The majority of medical clinics treat patients ethically and in compliance with their applicable local/state/federal statutes. That being said, medical clinics are a service business — needing to stay in business and be profitable by generating traffic. An empty waiting room equals a clinic out of business. Therefore, the temptation to keep clients/patients coming back for treatment longer than necessary becomes a real possibility.
Without painting with a broad brush, there are certain areas susceptible to over treatment, continued treatment when the patient fails to heal or reaches maximum medical improvement, or just plain “never let go of this patient” syndrome. These five types of therapy, often called holistic, can and do offer very legitimate and useful treatments and are often an excellent adjunct to more traditional medical care, providing the injured worker achieves good results.(WCxKit)
It is the role of the employer/adjuster to pay attention and manage these holistic therapies by realizing the results may be very subjective, not work for everyone, and must be results-centered. Results-centered means taking measurements of the worker’s status before, during, and after therapy and setting down expected improvement goals, and remeasuring to track healing. The minute healing stops, end therapy .
1. Chiropractic
Unfortunately chiropractic therapy is the number one stereotyped method of medicine open to overused/abused without much gain. Chiropractors include occupational injuries, such as carpal tunnel, epicondylitis, arthritis, radiculopathy, etc., as areas benefiting from chiropractic manipulation. In certain situations, chiropractic medicine is beneficial. Some people swear by these treatments. From a claims standpoint if the injured worker makes objective gains on a strain injury, then continue treatment. However if three times a week therapy continues for two or three weeks without improvement (reduced swelling/pain/mobility) it is time to move on to a more effective medical treatment. Chiropractors may attempt to continue treating the patient even though no gains are made. The adjuster must stop treatment before the claim incurs any more medical cost without objective benefit.
HOT TIP: Make therapy authorization in limited time quantities, like 2-3 times a week for 4-6 weeks and then re-evaluate. Some clinics see dollar signs when given unlimited authorization and may be tempted to let therapy go on and on.
2. Physical Therapy
Many physical therapists are great at rehabbing patients back to full duty. Sometimes, they keep patients around a little too long before discharging them to a home exercise program. If the therapist is placing a cold pack on the injured party and directing some stretching exercises, it is probably time to check with the doctor and see if the injured worker still needs formal therapy or if discharge to a home exercise program is appropriate. Formal therapy and work hardening programs are expensive, and the frequency per week or month can lead to a higher claim cost over time. It is beneficial to be proactive while reading the therapy notes to see exactly what the therapists are doing with their modalities and treatment plans. Make sure they are staying involved and getting the patient into a rehab program that continues to make objective medical gains.
HOT TIP: Watch out for a “shift” in therapy goals. The patient presented with a diagnosis of a torn meniscus and as therapy is winding down, it is suggested she might possibly have another, unrelated condition for additional treatment. (This actually happened to our blog editor!) Adjusters need to educate everyone that only the medically diagnosed condition appended with a doctor’s written orders is eligible for benefits and any collateral treatments will not be paid for. Employees need to know they may become liable for unauthorized treatments.
3. Pain Clinics
Pain clinics are one the most expensive types of therapy. An injured worker is referred to a pain clinic usually after surgery fails, or is achieving no benefit from several other types of treatment. A combination of medications, mostly narcotics, are prescribed and follows a treatment plan of strategically placed injections for pain alleviation. These prescriptions are very expensive, can be highly addictive, quite painful and given in a series of three per type. If an injured worker receives 2-3 injections without benefit, the doctor tries a different location, with possibly a different solution of medicine, to see if that helps lessen the patient’s pain.
When an injured worker is referred to a pain clinic, the adjuster must be very aware of what is going on, reading the medical notes to see the patient’s complaints and setting up a dialog with the treating physician to monitor the success (or not) of treatment. Ask: Is the patient getting better?
When pain treatment fails, the claimant may show signs of drug-seeking behavior, (addiction) and pain complaints escalate over and beyond the objective evidence of injury. It is at this point a claim may unravel. Adjusters must watch very closely that the treatment rendered is necessary and of benefit to the injured worker.
HOT TIP: Think – Do you want to be paying for drug rehab also?
4. Acupuncture/Yoga/Massage
In occupational injuries, certain injuries can call for some acupuncture/yoga/massage as a treatment. While not seen a lot these days, it depends on the physician. Certain strains/sprains benefit from these treatments. Again lack of objective gain after a few weeks should lead to discharging the patient and moving onto another modality of treatment recommended by the treating physician to rehab the worker back to transitional or full duty status.
5. Primary Care Physician (PCP)
The PCP, with whom most people enjoy a good relationship, is normally the first doctor seen for an injury. Since they trust the doctor, injured workers try to stay with their PCP as long as possible, depending on the injury, before referral to a specialist.
The danger of staying with PCPs is they may try to diagnose and treat conditions not part of their specialty. As long as the patient keeps coming back, the PCP attempts to treat. The adjuster must intervene to ask the doctor to refer the patient to a specialist when no objective healing is taking place. (WCxKit)
HOT TIP: It is not a bad idea for the adjuster to intervene sooner than later since running up medical bills with the PCP becomes a duplication of payments when the worker, failing to heal, starts over with a specialist.
Summary:
1. Holistic treatments must be monitored for effectiveness.
2. The adjuster must be in involved in monitoring every treatment and successful outcome.
3. Treatment must move toward healing.
4. When no gains occur, it is time to change treatment modalities/physicians.
5. The treating modality/physician must not only be good but also have the right credentials to bring the worker to maximum medical improvement quickly, efficiently, and at the lowest cost.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact:RShafer@ReduceYourWorkersComp.com.
Our WORKERS COMP BOOK: www.WCManual.com
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
An Ontario laboratory was quarantined following a chemical exposure occurrence and the company is working with the Ministry of the Environment to effect a clean up.
According to the Canadian OH&S News, Hamilton, Ontario-based Stern Laboratories Inc, which conducts safety tests for nuclear reactor and fuel vendors and manufactures equipment for handling spent nuclear fuel rods, among other things, had a beryllium exposure in one of their labs at the end of July. The Hamilton Spectator stated workers were testing a fuel bundle that contained beryllium in an alloy form when the beryllium was exposed. (WCxKit)
Beryllium, a by-product of aluminum smelting commonly used as a hardening agent, becomes a danger when it is heated or worked with to create particles, fumes, or mists, according to information from the National Institute for Occupational Safety and Health (NIOSH) in Washington, D. C.
A spokesman for the Ministry of Labour says following the testing of a piece of equipment, dust was tested and found to contain beryllium. Air monitoring and swipe sampling also took place.
The company is still trying to determine how many employees were in the area at the time of the exposure, according to reports.(WCxKit)
Ontario's Occupational Health and Safety Act lists the 8-hour limit for beryllium exposure at 0.002 milligrams per cubic meter (mg/m3), but the provincial government is considering lowering the exposure limit to 0.00005 mg/m3, reports Lorraine Shaw, the lab manager of the Occupational and Environmental Health Laboratory at McMaster University in Hamilton.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
In Arizona, every employer who has one or more employees, whether full-time or part-time, minors, family members or aliens, is required to carry workers compensation insurance. There are some exceptions – sole providers and members of a limited liability company or a limited liability partnership are not required to have workers comp insurance on themselves, but are required to provide workers comp coverage for themselves. Workers comp coverage is not required for independent contractors or a worker whose employment is both casual and not in the usual business of the employer. The only other exception to workers comp coverage is for a domestic servant who works in a home.
Obtaining Coverage
To obtain workers compensation coverage in Arizona, the employer has four options:
1 . Purchasing a workers compensation insurance policy from an insurance company licensed to do business in Arizona.
2. Obtaining approval to self-insure from the Industrial Commission of Arizona.
3. Purchasing insurance from the state fund.
4. Joining a group of employers who are self-insured.(WCxKit)
Claim Reporting
The employee must report the injury to the employer “forthwith,” but the failure of the employee to report the injury is excusable, if the employee has a valid reason for not reporting the claim timely. The employer is required to report the injury claim to the Industrial Commission of Arizona within 10 days of the claim being made.
Medical Benefits
The employer must provide full medical benefits without time or monetary limitations. The employer can direct the injured employee to a medical provider of the employer's choice for the initial medical visit. After the first visit to a medical provider, the employee has the choice to continue to treat with the medical provider chosen by the employer, or to select their own medical provider. This does not apply to self-insured employers. If the employer is self-insured, the employer may select the medical provider, except in emergencies.
Temporary Total Disability Benefits
The temporary total disability (TTD) benefits are calculated as two-thirds of the employee's average monthly wage, with the average monthly wage capped at $3,920.75 for TTD calculation in the calendar year 2011. The Industrial Commission determines the average monthly wage each August for the next calendar year. The maximum weekly TTD benefit in 2011 is $603.19. TTD benefits are paid every two weeks. In addition to the amount paid based on the average monthly wage, there is an additional $25 allowance for dependents added to each biweekly check if the employee has any one or more dependents. The Industrial Commission calculates an annual percentage increase in the TTD benefit, based on changes in the state's average monthly wage. There is an automatic cost of living increase each January 1, for accidents with a date of injury of January 1, 2010 or later. The minimum TTD benefits are calculated as two-thirds of the employee’s average monthly wage, but there is no statutory minimum amount.
The first seven days of disability (the waiting period) is not paid to the injured employee unless the employee is disabled for more than 14 days. TTD benefits can be paid for as long as the employee remains disabled.
Temporary Partial Disability Benefits:
In Arizona, if the employee is able to return to any type of work, but at a lesser rate of pay then the amount the employee was earning prior to the injury, the employee is entitled to temporary partial disability (TPD) benefits. The TPD benefits are paid at two-thirds of the difference between the pre-injury wage and the post-injury wage.
Permanent Partial Disability Benefits:
Arizona has two types of PPD benefits, scheduled and unscheduled. Scheduled disabilities are for body parts listed in the Arizona law, which includes arm, hand, thumb, fingers, legs, foot, toes, eyes, hearing, teeth, facial disfigurement, and scarring. For PPD, the injured employee receives a percentage of the schedule amount based on the percentage of disability. The PPD is then paid monthly on a percentage of the average monthly wage until the award is paid.
If the employee has an unscheduled disability, the injured employee may receive a percentage of the loss of earning capacity. The claim is referred to the Industrial Commission of Arizona who will review the claimed loss of earning capacity and will decide to what extent the employee will be compensated.
Permanent Total Disability Benefits:
If the employee is determined to be totally disabled as a result of the injury, the employee will continue to receive two-thirds of the average monthly wage for the duration of the disability, even if for life. PTD follows the same dollar caps as TTD.
Death Benefits:
The burial expenses in Arizona are covered for a work-related death up to $5,000. The death benefits for a dependent spouse and children follow the same guidelines as TTD benefits – two-thirds of the average monthly wage – up to a maximum of 500 weeks. There is no dollar maximum for death benefits. The spouse loses the death benefit if the spouse remarries, but receives two years of benefits in a lump sum. Children receive the death benefit until they are 18-years-old, or 22-years-old if enrolled in accredited educational institution.(WCxKit)
Vocational Benefits:
Arizona workers compensation law does not require rehabilitation benefits/vocational benefits to be paid for by the workers compensation insurer. The injured employee can apply to the Industrial Commission of Arizona Special Fund for economic assistance with rehabilitation.
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 website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Firefighters describe Australian State Government’s move to introduce random drug and alcohol testing across the brigade as an unnecessary invasion of personal privacy, according to a report from their union.
Fire Brigade Employees Union State Secretary Jim Casey said the State Government move was unwarranted, given there is no established problem with drug and alcohol abuse among firefighters. (WCxKit)
“There is absolutely no evidence to suggest firefighters have a problem with substance abuse and, on that basis, we see this as a gratuitous invasion of personal privacy. Nobody asks Mike Gallacher, the NSW Cabinet or their staffers to submit to random drug and alcohol testing,” Casey said. “StateGovernment ministers make multiple-billion dollar policy and investment decisions all the time. How do we know their judgment is not impaired by substance abuse?” he added.
Casey went on to say the brigade already has effective drug and alcohol protocols in place that are supported by the union. As he sees it, random drug and alcohol tests represent nothing more than a waste of time and money. (WCxKit)
“Firefighters run into burning buildings every day; they’re highly aware of the need to remain sober while on the job,” Casey added.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Alberta Justice Minister Verlyn Olsen has ordered a fatality inquiry into the death of a mental health worker on the job in Camrose. According to a report from The Canadian Press, Valerie Wolski, 41,was killed in February while providing care to a man with limited mental capacity.
The man she was caring for, Terrence Wade Saddleback, 25, was charged with manslaughter but found mentally unfit to stand trial. A July 2009 risk assessment done on Saddleback after he attacked a female staff member in Wetaskiwin, Alta warned of the consequences to anyone caring for him. (WCxKit)
Saddleback is currently at Alberta Hospital and is subjected to regular mental health assessments. His case is now in the hands of the Alberta Review Board. The fatality inquiry will not be scheduled until the end of an Occupational Health and Safety investigation. The inquiry is not to lay blame but to examine all circumstances that will prevent this kind of tragedy from happening again.
Graham Jones, Saddlebacks legal guardian, said he warned the Canadian Mental Health Association that they needed to be careful with him, but he says his concerns were dismissed. Edmonton NDP MLA Rachel Notley has said that given Saddleback's history of violence, his care should not have been put in the hands of the Canadian Mental Health Association. She says numerous evaluations show he was never ready to live independently at home. (WCxKit)
Notley said Saddleback's past violent incidents prevented care at another community agency. She urges the government to put those who pose a threat to themselves or to others into properly staffed public care. It took five RCMP officers and a male staff member to subdue Saddleback using handcuffs and pepper spray.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
It seemed like a simple enough claim. The employee, a truck driver, was driving along when a car pulled in front of him from a stop sign. The big Mack knocked the car out of its path, while the truck driver brought the truck to a stop. The truck driver jumped out of the cab and ran over to check on the woman and her children in the car. The ambulance arrived and took the family away. When the police interviewed the truck driver and asked if he was hurt, he said, "No." The next morning the truck driver awoke with a very sore neck and aching back.
It was three weeks to Christmas and the truck driver, having a family to care for, continued to work each day taking heavy doses of Tylenol. By Christmas he was in constant agony and with his wife's encouragement, went to the local emergency room. The doctor diagnosed both back and neck strain, and told him he could not work. The employee reported the claim to the trucking company. The trucking company clerk, whose job it was to report all workers comp claims to the
third party administrator (TPA), noted the accident occurred three weeks prior to being reported. The trucking company's policy with its employees was for all injuries to be reported within five days of the date of injury. When the clerk reported the accident to the TPA, she told the adjuster the claim should be denied, as the police report showed the truck driver was not hurt and failed to report the claim within the employer’s five-day reporting period. (WCxKit)
The adjuster said, “Okay, if that is what you want,” and promptly sent the truck driver a denial of benefits letter. Unfortunately, the state law where the claim occurred, allows the
employee one year from the date of the accident to report the claim. When the truck driver received a denial of benefits letter he immediately hired a lawyer.
The adjuster knew what the law was, but made a wrong decision, by allowing the employer’s reporting policy to prevail over state law. The adjuster should have immediately advised the reporting clerk that the state statutes give the employee a year to report the injury. The adjuster abandoned decision-making on the claim to the employer, even though the adjuster's knowledge of workers comp statutes was greater than the clerk reporting the claim.
Since the adjuster denied the claim based on the employer’s wishes (or the WC clerk), no further action was taken.
Ten things the adjuster failed to do:
1. Make 24-hour three-point contact with the employee, employer, and medical provider.
2. Obtain a recorded statement from the employee regarding the details of the accident and the nature and extent of the employee's injuries.
3. Obtain documentation on the damage to the truck (to reflect the force of the impact suffered by the driver).
4. Obtain information on the woman who caused the accident for the purpose of subrogation.
5. Put the insurance carrier for the other party on notice of the intent to subrogate.
6. Obtain the doctor's diagnosis and prognosis.
7. Obtain wage documentation and in order to calculate the indemnity benefit rate.
8. Establish appropriate reserves for the indemnity and medical cost.
9. Arrange for the employee to return to work on light/modified duty.
10. Provide any type of medical management on the claim.
Now, since employee hired an attorney who expects to earn a fee, when the employee was released to light duty following his first doctor’s visit, the attorney failed to convey that information to the adjuster. The attorney arranged for the employee to see a doctor he referred his client to. This new doctor kept the employee off work until the employee, ignoring the doctor's advice, returned to work on his own.
The attorney waited until the employee was released back to full duty before sending his letter of representation. The attorney-selected doctor gave the employee a small impairment rating from which the attorney would take his fee, plus his percentage of the employee's PPD, for the time the employee was kept off work.
When the defense attorney strongly recommended the claim be settled, the adjuster had nothing to mitigate the damages. As a part of the settlement agreement, the TPA gave up the right to subrogate against the woman who caused the accident, allowing the employee and his attorney to bring a lawsuit for the traffic accident.
The employer and/or the clerk did not know the law or understand the consequences of denying compensation on a legitimate claim, even when reported late. What should have been either a medical-only claim or a very minor indemnity claim became a PPD claim, costing at least five times what it should have, because the adjuster abandon her (or his) responsibilities and allowed the employer to make the decision on compensability. The TPA also had to negotiate away the right of subrogation to get the claim settled. With subrogation rights, the entire amount paid by the TPA on the claim could have been recovered. (WCxKit)
If, as an employer, you do not know all the aspects of the workers compensation statutes in your state, trust the adjuster to make the correct decision. If you question the adjuster's decisions on claims, discuss why they are proceeding in the way they are. Create a partnership with the adjuster in the handling of your claims, but trust the adjuster judgment and knowledge of the law. It is usually a wrong move to handle workers comp claims by what you want rather than by what state statutes require. And, it might be a good idea to train all employees involved in processing workers comp claims to not make suggestions on how a claim ought to be handled.
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 website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
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)
1. X-rays
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.
2. MRIs
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.
3. CT Scans
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.
4. EMG
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.
5. Myelogram
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)
6. Discogram
Under monitored conditions, sterile water is injected into several adjacent disc spaces to attempt to reproduce symptoms (i.e., parasthesias, pain). This test is subjective but common preoperatively to help doctors make sure they are operating at the source if the pain — which is not always the "worst disc."
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.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
After the New York City World Trade Centers fell, images of responders rushing in unprotected to help victims of the terrorist attach Sept. 11, 2001, are burned into the memories of every American.
Discussion loomed immediately about toxins in the air from particulate matter, burning materials, airplane fuel and more. Of course there was nothing victims could do to protect themselves and first responders, in a rush to help as quickly as possible, did not stop to assess the danger they put themselves in.
Now, a National Institute for Occupational Safety and Health (NIOSH) report indicates there is not enough evidence to link the collapse of the World Trade Center (WTC) towers to cancer in responders and survivors. The study means those groups will not be able to collect federal money for treatment or compensation
However, the report also does not indicate evidence of the absence of a causal association. And another review is scheduled for early 2012.
Under the James Zadroga 9/11 Health and Compensation Act of 2010, there must be periodic reviews of scientific and medical evidence. If a causal association were established, recovery workers and others with cancer diagnoses could be compensable.
The Zadroga Act provides funds for a specific list of illnesses, such as asthma and other respiratory diseases linked to the 911 attacks. Cancer could be included if a link was found.
The initial review was based on three information sources, according to NIOSH:
1. A systematic search of peer-reviewed findings on exposure and cancer resulting from the terrorist attacks that have been published in the scientific and medical literature between Sept. 11, 2001, and July 1, 2011.
2. Findings and recommendations related to cancer from the WTC Clinical Centers of Excellence and Data Centers, the WTC Health Registry at the New York City Department of Health and Mental Hygiene, and the New York State Department of Health.
3. Information from the public solicited through requests for information published in the Federal Register earlier this year.
The report said there was little evidence because few published research studies on the attack mention cancer and only a small number of those are peer-reviewed. Further, cancer is a common disease, making linkage difficult, the report said. (WCxKit)
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
The number of on-duty firefighter deaths is the lowest since 1977, according to the National Fire Protection Association’s (NFPA) annual Firefighter Fatality Report, showing a total of 72 on-duty firefighters died in the United States in 2010.
Officials reported this is a sharp drop from the 105 on-duty deaths in 2008 and 82 in 2009 and it is the lowest annual total since the NFPA began conducting this annual study in 1977. (WCxKit)
This is the fifth time in the last decade the total number of deaths was below 100. While the number of total deaths dropped sharply, the number of cardiac-related deaths did not. Heart attack deaths were remarkably stable over the past six years.
According to the report, the areas in which the deaths fell is diverse. The year 2010 saw the lowest number of fire ground deaths ever (21) and deaths while responding to or returning from alarms (18), the second lowest death number. Deaths related to training activities (11) and while engaged in other non-emergency duties (18) about matched the average numbers from the previous 10 years.
Other key numbers in the report included: Nine deaths in crashes of road vehicles in 2010 and 2009, the lowest since 1983. There were 44 volunteer firefighter deaths in 2010, continuing a downward trend. The ages of all U.S. firefighters who died ranged from 20 to 86 with a median age of 52.5 years.
Each year, the NFPA gathers information on all firefighter fatalities in the U.S. resulting from injuries or illnesses occurring while the firefighters were on-duty. The term “on-duty” means being at the scene of an alarm, whether a fire or non-fire incident; responding to or coming back from an alarm; or participating in other fire department duties.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Our Workers Compensation Book: www.WCManual.com
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Workers compensation statutes vary significantly from state to state, but one thing all states have in common in workers compensation laws is the requirement that employee be provided all reasonable and necessary medical care. The goal of all work comp jurisdictions is to return the injured worker to full productivity, if possible and to the level of maximum medical improvement if the employee can not be returned to work with full productivity. While all states require reasonable and necessary medical care, the divergence in the laws starts again when it comes to determining what is reasonable and necessary.
The employer/workers compensation insurer has the obligation to pay for all medical care for a work-related accident. Medical care includes not only doctor visits; it includes surgical care, hospital care, nursing services, medicines, and durable medical equipment. However, this obligation is not unlimited. It is limited to what is reasonable and necessary. Also, in states where the employer can control medical provider selection, it can also limit what is authorized. (WCxKit)
6 Areas Where the Question of Reasonable and Necessary is Debated:
1. Special devices.
2. Home improvements.
3. Massage, yoga and aqua therapy.
4. Attendant care by non-medical assistants.
5. Continuing medical maintenance.
6. Diagnostic testing.
1. Special devices
A question that often comes up when an employee has suffered a severe injury is the need for specialized equipment. While the adjuster is not going to question the need for a cane by someone who recently had back surgery, the criteria gets murky when the doctor states the employee needs a motorized wheelchair with four speeds, capable of doing wheelies. There is a tremendous cost difference between the non-motorized wheelchair for $99 and the motorized deluxe wheelchair for $1,999. Is it reasonable and necessary for the work comp insurer to pay for a deluxe piece of specialized equipment if the employee will only be using it for a month or so? The answer is, “No!” On the other hand, if the employee is going to permanently be in a wheelchair, the power version may definitely be reasonable and necessary.
2. Home improvements
A medical provider who specializes in providing favorable impairment rating reports for plaintiff attorneys also wants to keep the injured employee happy. If the employee complains to the doctor she is not sleeping well, and the doctor writes a prescription for a new, extra firm pillow-top mattress, should the insurer have to pay for it? The answer is, “No!” Usually the doctor will not insist on such if the adjuster denies it. (In one situation, a doctor tried to justify a new mattress but the adjuster arranged for a furniture rental company to provide a mattress until the employee was at maximum medical improvement.) Other favorites include plaintiff-friendly doctors prescribing a new hot tub for an employee with a back injury, or a new Bowflex Ultimate Home Gym for an employee to do physical therapy at home. When physical conditioning home improvements are recommended, an adjuster should offer physical therapy, whether hot water soaks or stretching equipment, at a reputable physical therapy facility.
3. Massage, yoga and aqua therapy
One well known “plaintiff friendly” Atlanta doctor sends all his back and neck injury clients to water aerobics, yoga, and massage therapy. Of course the doctor owns the water aerobics, yoga, and massage therapy facility. This is another situation where an adjuster must be vigilant to deny such medical services as not reasonable and necessary. If the doctor insists they are, then the adjuster should insist they be provided at a facility where the doctor does not have a financial interest.
4. Attendant care by non-medical assistants
The seriously injured or debilitated employee may need some at-home assistance. Reasonable and necessary medical care in some states is not limited to medical professionals. If the employee needs at-home nursing services, the insurance company's nurse case manager needs to consult with the primary medical provider to establish exactly what the employee needs in the way of home assistance. The work comp adjuster may have to approve the compensation for non-medical personnel to assist the injured employee with bandage changes or toilet needs. However, the adjuster should resist any efforts to expand the at-home assistance to cooking or doing laundry as not medically necessary.
5. Continuing medical maintenance
Most states allow for continuing medical maintenance (a few states end medical maintenance when the employee is paid a permanent partial disability award and most states will allow future medical exposure to be transferred to the employee in exchange for compensation to the employee). When the medical is left open for continuing medical maintenance after the indemnity claim has been settled, the only reasonable and necessary medical care is medical services directly related to the initial injury. State laws vary but a significant number of states have statutes that close the exposure for future medical care if the employee has not sought any medical care for the injury in a specific time period — a year in many states. After that point, the adjuster should maintain that long-delayed medical care is not reasonable or necessary.
6. Diagnostic testing
Diagnostic testing is an area in which some adjusters have difficulty determining whether the medical care is reasonable and necessary. Often it is necessary for the doctor to run various tests to determine the precise nature of the injury. If testing is a duplication of testing that has already been completed — for example, a repeat MRI — the diagnostic testing can be denied as not medically necessary. If testing is for a different body part — for example the cervical MRI on an employee who injured his lower back — the diagnostic testing should be denied as not being reasonable and necessary.(WCxKit)
Most industrial commissions and state work comp boards will approve anything the medical provider determines is medically necessary. However, in the areas discussed here, commissions and boards will often side with the employer when the medical necessity of an item or service is questionable and available alternatives are proposed.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
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