The most prevalent type of workers compensation injuries are the injuries to the musculoskeletal system. The musculoskeletal system is the muscles, bones, tendons, ligaments, and joints that control the movement of the human body. The doctors most involved in these types of injuries are the orthopedics. The treatment for the musculoskeletal injuries can be as varied as the type of injuries that can occur to musculoskeletal system.
Almost all musculoskeletal injuries involve some degree of pain. The pain can vary from mild to severe depending on the extent of the injury and the employee's threshold for pain tolerance. Pain is usually local to the site of the injury, but in some injuries it can be diffused (covering an area larger than the injury). The body areas with the most injury claims with resulting pain include: (WCxKit)
1. the neck
2. the shoulders (right side or left side)
3. the back (upper, middle and lower)
4. the wrist (left or right)
5. the knee (left or right)
6. the ankle (left or right)
Both diagnostic testing and pain medication may be provided at the start of the treatment for musculoskeletal injury. The pain will be alleviated by correcting the cause of pain, but in the meantime, the doctor will provide the employee with medication to control the pain. This will involve analgesics like acetaminophen for mild pain, nonsteroidal anti-inflammatory drugs for stronger pain, and opioids for severe pain.
The type of diagnostic testing needed for the musculoskeletal injury will vary. If the employee incurred a fall or an object fell on the employee, the doctor may expect a fracture of a bone and will utilize x-rays to confirm a fracture in a bone. X-rays only show images of the bones x-rayed, they do not show any other part of the musculoskeletal system.
If the x-rays confirms a bone fracture, but the x-rays do not provide enough detail for the doctor, the doctor will request a computed tomography (CT) scan to get a better picture of the fracture and the damage to the bone.
If X-rays and/or a CT scan do not identify the problem; the next step normally taken by the doctor is to request a magnetic resonance imaging (MRI) of the injured area. Unlike x-rays and CT scans that show damage to bones, the MRI will produce highly defined images of the joints, identifying abnormalities (injuries) to the muscles, ligaments and tendons. The MRI is commonly used for injuries to the knees, shoulders, wrist, neck and back.
The doctor will review the results of the x-rays and/or the CT scan and/or the MRI to determine the precise nature of the musculoskeletal injury. With the results of these tests, the doctor will decide on the best course of action to treat the injury.
The injury will often interfere with the proper movement of the injured body part. With fractures, immobilization of the bone(s) is the normal course of action to allow the fracture to heal. If the fracture is severe and the bones are displaced from their normal position, the orthopedist will surgically correct the alignment and may use surgical screws, pins or plates to hold the bones in place until they can grow back together.
With damage to ligaments, tendons and cartilage, the doctor will consider several different treatment options. If the damage is minor, the doctor discusses with the employee the option of leaving the injured part alone and letting it heal with time. If the injury needs repairing and is in a joint – the shoulder, elbow, wrist, knee or ankle – the doctor will first consider whether or not the employee is a candidate for arthroscopic surgery. In arthroscopic surgery, the doctor uses a small scope which is inserted in the incision to see the extent of damage and guide the necessary surgical repairs with specially created instruments designed for this type of surgery. The employee benefits from having a minimally invasive procedure to repair the damage and has lesser post surgery associated pain. The work comp insurer benefits by having the employee able to return to work in a shorter period of time.
If the damage is severe to musculoskeletal system, the doctor will perform reconstructive surgery on the damage body part in an effort to restore its function. Reconstructive surgery results in a larger incision, a longer healing period and a greater level of pain in the area of the surgery, then other, less invasive treatments.
The most difficult musculoskeletal injuries to treat are those involving the spine. Spinal fractures, especially those involving degenerative disk diseases, can create significant pain for the employee. Surgical procedures to correct the spine fracture vary. The least invasive technique is vertebroplasy where surgical bone cement is injected into the vertebrae to stabilize the fracture while it heals.
The most common surgical procedure on the spine is the laminectomy where a part of the vertebrae is removed. There are various levels of laminectomy from small incisions with minor scraping of the bone to large incisions with the entire posterior backbone is removed along with overlying ligaments and muscles.
The severity of the musculoskeletal injury determines the course of the medical treatment. If the injury does not require surgical intervention, the course of treatment will often entail physical therapy, or occupational therapy. If the injury does require surgically intervention, once the employee has recovered enough, the doctor will also start a program of physical therapy or occupational therapy.
The therapy is designed to provide the employee with exercises to stretch and strengthen the injured body part. The therapist may also use hot packs and cold packs, whirlpool treatments, electrical stimulation and ultrasound to treat the injured body part. The therapist will also teach the employee conditioning exercises to prevent future injury. (WCxKit)
Musculoskeletal injuries will continue to be the most type common workers compensation claims. Many of them can be eliminated through a strong safety program. When they do occur, the employer needs to understand the nature of the injury and the type of treatment that is provided to the employee.
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 employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact:RShafer@ReduceYourWorkersComp.com
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
WorkCover NSW of Australia is leaving workers compensation industry classification rates unchanged for 2011-12, according to information from the Work Cover Authority of NSW.
Each year the NSW government approves rates the WorkCover Scheme will charge employers for workers compensation cover. The government recently approved rates for the 2011-12 policy year and has published them in the Insurance Premiums Order 2011-12.(WCxKit)
The Insurance Premiums Order includes important information on the WorkCover Industry Classification System, premium rates, dust diseases rates and the manner in which an employer’s workers compensation premium should be calculated by scheme agents for the relevant policy period.
According to WorkCover NSW CEO Lisa Hunt, 87 percent of NSW employers covered by the scheme would see no change in their premium in 2011-12 unless their wages increase or decrease – or they move industry classification.
“For the 13 percent of employers whose premium takes into account their own claims experience, their premium may be affected by their wages and claim costs relative to other employers in the same industry classification,” Hunt said. “Those with a good claims record relative to their industry will benefit from a reduction in their basic tariff premium. Those with a relatively poor claims record would pay more than their basic tariff premium.”
Hunt added the NSW WorkCover Scheme target premium collection rate for 2011-12 will be 1.68 percent of wages covered by the scheme. “The decision to leave workers compensation industry classification rates unchanged is a good result for NSW employers, particularly small business,” she said.(WCxKit)
About 85,000 claims are made each year and premiums need to cover ongoing costs and claims payments, possibly over decades.
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. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
A Michigan dairy farm and its two owners recently plead guilty to charges of employing illegal aliens, following an investigation by U.S. Immigration and Customs Enforcement's (ICE) Homeland Security Investigations (HSI).
ICE reported Johannes Martinus Verhaar and Anthonia Marjanne Verhaar own Aquila Farms LLC., a dairy operation based in Bad Axe, Mich.
Court records revealed from about 2000 through 2007, the dairy employed 78 different illegal aliens, which constituted almost 75 percent of its workforce. Aquila Farms failed to conduct the necessary inquiries to determine the employment eligibility of its workforce, as required by federal immigration laws.(WCxKit)
"Criminal charges and fines are among the government's most effective tools to ensure employers maintain a legal workforce," said Brian Moskowitz, special agent in charge of ICE HSI in Detroit. "The charges and significant fines here represent HSI's firm commitment to holding employers accountable."
According to the investigation, of the 78 illegal aliens hired by the Verhaars, some were hired on multiple occasions using different names or social security numbers despite the Verhaars' being notified by both the Social Security Administration and ICE that its employees were not authorized to work in the United States. The defendants encouraged or induced the illegal aliens to reside in the United States by providing them with employment and free housing on the farm, away from scrutiny by ICE and the surrounding community.
As part of the agreement reached with the government, the Verhaars pleaded guilty to hiring illegal aliens, a charge that carries a term of imprisonment of up to six months and a $3,000 fine per hire. Aquila Farms plead guilty to harboring illegal aliens, a felony which carries a statutory maximum penalty of five years imprisonment and additional fines.(WCxKit)
The Verhaars and Aquila Farms agreed to pay fines and a payment in lieu of forfeiture totaling $2,734,000.
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. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
King Arthur is often credited with creating the roundtable discussion concept where various parties with different points of view were brought together to discuss an issue and to obtain consensus on how they should proceed. In the modern day of world of workers compensation claims administration, the roundtable concept is often used within the claims office where the work comp adjuster, the supervisor, the nurse case manager and possibly others sat down together and discuss the best approach to take on a difficult or complex claim.
As the employer, you should request to be included in the roundtable discussions of your more serious workers compensation claims. The roundtable discussion provides a forum where the members of the roundtable can provide input that will benefit everyone involved. (WCxKit)
Whether you want to have a roundtable discussion on a weekly basis or a monthly basis will depend on the number and complexity of your work comp claims. Once you have agreed with the claims office on when you will have the roundtable discussion, be prepared for it. Please remember the roundtable discussion is for the purpose of fostering approaches to moving the work comp claim forward, not to educate you about the claim. The fastest way to end the roundtable discussion practice is for you as the employer to join the discussion unprepared. If you have to ask the nature of the employee's injury, when the last doctor's visit was, or what the impairment rating is, you will be perceived as not involved. The purpose of the roundtable discussion is to advance the claim, not to answer basic questions you should already know.
You will need to know beforehand the participants in the roundtable discussion. Beside your participation, do you want others from your company involved? Would it be beneficial to have the workers compensation claims coordinator involved? The risk manager? The employer's claims manager? Someone else? You will also need to know who from the claims office will be participating. Will it include the nurse case manager, the adjuster, the supervisor, the claims manager? Will defense counsel be participating?
In a roundtable discussion is does not hurt to have a moderator who keeps the discussion on point and makes sure everyone contributes. Other than that, the roundtable discussions are generally free flowing without a formal structure on who can speak and/or when someone will speak. The agenda can be loosely defined as the list of claim files to be reviewed.
To be prepared for the roundtable discussion, you should thoroughly familiarize yourself with the claim(s) to be discussed. This means accessing the carrier's or TPA's claim management system and reading all the claim file notes, all of the medical reports and all of the defense attorney's reports beforehand. It is okay to ask questions in the roundtable discussion that are not answered by the claim file, as those are often the issues holding back the progress of the claim.
Be ready to share your concerns, thoughts, suggestions and recommendations about the claim. Also, be ready to listen to the ideas, suggestions and remarks of the other roundtable participants, keeping in mind that the claims adjuster, claims supervisor and the other involved in the roundtable specialize in workers compensation claims. A quick way to end the roundtable discussion practice is to mandate your approach to the claim is the only approach that can be followed.
In the roundtable discussion, the participants often share experiences they have had in similar situations and relate how their prior experience can affect the outcome in the present claim under discussion. When several members share approaches that have worked in the past, the members of the roundtable can compare the different approaches and select the method they think will work best in the present situation with the claim being discussed. Decisions should be made by consensus of the roundtable members. (WCxKit)
Roundtable discussions will improve the claim handling skills and job performance of everyone involved by presenting the roundtable members with different ideas and approaches they many not have previously used. If you are asked to participate in a roundtable discussion about your work comp claims, do so. If you have not been invited to participate in a roundtable discussion on your claims, ask the claims office to start a roundtable discussion on your serious work comp claims
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 employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact:RShafer@ReduceYourWorkersComp.com
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
According to a recent Supreme Court of Texas ruling, parents of a woman who drowned after her car missed a bridge can't sue the contractor who worked on and fixed the bridge.
According to setexasrecord.com, all nine Justices were in unison that Allen Keller Co. owed no duty to alter the design of the job or to warn the public of a hazardous condition. (WCxKit)
Justice Debra Lehrmann stated that any decision to rectify the condition would have had the effect of changing the terms of a contract. "Moreover, because Keller did not own the property, it was not in a position to make decisions about how to make the premises safe," Lehrmann wrote.
Gillespie County hired Keller for excavating an embankment and erecting a concrete channel next to a one lane bridge running across the Pedernales River.
The contract mandated Keller to adhere to specifications that O'Malley Engineers of San Antonio produced. O'Malley personnel visited the site from time to time, and a county representative appeared nearly every day.
"Prior to excavation, there was a space of approximately ten feet between the bridge and the embankment, most of which was spanned by a guardrail that was connected to the bridge," Lehrmann wrote.
"After Keller excavated a portion of the embankment to erect the pilot channel, as called for by the engineering plans, the gap between the end of the guardrail and the embankment was widened by at least ten feet."
"The contract specifications did not include extending the guardrail," she wrote.
Keller completed the job eight years ago, O'Malley certified it, and the county accepted it.
On a rainy night, a car slid out of control on a sharp curve heading down to the bridge. Passing through the gap between the guardrail and the embankment, the car plunged into the river.
The driver and a passenger escaped, but car owner Courtney Foreman was not as fortunate, drowning at the scene.
Parents Barbara Foreman and Steven Foreman sued the driver, Gillespie County, O'Malley Engineers, Keller, the city of Fredericksburg and the Texas Department of Transportation.
The Foremans settled with the driver, the county and the engineers, and they removed claims against the city and the state.
Keller moved for summary judgment and District Judge Stephen Ables granted it.
Fourth District appeals judges in San Antonio reversed Judge Ables, finding Keller was at fault in addressing whether it led to a dangerous condition.
They stated Keller could have foreseen the accident. The appellate justices held that completion and acceptance of the work didn't relieve Keller of a duty to protect the public, but the Supreme Court ruled otherwise.
"The presence of an unreasonably dangerous condition, of course, weighs in favor of recognizing a duty," Lehrmann wrote.
"The consequences of placing a duty on Keller to rectify the condition in these circumstances, however, lead us to conclude that Keller owed no such duty."
"Keller's contract with the county required absolute compliance with the contract specifications," she wrote.
She found evidence that deviation from the specifications could have resulted in no federal funding.
Lehrmann wrote that at oral argument, counsel for the Foreman’s argued Keller should have warned the county of the potential danger.
"We have never held that a contractor may owe a duty to warn a premises owner of a danger on the premises owner's own property," she wrote.
She wrote that the county knew the conditions at the location. (WCxKit)
"Keller was a contractor, not an engineer, and its work was certified by the engineer before it left the project site," she said in conclusion.
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. See www.LowerWC.com for more information. Contact:Info@ReduceYourWorkersComp.com
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
The number of serious injuries in Nova Scotia workplaces is at its lowest level in 15 years, the Workers Compensation Board of Nova Scotia announced recently in its 2010 annual report.
In 2010, 6,921 people suffered serious injury on the job – the first time that number has been below 7,000 since 1995, when time loss injuries began being calculated the way they are today. There were 10,515 time loss injuries in 1995. (WCxKit)
The report marks continued progress toward a safety culture.
Looking back a decade, in 2000, 9,061 people suffered time loss injury on the job – over 2,000 more than in 10 years later. Numbers show there has been a particularly steep and consistent decline over the past five years.
Meanwhile, assessable payroll, the WCB’s measure for the number of covered workers, has consistently increased. The injury rate – the number of people per 100 covered workers who are seriously injured on the job – is now 2.13, down from 2.26 in 2009. It was 3.0 in 2004.
Return to work has also seen improvement. The vast majority of workers – 95% – return to work making 100% of their pre-injury earnings. And in 2010, over 40,000 fewer days at work were lost due to injury. This benchmark is much better than results of U.S. companies.
Yet despite this continuous improvement, there remains much work to do. Nearly 120 people have died as a result of workplace injury or illness over the past five years.
“Since 2005, we’ve seen an average five per cent reduction in time loss injuries each year,” said Nancy MacCready-Williams, CEO of the Workers Compensation Board. “That’s good news and we are clearly heading in the right direction as a province. However, we must be clear: there is no acceptable number of workplace injuries. We want a Nova Scotia free from workplace injury.”
“Creating a safety culture in Nova Scotia is a team effort. Our team of dedicated employees at the WCB are collaborating with employers, workers, labor unions, safety and industry associations, and the Department of Labor and Advanced Education to make Nova Scotia a safer place to work and to help injured workers get back on the job sooner,” said MacCready-Williams. “We are seeing the positive impact of this collaboration in the 2010 results.”
The Workers Compensation Board continues to recoup the investment losses suffered during the global economic downturn in 2007 and 2008. Following significant market losses in 2007 and 2008, 2009 and 2010 have shown more positive results. The WCB ended 2010 a slight surplus overall of $3.5 million. (WCxKit)
The full Workers Compensation Board of Nova Scotia 2010 Annual Report is available at: www.wcb.ns.ca
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. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com or 860-553-6604.
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
A worker is injured, anxious, and depressed. Is his or her emotional condition caused by the injury? Is the psychological condition – separate from any physical injury – causing any
impairment? Is treatment needed and, if so, what kind? Can the worker return to full duty in the same environment the injury occurred? If not, why not?
These questions, and many others, are often faced by attorneys and insurance personnel in workplace injury cases involving claims of emotional distress. Such claims often prove both challenging and controversial, as the interplay of pre-existing conditions, injury, somatization, motivation, and intercurrent stressors can be difficult to unravel. In some areas of medicine, diagnostic tests can point convincingly to causation, such as in the case of a crush injury, fracture, or disc herniation. In contrast, psychiatry lacks even a definitive diagnostic test, much less one that provides objective indicators of etiology. The mental health examiner must weigh a host of potential contributing factors in arriving at opinion about causation. Then, it is on to impairment, where the line between capacity and motivation is blurred even more than in cases of physical injury. (WCxKit)
A full discussion on the nature and causes of psychiatric conditions in workers compensation far exceeds the current forum, as would a detailed description of the appropriate methods for evaluating and diagnosing these conditions.
The following 10 "red flags" are common problems seen in evaluations, not only from treating providers but from "expert" examiners as well, and are suggested as a quick reference guide:
1. Insufficient time spent with claimant: How long does it take to sort out the many factors needed to determine causation, impairment, and treatment needs? Anything under 1.5 to 2.0 hours is likely inadequate. After all, forensic experts in high profile criminal cases spend dozens, if not hundreds, of hours getting to know and understand the defendant. The stakes in WC cases, though different, are also high. The information needed to render a well-informed opinion cannot be obtained in 15 or 20 minutes.
2. Insufficient record review: Have both medical and mental health records been reviewed? So often we see records from medical providers noting some symptoms of depression or anxiety, and causally (and often casually!) attributing the symptoms to the workplace injury or event. Mental health records also frequently include diagnoses and causal imputation. A good evaluation report must not only note these records but must evaluate their basis and value. Also, request for and review of records preceding the injury is critical.
3. Failure to identify pre-injury, peri-injury, and post-injury stressors: It is critical that all other possible contributing stressors be detailed and accounted for. In Connecticut, where I practice, a psychiatric condition is only compensable under WC if it arises out of a physical injury. For example, if a worker loses a limb in a construction accident and develops depression secondary to the disabling injury, that clearly falls under the purview of the law. But often we see claims for emotional distress arising more out of the stressful workplace environment than in response to the actual injury. Not infrequently, a minor physical injury is incidental, and it is the stressful workplace event or context that is truly the substantial causal element. Other life stressors, including financial and social consequences of the workplace injury, must also be accounted for. Finally, prior life stressors or traumas (e.g., a prior history of abuse or injury) must be assessed, as these often represent a predisposing vulnerability factor and can be associated with both pre-existing symptoms and/or impairments.
4. Lack of malingering assessment: There are several widely used and standardized assessment instruments for assessing symptoms exaggeration or malingering (they will not be listed here to protect the integrity of the tests). A thorough assessment of malingering integrates results of these measures with observation, consistency of records, assessment of motivational factors, and collateral information to make a determination about the validity of the claimant's self-report. Any evaluation in a WC case that does not address this issue thoroughly should be cause for concern.
5. Psychological testing: Has psychological testing been conducted? Is the rationale for the tests used provided? It is difficult to determine the appropriate use and interpretation of test results without direct consultation with a psychologist. For starters, however, it is important to note that results of many objective tests are only valid when viewed in aggregate: Individual responses to individual test questions are not valid for interpretation, and should never be reported as such.
6. No family history: What is the claimant's genetic and environmental vulnerability? Providers and examiners frequently omit such history in WC cases in an effort to protect the individual's privacy. However, defensible assessment of causation cannot be done without knowledge of the family history.
7. Mental status exam: This section appears in most psychiatric reports, with the intent of describing what is observed about the claimant on examination. What is his or her apparent emotional state? Is he forthcoming with information, or guarded and defensive? Importantly, do the observed emotional state and the reported symptoms and function match?
8. Where is the beef? A description of symptoms supporting the diagnosis is critical, and these symptoms should accord with the criteria set forth in the DSM-IV-TR. Reports should also include a detailed description of day-to-day function. Can the claimant socialize, travel, engage in hobbies, or do housework?
9. Differential diagnosis. Is it really post-traumatic stress disorder (PTSD)? The diagnosis of PTSD is the sin qua non of psychic injury arising out of workplace events. Why? Because it is the only psychiatric diagnosis that denotes causation. However, many workplace injuries and their circumstances do not truly meet what is referred to as Criterion A: that is, a stressor must involve not only “threat to the physical integrity of self or others,” but the individual’s emotional reaction at the time must include “intense fear, helplessness, or horror.” Caution is urged in accepting diagnoses of PTSD caused by routine events or injuries.
10. Misguided Permanent Partial Disability (PPD) ratings: Mental health examiners rarely use the AMA Guides to the Evaluation of Permanent Impairment, instead relying on the traditional multiaxial diagnostic system per DSM. The only Axis that reflects impairment is Axis V, the Global Assessment of Functioning or GAF. However, the GAF scale reflects symptom severity and/or impairment, and in the case of desynchrony between the two the lower score is to be used. Thus, an individual who is functioning well despite severe symptoms may warrant a low GAF score that is not reflective of actual impairment in either social or occupational function. If asked specifically to use the Guides, mental health examiners must be aware that the Guides 6th edition has a new system that uses the median of three distinct measures to calculate a PPD rating. The process is not subjective yet is rarely used. In a recent WC evaluation, I reviewed a claimant’s file in which the treating provider had given a 40 percent PPD rating for mental health. In contrast, my evaluation following the AMA Guides formula yielded a 10 percent rating, of which I concluded about half was related to the workplace incident. Bottom line: impairment ratings are usually subjective and often unreliable. Beware of any GAF rating under 40, unless the person is gravely disabled and on the verge of hospitalization, this is likely to be an inflated rating of severity.(WCxKit)
These "red flags" provide a thumbnail checklist, but fall well short of the knowledge required to fully understand and evaluate reports and opinions in this field. Attorneys and insurance adjusters would benefit from additional education on the nature of mental illness and the challenges inherent in determining causation and impairment in these cases.
Author: Dr. Andrew Meisler is a clinical and forensic psychologist in practice in Hartford, CT, with faculty appointments at the UConn School of Medicine and the Yale University School of Medicine. He serves as independent examiner for attorneys and insurers, provides consultation to the office of the Attorney General in workers compensation claims, and has extensive deposition and trial experience in state and federal court as well as at the CHRO and Workers Compensation Commission. Contact at: andrewmeisler@gmail.com or phone (860) 236-8087, #108.
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
A Quebec worker remained hospitalized one week after the crane she was operating tipped on its side at a construction site in downtown Montreal. According to a report from the Canadian Occupational Health and Safety magazine, the accident occurred in early June, trapping the operator inside the crane.
As the first emergency responders on scene, members of Montreal's fire department extracted the worker and she was transported to hospital, where she remained with severe contusions as of June 15, according to Eric Arseneault, a spokesman for Quebec's workplace safety board, CSST. (WCxKit)
"When I saw the machinery on its side, I thought 'She is lucky to be alive,’ “Arseneault said. He attended the site, a 450-unit condominium development project overseen by a general contractor. According to Arseneault, the worker, an employee of Pétrifond Fondation, was "doing some sort of maneuver" when the accident occurred. The investigation is still in its early stages, he says, adding that the CSST is looking into reports that the operator was performing pile driving with a foundation beam on a slope at the time.
For its part, the CSST will be examining, among other factors, the work method, whether or not the equipment was used properly, if the worker received adequate training, if she was aware of occupational health and safety dangers, and if she was properly supervised, Arseneault said.
Arseneault said a routine inspection of the site about a month before the accident found no occupational health and safety issues. However, before this inspection, work at another site involving Pétrifond Fondation workers resulted in a stop-work order alleging employees were working too close to electrical lines, Arseneault reported. (WCxKit)
And last year, the construction site in question was shut down until asbestos found in buildings being demolished was safely removed, he added.
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. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
The Food and Drug Administration (FDA) has ordered all producers of “metal-on-metal” artificial hips to undertake studies tied to high early failure rates and major negative health effects.
According to several media reports, the producers of “metal-on-metal” hips are required to conduct studies of patients to determine whether the implants are shedding high levels of metallic debris. The FDA sent the request to J&J and 20 other device makers, including Biomet Inc., Stryker Corp. and Zimmer Holdings Inc., asking them to conduct post-market surveillance of the hip replacements. Metal-on-metal hips, in which the ball-and-socket components are made from metals like cobalt and chromium, accounted for about one-third of the 250,000 hip replacement procedures preformed annually in the United States. (WCxKit)
The British Orthopedic Association, stated that one model of all-metal hip made by a unit of Johnson & Johnson was projected to not work in one-half of the patients who received it within six years after implant. The company no longer sells the ASR device. The British medical group also estimated, based on hospital data that the early failure rate for all-metal hips made by other manufacturers was higher than expected, ranging from 12% to 15% within five years after implant. Artificial hips are designed to last for 15 years or more.
According to Dr. Maisel, FDA. official, it was up to each manufacturer to determine how to conduct its studies. Under the agency rule, producers have 30 days to file a proposed plan with the FDA. He also indicated companies would be expected to collect information from patients who received the devices, including taking blood samples to determine the levels of metallic ion in their systems. The companies are also being asked to figure out how often the devices are not working. (WCxKit)
Along with the DePuy division of Johnson & Johnson, other major producers of hip implants include Zimmer, Stryker, Biomet and Wright Medical.
Author Robert Elliott, executive vice president, Amaxx Risk 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. See www.LowerWC.com for more information. Contact:Info@ReduceYourWorkersComp.com
Our WORKERS COMP BOOK: www.WCManual.com
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
A small but growing trend in personal injury liability cases is beginning to make an appearance in workers compensation claims, “lawsuit funding loans.” In a lawsuit funding loan, also known as “worker compensation funding”, a third party “lender” advances to the injured employee a non-recourse loan against their future settlement proceeds.
Workers compensation funding loans are designed to provide the injured employee who is short on cash a quick lump-sum in exchange for the employee giving up a portion of their future settlement. The loan structure varies depending on the company providing the funding. With some funding companies, they loan 10% or 15% of the projected settlement, and charge interest at a high rate until they are repaid. Others provide the loan in exchange for a set percentage of the future settlement. (WCxKit)
The workers compensation funding companies look for claims where:
1. the employee has received a disability rating, or the nature of the injury is such that the employee will definitely received a disability rating
2. the entire settlement proceeds are paid to the employees attorney
3. the state allows liens to be placed on the workers compensation settlement
Many people will wonder “why would the employee give up a substantial part of their future settlement for a relatively small loan, comparatively speaking?” It goes back to human nature. In most states, the temporary total indemnity benefits are paid at 2/3 of the employees average weekly wage. For lower earning employees, two-thirds of their average weekly wage is less than they normally take home. If the employee does not alter their lifestyle and spending habits, they soon find themselves short of money, especially if they were living paycheck to paycheck before they got hurt.
Workers compensation funding companies, like payday lenders, prey on the employee who needs cash now. They will claim they are providing valuable assistance to the injured employee. Some of the workers compensation funding companies will not even call the money they are giving the employee a loan, they will refer to it as a “cash advance” or “pre-settlement funding."
The workers compensation funding companies are in high risk lending, so they usually have some stringent guidelines to control who they will loan money to. Their guidelines will include:
1. the injured employee must be represented by an attorney (so that the attorney will have control of the settlement funds and will honor their contact with the employee)
2. they will only make loans in the states where the employee has the right to demand a cash settlement for their permanent partial disability or permanent total disability
3. they will tell the employee that he/she does not have to pay the loan back if they do not receive a settlement (but they will absolutely not loan money on any claim of questionable compensability)
4. reviewing all first report of injury, doctor reports, MRIs. CAT scans, surgical reports, x-ray reports, emergency room records and any other medical documentation available
The states where workers compensation funding companies are making loans include Alabama, Arizona, Arkansas, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, Tennessee, Vermont and West Virginia. The workers compensation funding companies do not make loans in the states where the employee and the employee's attorney receive separate checks. Therefore, the workers compensation funding companies will make loans in Michigan and Oklahoma if the retainer agreement between the employee and the attorney specifies the entire settlement will be sent to the attorney, who will then in turn write the injured employee a check.
In most cases, the workers compensation funding company is unknown to the employer or the insurance company. It is a secret between the employee, the employees attorney and the loan company. The workers compensation funding companies will tell the employee that by taking advantage of their service, the employee is not financially pressured to settle their claim for less than it is worth. However, like with the payday loan companies, the employee eventually will spend the entire loan amount, and will be back at the workers compensation funding company asking for another loan……ugh, cash advance.
There are a couple of problems that can develop when an employee utilizes a workers compensation funding company. They are:
1. The settlement value turns out to be lower than the funding company had originally anticipated. The attorneys fee plus the funding company loan and fees leave nothing or a small amount for the injured employee. This results in the injured employee refusing what would otherwise be a fair settlement from the insurance company.
2. The employee's medical care takes longer than anticipated and the cash advance was in exchange for a percentage of the settlement. The funding company recognizes their return on their investment is being reduced and they began to pressure both the employee and the employees attorney to settle the claim.(WCxKit)
There is little employers can do about workers compensation funding loans. As the workers compensation funding company will tell the employee that the “cash advance” is none of the employers business, the employer will usually never know the employee has been taken advantage of by the funding company. When the employer does learn of the workers compensation funding loan, it is normally because the employee is in a position where he/she can no longer afford to settle the work comp claim for the claim's true value and the claim begins to vanquish.
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 employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact:RShafer@ReduceYourWorkersComp.com.
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.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com.
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