Workers’ compensation claims that involving chronic pain issues can be the proverbial pain in the butt for the injured employee – and claim team. Working on these claims and driving them toward settlement involves proactive steps from the claim handler that require care and caution. It also involves adequate and complete investigations and time. It can ultimately result in saying “No” and using litigation to resolve the matter.
What is Chronic Pain?
Chronic pain is commonly defined as pain lasting three or more months without resolution. Chronic pain includes arthritis in joints, headaches, post-surgical pain, or muscle pain that lingers. Other sources of chronic pain can include fibromyalgia, musculoskeletal pain, phantom limb pain in claims involving amputation, and shingles.
Common signs include someone suffering from chronic pain, including statements in medical records or complaints such as:
- I have tried everything, and nothing seems to work;
- The insurance carrier is only interested in saving money – is ignoring my condition; or
- I need ______________ to get better.
When left untreated, chronic pain can become debilitating. Referrals to pain clinics and other specialists are standard treatment plans for employees suffering from chronic pain following a work injury. When left unchecked, the money spent on medical care can multiply exponentially.
Using Accepted Treatment Guidelines to Combat Excessive Medical Care
The goal of any recommended treatment modality should be to restore the employee to their pre-injury condition and allow them to enjoy a high quality of living. Factors to consider should include the following:
- Restoring the employee to an optimum level of function
- Improving the employee’s quality of life; and
- Reducing the employee’s chances of becoming addicted to pain (opioid-based) medications.
All medical care recommended by the employee’s treating doctor should follow the American College of Occupational and Environmental Medicine (ACOEM) and Official Disability Guidelines (ODG) treatment recommendations. Other sources of guidance should include state-established medical treatment parameters, if applicable. This set of rules is the gold standard for proper medical care. General treatment rules suggest the following:
- Active Therapeutic Exercise: Recommended only if there is strong evidence that it will include aerobic conditioning and strengthening.
- Prescription Medication: Significant scrutiny of the type of medication, including its dosage, frequency of use, and duration. Extended use of narcotics limits the employee’s pain tolerance and leads to the body’s decreased production of endorphins, hypersensitivity, and addiction.
- Injections and Spinal Cord Stimulators: Spinal cord stimulators are recommended when there is a confirmed and undisputed diagnosis of Complex Regional Pain Syndrome. Injections should be used cautiously and only when appropriate under guidelines or treatment parameters. IDETs, radiofrequency ablations, prolotherapy, and Botulinum injections are not recommended per ODG/ACOEM.
- Functional Restoration Resources: Work conditioning and hardening, vocational rehabilitation, and cognitive behavioral therapy can be beneficial in the right circumstances.
- Surgical Intervention: This is the most effective option when treating chronic pain.
An employee will consider countless treatment options when suffering from chronic pain. It is the ultimate responsibility of the claim team members to make the best decision and to do so with compassion and empathy.
Looking for Better Results
When handling a workers’ compensation claim involving a chronic pain diagnosis, the ultimate goal is to look for options that will lead to the best result. Issues to consider must include the following:
- Will the care result in increased functional improvement? This results in a better chance of returning the employee to work on time. Quicker return to work reduces money spent on a claim.
- Will the care result in reduced dependence on prescription medications? The opioid crisis in the early 2000s taught American many painful lessons about the dangers of prescription drugs. Suicide and unintentional overdose impacted millions of people and resulted in additional monies being spent to resolve claims.
- Will the care result in a better quality of life? This should be the goal of every claim handler.
Now is the time to consider options and make better claim decisions.
Chronic pain impacts countless workers’ compensation claims and results in extra money being spent on a claim. The result is program inefficiency and increased litigation. Now is the time to identify impacted claims and make better decisions based on recognized medical standards and jurisdictional treatment parameters. The ultimate goal of every claim handler when dealing with this issue should be to drive a claim toward a settlement with compassion and look for better results. Failing to do so will result in pain in the butt for all.
Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment system and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%. He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaches injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors. IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.
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