Many injury cases need some sort of diagnostics that are more extensive than just plain X-Rays. But the question comes up as to whether to do testing shortly after an injury occurs, or to wait and try conservative treatment and if that fails or plateaus out to then perform whatever tests are needed.
Damned If You Do, Or Damned If Your Don’t?
These diagnostics are not cheap, whether it is an MRI or EMG or anything else. Plus if you think about how many MRIs or EMGs a large employer has to incur for their injured employees over the course of a policy year it can be a sizeable amount of money. The question arises as to how many of these tests are actually objectively and medically warranted, and how many are being completed to just be completed.
Taking it even further, you have a double-edged sword: If you wait to do the diagnostic test, how much money did you waste on failed physical therapy? But then if you complete the testing too early, was it actually needed and warranted? So there is a lot more to this issue than meets the eye.
Medically, every physician will have a different point of view. Some are more old-school, saying that conservative treatment measures should be exhausted before you go in and perform testing. Other physicians say the sooner you get the testing completed, the sooner you know if something structurally is compromised, and the sooner you can customize treatment to correct whatever the internal issue may be.
The Longer You Wait, The More Chance of Permanent Damage
For example, if a worker has some carpal tunnel-like complaints of numbness and pain in their hands or fingers, do you get the EMG right away or wait until they have had some therapy and splinting and see what happens? Classically, if carpal tunnel is indeed present, the sooner you treat after symptoms surface the sooner it can resolve. The longer you wait to identify the actual diagnosis, the more you risk permanent nerve damage and potentially no resolution at all. That could be one expensive carpal tunnel claim!
If EMG is Negative, Cost of Test Could Be As Much as Treatment
But, if you rush the EMG and it is negative, the cost of the test could be as much as the conservative therapy needed to correct the problem. If the EMG were to be negative, and the diagnosis is just a sprain, then simple splinting and a short course of therapy would be probably all that is needed. Along with some ibuprofen.
Employers question adjusters on both sides of this fence. Really, the adjuster is in a no-win situation. If they get the EMG too early and its negative, employers complain about the cost. If adjusters wait and the EMG is positive, then the employer complains about why the EMG was not done sooner.
The same story could be true for an MRI of the knee. A worker twists their knee, and has swelling. Does that mean you rush in and get an MRI a week later? Maybe not, but who is to say what is too soon and what is too long? Is a month too soon, or too long, if a ligament tear is present? Same for a rotator cuff tear in the shoulder. What is too soon or too long? If doctors really cannot agree on this issue, then you know adjusters have their own ideas on what should be done and when diagnostics should be completed.
No Two Files Are The Same, Make Judgment Based On Mechanism of Injury
My opinion is that no two files are the same. There is just no way to handle every claim the same way, especially when you consider the extent of injury, the mechanism of injury, the age and overall body habitus of the claimant, and any other pertinent details essential to the claim. Probably the most important factor to consider out of those would be the mechanism of injury. Was this an acute injury, with immediate symptoms and swelling, or more gradual in nature? Was it a violent twisting type of mechanism with a fall to the ground, or just a simple twist with no other issues? Was it a violent fall directly to the ground, or did the claimant catch themselves on something then fall?
For carpal tunnel issues, how long were symptoms present? Does the claimant have other factors to consider such as diabetes or pregnancy? What is their job? Is the repetitive twisting and forceful grasping a part of everyday work or are the symptoms just arising when the worker is doing one aspect of one job every now and then?
You can see just by those above questions that you can start to screen out injuries and make your own judgment. The more vicious the mechanism of injury, the better chance of internal derangement, the more likely I would recommend getting some sort of diagnostic testing.
You also have to remember, diagnostic tests are tools to help in diagnosing symptomology. The good thing about getting a knee MRI or a spinal MRI is that later on you can use that test for comparison if this claimant comes back and files another claim in the future, which is the same for an EMG. This will strengthen your defense of that future claim.
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. http://reduceyourworkerscomp.com/about/. Contact: firstname.lastname@example.org.
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