician will have a working relationship with various physical therapist in the local area. The physician will recommend the physical therapist best suited for the type of injury the employee has. The physical therapy will be conducted in an out-patient clinic setting.

 

Depending on the severity of the injury and the need for physical therapy, the physician will prescribe the expected amount of physical therapy treatments the employee may need. The request for treatment will state something like three treatments per week for five weeks.

 

During the first visit to the physical therapist, the therapist will review the injury information provided by the physician, the amount of care the physician is prescribing and then determine a treatment plan to address the employee's needs. The treatment plan can include improving flexibility, endurance, strength, coordination and balance.

 

Usually the first step for the therapist is to introduce therapy designed to reduce swelling, stiffness or pain. The actual physical therapy sessions can include various modules of care. The initial modules can include water hydrotherapy, ultrasound, electrical stimulation, heat packs and cold packs. These are normally followed by stretching, walking, weight lifting and various types of exercise. The physical therapist will often teach the employee exercises to be done at home that are specifically designed for the employee type of injury.

 

In addition to the various modules of care provided by the physical therapist, the therapist will create a total treatment plan. This will include educating the employee on how to avoid re-injury and in how to avoid injury caused by repetitive motion. The best physical  therapists incorporate into their treatment plan not only the physical treatment, but also the psychological and emotional support needed by the injured employee.

 

 
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©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact  Info@WorkersCompKit.com.

Posted in Coordinating Medical Care, Medical Issues |

The 45-year-old man injured his wrist in 2005. For various periods between 2005 and 2009, he presented medical certificates to ACC certifying him as unable to resume any work duties. As a result he received weekly compensation to replace lost earnings. (WCxKit)

ACC General Manager Claims Management Denise Cosgrove welcomed the successful prosecution saying, “This prosecutionis the result of hard work by our dedicated investigation unit and serves as a warning to anyone else who is claiming financial support that they are not entitled to. People that defraud ACC are stealing money from all New Zealanders and diverting funds that would otherwise be used to pay for services for those who really need our support.” (WCxKit)

 
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Posted in Fraud and Abuse, Litigation Management, WC in Other Countries (International) |

Following the death of a volunteer firefighter, two supervisors were charged with three safety violations and four other charges each according to Ontario’s Ministry of Labor. (MoL)

The 51-year-old veteran volunteer firefighter died when he became trapped under a large ice flow during an ice-water rescue training exercise as reported by Canadian OH&S News.

Three charges under the Occupational Health and Safety Act were made against the Village of Point Edward, as an employer, for failing to take every reasonable precaution in the circumstances to ensure the protection of a worker, according to MoL spokesman, Matt Blajer. (WCxKit)

The two supervisors were charged with four counts each for failing, as supervisors, to take every precaution reasonable in the circumstances to ensure the protection of a worker.

Specifically, the village of Point Edward and each of the supervisors are charged with the following: failing to ensure adequate pre-training had been completed; failing to ensure there were an adequate number of rescuers on shore and adequate rescue equipment was provided and available; and failing to appoint a safety officer for the training exercise.

In addition, the supervisors have each been charged with failing to have an adequate training plan and an adequate pre-training briefing.

Barry Malmsten, the Ontario Association of Fire Chiefs (OAFC's) executive director, points out that firefighter training exercises can be inherently dangerous due to the nature of the job. (WCxKit)

"The only way [firefighters] are really going to be able to cope with it when they hit an emergency and things are not controllable is you have to put them into those situations," Malmsten argues.

 
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Posted in Safety and Loss Control |

Officials in New Mexico closed a San Juan County business for alleged non-compliance with the state’s workers compensation insurance coverage requirements.
 

According to New Mexico Business Weekly, a representative from the New Mexico Workers Compensation Administration, accompanied by New Mexico State Police, closed and locked the doors of Four-Four Inc, aka H&S Enterprises, dba Circle S. The company’s operations include pipeline work and convenience stores. (WCxKit)

State officials withthe Workers Compensation Administration compliance bureau said the company allowed its workers comp insurance to lapse as a result of non-payment of premiums in September 2009. This is the third time the company is out of compliance since 2007, according to state officials. The firm has five different business locations, and the lapse places a number of employees at risk, according to state officials. (WCxKit)

The WCA moved to close the business until such time as it acquires and provides proper workers comp insurance coverage

 
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Posted in Buying Workmans Comp, Fraud and Abuse, Insurance Issues, Rates, Premiums |

Effective July 1, 2010 the Connecticut Workers Compensation Commission established new guidelines to enhance communication between payors and medical providers in the workers compensation context. The goal of these guidelines is to improve the coordination of medical services to benefit both the employee by restoring their health as quickly as possible and the employer by returning a valuable employee to work without the need to defend a costly personal injury civil suit. In the introduction to these new guidelines the Commission explains that the major impediment to the delivery of prompt medical services is the lack of communication between the payors and providers. This lack of communication requires a voluminous number of largely unnecessary hearings wasting time and resources of the Commission as well as claimants and respondents. As such, these new guidelines target the “breakdown in communication” between health care providers and respondents with the goal of establishing a cooperative system to enable injured workers to promptly obtain necessary medical services.

In terms of payor responsibilities in these guidelines, the unmistakable goal is consistency in how claims are handled. Regarding accepted claims where all parties acknowledge an injury occurred in the course of employment, the new guidelines first mandate that voluntary agreements be issued on all accepted lost-time cases. Second, in accepted cases no “pre-approval” can be required by payors for basic medical services such as routine office visits and physical therapy for the accepted body part. Third, in these cases the guidelines advise that all forms of communication between health care providers and payors; telephone calls, facsimiles, e-mails, etc. should be returned in two business days. This rule is intended to include payors’ requests for medical records. While this rule will frankly be difficult to enforce, it is referenced on numerous occasions throughout the new guidelines.

Keeping in mind that prompt communication is required; the guidelines remind payors and their representatives that they are only permitted to communicate directly with treating physicians in writing with notification to all parties. Claimants and their counsel are conversely prohibited from speaking with a Respondent’s examining physician. Finally, in the event that a Commissioner’s Exam occurs, neither party can communicate with the examining physician except through the Commissioner who ordered the exam itself.

Regarding extensions of treatment requested by claimants, in accepted cases, the guidelines require that payors decide to approve or deny further diagnostics and/or treatment plans and communicate that decision to both the claimant and the authorized physician within five business days from the date of the claimant’s request. Due to the cost of such studies and/or treatments, written authorization is required for the following: EMG, CT scan/MRI, Bone Scan, Epidural steroid injection, Additional physical therapy and/or chiropractic treatment beyond the Commission’s Medical Protocols, surgery, diagnostic arthroscopy, pain management, physical rehabilitation, referrals for second opinions and functional capacity evaluations.

Should a payor deny any of the above treatment/diagnostic studies, or contest a claim in general, a Form 43 should be filed and the payor should consider the need to refer to peer or utilization review or schedule a Respondent’s Medical Exam with a provider in a similar medical specialty. The “Respondent’s Medical Exam” (previously referred to as an Independent Medical Exam) if pursued, must be scheduled within twelve calendar days of the payor’s receipt of the claimant’s medical reports. The RME must then be held within sixty calendar days after it is scheduled. In terms of the medical provider responsibilities when an “RME” occurs, the examination report must be issued within twenty-one days of the exam. Again, while difficult to enforce, the objective behind these guidelines is simply to expedite the communication between payors and providers.

In regards to contested claims, it is imperative that payors serve a Form 43 on the Commissioner and the claimant within twenty-eight days of receipt of the written notice of the claim. However, even in contested cases the guidelines encourage payors to authorize evaluations or even indemnity benefits without prejudice pending pursuit of an RME.

In the event that a hearing is necessary to decide a Form 43, the guidelines require that the payor’s representative at the hearing have authority to potentially resolve the noticed issue. Conn. Admin. Reg. § 31-279-5. Further, if the same issue remains unresolved and the matter proceeds to a preformal hearing, an adjustor must be available by telephone to assist in resolution. If no authority is provided by the time a matter reaches the preformal stage, the guidelines permit sanctions/penalties at the presiding Commissioner’s discretion.

As medical providers have a pivotal role in the handling of workers compensation claims the guidelines set forth an array of responsibilities on their end as well. In accepted cases, medical providers should not seek pre-approval for rendering routine medical services unless it has been more than one year since the claimant’s prior treatment. After rendering treatment in these cases, providers must furnish reports to the payor and the claimant within thirty days of the treatment’s completion. Connecticut General Statutes § 31-294f (b). The requisite content of these reports is specified in the guidelines and includes the following: the injury history and causal relationship to work (if applicable), the claimant’s current complaints and the physical findings of the exam, the diagnosis and treatment plan, and the claimant’s present work capacity and restrictions if any. If the treating physician desires to refer a claimant to a specialist and/or for a second opinion, the request must be made in writing to the payor and include a medical basis for the same. Finally, medical providers are instructed to maintain a summary sheet in each respective claimant’s file including: employer identification, claim number, adjuster name and contact information, the medical care plan applicable and its requirements.

In terms of medical providers’ responsibilities with contested claims, the guidelines advise that payors may contest claims on the basis that they are untimely, non-compensable, not the cause of injury due to a subsequent intervening event, or because the treatment requested is not considered reasonable and/or necessary (i.e. palliative). When the claim itself or specific treatment for a claim is denied the provider may need to justify treatment recommended or be willing to testify at a hearing regarding their findings. In terms of payment for treatment in contested cases, if the claimant is covered by a group health insurance policy, the insurer must pay for the claimant’s treatment. C.G.S. § 31-299a. In the absence of group health, the guidelines emphasize that attorneys are prohibited from paying for treatment but that a provider has the right to request a Commission hearing to discuss any bills outstanding.

As the additional obligations placed on medical providers in these guidelines may be met with some resistance, the penalties found in the pre-existing General Statutes Administrative Regulations can be exercised on those physicians who do not comply. Specifically, physicians who fail to comply with the guidelines established by the Commission can be removed from the approved list of physicians to provide treatment in workers compensation cases. C.G.S. § 31-280 (b)(10); Conn. Admin. Reg. § 31-279-9 (g).

Finally, though at first glance they appear minimal, the guidelines do establish obligations on injured workers as well. In accepted cases claimants must immediately notify their employer of the injury and attend all scheduled appointments to obtain written updates on work status. If further treatment beyond initial exams is required, claimants can select a medical provider from the employer’s approved workers compensation network or within the state of Connecticut if none exists. If at any point a payor desires to pursue an RME, or in the event that the Commissioner orders an examination, the claimant must attend and bring any relevant radiographic studies. The guidelines further recommend that claimants review all medical reports to ensure their accuracy.

In contested cases claimants are instructed to contact their employer to attempt to resolve the issue absent a hearing and provide any further information requested. In the event resolution is not possible, the claimant should request a hearing if he or she elects to pursue a claim. Group health insurance, Medicare, Medicaid and Veteran’s benefits are available to pay for treatment when claims are contested but the guidelines advise that claimants should keep a detailed record of any out of pocket expenses incurred.

While these guidelines appear quite broad, the Commission’s goal in enacting them is quite simple; to expedite the claims process and avoid the need for unnecessary hearings. Although the obligations imposed on payors and medical providers in particular appear extensive, no new penalties were established for those who do not comply. Accordingly, only time will tell if the guidelines can accomplish their intended purpose.

Authors: Collette S. Griffin, Esq., Howd & Ludorf, LLC, Hartford, CT represents employers, self-insureds and insurance carriers in workers compensation matters. Contact Info: 860-249-1361; www.hl-law.com

 
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Posted in Medical Cost Containment & Managed Care |

The TPA adjuster upon receiving the claim went into their computer link to the client's database to verify coverage.   The coverage had expired on June 30, 2005.   The claim was reported on July 12, 2005 with a date of loss of July 5, 2005. The adjuster wrote in the files notes “Coverage not updated yet in computer, will confirm coverage before making any payments.” That would have been fine if the adjuster had done so, but the TPA switched adjusters and the coverage question was forgotten. [Mistakes – (1) Proceeding to handle the claim before coverage was verified, (2) the second adjuster not reading the first adjuster's file notes]. (WCxKit)

The lack of coverage wasn't address again until the pool's executive director contacted the adjuster over a year later. By then over $65,000 had been paid on medical and indemnity by the TPA from the pool's trust fund. There was no coverage but the pool was in an estoppel situation, so a decision was made to continue to cover the claim. 

The published Best Practices for the TPA included making 24-hour contact with the employer, the employee and the medical provider. The TPA had overloaded its workers comp adjusters with over 200 files each (the government pool's contract did not contain any provision for the maximum number of claims to be assigned to an adjuster).  [Self Insured Mistake – Not having a stipulation in the contract on how many files can be assigned to one adjuster]. The second adjuster on the file never even saw the claim during the first three months is was assigned to the adjuster.  [Mistakes – (1) Not reviewing the file when it was assigned, (2) Timely contacts with the involved parties were not made].

Since the second adjuster never contacted the insured or the claimant or the medical provider, there was no investigation of the claim. The Employer's First Report of injury reflected, “the employee (a painter) hurt her lower back when she tried to move a five-gallon bucket of paint.”   [Mistake – No investigation of the claim].

The medical reports and bills started coming in. Entries into the file notes all read “Received medical bill” or “Paid medical bill” with the name of the medical provider and the bill amount. One medical report summarized in the file notes stated, “employee continues to work with her low back pain and wrist pain.”   Three months into the claim a medical report states “will need to do bilateral CTS (carpal tunnel syndrome) surgery.”   [Mistake – Not comparing the medical reports with the reported injury on the claim].  The employee was an obese woman with diabetes – two factors that can bring on CTS without an injury. Even though the claim was reported as a back injury, at no time did the adjuster question the carpal tunnel syndrome treatment. [Mistakes - (1) failure to separate a covered injury from other medical conditions of the employee, (2) lack of medical knowledge that CTS is not always injury related, (3) failure to get a medical termination based on whether the CTS was work related or not – if it was it should have been handled as a separate claim].

The first contact with the employee occurs over four months into the claim when the employee calls the adjuster inquiring about when she would be paid for her TTD, as she was off work due to the right wrist CTS surgery (the left wrist would be done a couple months later). The adjuster does not follow up on the TTD question and gets another phone call from the employee. The first contact with the employer occurs almost five months into the claim when the adjuster calls the employer for a wage statement.  [Mistakes – (1) no on-going contacts with the employee and the employer, (2) not obtaining the wage statement from the employer when it was first noted the employee was going to need CTS surgery].

The adjuster puts the temporary total disability (TTD) checks on autopilot and forgets about them. After about six months, the employee returns to work. As the adjuster had not been in contact with the employee or the employer, the TTD checks just kept on going out. The adjuster does not know the employee is back to work until the medical reports comes in stating the employee was at maximum medical improvement on her wrists and had been given a 15% impairment rating for both wrist combined. The employee would receive an extra eight weeks of TTD after she was back at work for the employer. The adjuster states in the claim file notes the overpayment of TTD will be taken out of the permanent partial disability (PPD) settlement (it never was recovered). [Mistakes – (1) no on-going contact with the employer or the employee, (2) not making any effort to get the employee back to work earlier or to return to work on light duty, (3) putting TTD checks on long-term automatic issue]. (WCxKit)

The employee had only been back to work for two months when the adjuster contacted her in regards to the overpayment of TTD and settlement of the PPD claim. The employee advised the adjuster that her back still hurts her and she needs to go to the doctor about her back.   The doctor orders an MRI of the low back. The employee has a herniated disc at L4-L5 and a partially herniated disc at L5-S1. The doctor schedules surgery for the employee. [Mistake – Not having inquired about the lack of medical treatment on the low back for almost a year].

The adjuster (who is finally paying attention to this claim) refuses to approve the surgery until an independent medical evaluation (IME) can be completed. The IME confirms the need for the surgery and the surgery is performed. After the surgery, the employee is off work for another seven months before the doctor places her at maximum medical improvement with a 25% rating.    [Mistake – not making any effort to get the employee back to work earlier or to return to work on light duty].

The adjuster contacts the claimant and offers to settle both of her PPD ratings based on her being 40% disabled. The employee counters that she should be considered 100% disabled as she is not able to go back to her job as a painter. The adjuster declined to consider the claimant as having permanent total disability (PTD). A week later the adjuster receives a letter of representation from the new attorney for the employee. The adjuster declines to agree with the attorney that the employee is PTD. The employee's attorney files for a hearing before an administrative law judge (ALJ). The ALJ reviews all the medical records and agrees with the defense attorney hired by the adjuster. The employee's attorney appeals and the Workers Comp Board (WCB) agrees with the defense attorney. The adjuster pays the 40% PPD rating.

A year later the employee's attorney contacts the claims office, but the second adjuster is no longer with the TPA. A third adjuster on the claim learns that the attorney is filing with the WCB a request for the WCB to consider a “worsening of condition.”  

The new (third) adjuster looks over the file and realizes an ISO Index has never been filed on the claim. The index is filed and it comes back that the employee had a prior back injury claim in 1997 (the employee was represented by the same attorney for both the 1999 claim and the 2005 claim). A check with the prior insurance company turns up the employee was already classified as 10% PPD (for a non-operated herniated disc) before the 2005 accident. The prior medical is obtained and the employee's 1999 accident was for an L4-L5 herniated disc – the same injury the claimant had surgery for in 2007. [Mistake – Failure to index the claimant resulted in the TPA/pool paying for a claim that should have never been paid].

At this point it was obvious that the 2005 injury was not a new claim, but the exacerbation of an old claim. If the index had been done in 2005, the claim could have been referred back to the prior insurance carrier. The defense attorney files a plea with the ALJ to transfer the claim back to the original insurance company (remember this is after the TPA has already paid the employee a 40% award [15% wrist and 25% back] on top of the 10% award the employee had received for the 1999 claim).

The ALJ responds the TPA had already accepted the 2005 injury as a new claim and would not change it now. The appeal to WCB went nowhere, so the current insurer was stuck paying for the claim even though it was an exacerbation of a preexisting injury.

The employee's fusion had failed. The treating doctor was recommending another surgery. The third adjuster was too inexperienced to be handling this type of claim. [Self Insured Mistake – Not having a stipulation in the contract requiring experienced adjusters to handle the claims -especially the high dollar ones].  She asked her supervisor what to do.    The supervisor advised to get another IME. The IME stated the fusion had partially failed, but absolutely would not recommend another surgery.  

The attorney gave the third adjuster a sad tale of how much pain the employee was in, that employee's marriage was falling apart due to her pain and she was desperate to have the surgery. The attorney played on the adjuster's sympathy until the adjuster agreed for the employee to have the surgery. [Mistake – Allowing emotions instead of medical facts to make the determination on how to proceed on a claim – she should have had denied the additional surgery and forced the employee's attorney to have the ALJ or even the WCB make the determination].

Following the second surgery – did the employee and her attorney appreciate the adjuster agreeing to surgery even after the IME said it was not needed? No, the attorney filed a petition for PTD.   The treating physician had given the employee a total 75% PPD rating based on the bilateral CTS surgeries and the two back surgeries. The defense attorney arranged another IME of the employee and got a similar rating of 65% total. The ALJ looked at the total medical history and the employee's 65% or 75% permanent partial disability rating following her two wrist surgeries and her two back surgeries. The ALJ gave the employee a PTD finding. The defense attorney appealed to the WCB.   The WCB agreed with the ALJ and the third adjuster paid the employee another 50% (on top of the 10% award from the 1999 claim and the 40% already paid on the 2005 claim). (WCxKit)

The failure to do the simple things in the claim file handling resulted in the self-insured pool paying out over a half million dollars in medical, indemnity and legal expense. Verification of coverage would have stopped this claim before any dollars were paid. A proper investigation at the start of the claim, including an index of the employee, would have shown the low back claim was an exacerbation of a prior injury and would have eliminate that portion of the claim. The review of the medical reports would have resulting in a denial of the CTS or at least had it treated as a separate claim. The non-compliance with Best Practices changed what should have been zero dollars paid into a PTD claim. (The E&O claims brought by the self-insured pool against the TPA have not yet been resolved).

  \ Author Rebecca Shafer, J.D., President, Amaxx Risks Solutions, Inc. is a writer, speaker and publisher. As an industry leader in workers' compensation cost containment, she has worked successfully for 20 years with many industries to reduce workers’ compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, transportation and manufacturing.  Info@ReduceYourWorkersComp.com  or 860-553-6604.

  

Posted in Settling WC Claims, TPA and Claims Administration |

North Dakota law states the performance reviews of Workforce Safety and Insurance must be done every two years. Auditors focus on specific issues and put together reports for state legislators to review. (WCxKit)

Klipfel said this year's review by the Sedgwick Claims Management Services firm was overall positive and confirmed that WSI was managing injury claims correctly. (WCxKit)
  \ 
Author Robert Elliott,  executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.  Contact: Robert_Elliott@ReduceYourWorkersComp.com  or 860-553-6604.  

 
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers' comp issues.

Posted in Assessment & Diagnostics, TPA and Claims Administration |