Posted in Settling WC Claims, WC in Other Countries (International) |

 

An investigation by the U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) found the Metro North Commuter Railroad Co. discriminated against an employee by classifying his on-the-job injury as not being work-related and denying him a promotion.

 

 

According to an OSHA report, the agency ordered the railroad, which provides commuter rail service in Connecticut, New York, and New Jersey, to take corrective action by promoting the worker and paying him $125,000 in punitive damages, $5,000 in compensatory damages and $11,651 in legal and medical expenses. The railroad also must pay him the difference between his current rate of pay and that of the new position, plus interest, and correct its records to show his injury as work-related.(WCxKit)

 

 

Additionally, Metro North must post a notice to employees at all 120 of its stations of their protections under the Federal Railroad Safety Act (FRSA) as well as provide all employees with an FRSA fact sheet and information on reporting work-related injuries and illnesses.

 

 

The worker filed a complaint with OSHA in October 2008 after Metro North classified his July 2008 injury as not work-related even though it occurred on the job, which forced him to pay out-of-pocket for injury-related medical expenses. Metro North notified the worker in November 2008 that he was not selected for a promotion for which he had previously applied. That decision was based in part on the worker's injury record, which should not have been considered in evaluating the promotion request. OSHA's investigation determined that both the injury misclassification and the promotion denial constituted discrimination against the worker.

 

 

Metro North and the complainant each have 30 days from receipt of the findings to file an appeal with the Labor Department's Office of Administrative Law Judges.(WCxKit)

 

 

Under the FRSA, employees of a railroad carrier and its contractors and subcontractors are protected against retaliation for reporting on-the-job injuries, reporting certain safety and security violations, and cooperating with investigations by OSHA and other regulatory agencies.

 

Posted in Legal Doctrines, Litigation Management, Settling WC Claims |

 

The National Federation of the Blind (NFB), the oldest and largest nationwide organization of blind people, held more than 20 informational protests across the United States to raise awareness about the practice of paying below the federal minimum wage to Americans with disabilities.

 

 

According to the NFB, the protests were held July 26, the 21st anniversary of the Americans with Disabilities Act, at the primary district office locations of United States senators serving on the Senate Committee on Health, Education, Labor and Pensions (the HELP Committee). The HELP Committee is currently considering legislation—the Workforce Investment Act—which would reauthorize the payment of subminimum wages to disabled workers.(WCxKit)

 

 

Dr. Marc Maurer, president of the National Federation of the Blind said, “Unequal pay for equal work on the basis of disability is unfair, discriminatory, and immoral. We urge the senators who serve on the HELP Committee to eliminate the indefensible practice of paying disabled workers less than the federal minimum wage.”

 

 

Twenty-one informational protests were held in 16 states, including Alaska, Arizona, Colorado, Georgia, Iowa, Illinois, Kansas, Kentucky, Maryland, Minnesota, North Carolina, Oregon, Pennsylvania, Tennessee, Washington, and Wyoming.

 

 

Unfortunately, the reauthorization vote on the Workforce Investment Act (WIA)  scheduled for August 3, 2011 did not take place and as of August 11 is still stalled in committee.(WCxKit)

 

 

 

Posted in ADA (Americans with Disabilities Act), Communication with Employees, EEOC Discrimination Laws, Employment Law Issues, Management Commitment |

 

 

Texas is the only state in which an employer can choose “to go bare” when it comes to workers compensation insurance. It does eliminate the cost of workers compensation insurance, but exposes the employer to the very real possibility of being sued and having to defend from the allegations that the negligence of the employer caused the injuries to the employee. To avoid that possibility, employers in Texas who do not have workers compensation will often offer a non-subscriber plan that provides the employee with both medical coverage and disability benefits when the injury occurs within the scope of the employment.

 

 

The non-subscriber plans are often referred to as “Voluntary Employee Injury Benefit Plans” and are normally written in both English and Spanish. The plans are written to comply with federal Employee Retirement Income Security Act of 1974 (ERISA) as the non-subscriber plans are considered an employee welfare benefit plan.

 

 

1.      Full medical benefits for any work related injury.

2.      Short-term wage replacement benefits.

3.      Long-term wage replacement benefits.

4.      Death benefits.

5.      Dismemberment benefits.(WCxKit)

 

 

The plans usually have an introduction and specify who is eligible for coverage. It states the employer is a “non-subscriber” to the Texas Workers Compensation Act and advises employees there is no coverage for workers compensation, but the plan provides the benefits outlined above and will provide the benefits without regard to whose fault the accident was. The official address of the plan administrator will be given along with the telephone number for the plan administrator and the business hours of the plan administrator.

 

 

When the Texas employer with a non-subscriber benefits plan hires a new employee, they offer the employee the option to join the non-subscriber plan. If the new hire elects to join the plan, the employee is given an enrollment and waiver agreement wherein the employee joins the non-subscriber plan and is eligible for all benefits available under the plan. In addition to becoming eligible for the plan's benefits, the employee acknowledges he or she is giving up any right to benefits under the Texas Workers Compensation Act and is giving up any rights to sue the employer for any benefits not provided by the non-subscriber benefit plan.

 

 

The plan will spell out the conditions under which the employer will pay to the plan participant’s income benefits and how the income benefits would be calculated. Short-term disability benefits are usually capped at 52 weeks (one year) while long-term disability benefits are often for 156 weeks (three years). The amount of short-term disability benefits is usually calculated by taking the average weekly earnings for a set number of weeks prior to the injury and multiplying the average weekly earnings by a percentage (often 70 percent or 75 percent) to obtain a short-term disability payment amount. The weekly amount will be capped at $1,000 or some other amount regardless of the plan participant's pre-injury average weekly earnings. Long-term disability will be calculated in the same manner, but is often at a slightly lower percentage (60 percent or 65 percent). Short-term benefits normally start after a non-paid waiting period which is usually a week or a set number of “business days.”  Long term disability benefits are only paid when the plan participant has exhausted all short-term disability benefits.

 

 

The non-subscriber plans will pay 100 percent of all necessary medical care, but will limit medical care to the physician or medical facility specified by the plan administrator. The plans also allow the plan administrator to change the designated medical facility at any time. Unapproved medical providers are only paid for when emergency medical care is needed. When a plan participant receives medical care, the plan participant can be required to submit to drug and alcohol testing at the time of the medical treatment. Medical care is provided until the plan participant reaches maximum medical improvement, dies, or is terminated for cause by the employer.

 

 

Death benefits are often based on a one-size fits all approach with a stated lump-sum amount to be paid to the beneficiary(s). The lump sum will often be broken down into a set percentage (often 10 percent) being paid immediately to the beneficiary(s) and the remainder of the lump sum being paid in monthly installments over a set number of year (often 5 years).

 

 

The non-subscriber plans also have a dismemberment chart which specifies what percentage of the death benefit will be paid in the event of the loss of limbs, hands, feet, fingers, eyesight, and hearing.(WCxKit)

 

 

If the Texas non-subscriber plan sounds a lot like workers compensation coverage, that is because it is designed to mimic workers comp. The employer is basically providing free medical coverage for on-the job injuries and disability insurance for on-the-job injuries, but maintaining more control over the benefits provided. If you feel your Texas company is large enough to self-insure for work-related injuries, a Texas non-subscriber plan might be the answer, but definitely consult with your employment law attorney before starting a non-subscriber plan.

 

 

Our WC Book: http:// http://www.wcmanual.com

Posted in Insurance Issues, Rates, Premiums, Legal Doctrines, Management Commitment |

Every day employers introduce increased risk for worker injury. At any given time, outside or internal forces can create a new hazard for injury. With the injury comes medical cost, lost wages, decreased production, decreased profit margins, more strain on current workforce, and other negative issues.

 

 

Below we will discuss a few factors involved in the increased risk of worker injury, and the way to decrease the hazard when these forces are present in your workplace.(WCxKit)

 

 

Your workforce has a span of experience that varies by employee. Some workers are new to your industry, whereas others may have decades of experience. But new equipment is a great equalizer.

 

 

When there is hazardous equipment on the work floor unknown to your operators, the risk of serious injury increases dramatically. Your workers are unfamiliar with these machines, and, without proper training, a severe injury may occur.

 

 

The way to prevent injury is to take the time to properly train each employee on proper use of the new machine. Make sure they complete the training course and can pass a safety test before operating the equipment. This should decrease your risk, and make your workers safe.

 

 

A lot of employers ignore training, letting experienced workers train others. Managers can be surprised that older workers typically do not have the advanced technological experience to know these new machines inside and out, and therefore, without a properly trained workforce, you run the risk of increased worker injury.

 

 

As the economy continues to struggle, employers are scrambling to find ways to continue to stay above water. Some are experimenting with decreasing fringe benefits made available to employees, or by decreasing the employer contribution which increases employee cost for the same benefit package they may have had for years.

 

 

Backlash against this can lead to an increase in workers compensation claims. It is not going to be across the board, but some people may adopt the attitude they want to show the employer what happens when they alter the benefits. This is done by workers who stop caring about their jobs. They do not do safety checks or machine checks before operation. They do not clean up as they used to. They do not work as hard as they once did. The end result is other workers injured by someone else’s carelessness.

 

 

Similar to what was discussed in item  two, workers who are demoted or moved to another job title may hold a grudge. They become upset and want to sabotage their employer through a lackluster work performance, decreased safety awareness, decreased work production, etc. All of these are detrimental to the employer, and another employee may become injured inadvertently by the disgruntled employee’s issue with the employer.

 

 

When job titles change or people get moved around to other job duties, watch for an increase in claims. If this happens, employers should talk to employees immediately. Let them know that these moves are not a personal attack and may not be permanent. You need to make those workers feel like they are part of the team again, so they stay on board and on top of their safety protocol.

 

 

Probably the most common time a claim count increases is when workers are notified of a potential layoff or worse — an entire plant shut down. Workers with any type of injury feel if they do not report it now they will miss out. Often any worker who has ever had any sort of pain while working is going to come forward to tell you how injured they are, and how they kept working to try and be of some benefit to the employer and keep earning a paycheck.

 

 

Not all of these types of last-minute claims are fraudulent. In fact, some long-term employees may have an occupational claim that is compensable. All claims need to be reported to your workers comp carrier so the adjuster can investigate the claims and get them taken care of, whether they are denied or compensable. Any delay can cause an increase in claim cost, especially if said employee is laid off, or terminated when the shop closes down. The sooner the adjusters get the claims, the better your company will be protected.(WCxKit)

 

 

In conclusion, several issues can contribute to a spike in an employer's claims count. But with proper communication, thorough training, and a good safety team you should be able to weather the storm and keep your claims count in check.

 

 

Posted in Layoff Planning & Workers Comp, Management Commitment, Professional Development Issues, Risk Management, Safety and Loss Control |

California Insurance Commissioner Dave Jones announced $32 million in Workers Compensation Insurance Fraud grants statewide to aid district attorneys in investigation and prosecution efforts, according to agency.

 

 

"Workers compensation insurance fraud is a costly problem in California," Jones said. "As the economy struggles to recover, fraud of this type creates an additional strain on the system. We must protect those injured workers who need care and compensation so they can return to work in a timely manner and bring to justice those who seek to cheat the system."(WCxKit)

 

 

The grant funding is the result of assessments on California employers that are determined annually by the Fraud Assessment Commission. Counties submit applications to the department, which convenes the Workers Compensation Grant Review Panel that then reviews and makes grant funding recommendations based on multiple criteria including previous-year performance.

 

 

The panel then forwards a recommendation to the insurance commissioner who either accepts or amends the panel's recommendation. Once completed, the commissioner's recommendation is submitted to the Fraud Assessment Commission for their advice and consent.

 

 

The Fraud Assessment Commission agreed with the commissioner's recommendations in their meeting last month, ratifying the grant allocations.(WCxKit)

 

 

By county	Dollars	By county	Dollars
Alameda	$1,400,000	Sacramento	$   900,000
Amador	$   431,569	San Bernardino	$2,321,853
Butte	$   200,000	San Diego	$4,861,584
Contra Costa	$   575,000	San Francisco	$4,739,200
El Dorado	$   330,000	San Joaquin	$   608,808
Fresno	$1,240,529	San Luis Obispo	$     65,000
Humboldt	$   175,000	San Mateo	$   650,000
Imperial	$     51,200	Santa Barbara	$   290,000
Kerns	$   760,000	Santa Clara	$2,321,853
King	$   275,297	Santa Cruz	$   120,000
Los Angeles	$5,700,000	Shasta	$   175,000
Marin	$   238,000	Siskiyou	$     37,428
Merced	$   140,000	Solano	$   175,000
Monterey	$   520,000	Sonoma	$    98,735
Napa	$   119,000	Tehama	$    88,950
Orange	$3,500,000	Tulare	$   362,221
Plumas	$       6,000	Ventura	$   735,913
Riverside	$1,463,732	Yolo	$   245,960
		TOTAL	$31,774,392

 

Posted in Fraud and Abuse, Legal Doctrines |

 

Should we use legal expense review companies? An attorney I know posted a joke on a Facebook page that is fairly accurate these days. An adjuster hands a new file to her counsel and tells him, “I do not want to pay anything on this file, including legal expenses.” Upon hearing this, the attorney asks why he should be expected to review, handle, and get rid of a new case for free? The adjuster advises, “That is not my problem it is yours. If you want the business, do as I ask.”

 

 

This is a current trend within the insurance business. Insurance companies have long used outside Medical Bill Review (MBR) companies, or they have internal review departments, to review procedure codes in medical bills and reduce charges per jurisdiction guidelines.

 

 

Legal expense review companies have popped up and are growing rapidly. Their purpose is to do the same bill review on legal fees for cases and reduce charges accordingly. This has led to some aggravation on the part of legal firms, who feel their bills are being reduced more and more. It seems like the carriers want more services for less cost. This can be achieved properly, however, if we use a lot of common sense here. Using the most experienced and attentive attorney on files, not the least expensive, is sometimes the best way to go, because one has to take a "TOTAL cost" approach, not a "short term cost reduction" approach. Sometimes it is better to spend more now to reduce overall expenses in the longer term.

 

 

 

 

Certain adjusters have always used dedicated counsel — specific attorneys — to handle their cases. Sometimes the dedicated attorney is advised to handle the case from start to finish. The legal firm will use this as a chance to bill the insurance companies for all activity, including file review and setup.

 

 

The hourly charge between the actual attorney doing all tasks, and what they charge for their assistant doing the same tasks, can be very large. Attorney fees can range up to $300+ an hour, whereas legal assistants doing the same work can be billed up to one quarter of that, if not less, depending on the firm and what the insurance company has negotiated for a rate. These are called "negotiated rates."

 

 

The initial legal file setup, timeline construction, and medical records review are usually the most time-consuming tasks, depending on the size of the file and how complex it is. In one million dollar claim and the medical records took up an entire side of the office. The utilization review expert was reviewing each document, finding inaccuracies and reducing the medical expenses accordingly. An RN with 20 years surgical experience was doing this review. There can be significant cost-savings by making sure the assistant does this task, and not the actual attorney. An RN can be quite helpful on these tasks, and many paralegals are excellent.

 

 

The first meetings between plaintiff attorney and defense counsel are usually uneventful. Both sides review the case and offer their stance on the file. They point out differences in the case and why there is a difference in opinion. Legal expense reduction companies state the actual attorney should not be present at these hearings, since nothing of significance happens. This way you do not have to pay larger travel costs, and time charges while waiting for plaintiff counsel to show up. This can be a nice savings in your legal budget.

 

CAVEAT: While this is the advice proffered by legal cost reductions companies, some adjusters prefer to use the more expensive upfront strategy, which is to use the MOST qualified person on the team – usually an experienced defense attorney.

 

 

One thing the legal expense review companies see a lot of is overcharging for simple communication with the adjuster. A quick email response or phone call does not need to cost a quarter-hour fee, even though some firms try to sneak in such charges.

 

 

Granted, if discussion is part of a conference on an action plan or overall case review, the attorney can justify charges, and if it is a detailed discussion important to the case, the adjuster should be charged for that time. But, if the question is a simple issue, there is no need to overcharge for the service. Legal firms will often say simple communication is included in their negotiated cost for the opportunity to handle the case, and if such charges are included in their bill the legal expense company will cut the charge down or eliminate it totally.

 

 

If your attorney goes to local court to handle most of their clients’ cases, they should not be able to bill each carrier separately at maximum rate if they were going to travel there anyway on cases for other carriers. Or, if they do, you should be aware of this practice. Most legal firms will bill separately for this reason, but there are some that will isolate each case and bill accordingly at the maximum rate.

 

 

Legal expense review will often ask, if counsel was heading to court to handle a day’s worth of case negotiations for various clients, why should each carrier have to pay a large charge for this travel? Granted, if this is a special trip, or a trip to another jurisdiction especially for your case, then the charge may be justified. But it is the job of the legal firm to handle their bills accordingly for each carrier or the charge will be reduced by the legal expense firm.

 

 

 

Due to carrier demands, and the abundance of files for firms to handle, negotiating power is in the carrier's hands. The consensus is, if a firm does not want to reduce fees to what the carrier wants, the carrier will find a firm who will do what they want. This is creating a bad environment for attorneys since most of them have longstanding relationships with certain carriers and adjusters. They do not want to lose the business, but they have no choice.

 

 

Of course there are some carriers who are trying to cut down legal expense as much as possible, sometimes unfairly. By doing this they are trying to take advantage of legal firms to get as much out of them for as little cost as possible. Larger firms can sometimes absorb this possible loss just to keep the carrier’s business. But smaller firms that cannot compete are losing a lot of business.

 

 

In most cases, the relationship between carrier and legal firm can work if they negotiate an hourly rate, and the associated tasks that go along with it. Tasks need to be clearly defined so no confusion comes when the bill arrives. The legal expense review company should also be informed of certain fees and tasks as negotiated between the carrier and firm so no issues arise. The goal should be to maintain that solid relationship between counsel and carrier, and the associated fees that go along with the handling of a litigated case to overall settlement.(WCxKit)

 

 

Legal expense review companies can be a great asset in reducing your overall legal costs when handling litigated files. But the hourly rates and the tasks that go along with it need to be clearly defined between the carrier and the legal firm. Any confusion on any of these issues can lead to a breakdown of the relationship, which benefits no one. By being proactive and establishing clear expectations at the beginning of the lawsuit, both parties can deal fairly with each other. To get good service, you have to pay a fair price.

 

Posted in Insurance Issues, Rates, Premiums, Litigation Management, Settling WC Claims |

Workers compensation costs are a significant portion of business operating expenses especially in difficult economic times when employers look for ways to reduce these expenses.

 

Work Comp Roundup recommends over and over ways to control workers comp costs.  We also recommend a number of ways employers NOT  try to reduce WC costs. Using these techniques may lead to canceled insurance coverage, penalties, fines, and even jail time. (WCxKit)

 

 

Most employers understand the nature of the work done by employees is used to calculate the workers comp insurance premium. When the skyscraper window washers are classified as janitors the the employer is not charged the correct amount of premium. Classifying construction workers as clerks will be uncovered during a premium audit and the employer pays the price. ( The Ins and Outs of the NCCI and Classification.) 

When a state law allows a corporate officer exemption from workers compensation requirements, and most employees are classified as “president,” the employer is committing premium fraud. Corporate officers must have the final say over the operations they are responsible for or they are not corporate officers.

 

 

Another way employees are misclassified is by calling them independent contractors and providing them with a 1099 form instead of a W-2, while controlling the when, where, and how the “independent contractor” works. In addition to creating insurance issues for the company, the IRS now has a very good reason to probe deeply into the company's business model. See: Independent Contractors and Workers Compensation.

 

 

As the amount of payroll is a factor in the calculation of the workers comp premium, understating payroll lowers the workers comp premium. If total payroll is $4 million but is reported to the insurance company as $3 million, that is a 25 percent reduction in the WC premium.  An audit will definitely happen as, most likely, claims will be one-third more than would be normal for a $3 million dollar payroll. In addition to being assessed the unpaid premium, there is the risk having the workers comp insurance canceled and legal trouble for fraud.

 

 

One of the simplest forms of reducing workers comp cost is not to carry workers compensation insurance. In some states employers cannot be licensed without workers comp insurance. So, in addition to committing fraud, they are also operating illegally.  The small employer with five employees may figure no one is going to get hurt and takes the chance no one will. When an employee is hurt and the employer has no workers comp insurance, the employer is considered “self insured” and must pay the employee's medical bills and lost wages. If the injury is severe, the employer without workers comp insurance may go out of business, owing a large debt.

 

 

The cash economy is a different slant on under reporting actual payroll. Unskilled or semi-skilled employees are often thankful to have a job. When the employer offers to pay them in cash and not deduct taxes, they usually go along. Everything is fine until they get hurt and learn that since they were never an employee on the employer’s official books, they do not qualify for workers compensation. Employees caught in this mess usually end up suing the employer and – the employer pays.

 

 

 

1.     Providing “free rent” or meals in lieu of pay.

2.     Bartering instead of using a payroll.

3.     Classifying payroll as “expense reimbursements.”

4.     Paying minimum wage by check for payroll purposes and the balance of the hourly rate in cash.

 

Every employer knows the more workers comp claims reported, the higher the workers comp insurance premium. A dishonest employer may pressure the employee not to file the claim by suggesting the employee report the injury as a non-work related injury to the employee’s health insurance carrier or the employer pays for the medical expenses instead of reporting the claim.

 

 

Even otherwise honest employers may think by paying the small workers comp claims themselves they are saving the insurance company money. Failure to report all workers comp claims results in the insurer not charging the appropriate premium. When an employer does report  a very severe claim to the insurance company, the insurer must still pay that large claim even though an appropriate premium was never collected.

 

 

When the insurance company adjuster contacts the employer for payroll information to calculate the employee's temporary indemnity benefit, the adjuster is relying on the employer’s honesty. If the employer, either through error or from misunderstanding the workers comp law, leaves out part of the employee's income, such as bonuses or commissions, the error results in the injured employee receiving less in indemnity benefits. When the employer intentionally leaves out bonuses, overtime, commissions, and other income when reporting the employee's earning, the employer is committing fraud. The employer may think paying less to the employee in indemnity benefits reduces workers comp cost. However, the employee knows the indemnity benefit is wrong, hires an attorney, the correct indemnity benefit is paid, and the claim ends up costing more due to attorney involvement. (WCxKit)

 

 

We are all for employers reducing the cost of workers compensation. For recommendations on how to lower your workers comp legitimately, please contact us.

 

Our WC Book: http:// http://www.wcmanual.com

 

Posted in Employment Law Issues, Fraud and Abuse |

 

The Alaska Workers Compensation Board assessed a $1.5 million civil penalty to Ultimate Tours, LLC, and Godwin Glacier Tours, LLC, for its reported failure to carry workers compensation insurance, misclassifying employees as independent contractors and violating stop-work orders.

 

 

"Ultimate Tours/Godwin Glacier Tours operates seasonally in the Seward area," said Mike Monagle, director of the workers compensation division.(WCxKit)

 

 

"Division of Workers Compensation staff repeatedly attempted to resolve the situation and bring the employer into compliance with state law, but for six seasons failed to reach an agreement with this employer," Monagle added.

 

 

The tour company, which operates glacier dog sled tours, glacier hikes, and helicopter flight seeing on the Kenai Peninsula, was in violation of stop-work orders for failure to insure its employees for 341 days, from Nov. 7, 2005 to Aug. 30, 2010. Five injuries have been reported to the division of workers compensation.

 

 

The tour company was assessed the penalty on 1,215 uninsured employee work days and additional penalties for knowingly misclassifying employees to evade workers compensation premiums.

 

 

Alaska law requires all employers to carry workers compensation insurance.

 

 

Employers who fail to comply with the law may be liable for civil penalties up to $1,000 per uninsured employee per workday.

 

 

Employers, who violate a stop work order issued by the Alaska Workers Compensation Board or the division of workers compensation, may be liable for an additional civil penalty of $1,000 for each day the employer is in violation of the stop work order.(WCxKit)

 

 

Officials also point out that employers who knowingly misclassify employees for the purpose of evading payment of workers comp premiums are not only subject to civil penalties for failure to insure, but may also be subject to criminal penalties for fraud.

 

Posted in Management Commitment, Settling WC Claims |

The most common and often the most expensive workers compensation claim is the back injury claim. Back injury claims often are associated with lifting heavier objects, twisting, bending, or falling. When the injured employee goes to the doctor, the doctor will normally treat the injury conservatively with rest and medication to see if the back injury is a sprain or strain of the musculoskeletal system.

 

 

If the injury does not respond to rest, the doctor will consider various types of diagnostic testing. There are several types of diagnostic testing the doctor can consider and request to determine the nature and extent of the back injury. The six most common diagnostic test are x-rays, MRIs, cat scans, EMGs,  myelograms, and discograms.(WCxKit)

 

 

The most well known diagnostic test is the x-ray. It is often the first diagnostic test when the employee has fallen or suffered some other type of impact. The purpose of the x-ray is well known – to see if the injured employee has fractured any bones. The x-ray also allows the doctor to examine the vertebrae for other causes of back pain including osteoarthritis and for deformities like scoliosis.

 

 

The days of x-rays produced on film are no more. Today, x-ray images created by radiation are reproduced in a computer. There is very little risk to the employee in having an x-ray, unless the employee is pregnant, as radiation could harm a baby in utero. The results of x-rays are often available immediately, but there is usually a wait for the doctor to review results.

 

 

Magnetic Resonance Imaging (MRI) is a way for the doctor to examine soft tissues in an employee's body. The MRI machine uses radio waves, a large magnet and a computer to create images of soft tissue. In some cases, it is necessary for a dye to be inserted via a intravenous line (IV) into a vein to make it easier to detect inflammation or abnormality. Each MRI picture shows a view of the area being examined. Each picture is about a quarter inch deeper (or shallower) than the prior picture, allowing the doctor to get a detailed view of the area being examined. With a MRI of the spine, it shows areas where other structures may be impinging on nerve root areas. An MRI has no side effects, but occasionally there is a reaction to the dye.

 

 

The MRI machine is a circular tube with a table in the middle that the injured employee lays on — though response to claustrophobic patients has encouraged the creation of standing MRI machines. Typically, the MRI technician moves the table back and forth in and out of the tube while each MRI scan is taken. If dye is needed, it is injected about halfway through scanning. The employee will be told to hold their breath while each picture is taken. The MRI pictures are recorded on film which the MRI technician develops. It takes a doctor trained in reading the images to examine and interpret the images. Many physicians consider and MRI to be the best use as a pre-surgical tool.

 

 

A Computed Tomography scan, referred to as a CT scan, or a Computerized Axial Tomography Scan, or CAT scan, is another way of taking pictures of the body using a specialized x-ray machine. The machine circles the employee's body and scans the area from every angle. The machine measures how x-ray beams change as they pass through the body. A computer generates a series of black and white pictures each showing a slightly different cross section.

 

 

If the x-rays and the MRI have not identified the cause of the employee's back pain, the doctor may request a CAT scan. The CAT scan is not often used for back injuries. When the treating doctor asks for a CAT scan instead of an MRI, the doctor is looking for some other reason the employee is experiencing back pain including problems with the kidneys and pancreas.

 

 

A CAT scan is done much the way a MRI is done. The employee lies on a table that passes in and out of the tube-shaped machine. The CAT scan is done with dye to outline the soft tissues and blood vessels. There is a small amount of risk from the dye. Some people have an allergic reaction to it. Also, since the CAT is a specialized x-ray machine, it should not be used on pregnant employees.

 

 

An electromyography (EMG) is used to test the employee's nerve and muscle electrical activity. EMGs are usually done with a nerve conduction study (NCS). If the treating doctor suspects the back injury and resulting pain is to muscles or a pinched nerve, an EMG may be requested. In the EMG test, the employee has fine needles inserted into the muscles. Each needle is attached to a wire that sends signals to the EMG machine. The electrical patterns inside the muscles can be analyzed to determine which muscle is damaged. The EMG portion checks on muscle responses and the NCS checks nerve velocities. Together both are interpreted to help diagnose many problems from nerve
impingement to neuropthies and more.

 

EMG needles are too small to cause bleeding but most employees find the test uncomfortable. The electrical shocks that occur in the test are too mild to cause any permanent damage.

 

 

A myelegram is an x-ray combined with a dye that is injected directly into the spinal canal. The myelogram is used to identify the point(s) in the employee's back where vertebrae are pinching the spinal cord. It is often used prior to surgery to confirm the MRI results. The myelogram is also used to diagnosis leg pain problems occurring in conjunction with back injury.

 

 

As with other dyes used in testing, some people have an allergic reaction. Also some people experience headaches from the dye, and pregnant women should not have the test done.(WCxKit)

 

 

 

Now when you hear the employee is having one of these tests done, you will have an idea what is happening to diagnose the employee's back problem.

 

 

Posted in Assessment & Diagnostics, Medical Issues, Professional Development Issues |