The Impact Of Artificial Disc Technology On Work Comp

The issue of spinal fusion surgery and artificial disc replacement is an evolving issue in workers’ compensation and personal injury cases.  While this medical technology is increasingly becoming accepted, it remains an expensive component of medical costs in workers’ compensation claims.

 

 

An All Too Common Scenario

 

Employee sustains a compensable low back injury and receives conservative medical treatment, which does not provide long-term pain relief.  The employee is eventually referred to a spine surgeon for evaluation and an anterior fusion at L5-S1 with disc replacement at L4-5 is recommended.

 

Following this recommendation, the employee undergoes an independent medical examination.  According to the IME report, the risks of the proposed fusion surgery are questioned and it is noted the proposed procedure outweighs the potential benefits.  It is also opined the proposed anterior approach is not “reasonable and necessary.”  At a later deposition, the IME doctor testifies that it was his understanding that based on the diagnosis of the injury, the proposed surgery with a disc replacement is not approved by the US Food and Drug Administration.

 

The matter later goes to a hearing in front of a compensation judge who receives into evidence documentation from the FDA regarding the proposed surgery.  Based on this evidence, as well as the testimony of the IME doctor, the proposed surgery is denied.  In the order, it is also noted the proposed surgery is not approved based on the diagnosis.

 

 

Artificial Disc Replacement and Workers’ Compensation

 

This hypothetical represents a growing line of instances where artificial disc replacements are being used in workers’ compensation matters.  Several years ago, this advance in medical technology was rarely considered and viewed by many as questionable even though it was being used with increasing frequency outside the United States.

 

Due to increases in medical technology, the use of artificial disc replacement surgeries are gaining acceptance as being a “reasonable and necessary” alternative to fusion surgeries.  These procedures are also gaining more acceptances in the United States, as the technology used in demonstrating a reliable history of use in other parts of the world.  Notwithstanding this greater acceptance, it is still viewed by many as a costly procedure with uncertain outcomes as the disc technology has a tendency to breakdown over the course of time.

 

As with any workers’ compensation case, claim professionals need to be cautious and do their homework before accepting claims for artificial disc technology and understand likely medical outcomes:

 

  1. Establish a team of claim handlers dedicating to spinal injuries that will likely result in a claim for fusion and/or disc replacement surgery. This allows your teams to manage better costly claims and provides for a better understanding regarding likely outcomes.
  2. Early investigation is key to properly defending back injury claims. This is especially important when dealing with claimant’s who work in occupations with an increased exposure to back injuries or have documented histories of pre-existing back problems.  It is also important to take special note of populations who use tobacco, which impedes the healing process following a highly invasive surgery.
  3.  Selection of the correct medical expert is also important. When reviewing a claims file on intake, it is essential to evaluate it for possible future treatment.  Instead of selecting an orthopedic surgeon who only performs certain procedures, it may be an opportunity to select someone with additional background in neurosurgery and is familiar with disc replacement procedures.  Carefully review the doctor’s curriculum vitae and take note of residency experiences, work history, training and articles the doctor has written.

 

 

Other Factors to Consider

 

As the practice of workers’ compensation law becomes more sophisticated, law firms across the country are also developing practice groups that move behind the “one size fits all” mentality often associated with this area.  In some instances, attorneys are developing their defense practices around area like back claims or surgeries.  This includes a concentration on medical trends, technology and scientific study of human movement.

 

During the course of discovery, it is also important to coordinate with members of the defense team.  This can include:

 

  1. Recommendations on other means of investigation including surveillance
  2. Expert deposition preparation and use at hearing
  3. Regular file reviews on matters involving troublesome claims.

 

 

Author Michael Stack, Principal of Amaxx Risk Solutions, Inc. He is an expert in employer communication systems and helps employers reduce their workers comp costs by 20% to 50%. He resides in the Boston area and works as a Qualified Loss Management Program provider working with high experience modification factor companies in the Massachusetts State Risk Pool.  As the senior editor of Amaxx’s publishing division, Michael is on the cutting edge of innovation and thought leadership in workers compensation cost containment. http://reduceyourworkerscomp.com/about/.  Contact: mstack@reduceyourworkerscomp.com.

 

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The Hunt for Medical Provider Fraud

Fraud in any industry has a domino effect on a number of people, businesses, organizations and more.
As all too many in the workers compensation industry know, fraud is an on-going problem that has not only monetary fallout issues, but also changes lives forever.
According to the Iowa Fraud Bureau, health insurance fraud nationwide costs Americans approximately $80 billion yearly, which is close to $950 for each family.
With those figures in mind, is it safe to say that medical provider fraud is running rampant nationwide, a problem that the majority are taking part in? Of course the answer to that would be no.
When it comes right down to it, the vast number of doctors, hospitals, pharmacists, and others providing medical services are in fact honest people that follow the necessary rules and regulations to make sure everything is within the law.

 

 

 

What Types of Fraud Are Most Prevalent?
While authorities and honest medical providers and workers for that matter can do their best to prevent fraud, it is still happening at an alarming rate.
Keep in mind that a vast majority of medical provider fraud cases begin with legitimate injuries, injuries that are then essentially “milked” to allow one to get more than they are truly entitled to.

 

 

With that in mind, what are some of the more common medical provider fraud issues? Five of them are:

 

  1. Upcoding – This is where someone submits a claim towards a service that proves more severe than the actual/original service provided. In such an instance, a claim could be turned in for a broken finger when in fact that patient only obtained treatment for a sprained or bruised finger from a workplace injury;
  2. Phantom billing – In these instances, bills are sent for services that were in fact not performed;
  3. Exaggerated hospital expenses – In this case, there are charges that are way over top what would normally be charged for items like medication for starters;
  4. Self-referral – This is where a provider ends up referring themselves or a partner provider to oversee a service. In many instances, the shady goal here is for financial incentive;
  5. Repeated billing – In this scenario, billing is incurred twice for the same procedure, medications or necessary supplies. Much like someone padding their mileage, they are being compensated more than they deserve.

 

 

Medical Provider Fraud Signs
In order to lessen the chances of medical provider fraud, all eyes and ears must be on alert to any discrepancies that appear either on paperwork or are caught during discussions or visits with medical personnel.
One of the goals of the individual or individuals committing such fraud is to keep the number of people involved to a minimum. Just like the old saying “loose lips sink ships” goes; it just takes one person to say something either accidentally or on purpose to kill a fraud scheme.
In order to be most vigilant against medical provider fraud, look for any inconsistencies in both statements and actions. If something seems amiss, by all means check out.
Remember, not doing so can lead to financial hardship and other problems.
If you have come across medical provider fraud, what were the initial signs that something was wrong? Also, did you suffer financial setbacks as a result of the fraud?

 

 

 

 

Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com.  Contact: mstack@reduceyourworkerscomp.com.

 

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One of Biggest Shams in Comp Claims Is Unwarranted Diagnostic Testing

I saw an article in the newspaper the other day where a doctor in was diagnosing patients with “Cancer” and sending them for treatment they did not need, while billing Medicare millions upon millions of dollars. Some of the patients needed this testing and treatment, and others did not. I really did not know whether to feel shocked, saddened, outraged, or all of the above.

 

As with everything in this world, I draw the conclusions of that article back to the Insurance claim industry. Boy, imagine if doctors were guilty of that type of behavior within an auto or work comp claim! Ha ha, you the know for a fact that there are doctors out there that see dollar signs as soon as they see an injury from an accident, be it auto or work comp. Some studies have shown that the prices go through the roof once a doc sees an accident claim, due to lack of fee schedule allowances and so on.

 

 

A Good Percentage of EMG Tests Are Useless

 

One of the biggest shams in injury claims is unwarranted diagnostic testing, especially EMGs and MRIs. They are usually clinically unwarranted, performed too soon, performed too late, or performed multiple times.

 

A positive EMG test can bury the defense of a claim, especially if it is taken for its word on its own merits without taking into account the doctor that is performing the test and their experience, training, and background.

 

Rationale for an EMG can come in many forms, but the usual reasons for the test are to correlate or objectify positive findings on clinical examination. They also provide a baseline for future comparison testing, differentiate between organic and non-organic pain complaints, and provide assistance on surgical opinions.

 

A good percentage of EMGs are also useless. Any doctor can get an EMG machine and perform the testing. This does not make them qualified to perform EMG testing. In some states you do not even need to meet certain training qualifications to perform the testing. Really all you have to be is a physician. In my opinion, the only person that should perform an EMG that relates to an injury claim is a physician that is AANEM certified (American Association of Neuromuscular & Electrodiagnostic Medicine). Physicians with this certification have received extensive training and have board certification in Neurology or Physical Medicine & Rehabilitation. They have also completed numerous continued education credits along with a laundry list of other criteria they have performed. Remember, you can always obtain a second opinion on an EMG, and get a second test ordered to compare with whatever the treating doctor had performed.

 

There are several variables that can affect the outcome of an EMG, resulting in a false positive. These include:

 

• Physician training

• Physician experience

• Use of a technician

• Skin temperature

• Wrong nerve group study in relation to injury

• Wrong muscle group study in relation to injury

• Over interpretation of test results

• Under interpretation of test results

• Examination bias

 

 

Study Shows 68.1% of EMG Tests Were Not Needed, Or Not Accurate

 

In a study performed by Dr. J.E. Robinton, Dr. A.L. Seidner & Dr. J.M. Pearson entitled “Evaluation of the Medical usefulness of Electrodiagnostic Reports by Physicians not Prequalified to Meet Set Standards” results showed that 68.1% of EMG tests studied were either not needed, or were not accurate. As if that were not shocking enough, 40% of the physicians studied that were performing EMGs were performing studies below acceptable levels. These numbers should serve as a wake-up call in the insurance industry.

 

Think about the impact this has. If the patient hears that they have a positive EMG, you know the next thought in their mind is that surgery is the only way to resolve whatever pain they are feeling, be it “real” pain or just plain subjective issues. But the problem with this testing is not just on the shoulders of the patients. After all they are just going along with whatever the doctor is telling them.

 

The reality remains that EMG testing is a good way to make easy money. The machines can vary in cost, but the fixed cost of the machines can easily be made up in excessive profits after a few months of testing on your injured patients. This money goes right into the pockets of the physician. Even better is the doctor selling bilateral testing of limbs so they can use the “good, uninjured” side as a comparison. If you didn’t need an EMG on your left arm, then why get one? The answer is you get one because the doctor said you should and you are trusting that your doctor has your best interests in mind to heal from whatever injury you sustained.

 

Oftentimes adjusters become complacent with whichever doctor is ordering the testing to be performed. The adjuster thinks if the doctor has an EMG machine and can perform the EMG, then they must be qualified to do so and whatever the results are they are what they are. Fact is that EMG findings are subjective and up to interpretation of the physician completing the test. If this doctor is a good businessperson, then obviously positive EMG results lead to more treatment, more billing, and more profits. Ethics aside, it is what it is. You sure would like to think that every doc has the ethical capacity to do the right thing. Sadly, all you have to do is open the newspaper to get the real answer on this issue.

 

Time for my normal disclaimer: Not every doctor is unethical, not every doctor is unqualified to perform and interpret EMG testing, and not every doctor is motivated by profit.

 

 

Get A Second Opinion on EMG & Ensure Physician is AANEM Certified

 

My opinion is this: If you have a case where an EMG was performed, before surgery is recommended or scheduled, get a second opinion and make sure that the physician is AANEM certified. You are going to be surprised at how many cases get turned around and how much money you save by not having to deal with unnecessary surgeries and their complications. Actually a lot of cases are probably going to go from having positive EMGs to negative EMGs, which will posture your defense on further disability. After all, if you were the one injured, wouldn’t you want accurate testing to begin with?

 

 

Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com.  Contact: mstack@reduceyourworkerscomp.com.

 

©2013 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.


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

Are Diagnostic Testing And Physical Therapy Overused In Workers Comp?

If you are handling a pesky claim that just will not go away, or the objective signs are just not lining up, chances are a key diagnostic test is what you need to tie it all together. A well done MRI or EMG could be just what the doctor ordered (literally). However you must keep in mind that not all diagnostic testing is warranted. Below we point out some surprising statistics, and ways to prevent you from authorizing testing that may not be of any help:
 
  1. The right EMG test needs to be done at the right time
 
This is especially true for insurance claims, whether it is work comp or an auto accident injury. And it is especially true when dealing with Medicare, although it’s not necessarily applicable to our thoughts here. Doctors and their businesses sometimes are under the impression that once an insurance claim arrives at the waiting room looking for treatment they have free reign to treat at will. This is a big no-no, since if you get the wrong test done in the wrong location, what good does it do? Sure, numbness in the hands can mean impingement at the wrists or elbows, but what about the neck? Cervical radiculopathy can be the culprit underneath what seems like simple and basic carpal tunnel syndrome. 
 
So if a doctor performs an EMG at the wrist, which is negative, then they will be doing another test at the elbow, and possibly one at the shoulder, and one at the neck. When it is all said and done, they have performed 4 EMGs, when 1 would have sufficed if done properly at the neck level. 
 
Adjusters need to think outside the box a little, and look at the other symptoms as well as the medical history. Adjusters can also utilize their Utilization Review department, a nurse case manager, or a Record review from another physician to see what type of test should be done. All of these steps need to be taken in order to avoid medical cost leakage due to a hunch from the treating physician.
 
 
  1. Does an MRI really need to be performed?
 
The best way to see why a back injury will not subside is to obtain an MRI test. MRIs are probably the most common test performed, since a back injury is one of the most common injuries in the occupational world. However, if a back injury is not getting better after 3 weeks, obtaining an MRI may be jumping the gun.  Other symptoms need to be present, such as leg weakness, numbness, radicular pain, etc. If the claimant complains of just pain, should that warrant obtaining an MRI? Pain is a subjective complaint, not necessarily something that warrants expensive testing, other than possibly a series of routine X-rays.
 
It is my opinion that doctors sometimes want to pacify the patient by doing some sort of test. Plus, there are patients out there that want something objective and/or invasive to be done in order to feel “better.” So, to make lives easier on themselves, doctors will just order the MRI. When it fails to show anything remarkable, they move on to the next step in the course of treatment that they would have moved to anyway.
 
This is not to say that every spine MRI is unnecessary. If months have passed and the claimant is still in considerable pain with functionality issues, then yes it is time for additional testing to see what is going on. But not within the first few weeks after an injury occurs. Bearing in mind again that the other obvious symptoms are not there, those being the leg pain, foot drop, muscle atrophy, etc.
 
 
  1. Does the injured worker need months of physical therapy?
 
By default, there are many clinics that will see an injured worker, then dump them into their physical therapy program to help rehab their injury. The adjuster must stay on their toes when this situation happens. Oftentimes the patient will get prescribed a course of physical therapy after an injury, and this is the correct course of treatment for soft tissue injuries. But, to take a back strain injury and dump a person into a 6 week therapy program, then have the doctor reevaluate them 6 weeks later is not acceptable. The physician should be involved in the program, seeing the patient at least on a weekly basis so they can modify the frequency and duration of the program if needed. 
 
Dumping a patient in a long term therapy program happens more often than you would think, especially when the program is run inside of the treating doctor’s office. This means the doctor is getting two sources of income coming in: one from treating the patient, and one from the therapy program. 
 
Even if an injured party needs surgery, post-op patients need to be carefully monitored during recovery. Again, the doctor needs to be involved in the program, and watching the hopeful steady progress back to full duty. It is easy for these docs to forget about the patient, and just let the 6-8 week therapy run its course. What if the patient is not attending all of their therapy sessions? What if the patient tells their adjuster that therapy is causing an increase in pain? What if the patient is not being compliant with their home exercise and stretching program? All of these questions need to be addressed, and they need to be addressed right away, not 8 weeks later after the program has completed.  
 
 
  1. Some statistics to keep in mind (stats pulled from GAO Analysis of Medicare Part B Claims data; Boden et al. JBJS, 1990; Friedly J, Chan L, Deyo R; Spine, 2007)
 
  • Billing from 2000-2006 increased from $6.89 billion to $14.11 billion for lumbar imaging.
  • MRI research with patients that had “no back pain” showed that of those under age 60: 36% showed herniated discs, 21% had spinal stenosis, 79% had a bulging disc, and 93% had a degenerated disc.
  • The Medicare population increased 12% from 1994-2001, but billing for services increased 637%. 
 
 
Summary
 
Diagnostic testing and physical therapy can be two keys to helping discover what injury a patient has, and how they can get better. For the most part, these tests and therapy programs are done properly and when needed, but not all of the time. Adjusters have to use their network of professionals to help gauge what is needed and when. Nurses, Utilization Review departments, IME physicians, and Peer Record Reviews all can be implemented should testing or therapy not seem like the right course of action. The adjuster has to take the time to get involved in the claim, question why these things are being recommended, and keep the patient on the track to recovery. Just because a doctor recommends a certain action doesn’t make it in the best interest of the patient, or the carrier/TPA as a whole.  
 
 
Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com.  Contact: mstack@reduceyourworkerscomp.com.
 
©2013 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 


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

How You Can Prevent Pain Medication From Causing More Pain

Opioid-Induced Hyperalgesia

 

Anytime I discuss medical issues I always clarify that I am in no way a medical physician.  Whether it is to a claimant, or an attorney, I can only interpret medical in my own opinion based on training and years of experience in this business. I do also clarify to people that I always try to stay up to date on new medical issues, since they can have a direct application on the handling of workers compensation insurance claims. 

 

There has been some talk of late about a new issue involving opiate medications, coined “Opioid-induced Hyperalgesia” or “OIH” for short.  Oftentimes a claims adjuster has a file where a claimant is taking a large amount of opiate medications for pain.  Every time the adjuster reviews the medical records, or talks to the claimant, the injured party seems to be in more pain than before, despite the presence or even increased dosage of strong narcotic medications.  How is this possible?  If Oxycodone is doing nothing for pain control, then what other steps could you take for pain control?

 

In the past, an adjuster worried about narcotic pain medication causing addiction issues, dependence issues, and increased medication tolerance issues. In addition to that, these medications are costly, and they seem to be prescribed on every claim no matter what the severity. But OIH has raised new concerns about longer-term chronic pain issues and what to do before these claims get out of control. 

 

 

The Cause of OIH:

 

The exact cause of why OIH occurs is currently under medical investigation.  The leading theory continues to be the excitation of nerves through chemical pathways by certain types of narcotics.  Research has shown that some narcotics may have a higher propensity to cause OIH than others.  These are mainly known as the “phenanthrene opioid” class of medications, which includes codeine, hydrocodone, oxycodone, and hydromorphone.  In patients where OIH could be the culprit, switching to a non-phenanthrene medication such as meperidine or tramadol often times leads to adequate pain relief, much to the surprise to those involved.

 

In simpler terms, OIH may be caused by the narcotic itself increasing the level of pain that the patient may be experiencing.  Almost out of the blue, this medication that is supposed to be used as a pain reliever is actually worsening the pain, thus requiring larger and larger doses of medication for adequate pain relief.  As these doses increase, so do the risks for the more well-known issues with pain medication which include central nervous system issues, depression, addiction, drug-seeking behavior, and the risk of overdose. Even more, the financial costs of these medications begin to dominate the claim more than anything else, including wage loss.

 

 

What to Watch For:

 

Some common characteristics of OIH include:

 

  • Worsening pain over time despite increased dosages of opiate narcotics used for pain control.

 

  • Pain that becomes more diffuse in and around the area of injury.

 

  • Sensitivity to touch around the injured area specifically.

 

  • Subjective setbacks in the progression to MMI without diagnostic objective findings.

 

 

The Future of OIH

 

Although this is a newer phenomenon, the study of OIH can change the way physicians diagnose and treat chronic pain cases.  To date, if a patient’s pain in not controlled by whatever medication they are taking, it is common to step the dosage up to the next level, and re-evaluate pain at the next doctor appointment.  Because increased doses are used, the patient also has increased tolerance for pain medication, and at that point the dose must increase again. But if OIH were to be present early on, but not addressed specifically, then who knows if that medication would have ever helped this person’s pain, no matter what the dose?

 

There is a large potential for work comp claimants to experience OIH symptoms since narcotic pain relief is often used early on, usually at the first visit to the clinic.  When reviewing your comp files, especially those longer-term files where a person has had chronic pain symptoms of an escalating nature without any exacerbation of the injury, those files should be sent for an OIH evaluation by a medical professional.

 

 

Summary

 

I believe it is a safe assumption that OIH could be responsible for a significant percentage of claims dollars spent within the workers compensation system.  Cost drivers that can occur if this is not diagnosed will be increased medication costs, medication side-effect management, and addiction treatment.  These three issues alone can be responsible for large amounts of money spent on the claim.  The ability to identify OIH very early on in the life of a claim can save massive amounts of claim money, and also benefit the claimant who would not have to deal with the strong side effects of the long-term use of these dangerous medications. The ability to identify and treat OIH correctly will lead to better claim outcomes, earlier returns to the workplace post-injury, and an overall decreased burden on the work comp system as a whole. 

 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and 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. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%Contact: RShafer@ReduceYourWorkersComp.com.

 

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 


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Top 6 Causes of Workers Comp Injuries and How to Avoid Them

 

Injuries on the job can occur at any time.  Some employers have a higher risk of injury depending on the type of job they do day in and day out.  Some workers have higher exposure to injury based both on their type of job tasks and their non-occupational conditions they bring into the workplace.  This could be fatigue, other injuries, years of work experience, etc.  Despite whatever baggage some workers carry to into employment, we see the same types of injuries that occur.  These injuries fall into certain classes, which we discuss below:

 

 

  1. Lifting

 

Perhaps the most common cause of injury is lifting.  When workers are exposed to lifting tasks often, their bodies can start having some wear and tear, and the progression of this injury can morph into symptoms of muscle strains, spinal injuries, and the like.

 

A lot of the time workers will disregard the warning signs predisposing them to a muscle strain that needs medical attention.  Everyone has aches and pains, some worse than others.  But for the most part workers will continue to carry on through the pain, until they perform a lifting task that finally prompts the needs for treatment.  In a perfect world, these workers will stop what they are doing at the first sign of injury and report it to their supervisor to get medical attention.  But this is rarely the case.  I have performed tons of investigations into these types of injuries, and when I talk to workers they usually tell me that they noticed the start of the particular pain days or weeks ago, it continued to nag them, until they were working and their back or shoulder finally gave out on them.

 

If you have a lot of lifting on your job floor, there are many ways to try and limit injury including rotating staff, taking frequent breaks, lifting in smaller increments, using back braces, on so on.  Just be aware of the fact that if your labor force does a lot of lifting, and this can take its’ toll on your workers.  So listen to them when they say they have a problem and report a claim if they feel it is serious enough to warrant medical treatment. [WCx]

 

 

  1. Slip/fall injuries

 

About as popular as lifting injuries can be slips and falls.  These injuries can be minor in nature, or as severe as a bone fracture.  Especially hazardous will be slip/falls on stairs, or construction sites, leading to falls and the potential for more serious injuries.

 

Factors out of your control such as rain, snow, ice, and so on can lead to an increase in these types of injuries.  Carriers see increased reports of slip/fall injuries in the Fall and Spring, due to the increase of icy conditions.  Equally dangerous is snow, especially when it is carried into your building’s doorways which then melts and creates a slip/fall by an unsuspecting employee passing by.

 

As employers it is hard to be proactive against these types of injuries all of the time.  But if you pay special attention when the weather conditions warrant, you may be able to save some of these injuries from occurring.  Replacing your doorway carpets is a main way to stop the spread of snow and water into your building.  Placing non-skid mats and borders on steps can also help.

 

So if you have a lot of in and out foot or machine traffic, especially when the weather seasons warrant, keep a careful eye out for these hazards.  You may save a serious injury from occurring.

 

 

  1. Machine injuries

 

It is obvious to say that manufacturing jobsites will have a lot of moving machinery.  And with this increased presence of machinery you will see people being injured by these machines.   Whether it is contusions or amputations, injuries will occur.  A lot of the time these injuries can be prevented from happening.  There are countless claims where the machines are modified, guards are removed, people placing their hands in the machines to remove clogs or stuck parts, and so on.  This is especially true in workplaces where there a lot of parts and fast moving machines on an assembly-type line; workers are trying to do what they can to keep pace with their job demands. 

 

Employers have to be very aware of the fact that machinery should never be modified in a way that removes the safety mechanisms from doing the jobs they were designed to do, which is preventing injury. Even worse is after the injury occurs, the carrier may try to subrogate against the machine manufacturer.  But once the carrier discovers that the machine was modified or guards were removed, this deflates the effectiveness of their claim against the manufacturer.  And worse yet, some states will punish the employer for allowing this modification to happen, which created an increased chance of injury.  So save yourself the headache, and leave the machines to operate as they were designed to operate.

 

 

  1. Lacerations

 

Laceration injuries can occur due to a variety of reasons.  An employee can cut themselves on anything, ranging from a tool or part they are working on to a shelf, a nail, or just about anything else that has a sharp edge to it.  These injuries may be hard to avoid, but you can try and lessen the hazard. 

 

Taking input from your employees is always a good place to start.  These are the people doing the jobs day in and day out.  If they are telling you about sharp edges and sharp parts, listen to them.  Equally important is watching the trend of your injury reports and loss runs.  If you begin to see a lot of people sustaining a laceration injury while doing a particular task, it is time to investigate, before someone loses a finger or thumb due to injury.

 

 

  1. Other employees

 

As dangerous as lifting, slips/falls, machines, and lacerations can be, equally dangerous are the other employees milling around on a typical day.  Countless injuries occur from the fault of coworkers.  I have seen employees dragged, pinched, ran over, dropped, cut, poked, burned, and the like. Of course the other worker feels bad, but not as bad as the person that was injured!

 

You have to preach awareness at the workplace.  Have walkways taped off away from machines and where people in vehicles may be.  Install mirrors around corners so people can see others coming.  Beep horns and enforce speed limits around your work floor.  The injury you may prevent may be your own.

 

 

  1. Repetitive injury

 

Lastly we discuss repetitive injury.  Workers that do the same task day after day use the same muscles and make the same movements day after day.  Over the course of months and years, injuries can occur, the most common or popular being carpal tunnel.

 

Technology has come a long way in helping the worker to avoid a repetitive motion injury.  Job tools are more ergonomic, employers use rotating job tasks and shift employees so they are not doing the same task all of the time.  Machines have become more automated leading to less user interaction, which is helping to prevent injury.   [WCx]

 

But this doesn’t solve the problem that repetitive injury can still occur.  A word to the wise is that the earlier these injuries are reported, the better chance the employee has for a full recovery.  If you wait too long, the worker may be so injured that they will never make a full recovery.  So again, listen to your employees and watch your loss run reports for trends of injuries on certain jobs or while working certain machines.  It can prevent injury in the long run.

 

 

Summary

 

The 6 mechanisms of injury stated above are not the only ones, but they are the most common.  If you as the employer become more involved, and more proactive, you can prevent a lot of these injuries from occurring.  Time and time again I recommend to you enlisting the help and input of your employees.  They work the jobs, they face the hazards, and they can help you prevent some injuries from happening in the first place.

 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and 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. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%Contact: RShafer@ReduceYourWorkersComp.com.

 

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

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.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

 

New Opioids Being Developed to Decrease Abuse, Save Work Comp Costs

Prescription Drugs Major Expense in Insurance Claims

 

Recent trends in auditing the expenses within insurance claims point to prescription medication as being one of the major expenses involved in these insurance claims.  Within these costs, opioid pain medications tend to lead the way as some of the most expensive medications out there.  It seems that physicians can be rather quick to prescribe Vicodin and OxyContin for the general strain injury, and of course the prescription of these medications can lead to a ton of problems, namely addiction and overall general misuse, which can complicate a claim tenfold.

 

 

Drug Manufacturers Looking for Answer to Addictive Side Effects

 

Faced with intensive scrutiny, drug manufacturers have been scrambling to come up with alternatives to lessen the side effects of these very strong pain relievers. Probably the most common new tactic being created are ways to “disable” the medication when crushed, so when the actual tablet is tampered with it will lessen the potency, thereby making any misuse less attractive to the drug abuser, which also should decrease the overall street demand for the drug. [WCx]

 

In addition to Vicodin and OxyContin, which have lead the way in the newspaper headlines, insurance carriers started to see an increase in the prescription drug Opana, which generally has effects similar to those of OxyContin.  To refresh your memory, this certain classification of medication is used for treating severe breakthrough pain in acute injuries.  Other medications that have stereotypically had a negative connotation within the insurance claim world include Valium, Xanax, Ambien, and to a lesser extent Ultram, Flexeril, Percocet, and the like.  All will fall within a class of benzodiazepines and/or opioid medication used to treat severe and chronic pain complaints. Certainly when an adjuster sees any of these medications being prescribed, a red flag goes up and the adjuster will start an aggressive track of working with the prescribing doctor in an attempt to try alternative, less addictive medications that may be more reasonable to treat short-term injury pain relief. 

 

Instead of these stronger medications being used very sparingly, and often times very early on in the work comp claim as a means to control pain, it is also becoming more common to see these medications prescribed over and over again, even after the acute stage of the claim has long since passed.  This is when the real cost starts to set in, as you can imagine if a claimant is being prescribed a handful of these medications month after month, and sometimes year after year. 

 

 

Overly Prescribed

 

If a claimant is still complaining of pain and states they are no better, then why are these medications being prescribed again and again?  You would think that if the medication were actually not working, that a change would set in sooner or later, and the doctor would start to try to utilize other means of pain relief such as decreasing and tapering the dose, or switching to anti-inflammatory medications instead of opioids. Sadly, this is not often the case.  You could blame this on anything, maybe sometimes just general laziness of the doctor, but really only the doctor knows the real reason.  This is why adjusters, nurse case managers, and pharmacy benefits managers will intervene early on in an attempt to shift the prescriptions into safer, less expensive waters.

 

 

New Drug Alternatives

 

Whatever the reason, there are a few new drugs being marketed out there that you should be aware of.

 

Butrans—A topical patch that delivers relief for moderate to severe chronic pain.

Abstral—A tablet designed to address breakthrough pain in cancer patients.

ConZip—An extended release tablet engineered to address moderate to moderately severe chronic pain.

Lazanda—Delivered in an intranasal spray also for breakthrough pain in cancer patients.

 

These 4 medications will probably only be the tip of the iceberg.  In the past, I would estimate it to be common to see a new drug or two over the course of a year being introduced to treat pain.  As the negative press continues, I would guess you will start to hear more and more medications branded as the “next greatest thing to treat pain while limiting harsh and addictive side effects.” 

 

In addition to new medication, the FDA is also making pharmacists and doctors work more closely together by having more stringent registration requirements once these drugs are prescribed.  I guess the threat of more paperwork and possible penalties may deter doctors from casually prescribing these strong medications when the common injury presents itself.  Whether or not this will work we have yet to find out. [WCx]

 

 

Summary

 

There is an air of change in the world of insurance claims, with the costs of prescribed medication being the main culprit of overall increased costs of long-term injuries, as well as short-term.  But there are changes being made, and it is important to be aware of these changes and the hopeful cost reductions that they hope to achieve. 

 

Saving money on claims affects us all, since in one way or another we all have to compensate for increased costs in the form of increased premiums across the board, no matter what classification the injury claim may be.  Cost reduction starts one claim at a time.  It is never too late to become involved and make these doctors explain why claimants remain on these expensive, oftentimes dangerous opioid medications in long-term use situations.  Make these physicians defend their actions, and don’t let it pass you by and slip through the cracks.

 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and 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. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%Contact: RShafer@ReduceYourWorkersComp.com.

 

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

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.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

 

Exposure to Diesel Fumes Proven to Cause Cancer

 

Call for Urgent Action for Diesel Fume Exposure
 
A call for Great Britain’s Health & Safety Executive (HSE) to take urgent action to prevent deaths in many workplaces due to exposure to diesel fumes was made recently at GMB Congress.
 
This followed the announcement from the International Agency for Research on Cancer (IARC), that Diesel is now listed as a proven human carcinogen. A HSE discussion paper in May 2012 estimates 652 deaths from occupational diesel exposure due to lung and bladder cancer and an estimated 100,000 workers exposed. [WCx]
 
GMB’s call is backed by Professor Andrew Watterson and Tommy Gorman of the Occupational and Environmental Health Research Group at the University of Stirling, Scotland.
 
Particular Concern for Professional Drivers
 
GMB has many thousands of members working as professional drivers and is particularly concerned about the crews of security vehicles which are loaded in security vaults and the many other workers who work with continually in and around diesel fumes.
 
Brian Terry, GMB senior safety representative from the security industry where workers are exposed to diesel fumes said, “In the past the HSE has said that diesel fumes might cause cancer. Now they are saying that it does.
 
GMB members across the UK working in many sectors, now know the dangers of diesel fumes in the workplaces where vehicles are used in confined spaces and the workforce are exposed. GMB is calling on the HSE to take immediate, decisive action to safe guard the many workers who will be worried by this report. [WCx]
 
Health & Safety to Prioritize Inspections
 
The HSE acknowledges that some professional drivers are a high-risk group, while other high risk groups include railway workers and lorry drivers. Officials say these groups must be prioritized by HSE in inspections and for enforcement as it is thought that the biggest risk groups have a 40% increased risk of lung cancer due to diesel exposure.
 
 

Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

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.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

Kansas Division for Workers Comp Takes Huge Step In Ankle Replacement

 

Privately Held Company Engineers Product
 
Small Bone Innovations, Inc. (SBi), a privately held orthopedics company focused on arthroplasty and joint-related trauma technologies and treatments for the small bones and joints, reported that the Kansas Dept. of Labor’s Division for Workers Compensation (DWC) recently adopted guidelines specifying the use of SBi’s STAR total ankle replacement implant when meeting certain patient guidelines. It is the only total ankle system being recommended by the Division based upon its adopted medical treatment guidelines.
 
According to the U.S. Bureau of Labor Statistics (BLS) for 2010, there were approximately 300 reported cases in Kansas of foot and ankle disability claims among private sector employees.
 
The STAR ankle is reportedly the only total ankle replacement system approved through the U.S. Food and Drug Administration's (FDA) Premarket Approval (PMA) process.
 
 
Greater Clinical Success, Shorter Operating Time
 
In the PMA process, the STAR ankle's safety and effectiveness was compared with ankle fusion in a multi-center, multi-year, Investigational Device Exemption (IDE) study. The IDE study results, published in 2009, reportedly demonstrated STAR to be superior in efficacy and comparable in safety to fusion. The IDE and other subsequent studies reportedly show that the STAR ankle has better pain relief, greater clinical success, less blood loss and a shorter operating time than fusion.
 
Michael Simpson, president & CEO of SBi, noted “Nationwide, patients suffering from acute arthritis are demanding the preservation of joint function and anatomical motion in addition to pain relief. As occurred with hips and knees more than a decade ago, ankle replacement is quickly becoming the future for baby boomers who want to maintain an active lifestyle.
 
 
Mainstream Product Covered by Medicare
 
The fact that the STAR has become a mainstream treatment covered by Medicare and major private insurers is a huge step, literally, in the direction of fulfilling patient demand,” he added.
 
Anthony Viscogliosi, founder & executive chairman of SBi added “Kansas joins Texas as one of the first states to adopt the latest disability management guidelines for workers compensation programs that specify the STAR ankle as the only suitable ankle replacement solution.
 
As a result, we are raising the level and content of communications with patients and their primary care physicians in these states to enhance knowledge and understanding of the STAR ankle’s benefits.”
 
According to SBi, leading foot and ankle surgeons in Kansas have already been trained and certified in the STAR procedure and are performing total ankle arthroplasty procedures. Nationwide, more than 700 surgeons are qualified to perform the procedure and in excess of 20,000 patients worldwide have received the STAR ankle, the company noted. 
 
 

Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 

 

 

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

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.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

When to Expect Your Employee Back at Work

Employers want to know how long an employee will be off work following a workers compensation injury. There are a lot of factors that go into the answer including the nature and extent of the injury, the employee’s age, the employee’s physical conditioning, and the overall state of the employee’s health.

 
 
The most common types of injuries are sprains and fractures. There are several factors that determine the disability period for sprains and fractures. The first factor to consider is the nature and extent of the injury. A moderate sprained ankle heals much quicker than a compound femur fracture. To get an idea of how extensive the medical provider considers a sprain, look for the adjective before the word sprain or strain. The adjectives most commonly used with sprain and strains are:
 
  • Slight – it happened, but there is not much to it.
  • Moderate – more extensive than slight – middle range
  • Severe – more extensive than moderate – really hurting
 
To understand how extensive a fracture is, again look for the adjectives the medical provider uses to describe.  Fractures are normally described as:
 
  • Simple: it has cracked, but has not done anything more than a little bit of damage to the surrounding tissue
  • Closed: basically the same as a simple fracture
  • Compound: the bone has broken in more than one spot, or the fracture has created significant tissue damage
  • Open compound: the broken bone is exposed through a wound in the skin
  • Compression: in the vertebrae where a brittle bone, due to age or osteoporosis, has cracked
 
Other adjectives to describe fractures include (per Wikipedia):
 
  • Complete fracture: A fracture in which bone fragments separate completely.
  • Incomplete fracture: A fracture in which the bone fragments are still partially joined. In such cases, there is a crack in the osseous tissue that does not completely traverse the width of the bone.[1]
  • Linear fracture: A fracture that is parallel to the bone's long axis.
  • Transverse fracture: A fracture that is at a right angle to the bone's long axis.
  • Oblique fracture: A fracture that is diagonal to a bone's long axis.
  • Spiral fracture: A fracture where at least one part of the bone has been twisted.
  • Comminuted fracture: A fracture in which the bone has broken into a number of pieces.
  • Impacted fracture: A fracture caused when bone fragments are driven into each other.
 
In addition to the nature and extent of the injury, the employee’s age is a factor. A 25 year old employee with a simple fracture will heal more quickly than a 55 year old employee with the same injury. 
 
 
The employee’s physical conditioning before the injury will play a significant factor in the employee’s disability recovery time. The 50 year old employee who runs in the Boston Marathon will recover from an injury faster than a 20 year old employee who spends all his free time in front of a video game monitor. 
 
 
The overall state of an employee’s health will also impact the disability time. An employee with truncal obesity, diabetes, or other comorbidity issues will recover from an injury much slower than an employee who has the same injury, but no other on-going medical issues. Additionally, the non-smoker will recover from an injury faster than a smoker, all other factors being equal.[WCx]
 
 
For more information, please see:
or       
 
Please note that all disability times are normal ranges, and the medical facts will determine the disability period. Hospitalization times vary greatly depending on the severity of the injury. The total disability time range is the expected length of time before the medical provider will allow the employee to return to light duty work. The partial disability time ranges is the approximate amount of time the employee should be in a light duty job.

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and 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. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.

 

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com
MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

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.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

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