In order to properly monitor and control workers compensation losses, it is necessary for the employer to have a working knowledge of traumatic injuries and occupational diseases. For adjusters this knowledge is mandatory.
The following sample questions demonstrate the need for medical fact information knowledge and understanding:
- What are usual treatments for the injury or disease?
- What are the normal recovery periods?
- Will there be any residual disability?
- What are the problems associated with improper treatment?
- Did the mechanics of the loss or job exposures cause the injury claimed?
- What underlying health conditions might be aggravated by this injury?
- Is treatment in compliance with accepted medical practice?
- Is there a prior record to demonstrate apportionment possibilities?
- What apportionment ratios are possible?
- What are indications that point to the need of an independent medical examination?
- What questions and findings need to be presented to the examining medical practitioner?
- Should the examination be done by a specialist, a general practitioner or physician’s assistant?
- Are all facts of the occurrence and medical treatment available for presentation to the examining doctor?
Difference Between Sprains & Strains
The difference between sprains and strains is a classic example. The terms are often used interchangeably, yet the actual injuries are quite different. Their cause, severity, course of treatment, and residual possibilities vary greatly.
Sprains are generally associated and limited to ligament stretching or tissue tearing. Typically, they occur to knees, ankles, or wrists, and happen while walking, running, jumping, or falling. The incident is usually abrupt or sudden and is prominent in sports or sports like activity. Falling, while limbs are in out stretched position, or sliding, are ways sprains happen.
Symptoms are usually apparent almost immediately. There is pain, swelling, bruising, loss of functional capacity, and weight bearing or applied pressure may be intolerable. The patient may feel a pop or tearing sensation. The symptoms can vary on intensity depending on the degree of severity.
Treatment generally consists of an x-ray or MRI, immobilization, pain medication, and applications of external heating or cooling devices, non-weight bearing, physio therapy, and possibly surgery. Use of crutches, slings, wheel chairs, walkers, and canes may also be necessary.
Recovery Disability can range from several days to twelve weeks without surgery. Hospitalization can range from several days to weeks depending on severity, and total disability can range from days to months.
Strains are caused by twisting, or pulling of the muscle or tendon. They also occur from prolonged repetitive movement, and/or over use.
A strain is an acute situation brought about by trauma, blows to the body, improper lifting, and stressing. The symptoms may be immediate or develop over a few days. Strain symptoms are pain, localized swelling, cramps, muscle spasm, inflammation, loss of muscle function, general weakness of the muscles involved, and radiating symptoms following nerves.
Chronic strains develop over time as a result of repetitive motion or over use and symptom onset is delayed. These cases may be accepted for other possible medical conditions.
The treatment and grades of strains are similar to strains, however full rupture of muscles often occurs and requires surgical repair. Carpel Tunnel Syndrome is one of the chronic strain injuries and may need surgical intervention at the wrist level.
Recovery Disability parallels that of strains.
Learning and Reference Sources:
In addition to formal medical education courses, there are other places where medical knowledge can be obtained. A few are:
- ACOEM and/or ODG Guidelines
- Local First aid and EMT classes
- Medical dictionaries
- Medical hand books designed for lay people and to be used in home or business
- Training sessions led by Medical Practitioners
A strong medical knowledge of traumatic injury and occupation diseases is necessary. This will allow for expected treatment, recovery periods, residual disability, and medical payments.
Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: firstname.lastname@example.org.
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