It is time to address a topic about causal relation in a workers comp case. This case involves a teacher and school aid in a library, where the desktop computer is being replaced by a laptop. Soon after the switch, both employees begin to complain about neck pain since the height of the monitor on the laptop could not be adjusted from person to person, and extended use was causing some neck pain. The insured wondered if the change to a laptop was causing the neck problems and if these would be considered as workers compensation cases. We discuss the investigation of causal relation here.
What does the treating doctor say in the medical records?
The most important aspects of this case will be the causal relation statements the physician makes. If the two employees are of the same height and build, why are they complaining of pain, more importantly how is the laptop situated, and how is that causing neck pain? Prolonged sitting in a non-comfortable ergonomic position can lead to strains of the neck, but at a normal desk this should not cause neck pain. Is the laptop screen at eye level or situated down inside the actual top of the desk, where the employees are looking down at the screen? Or is the laptop mounted on top of something where the neck is in a constant extended position? Are other employees complaining of pain or having a hard time viewing the screen of the laptop?
It is important to remember in this situation that if an employee comes to an employer and complains of pain and wants to pursue a workers comp claim with supporting medical documentation stating a work injury is present, then it is the employer’s duty to call the claim in to the carrier. The adjuster will make the determination, if the claim is compensable. Certainly more than one employee complaining about the same issue can lead to a more convincing case, but it does not mean it will be automatically accepted. Take pictures of the desk and of these people sitting at the desk as they normally would and send those on to the adjuster as well, so the adjusters can see the setup of the work station and pass that information on to the physician. Being able to actually see the worker sitting as they normally would will help them arrive to the proper decision on the case.
Does either employee have a history of neck pain from another source?
One of the first questions the adjuster will ask is if either employee has a history of neck pain or prior surgery. This could predispose them to having pain if the neck is positioned in certain ways. Again it does not mean that the laptop setup itself is responsible for the pain. It could be pre-existing post-surgical pain that is the culprit. Prior auto accidents involving whiplash complaints can also contribute to neck pain in the future. Also the employees’ activities outside the workplace are unknown. Maybe one or both of them are engaged in activities that fatigue the neck, and this laptop exacerbated that non-occupational pain. A question about whether the injury could have another cause is part of a normal investigation in just about every workers compensation claim.
Is the workstation adjustable or not?
If these employees are of different height, can the chair or workstation be adjusted to properly fit them? And if so, are they still complaining about pain? If nothing is adjustable, are other employees of similar builds complaining about the position of the laptop screen? Why or why not? Again, if no other employees are complaining about any problem with the laptop, then go back to these two employees. What is the relationship to each other? Do these two often hang out at the school? Are they in common positions and have similar duties? How long are they actually sitting at this computer and how often are they required to be moving up and around during the day? All of these questions are part of a normal investigation the adjuster will do, and as the employer, try and gather as much of this information as possible to help the adjuster make the proper determination on the claim.At the same time the claim is investigated by the adjuster, the incidents should be reported to the safety director who should review the workstation design. Consider having an ergonomic consultant review the set up. Ask your TPA or insurance carrier what resources are available for ergonomic consulting. Consider what other equipment could be provided to make the work station more comfortable.
Has the adjuster performed an IME or peer review yet?
Usually background searches have been completed for prior injuries, and the next thing is to gather all of the medical evidence and set an IME with a qualified physician or occupational medicine doctor to address the causal relation. Is there any objective evidence of degenerative arthritic conditions in the neck that can contribute to this pain? Was an MRI performed, and if so are there any objective results, and, if so, how can they relate to the ergonomics of the workstation? This should all be part of the normal investigation on the claim, and all of these questions should be included in the cover letter to the IME doctor, so that doctor can specifically address these questions with the correct answers, using objective medical evidence to back up the opinion.
What is the decision–is this compensable or not?
This is the million-dollar question. There are cases like this where these are accepted injuries under workers comp and similar cases where coverage is denied for similar complaints. The lesson here is that no two cases are the same. Maybe one of these employees has no pre-existing condition, and the other one has a prior surgery. This could play a role in which case is compensable and which one is not. It will be up to the adjuster on the file to make a decision on the compensability. Even if the employer disagrees with the decision, there is little to do to swing the case the other way. Let the adjuster do a thorough investigation and stand by the decision. If the worker disagrees with the decision, there are ways to appeal the decision and research to pursue that on their own. That is the choice of the worker.
Ergonomic claims such as this one are going to happen at some point. The key thing to remember as the employer is to do a thorough investigation. Gather as much information as possible, even if it appears to not matter in the final outcome. The adjuster always prefers too much information rather than not enough. Take pictures, and assist the adjuster in any request they have. They will make the proper decision on the claim, since that is an adjuster’s job day in and day out. If, however, you disagree with the decision, make sure to talk this out with the adjuster and the claim supervisor.
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.
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