Even when I type those words in the title, I cringe a little bit. But before I start to discuss this topic and what adjusters should do at the first mention of this diagnosis, let me give you my normal disclaimer:
I am not a doctor, nor do I claim to be one. I have no formal medical school credits. Please do not consider this medical literature in any way, shape, or form.
The Mayo clinic describes Complex Regional Pain Syndrome as:
Complex regional pain syndrome is an uncommon form of chronic pain that usually affects an arm or a leg. Complex regional pain syndrome typically develops after an injury, surgery, stroke or heart attack, but the pain is out of proportion to the severity of the initial injury.
The cause of complex regional pain syndrome isn’t clearly understood.
Signs and symptoms of complex regional pain syndrome include:
- Continuous burning or throbbing pain, usually in your arm, leg, hand or foot
- Sensitivity to touch or cold
- Swelling of the painful area
- Changes in skin temperature — at times your skin may be sweaty; at other times it may be cold
- Changes in skin color, which can range from white and mottled to red or blue
- Changes in skin texture, which may become tender, thin or shiny in the affected area
- Changes in hair and nail growth
- Joint stiffness, swelling and damage
- Muscle spasms, weakness and loss (atrophy)
- Decreased ability to move the affected body part
Symptoms may change over time and vary from person to person. Most commonly, pain, swelling, redness, noticeable changes in temperature and hypersensitivity (particularly to cold and touch) occur first.
For those who may not know, CRPS used to be known as RSD, or Reflex Sympathetic Dystrophy.
A Real World Example of Complex Regional Pain Syndrome
I can also give you a real world example. A friend of mine, who is an insurance attorney, has had to live through this nightmare. But she was not the one diagnosed with it, it was her husband.
He stepped on a nail at a construction site. What happened next was 3 years of torture, and his work comp claim spiraled into a disaster. It took a normal, active, hardworking, fun loving husband and reduced him to a secluded and depressed shell of a man. They have now finally settled his work comp claim, but the condition lives on.
This did not happen because of adjuster error, or a lack of getting proper treatment. They tried everything. He saw countless doctors and specialists. He tried tons of different medication, most of them leaving him in a drug-induced haze that was so bad he stopped taking them.
Early Diagnosis of Complex Regional Pain Syndrome Yields Better Results
As insurance professionals, we have to be aware of the fact that even the most normal of claims can turn in to a real big claim real fast. In addition to that, we have to fight the fact that some doctors can use this diagnosis to describe pain that they cannot locate or control, be it objective or subjective in nature. This is where adjusters we can utilize their resources.
As the Mayo Clinic notes, early diagnosis and treatment of CRPS will yield better success in treating and controlling the symptoms. Most of the time when a claimant starts to have odd pain complaints, the adjuster will consider malingering or secondary gain rather than potential early CRPS symptoms.
Some of these symptoms include pain in the opposite limb, uncontrollable pain complaints, and other subjective pain complaints that on the surface seem crazy. If you have a person that had trauma in the left leg, and all of the sudden they have right leg pain complaints, 95% of adjusters will be quick to disregard it as CRPS. Instead they will label the claimant as a malingerer and one that is only interested in trying to extend the life of their work comp claim for whatever reason.
But what adjusters should do is set an IME right away, with a doctor that is certified to diagnose this condition. If you are lucky, and CRPS is there, you can catch and treat it right away. If it is not there, then you have at least ruled it out and can address your next step of case defense at that point.
Adjusters Job is Use Your Resources to Solve the Medical Mystery
Not all of your cases with wild pain complaints are going to be diagnosed and certified CRPS claims. In fact, it will probably be a small percentage of them. But the chance is there, and as adjusters you have to step outside of the box and take an outside look at chronic pain complaint cases and consider a potential CRPS diagnosis as the culprit.
If CRPS is there and you catch it early, then you have solved the mystery and can start treating it and moving the claim towards a hopeful resolution. If you just ignore it, then you have failed not only the claimant, but your employer as well because you did not do your job.
Your job as adjusters is to use your resources to solve the medical mystery and to put the pieces of the puzzle back together to correlate pain complaints back to a work injury. Use the doctors and resources you trust, because either way it is your job to investigate and handle claims accordingly, no matter how crazy the pain complaints may be.
Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: firstname.lastname@example.org.
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