An Interview with Doctor Alice Martinson
We hear a lot about the rising cost of workers compensation when injured workers suffer from co-morbid conditions. What is “comorbidity?”
Co-morbidity refers to any unrelated medical condition, which nonetheless has some bearing on the primary condition under discussion, or upon an individual’s ability to return to a functional level. An example of this would be a chronic cardiac condition delaying or preventing surgery in someone who has work-related knee osteoarthritis. Another, though somewhat graphic example, is an individual with a leg amputation who sustains an injury to two of the remaining three extremities. Given the number of returning Middle East veterans who are amputees, this is not such a far-fetched possibility.
How do you define obesity?
Obesity is defined in terms of body mass index (BMI). A BMI between 25 and 30 is considered “overweight.” A BMI over 30 is considered obesity, and a BMI over 40 is considered extreme obesity. In some written material it is called “morbid obesity.” This latter term is falling out of favor because it can carry an emotionally-charged meaning getting in the way of useful discussion. BMI is calculated as the relationship between height and weight. (WCxKit)
Rather than fooling with the math, I use a very convenient table available on the NIH website: Calculate BMI
Workers compensation will usually not cover that portion of a workplace injury related to a comorbid condition. How can the workplace injury be separated from the pre-existing condition for compensation?
For workers compensation treatment, that is not usually a hard distinction to make. A good example here would be carpal tunnel syndrome in a diabetic. Diabetes does not cause carpal tunnel syndrome, but diabetics will many times experience progression of the condition, once it occurs, at a much faster rate than non-diabetics do. Thus, surgical decisions and timing may well be affected by the diabetic state.
Where it gets harder within the workers compensation system is the question of whether a co-morbid condition interfering with the treatment of a workers compensation problem should be treated through the workers compensation system.
The most frequent instance of this I have come across is the question of whether bariatric (weight loss) surgery should be covered by workers compensation when the primary injury is knee trauma. Continued obesity in the face of a knee injury is inviting progressive osteoarthritis, so the question comes up – “Is bariatric surgery necessary to cure or relieve the effects of the work injury?” A similar example would be when a serious cardiac condition is found that interferes with necessary surgical treatment of a work injury.
Should treatment of the cardiac condition be provided under workers compensation?
There are different policies and case law in each state, so I would encourage anyone who encounters this issue to check for the rulings in their particular locale.
What pro-active steps can an employer take to communicate to employees their pre-existing conditions are not covered in the event of a workplace injury before injuries occur in a way that does not cause “uproar,” i.e., hurt feelings, cries of discrimination, threats of lawsuits?
The key word in your question is “pro-active.” Certainly, employees need to be educated about health maintenance issues and policies as general principles BEFORE a specific instance workplace injury brings up a specific question in a specific individual. Many large employers have incentive programs for smoking cessation, weight loss, and similar issues further reinforcing the importance the employer places on avoidable problems. There are enough benefits to these programs, that I encourage even small employers to adopt wellness programs as part of their employee policies.
Do you recommend pre-employment/post-offer screening for pre-existing conditions?
Except in the unusual case of extraordinarily critical or demanding work, pre-employment/post-offer screening using such things as spine X-Rays does not seem to be cost-effective. It is always appropriate to obtain a history of pre-existing conditions after an offer is made, because no one can predict the future but it is a great way to document the past. Having a starting point is very beneficial if the question of work-related progression or aggravation comes up. The best pre-employment screening I know of is not screening of the employees, but of the physical demands of the job for which an employee is sought. (WCxKit)
Can you explain what you mean by having the employer screen the physical demands of the job?
The more physically demanding the job, the greater the opportunity for something bad to happen to an individual doing it. An employer must know the physical demands of the job tasks. This is not rocket-science. A 5’2” woman weighing 130 lbs should not be hired to lift and carry cartons about a warehouse that are almost as tall as she is. You laugh! Several months ago I was doing a workers compensation exam on just such a woman doing just such a task. Or a more subtle instance — someone with knee pathology (problems) is not suitable for a job requiring constant squatting or climbing stairs and ladders. If you know those are the physical qualifications of the position, you as the employer have every right, and perhaps the responsibility, to determine if a prospective employee meets those qualifications. What is important is to determine the physical qualifications in advance, just as you do with education, temperament, ability to work without supervision, and so many of the other non-physical aspects in any job description. When you decide on an individual’s suitability for hiring into a specific position, you then have the opportunity to choose the whole package. A physical therapy or rehabilitation firm can often do a physical demands evaluation of the jobs in your facility.
As an example – a clerk is hired into a prison office. The only problem is it takes a half-mile of walking each way from the parking lot to her job. You would never know that from her job description. Some folks cannot do that. Same thing for some work settings where the employee works on one floor and the bathroom is on another. Do not think that does not happen – the IRS office in Fresno is exactly like that.
Does the ADA come into play when dealing with employees with comorbid conditions?
The ADA requires “reasonable accommodations” for an individual who declares a disability. An employer should decide in advance how to define “reasonable” in their setting. Obviously, a bricklayer with a pre-existing back disability cannot be reasonably accommodated in another brick laying job. On the other hand, there are a great number of office jobs in which individuals with back disability can be reasonably accommodated by altering the seating or the supervisor’s expectations in regard to the need to get up and change positions periodically.
What can employers do to reduce comorbid obesity in their workers and make them less likely to suffer workplace injuries aggravated by their condition?
Peer pressure is a wonderful thing. If all workers are educated about wellness issues and buy into proactive wellness efforts, getting an obese individual working towards his or her own wellness should not be too hard. It has to be a group effort for support and encouragement. That is one of the principles behind Weight Watchers, the 12-step programs, and – for that matter – TV’s “The Biggest Loser.”
What do you think about employer-sponsored wellness programs?
I am clearly in favor of them. They have to be properly designed and incentivized in order to be effective. That means the leadership needs to be involved in them too, and there has to be public recognition and tangible benefits – even small ones – to encourage ongoing participation
Are there any “pre-canned” programs out there an employer can use rather than reinventing the wheel? Do you recommend them?
Each program has to be tailored for the specific work situation. Something is better than nothing, but whenever feasible I would suggest seeking the advice and participation of a consultant who is experienced in these issues and has a track record of success they can point to. (WCxKit)
There is a really good article in the magazine Inc. that addresses these programs. See How to Build a Wellness Program. There are an abundance of commercial firms interested in getting consultant business. Read the article first.ThTTh
Author: Alice M. Martinson, MD has practiced for 40 years as a board-certified orthopaedic surgeon, 25 of which were as a Naval Medical Officer. Relying on her extensive military experience with injury evaluation, she performs IMEs and consults on loss control issues. Contact: 870-480-7475 or
docalice@aol.com. To read more about "Doc Alice,” go to our Directory at:
http://reduceyourworkerscomp.com/workerscomp-medical-doctor-advisors.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.
©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.
Travel as a Stress Factor
The American College of Occupational and Environmental Medicine reported employees who travel more than two-thirds of the month are more than two and a half times more likely to rate their health as poor than workers who travel less often.
According to HeartMath.com, the heavy travelers were also 92 percent more likely to be obese and had higher blood pressure and cholesterol than their co-workers who were only traveling one or two times per month. (WCxKit)
Authors of the study attributed the health discrepancies to the long car rides, unhealthy food, and disrupted sleep patterns that usually happen when someone spends a great deal of time away from home.
Interestingly, the research involving 13,000 employees also discovered that workers who did not travel were not as healthy as those who traveled lightly. The authors said this is likely due to the fact unhealthy workers are less likely to be put on travel assignments.
The researchers commented that organizations that want to assist their hard-working employees attain improved health may want take initiatives like implementing employee wellness programs and offering gym memberships.
High Level vs. Low Level Stress
While it is common knowledge that high levels of stress have detrimental effects on an individual's mental and physical health, a new study reports that even moderate anxiety may increase a worker's chance of disability by 70 percent. The study was published in the Journal of Epidemiology and Community Health.
According to a report from Heartmath.com, researchers examined the journal's data of more than 7,000 employees from 45 to 65 years of age over a five-year period. They discovered that the results supported long held beliefs regarding the health of those under intense stress but were surprised about the effects of everyday anxiety on individuals, a number that was high even when they corrected for lifestyle habits. An abstract of the journal's study indicated scientists looked at the combined effects of work stress and socioeconomic position. Figuring in socioeconomic position, occupational position and educational level, scientists found stress is related to angina pectoris, depression, and poor self-rated health. All three measures in the journal study created additional work stress but poor health was highest in cross-sections combining high work stress and low socioeconomic position.(WCxKit)
The abstract reads, "Although stress at work was related to poorer health in the total study group, the strongest associations were consistently observed in men and women with low educational level or low occupational position. Worksite health promotion should be directed primarily towards these target groups."
Authors of the study commented its results could have important implications for modern employers, who seem to be placing more stress on workers than ever.
"Are the strains and demands of modern society commonly exceeding human ability?" researchers asked.
Stress accounted for one-fourth of disability claims related to physical illness, and two-thirds of those stemming from mental issues. (WCxKit)
Further, nearly 40% of employees in a Chartered Management Institute (CMI) study pointed to their supervisor as a chief contributor of workplace stress. An additional 34% said their boss makes work less enjoyable and 10% blamed the boss for their poor health, as reported by website Heartmath.com.
Joe Robinson of the Huffington Post concluded workplace stress triggers the brain's panic responses saying, " Stress constricts your brain to the perceived crisis and inhibits all the things that can reduce the stress, such as relaxation, recreation and play." This kind of stress can lead to anything from adrenal dysfunction to back pain, he said, noting that a relaxed breathing techniques are among the best tools for reducing stress.
In addition to making sure staff members have manageable workloads, organizations may want to think about employee wellness programs in order to lessen workplace stress and improve employee wellness.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact:Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
In Tennessee, every employer who has five or more full or part time employees, is required to carry workers compensation insurance. Employers in the construction or coal mining industry must provide workers compensation coverage if they have any employees. Corporate officers may decline workers compensation insurance. But they are included in the count of employees. Family members working in the business are also included in the count of employees. State and local governments are exempt from the workers compensation law, as are employers of farm laborers and domestic help. But all can elect to purchase workers comp coverage.
Obtaining Coverage
To obtain workers compensation coverage in Tennessee, the employer has 4 options
1. purchasing a workers compensation insurance policy from an insurance company licensed to do business in Tennessee
2. self-insurance for the employer who has sufficient assets to self insure
3. purchasing insurance from the state owned Tennessee Workers Compensation Insurance Plan
4. setting up a self-insurance trust (WCxKit)
Claim Reporting
The employee must report the injury to the employer within 30 days in writing. when the employee receives medical care outside of the employer's premise. If the employer does not have actual notice, the employer must report the injury to the Tennessee Department of Labor within 14 days
Medical Benefits
The employer must provide the employee a panel of three physicians. From this panel, the employee will choose a medical provider. If it is a back injury, the panel must include a chiropractor. However, chiropractic visits are limited to a maximum of 12 visits under the workers comp law. If specialized treatment is needed, the selected medical provider will make a referral. At this time, the insurer or employer is required to form another panel of three physicians that offer the specialized medical care needed.
There are neither time nor monetary limitations on medical care. The medical care will continue as long as the authorized panel physician deems it necessary. Mileage to and from medical treatment facilities is reimbursed only if exceeding 15 miles. The mileage rate is set by the state.
Temporary Total Disability Benefits
The temporary total disability (TTD) benefits are calculated as two-thirds of the employee's average weekly wage earned over the 52 weeks prior to the injury. The TTD weekly maximum and minimum is adjusted each year on July 1st. The weekly maximum is capped at $867.90 for injuries occurring from July 1, 2011 to June 30, 2012. The weekly minimum TTD amount is $118.35. TTD benefits are paid every two weeks and can be for a maximum of 400 weeks.
The first 7 days of disability (the waiting period) is not paid to the injured employee unless the employee is disabled for more than 14 days.
Temporary Partial Disability Benefits
In Tennessee, temporary disability (TPD) benefits are paid if an employee is able to return to any type of work but is earning less than prior to the injury or working fewer hours per week. 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
Tennessee employees who incur a permanent partial disability (PPD) are entitled to two-thirds of their average weekly wage, not to exceed a maximum of $789 per week. The minimum for PPD is equal to the minimum TTD benefit. For non-scheduled injuries, the maximum period of payments is 400 weeks. For scheduled injuries, the loss of a body part has a maximum of 200 weeks of benefits for a limb. The number of weeks declines based on the body part to only ten weeks of benefits for a toe other than the great toe.
Permanent Total Disability Benefits
Permanent total disability (PTD) benefits are set identically to PPD benefits. The exception is that if the worker is 100% disabled, the PTD benefits are payable to age 65 and may be offset by social security benefits. (WCxKit)
Death Benefits
Burial expenses in Tennessee are covered for a work-related death up to $7,500. The death benefits for a surviving spouse and dependents follow the same guidelines as TTD benefits. They are two-thirds of the average weekly wage up to a maximum of 400 weeks. If the spouse remarries, the spouse loses the benefit. But the children continue to receive the death benefit. until they are 18 years old, or 22 years old if enrolled in an accredited educational institution. When the deceased employee does not have any dependents, $20,000 is paid to his or her estate.
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.
A national nursing assistant survey yielded some interesting findings as seen on the
Health Care Management Review website. Brought to our attention by Jennifer Christian, M.D., the study tells that nursing assistants (NAs) are an important human resource in health care. They provide direct care to more than 1.5 million nursing home patients in about 16,100 nursing home settings according to the Centers for Disease Control and Prevention. A higher turnover rate in the field (about 66 percent in 2007) among NAs may be linked to reduced quality of patient care in nursing homes, according to the study.
Naturally, workplace injury is a serious concern among NAs, the study states. Transformational leadership (TL) has long been popular among management scholars and health services researchers, but no research studies have empirically tested the association of TL with workplace injuries and absenteeism among nursing assistants (NAs).(WCxKit)
The cross-sectional study explores whether TL is associated with workplace injuries and absenteeism among NAs. They analyzed the 2004 National Nursing Assistant Survey data. A multivariate logistic regression analysis was performed to test the role of TL in the context of workplace performances and results revealed the TL model was positively linked to workplace injury in the level of NAs. Injury-related absenteeism was also associated with the TL style, indicating that TL behaviors may help address workplace absence among NAs.
Findings suggest introducing TL practices may benefit NAs in improving workplace performances.
Over the past 10-year period (1995-2004), about 800,000 nursing, psychiatric, and home health aides were injured in the workplace, the report says. Over the same period, 154 workers in the occupation were killed on the job. Nursing aides, orderlies, and attendants experience the third highest number of injuries and illness, exceeded only by truck drivers and laborers and material movers. (WCxKit)
In a prospective study investigating workplace injuries among NAs in Washington State, revealed that about 46 percent of the sampled respondents reported back and shoulder injuries. The study was based on a national survey and reports that more than half of certified NAs had at least one work-related injury in the past year. Prior studies have suggested that occupational injury may be blamed for the attrition rate of NAs.
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.
A surefire way to make a workers compensation adjuster cringe is to hand them a medical report where it is alleged the injured employee has developed fibromyalgia due to a workers compensation injury. Fibromyalgia can be loosely defined as an incurable condition that causes widespread chronic pain in the muscles and connective tissues with an abnormal increase in pain level in response to touch or pressure. Fibromyalgia has other symptoms besides pain including joint stiffness, muscle spasms, weakness in the limbs, fatigue, and sleep disturbance. Also, some people alleged to have fibromyalgia, will have other symptoms including tingling, numbness, difficulty swallowing, and cognitive issues.
There is a lack of consensus as to the causes of fibromyalgia as there is no conclusive, objective diagnostic test. Some medical providers believe fibromyalgia develops in people who have a low threshold for pain with their brain being super sensitive to pain signals. Other medical providers question the validity of this. These medical providers do not consider fibromyalgia a valid diagnosis because abnormalities are lacking in the physician’s examination of the employee. It is for this reason that workers compensation adjusters will question the validity of a fibromyalgia diagnosis from a doctor known to be “claimant friendly.” (WCxKit)
People diagnosed with fibromyalgia often are suffering from stress, depression, and anxiety. It is the high level of overlap with stress, depression, and anxiety that leads many medical providers to consider a diagnosis of fibromyalgia to be an incorrect diagnosis. To these medical providers, it is not a musculoskeletal problem, but a neuropsychiatric disease.
Credence is given to the medical providers who consider fibromyalgia a neuropsychiatric condition because most people who develop fibromyalgia have various cognitive disorders including impaired concentration, diminished attention spans, long-term or short-term memory loss, the inability to multi-task, and impaired speed of performance.
Most medical providers, including those who diagnose fibromyalgia, are reluctant to attempt to treat it. The injured employee diagnosed with fibromyalgia will be transferred from the medical provider who was treating the claimant to a pain management specialist. But even with pain management specialists, there is a vast array of methods used to deal with fibromyalgia with no single treatment plan having widespread acceptance.
The pain management specialists will often try various approaches and combination approaches including prescription medications, aerobic exercise, patient education, cognitive behavioral therapy, behavioral intervention, and even alternative medicine including homeopathy, chiropractic, and herbal medicine.
It is the use of prescription fibromyalgia medications that causes concern in the medical community. When injured employees are given prescriptions for pain medicines for a medical condition that is hotly debated, it causes some consternation with the medical providers who do not consider fibromyalgia a valid diagnosis.
When the person with the diagnosis of fibromyalgia is given antidepressants, they improve primarily in their level of pain, depression, sleep disturbances, and fatigue. This seems to bolster the position of the medical providers that fibromyalgia is a neuropsychiatric condition, not a musculoskeletal condition.
Using narcotics to treat fibromyalgia creates a lot of controversy as well. There is a lack of clinical trials that support the use of opioid in people with fibromyalgia, but many pain management clinics prescribe them freely without concern for addiction and abuse. (WCxKit)
The frown on the workers compensation adjuster's face is due to the fact that rarely do people with fibromyalgia improve. They also never die from fibromyalgia and seldom does the condition degenerate after it is established. The workers compensation adjuster knows the fibromyalgia claim will be around for a long, long time.
_________________________________________________________
PERSONAL EXPERIENCE OF MEDICAL CASE MANAGEMENT RN:
After publication of the above article, an RN Medical Case Manager from a major medical case management company provided the following account of an experience she had with one of her employees. It was important information to relay, so I am reprinting it. She asked me not to use her name:
"I had an employee who suffered from this ‘disorder’ for almost 3 years now – as diagnosed by a Medical Doctor who was a specialist in treating Fibromyalgia. She had every test you can imagine to rule out brain injury / neuro disorders. She spent THOUSANDS of dollars and underwent PT for many months . . . I can only guess total costs exceed $150,000 in tests, MD visits, P.T. and medications.
I had a chiropractor who put on an Advanced Nutrition course who happened to mention that he strongly feels and can prove that Fibromyalgia can be ‘cured’ if the patient is willing to change their eating habits. This involves avoiding all sugars and grains and consuming good fats and protein. Among the treatment included was chiro adjustments – she underwent approx 12 and will need about 12 more on and off throughout her life. In under 45 days she had reduced her need for medication (saving over $300/month) and is pain free for the first time in 3 years.
He has implemented this treatment (nutrition, exercise and adjustments) on several occasions with patients diagnosed by medical experts for Fibromyalgia. My employee took pleasure in telling her Fibromyalgia doctor how she well she is doing now (he is a highly respected MD at Vanderbilt University). She is now completely free of taking any medications and considers herself back to normal!
But you know how our world frowns on chiropractic treatment! 
Such a shame."
I am providing this link for those who are interested in learning more about a nutrition-based program.
Maximized Living Nutrition Plan book by B. Lerner, BJ Hardick and K. Roberto.
https://store.maximizedliving.com/scripts/prodView.asp?idProduct=140
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.
We all know medical treatment costs per claim have grown exponentially in some jurisdictions. To help policy and business decision makers understand the growth better, the Workers Compensation Research Institute (WCRI) created a Medical Price Index for Workers Compensation, Third Edition.
The tool focuses on prices paid for medical care that injured workers receive, according to Ramona Tanabe, WCRI counsel and deputy director. Previously, the consumer price index for medical care was used, but it only measured general prices paid for medical goods and services. “If you are a policy maker or other stakeholder and want to understand the growth of medical prices in workers compensation, you need this unique tool,” she said.(WCxKit)
The tool will help state accurately understand how prices for medical care for injured workers in their state compare with other states. It helps them decide if prices in their own state are rising slowly or rapidly. The tool can help them learn if rapid price growth is part of a national phenomenon or if it might be unique to the home state and therefore subject to local management or reform.(WCxKit)
Since medical prices for workers compensation are regulated in about 80 percent of states, the consumer price index for medical care does not reflect changes in actual prices paid in the regulated workers compensation market.
To learn more about this tool, look
here.
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.
A fine of $65,496 was handed down recently by Judge Moran in the Limerick Circuit Criminal Court to "Mr. Binman," a waste collection and recycling company, providing services to both household and commercial customers in Ireland since 1994.
According to the Health and Safety Executive (HSE), the fines were imposed for breaches of health and safety legislation on March 21, 2008 at Luddenmore, Grange Kilmallock, Co. Limerick. The case arose as a result of the death of John Wright, an employee of Mr. Binman. (WCxKit)
Wright was involved in an accident at the waste management facility where he was struck with a loading shovel machine. Wright, a bin truck driver, was walking from his truck to the offices/canteen area when the incident occurred.
Wright was removed from the scene to the Limerick Regional Hospital where he later died from his injuries. He had worked for Mr. Binman for approximately 14 years and was 64 years old.
Speaking after the judgment, Martin O’Halloran, chief executive of the Health and Safety Authority, said, “This accident was foreseeable and preventable. It is clear in this case that "Mr. Binman" failed in its duties to ensure that mobile machinery and pedestrians could move about the workplace in a safe manner.”
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.
There are jurisdictions where workers comp is very employee-friendly. It seems the employee can do no wrong. In the mind of a judge, it is the employee who suffered this great loss while working for your company. They are in daily pain because of injuries suffered on the jobsite. They are trying to make ends meet on reduced wages.
For the most part, this is correct. But every adjuster has a few cases where there is that gut feeling that something is not right. But, if the medical adds up to supporting ongoing disability, and a nagging feeling still exists, then it is time to run surveillance. But how does it work to help in a specific case? There is no question the claimant is injured. More than 10 seconds of film of the claimant getting the mail is needed. Here are 5 ways to think about surveillance and its benefits. (WCxKit)
1. Use a surveillance firm that boasts results
There are many surveillance firms available. Some of them specialize in legal backgrounds in law enforcement, some with military backgrounds, and some with insurance backgrounds to name a few. Whatever the case may be, a reputable firm must be chosen. Video evidence of the claimant doing something outside of the medical restrictions must be obtained. Showing this as repeated behavior is key.
Obtaining this kind of evidence to help the case is partially due to luck. But this is where a skilled investigator plays a huge role. Through a background search and understanding the person’s habits, one can begin to theorize how and when the subject will be active. For example, if the claimant has pictures of deer on a Facebook page, it can be reasoned the Fall season is likely an outdoor time for the worker to be active.
Feedback from peers in the specific industry and from carriers is helpful. Some carriers now have their own surveillance unit and it can be considerably less costly to use a carrier’s firm than to go outside of network. This is a large expense. But if good film is recorded, it can save so much more in overtime cost and is a wise investment.
2. Plan on 3-5 days worth of surveillance
As mentioned above, the person must be shown breaking medical rules. If the claimant has restrictions of no lifting over 15 lbs and is caught at the grocery store lifting 2 bags of groceries, that is not exactly case-changing evidence. But, if the worker is lifting groceries one day, then going home and doing yard work for 2 hours, helping a neighbor the next day cut a tree down, then waxing the car a day later followed up by working with a friend to remodel a kitchen, now potential evidence is building to show a pattern. It shows the worrker living a totally normal life with little to no medical problems.
The scenario of finding evidence is probably not going to happen on every file, but it is amazing to discover what people are doing on their spare time. Some people hole up in houses and only stick arms out to retrieve mail from the bin by the front door. Those people may have experienced having surveillance usded on them! While others are out golfing, playing softball, deer hunting, or boating with a shoulder injury to name a few scenarios. Whatever it may be, the employer needs enough film to justify the person breaking medical restrictions as often as possible. This is especially helpful when an IME supports an ongoing disability. Then after film is successfully recorded, it is sent to the IME doctor for review. And the doctor may change an opinion to show no ongoing medical disability. If there is suspicion that a claimant is not being 100% truthful with a disability, and the right film and doctor’s opinions coincide, then the adjuster's suspicions are justified.
3. Be sure reports detail all activity
Just the film alone can be enough to swing an opinion to deny ongoing benefits. In addition to the film, record every activity, action by action. Sometimes the events unfold before the investigator can get the camera rolling. Or the investigator cannot get a shot due to location. Investigators should still document the activities of the subject in great detail. Chances are the agency may be deposed on the case at a later date, so most reputable firms are extremely detailed in every fact and activity on the case. In these cases , it is preferred to have too much information than not enough.
4. The film obtained has to be clear
Getting film of the claimant is very important, but it can be worthless if the claimant is out of view or the picture is fuzzy. A lot of this comes down to the investigator’s experience and the quality of the equipment the firm uses. Ask for examples of film and reports to gain an idea for how a case is handled.
5. The subject has to be violating their restrictions frequently
We mentioned above getting 3-5 days worth of film to show the subject breaking restrictions on multiple occasions. There are cases of a judge viewing a film of the claimant breaking restrictions on one occasion and then turning to the subject and saying “Why were you lifting 40 lbs when your restrictions state you should only lift 20 lbs?” The response is usually something like, “Boy I must have been having a good day that day, because I could hardly lift anything at all.”
It may seem unbelievable, but depending on the jurisdiction, some judges believe it. Show the judge the worker's behaviours are not just a one-time thing. The person is violating restrictions on a daily basis for 4 straight days. Imagine if surveillance could be done for 30 days in a row, so much evidence of restriction violation would exist. Malingering would be simpler to prove.
And that is the goal and challenge when filming a person doing the wrong thing more than one time. It shows a pattern and makes the point the person is leading a normal, pain-free life, despite reporting otherwise to the doctor. If blatant disregard is evident through the use of film on multiple occasions, there is a great chance of getting the desired result — terminating the fraudulent claim. (WCxKit)
Summary
Surveillance can be a useful tool to help confirm a claimant’s honesty. But to benefit from it fully, certain guidelines must be followed. First a reputable firm must be used making sure the firm is descriptive and up on the latest technology. Try to obtain as much film as possible and then tie it into the case defense. Although not every person "doing fraud" will be caught, chances are those violating the medical restrictions and working second jobs under the table will be caught.
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.
Psychosomatic injuries are among the most difficult workers compensation claims an adjuster receives. These injuries frequently start out as physical and develop into a psychosomatic one over time due to various circumstances. Establishing when a physical injury becomes a psychosomatic injury is challenging, because the injured employee does not fully understand the pain is from mental factors rather than physical injury. Merriam Webster defines "psychosomatic" as "of, relating to, involving, or concerned with bodily symptoms caused by mental or emotional disturbance." Such as, "The doctor told Mary her stomach problems were psychosomatic."
The doctor treating the injured employee notes the physical symptoms improve, but the employee still complains of pain, stiffness, numbness, tingling, and burning. When a physical exam does not explain away the employee's symptoms, the doctor requests additional diagnostic testing. When this occurs, the workers comp adjuster should pay close attention to the test results. If an MRI or CT scan or other diagnostic tests reveal no physical problem(s), then the adjuster is facing a significant challenge with the claim and must consider the possibility of a psychosomatic injury. (WCxKit)
The treating physician may suspect the employee’s medical issue has psychosomatic features, but few physicians voice an opinion. Instead, the physician often refers the employee to a pain management doctor. Unfortunately, pain management clinics are not designed to treat psychosomatic injuries.
Employers and adjusters often suspect the employee is faking, committing fraud, or malingering. It is almost impossible to distinguish between a psychosomatic injury and an employee exaggerating a claim for secondary motives. Sometimes an employee who fakes physical symptoms to seek out narcotics or avoid going back to work begins to believe the symptoms. So a case of what was malingering is now a psychosomatic injury.
The example of the long haul truck driver illustrates another psychosomatic scenario. A truck driver exits the tractor, when a foot slips causing the driver to fall. The driver uses his hands to break the fall, and this prevents head injury but in turn causes compound fractures in both wrists. A surgeon operates and inserts a plate and screws in both wrists. The driver is now unable to drive and support his family, and temporary disability benefits are not enough for the family to live on. The financial situation worries the truck driver and depression begins to develop. Despite this situation, there are positives for the driver. The family the driver rarely sees is now suddenly attentive. The driver’s family life and marriage even improve. As weeks pass, the trucker feels better and family life returns to normal. The driver does not consciously use pain to get attention, but psychologically realizes life is better when complaining about pain. A psychosomatic condition is born.
According to Wikipedia, there are three common mechanisms for the psychological exacerbation of symptoms in which a normally functioning human mind increases pain and pain related disability.
1. Depression and anxiety make pain seem worse. Chronic pain leads to a cycle of increasing depression.
2. When a person worries about a particular body part, the brain can actually signal to the spinal cord via outgoing neurons that it should be more apt to interpret nerve impulses from that body part as pain. For instance, the brain learns to automatically trigger pain when an injured limb is moved.
3. A belief that something is seriously wrong that does not lessen with normal medical test results and reassurance from the medical provider. Heightened concern and anxiety over the injury is commonly seen in psychosomatic injuries.
The employer and the adjuster can recognize what may be a psychosomatic condition in two ways.
1. The injured employee may have developed a psychosomatic injury, especially if the symptoms move around the body (the trucker discussed above developed severe pain in his elbow and shoulder after all physical symptoms of the fractured wrist had ended).
2. When an objective test addresses a specific set of physical symptoms and verifies there is not a physical cause, the injured employee replaces those symptoms with a new set of symptoms. (WCxKit)
The psychosomatic injury is a very difficult claim to resolve as the injured employee rejects that the symptoms are not physical. The reluctant medical providers understand it is psychosomatic but avoid officially stating it fearing the patient may replace them. The adjuster or the nurse case manager must be willing to incur the employees anger and urge the employees medical providers to also address the psychological aspects of the injury claim.
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 Fire Brigades Union (FBU) recently called on London Fire Brigade bosses to give greater commitment to the safety of its firefighters after a damning report by the Health and Safety Executive (HSE) identified several failings.
The report by the HSE was a follow-up exercise focusing specifically on areas of concern which arose following the deaths of two London firefighters – Bill Faust and Adam Meere – at a fire in Bethnal Green in 2004. While improvements had been identified in some areas, in others the lessons have not been learned. (WCxKit)
The report, made public by the Fire Brigades Union, highlights thirteen areas for improvement, including the need for better training in the use of breathing apparatus. The HSE has told London Fire Brigade to come up with an action plan to address the shortcomings.
Key points from the report include:
1. A widespread view by firefighters that training in core firefighting skills had taken a back seat to “community work;”
2. Concerns over the quality and frequency of training in the “risk critical” area of use of breathing apparatus while tackling fires;
3. Demands by firefighters for better training often going unheeded by bosses;
4. Officers expected to deliver training often complain that they have received insufficient training themselves;
5. A lack of facilities for “real fire training,” which would simulate real-life firefighting scenarios.
The FBU’s regional health and safety co-coordinator Gordon Fielden said, “This very disturbing report puts the London Fire Brigade on notice that it must do much more to protect its firefighters from danger while they are at work.
We are especially alarmed over the many concerns raised by the HSE over the inadequacy of breathing apparatus training. This is the most critical part of a firefighter’s job and one that can make the difference between lives being lost or saved. The London Fire Brigade expects its firefighters to put their lives on the line to rescue others. The very least it can do is to make sure it gives them the very best training to do their jobs. But it is failing and the result of that failure could well be lives lost.
“We have been arguing for a long time that training in core firefighting skills is being sacrificed to allow for more extensive work in the community. Community work has its place, but is wrong and dangerous for the brigade not to make basic training the priority.
“Previously the brigade has audited itself in some of these areas, and not surprisingly those audits produced glowing conclusions and an outpouring of self-congratulation. But it has taken an independent body to show that those audits were a charade. (WCxKit)
“Now the brigade has been handed an action plan for its failings. The chairman of the fire authority, Councilor Brian Coleman, has been very quick in the past to bathe in the glow of perceived success. Now he needs to take responsibility for these serious failings,” Fielden 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.
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