Five Buzzwords to Look for When Determining Causal Relation in Workers Comp Claims

An MRI report is a useful tool used to determine if an injury is work related or caused by a different (pre-existing) condition. Remember, always use an IME or a Physician Peer Review to officially make this determination!

Injuries are always very similar in nature. Even when dealing with different people with different personalities, the objective medical evidence will come down to either being occupational in nature, or more related to someone’s ongoing degenerative conditions. Below we list some buzzwords to look for and what they can mean to the causal relation of an injury. (WCxKit)

 

1. Complex tear

If a worker sustains a specific injury, due to an isolated incident, there is a good chance that any preliminary treatment will be related to the incident. But after a period of time, if the person is not getting any better, the doctor will send the worker for an MRI. This MRI will take a peek inside the joint to rule out if there is any internal derangement or not. Within the MRI report, if a tear is reported, that will not necessarily mean that the tear is directly related. In fact, unless this worker has had a prior MRI test, how does the employer determine or know what injury this person may have had in this joint before this incident occurred?

 

If the report lists a complex tear, this typically will relate to a tear of sorts, with some other medical issues going on in and around that area. Complex tears are usually several small tears within the area, sometimes without one specific massive large tear that can be pointed to as the pain generator. Complex tears can result over time, with several mini-traumas that cause the shoulder or knee joint to sustain numerous small injuries, usually not disabling in nature. Look for a larger tear within that area that can be related to support the ongoing disability. If the worker had a specific lifting incident, with complaints of a “popping” or “tearing” nature, this can indicate the causal relation showing that the incident worsened the person’s pre-existing condition of the several small tears by making one of those tears pathologically worse, resulting in the injury and increased pain complaints. Basically, if the word “complex” is in the MRI report, take a step back and look at the injury details, and see if it correlates.

 

2.  Fraying

This also will be related to a tendon. Fraying can mean that the tendon is actually fraying apart. This usually indicates years of small injuries, enough to make the tendon literally fray apart. Think of the tendon as a rope, an older rope that has been through a lot of abuse will start to unwind itself, and begin to fray apart, weakening the overall strength of the rope. The same can apply to a shoulder or knee tendon. Years of abuse have caused the tendon to break apart, and weaken over time. If the worker had a specific incident of lifting and was sent for an MRI and the results indicate fraying, it does not mean that it is all necessarily related to work. However, if the worker complains of shoulder pain over a long span of time, fraying could be related to work exposure, depending on what job duties the worker does day in and day out. The physician will have to solve this mystery, so it will be important to look at the job duties this worker does, along with any other internal derangement that they have within that joint. Bone spurs or other general arthritic conditions can also result in fraying of the tendons, so be sure to do a thorough investigation so you can make the proper determination on the claim.

 

3. Acute

If the doctor uses the word “acute” in the medical reports when referring to specific damage within an MRI report, this could doom any effort to deem the claim unrelated to a specific work incident. Especially true if the worker had a legit specific trauma, acute damage can instantly correlate the internal derangement to the work exposure. Using a rope as an example again, if the rope looks good and is not fraying, but it has a gouge in it, without evidence of fraying or weakening, that is fairly concrete damage. These tears have clean edges, are easily spotted on the MRI films, and are typically the pain generator. Acute tears will arise out of twisting or lifting injuries, where the tendons are strained under the pressure of doing whatever activity the worker was doing at the time. If the doctor labeled a tear as acute, more often than not it will be related to a specific incident, and if the worker had this incident, this will likely be a compensable claim. 

 

4. Multilevel degenerative disc disease

Moving to the spine, if an MRI shows multilevel degenerative disc disease, it is probably unrelated to work exposure. This condition is a condition of the body, typically unrelated to any specific work injury. Possibly if a worker claims that years of doing a heavy-duty job have led to “aggravation and acceleration of worsening of the spine” this could be potentially work related, but the doctor has to separate why that is, and how specifically the job duties tie in to it. Plaintiff counsel will always try to make this assumption, with long-term employees trying to make a case to say that the work exposure has rendered them disabled with a diagnosis of this degenerative disc disease. It can and has become compensable before, but the attorney has the work cut out for them. All of the chips have to line up perfectly, because most adjusters I know will be quick to issue a denial on a case with this diagnosis. Remember the burden of proof lies within the claimant.

 

5. Spondylolysis and spondylolisthesis 

These two words are hard enough to say aloud and even harder to link to work exposure. These two conditions summarize a shifting of the vertebrae in the spine, which lead to more pressure placed on the discs, thus weakening them and making the discs more susceptible to injury, or worse, herniation. Similar to degenerative disc disease, Spondylolysis and spondylolisthesis are the cause of the actual diagnosis of the disc disease. Plaintiff counsel again will try to say that years of work exposure worsened this arthritic condition and accelerated it to the point of injury, but it is a stretch. I do not know of any work positions that specifically cause these conditions, but the presence of these conditions can lead to lumbar strains, due to the overall weakening of the spine. These claims start out as a lumbar strain, which will not resolve. After an MRI has confirmed these conditions, it is then that the adjuster will set the IME, to show that any ongoing pain is related to this arthritis, and not due to any minor lumbar strain. It does not mean that these words justify denying claims at will, but chances are that any treatment rendered directly to these conditions will not be accepted under comp, generally. It is possible though, so approach the physician to opine what is exactly related to a work incident, and what is due to ongoing degenerative condition advancement. (WCxKit)

  

Summary

No matter what the MRI report will say, make sure to enlist a physician to help determine what is work related, and what is due to any arthritic condition. The key note here is no matter what the diagnosis, it does not mean you are out of the woods. Certain buzzwords can strengthen the defense, but  all of the pieces of the puzzle are needed, including job descriptions and duties, duration of the employment, prior MRI reports, and medical records if any, and anything else the doctor will need to make the proper decision on compensability. The more information given to the doctor, the better decision the physician can make in regards to the causal relation of the injury.

 
 
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
 
 
WORKERS COMP MANAGEMENT GUIDEBOOK:  www.WCManual.com
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php
 
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contactInfo@ReduceYourWorkersComp.com.

Vermont Proposes Radical Approach to Workers Compensation and other News

 
Vermont H 762 — a radical approach to workers compensation in Vermont
Noted WC writer Peter Rousmaniere writes that Vermont is set to pass a radical approach to dealing with the independent contractor problem in workers comp. “The problem is this: many businesses in the past, across the country, have chosen to define their workers as independent contractors, thereby saving themselves serious money in workers comp insurance, unemployment compensation insurance, and other benefits mandatory or voluntary, and leaving their workers exposed to the elements .(There are also other state labor protections that come to play),” he says.[WCx]
 
 
“The house bill 762 has a provision expressly designed to let workers define themselves as independent contractors!” he notes. “The intent comes out in the hearings: to let employers such as contractors hire them without having to worry about the risk of the engagement being seen as employment — even if the engagement looks, talks and walks like employment.”
 
 
Volume Three of the LexisNexis eNewsletter Available
Follow this link to see a summary of state and world news in the WC industry. This edition includes information on North Carolina’s reforms, Retaliatory Discharge and an experts year-in-review among many other “goodies.” Check it out!
 
 
Broadspire Holds First Annual Rx Summit
Danielle Lisenbey, chief operating officer for the Medical Management Services of Broadspire announced its first annual Rx Summit here in Sunrise March 22. As a leader in the industry, Broadspire first Pharmacy Issues Summit should prove to be helpful. They write, “The purpose of the meeting is to bring thought leaders from various organizations together to discuss relevant topics and issues surrounding pharmacy benefits in the workers compensation setting. The intent is not to share the specifics of what various companies are doing, but rather to focus on the global industry issues themselves and what may be the possible trends and developments for the future. One key objective of the program will be to help to identify and define common threads that run through all components of the industry – across claimants, payors, employers and carriers. Defining some of these commonalities will help the consumer to maneuver through the market. This will be an opportunity to brainstorm and share ideas amongst industry peers that can help to influence positive impacts for all.”
 
 
Email Mjaynes@choosebroadspire.com by March 15, 2012 for more information. The Summit is by invitation only.
 
 
TDI-DWC Launches Redesign of Homepage on the TDI Website
Texas Department of Insurance, Division of Workers' Compensation changed its site this week. The redesign of its homepage on the TDI website at http://www.tdi.texas.gov/wc/indexwc.html.
 
 
“In an effort to make online resources for workers’ compensation system participants more user friendly, the TDI-DWC homepage redesign features a new tab style menu with three sections to assist system participants in accessing workers’ compensation information. Topics A-Z features an alphabetical listing of workers’ compensation-related subject matter that directly links to website content. Online Services features direct links to services, including: safety violation reporting, employer coverage verification and attorney fee processing.
Resources features direct links to resources, including the Texas Labor Code, TDI-DWC rules, calendar of events and training and TDI-DWC forms,” they write.
 
 
There are many other helpful changes. Go take a look!
 
 
WCRI Releases Study of WC Laws
The Workers Compensation Research Institute (WCRI) and the International Association of Accident Boards and Commissions (IAIABC) just released a joint study, Workers’ Compensation Laws as of January 2012.
 
 
This tool allows users to compare WC system laws across U.S. and Canada. More information is available here.
 
 
WCRI calls it, “An essential tool for researching and understanding the distinctions among workers’ compensation laws in all U.S. states and certain Canadian provinces.”
 
 
LRP Publications Announces New EEO/Federal Manager Book
To prevent age discrimination and sexual harassment complaints, managers need guidance. EEO complaints can be avoided.
 
 
This new guide is updated with changes in the ADA and the Genetic Information Nondiscrimination Act. Follow this link to learn more: EEO and Federal Managers: Following the Principles, Avoiding Complaints. The book could be handed out to all managers to get everyone up to speed on their EEO responsibilities.
 
 
Chapters include:
EEO Responsibilities
Sex Discrimination and Sexual Harassment
Race and Color Discrimination
National Origin Discrimination
Age Discrimination
Religious Discrimination and Accommodation
Disability Discrimination and Accommodation
Toward a Diverse Federal Workplace
 
 
Early MRIs Impact Outcomes Workshop March 14
Liberty Mutual Insurance knows that while MRIs are commonly used in workers compensation claims, their findings may or may not always be related to workplace injury. To this end, they are hosting a workshop March 14. More information is available here.
 
 
Among the topics to be discussed will be the results from a Liberty Mutual Research Institute for Safety study on the early use of MRIs as they relate to claims outcomes, case studies from the field and best practices around the use of MRIs.[WCx]
 
 
The company recommends people with claims, loss control, risk consulting, or managed care responsibilities should attend as well as risk managers interested in the latest issues and research associated with MRIs and claims outcomes.

 

 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

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

 

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

 

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

6 Types of Diagnostic Testing for Back Injuries

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.

MRI and CT Scans Do More Harm Than Good and Are Ineffective for Back Pain

More than half the patients who see a doctor for back pain undergo X-rays, a CT or MRI scan. But new research shows scanning to find the source of back pain may do more harm than good.

Researchers reviewed six clinical trials comprised of nearly 2,000 patients with lower back pain. The data indicated that patients who get scanned for back pain may end up with more pain than those who are left alone.

The problem is that back scans can turn up physical changes in the back that are not really causing any problem. One study from The New England Journal of Medicine gave 98 people with no back pain an MRI. Two thirds had MRI reports showing they had disk problems.

With a positive scan, people start to think of themselves as having a terrible back problems. They stop doing exercise and things that are good for them, when in reality, most people have degenerative disks and arthritis and have no pain at all.

Even if there is a documented herniated disk, 90% will be pain-free in six weeks anyway. So rather than immediately getting an MRI, a better criteria for a scan should be if back pain persists for longer than a month, or if symptoms suggest a more serious problem like an infection or tumor, which are actually quite rare.

David Dubin, MD. is an emergency room physician who serves as a medical advisor for several companies. Formerly president of Aon Medical Consultants, he has been helping employers and insurance companies develop innovative cost containment programs and reduce workers comp costs for over 20 years. He can be reached at: MD@ReduceYourWorkersComp.com or 503-753-0168.

WC Calculator www.ReduceYourWorkersComp.com/calculator.php
TD Calculator www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php
WC 101 www.ReduceYourWorkersComp.com/workers_comp.php

Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel or other professionals before implementing any cost containment program.

©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

Professional Development Resource

Learn How to Reduce Workers Comp Costs 20% to 50%"Workers Compensation Management Program: Reduce Costs 20% to 50%"
Lower your workers compensation expense by using the
guidebook from Advisen and the Workers Comp Resource Center.
Perfect for promotional distribution by brokers and agents!
Learn More

Please don't print this Website

Unnecessary printing not only means unnecessary cost of paper and inks, but also avoidable environmental impact on producing and shipping these supplies. Reducing printing can make a small but a significant impact.

Instead use the PDF download option, provided on the page you tried to print.

Powered by "Unprintable Blog" for Wordpress - www.greencp.de