Remembrance: Tribute to Marsh and AON Colleagues Killed Sept. 11, 2001 — 10 Years Later

It is human nature to forget and move on from tragedy. Most of us do … eventually. But those of you new to Work Comp Roundup may not know our ties to Sept 11, 10 years ago today. We will never move on, only adapt.


Nestled in the World Trade Center Towers were two of the largest insurance brokers in the world, Marsh and AON – giants in workers compensation. As Roundup’s founder, I had been an employee of both companies and had recently retired when the towers fell. Nearly 600 people, so many friends and colleagues, were lost that day between those two companies. Some of these people were key to the field of workers’ compensation cost containment, working beside us and supporting our efforts to build cost containment into formalized practices. They helped bring cost reduction to many companies.


Click to read original post published September 11, 2011.




New Court Decision Marks Increased Importance Of Return to Work

A decision from the New York Appellate Division 3d Dept., “Schirizzo v Citibank NA-BANKING” signals a return to the original method of measuring workers’ compensation payments after a lapse of more than 65 years.


A worker with a permanent disability  (other than arm, leg, fingers and toes not requiring further treatment) receives in New York a ”permanent partial” or “permanent total” disability. According to the NY Workers’ Compensation Law, the amount of payment is measured by the “loss of earning capacity” not the severity of the injury. A clerical worker with a college degree would have far less of a loss of earning for an intermittent painful bad back than an unskilled assembly line worker.



Workers Were Receiving Far Greater or Far Below What Was Warranted


However, starting around 1947 the New York system casually abandoned the wage loss system on measurement in favor of medical disability (minimal, mild, moderate or marked disability) which awarded a percentage of the average weekly wage, regardless of the impact of the injury on future earnings. The medical “severity” yardstick was a lot easier in terms of trials and appeals since it eliminated the need for vocational testimony, but it led to cookie-cutter adjudication which swiftly led to the majority of decisions resulting in a fixed 50% disability. It sounded reasonable but, in fact people with little or no disability received the same payments and settlements as the most disabled, who were receiving far below what their disabilities warranted.


The new decision, published on 5/28/15, involves a person with a 75% medical disability who was awarded 99% wage loss awards; essentially a total disability. The court distinguished between medical damage and loss of earning capacity. The worker, who had a back injury, had little education and had an unskilled job requiring constant standing and lifting.



Decision Signals Return to Original Statutory Plan & Increases Importance of Return to Work


The decision signals a return to the original statutory plan, which will require vocational, in addition to medical, assessments before making extended disability payments. What will be the effect on employers? For some using unskilled workers, probably higher compensation costs. For others, with a clerical/professional workforce, probably a lot lower costs. (A lot will depend on the willingness of parties to become involved, provide objective information and resist the 50% settlements.)


The decision will also reward employers who provide return to work programs, which almost always reduce the amounts of permanent disability awards.  As helpful as vocational testimony might be, an actual return to work resolves all doubts.




Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.


©2015 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.





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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.



Defending Traumatic Brain Injury Cases

Over the last few years, more attention has been given to the seriousness of head injuries.  These types of trauma are often referred to as “traumatic brain injuries,” which can result in serious consequences if not properly investigated.



What is a TBI?


A traumatic brain injury (TBI) involves an event that causes change in the structure or metabolism of the brain.  Previously these types of injuries were referred to as “organic brain syndrome.”


TBI’s occur in a number of different ways.  The most common TBI is the result of a worker striking their head against an object.  It can also result from a slip/fall that results in the head making contact with a surface or via “whip lash.”  They can also occur after being exposed to chemicals or gases, such as carbon monoxide in the work environment.



How Can You Identify a TBI?


Unlike a broken bone, bruising or burns, TBIs are often not evident when looking at a person suffering from this condition.  While every worker who suffers a blow to their head should be immediately treated by a trained medical professional, it is essential to observe them for other symptoms that develop shortly afterward.  These symptoms include:


  • Physical deficits and motor skill operations;
  • Cognitive problems or dysfunction; and
  • Issues with strength and balance.


Exposure to a TBI may also impact a person from a psychological perspective.



Successfully Investigating a TBI Incident


A comprehensive post-injury investigation is essential for any claim involving a TBI or injury to one’s head.  This investigation should include the following components:


  • Specific information concerning the mechanism of injury and areas where impact was made on the person’s head. If the TBI involves a workplace exposure to chemicals, it is important to include this information.


  • Identification of all witnesses. This includes not only people who witnessed the incident or exposure, but those who have knowledge of the employee’s behaviors before and after the incident.


  • Obtain all medical records related to the incident and care provided immediately after the incident. It is also important to obtain a history of any and all psychological treatment and care before and after the occurrence of the TBI.



Management of a TBI Claim


Managing a complex workers’ compensation case that involves a TBI will require additional steps beyond the standard best practices.  In addition to an independent medical examination, the use of other specialists may be important to defend successfully these claims.  It is important to check with the requirements of the applicable workers’ compensation act and an attorney concentrating their practice in this area before scheduling any evaluation.


  • Neurological Evaluation: This type of examination is conducted by a neurologist and will pay particular attention to CT and MRI scans.  The neurologist will help explain the significance of any findings and provide an expert opinion as to causation.


  • Neuropsychological Evaluation: This type of evaluation is performed by a neuropsychiatrist.  It differs from a neurological evaluation in that this specialist will determine the existence of any brain dysfunctions.  In addition to an oral examination, testing will also take place during the course of this examination and analysis will be provided.


A complete psychiatric evaluation and surveillance may also be required when defending these claims.  Some claim management teams have developed specialized units to investigate and handle TBI cases.




TBIs require special claims handling practices from the onset of the claim.  In addition to a complete investigation, it is essential to understand these injuries and employ specialized experts that can be used to successful mitigate future exposures.




Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. He is an expert in employer communication systems and helps employers reduce their workers comp costs by 20% to 50%. He resides in the Boston area and works as a Qualified Loss Management Program provider working with high experience modification factor companies in the Massachusetts State Risk Pool.  He is co-author of the #1 selling book on cost containment, Your Ultimate Guide To Mastering Workers Comp Costs Contact:


©2015 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.





SUBSCRIBE: Workers Comp Resource Center Newsletter


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.




ADA and Return-to-Work Best Practices Webinar / Tues Mar 24 @ 11am EDT

On Tues March 24 @ 11am EDT, prepare for a surprise or two as a group of experts discuss how some common practices in workers’ compensation violate both the spirit and the law of the ADA, as amended in 2009.   The webinar will also clarify what employers who want to abide by the spirit as well as the letter of the ADA should be doing.  Injured workers with significant medical restrictions are likely to meet the expanded definition of people with newly-acquired disabilities — whose jobs should be protected.  This free, one-hour webinar will feature Amaxx Risk Solutions’ Rebecca Shafer, Webility Corp’s Jennifer Christian MD, EEOC’s Aaron Konopasky, Amaxx Risk Solutions’ Michael Stack, and Advisen’s David Bradford as panelists.  They will answer audience questions as time permits during a Q&A period.


This webinar is part of a series that expands on content contained in THE ULTIMATE GUIDE TO LOWERING WORKERS COMP COSTS, a $249 soft-cover book available via



Tues March 24 @ 11am EDT


This is a free, one-hour webinar



  • Rebecca Shafer, JD., President, Amaxx Risk Solutions, Inc., Attorney/Risk Consultant
  • Jennifer Christian, MD, President, Webility Corporation
  • Aaron Konopasky, JD, Senior Attorney Advisor, Equal Employment Opportunity Commission
  • Michael Stack, CPA, Principal, Amaxx Risk Solutions
  • David Bradford, President, Research & Editorial division, Advisen (moderator)



  • When do the employer’s obligations under the ADA kick in for a workers’ comp injury?
  • Can an employer require an employee to return to work after an injury?
  • What’s the difference between light/modified/transitional duty and a reasonable accommodation?
  • Can an employer set a policy about how long a transitional duty position can last?
  • What should the “interactive process” required by the ADA look like — in workers’ comp?
  • How long does an employer have to wait before terminating an employee who can’t come to work?
  • Are indefinite periods of time out of work permissible?
  • Can the injured employee refuse to accept a transitional work assignment?




  • Risk Managers and Safety Directors involved in workers compensation claims management
  • Brokers and Consultants who consult or advise on specific aspects of cost containment
  • Producers looking to impress prospects with the latest strategies to stay on top of workers comp issues



Purchase the book or view sample chapters via or contact Advisen’s Merri Bastone at   Author: Rebecca Shafer, JD.


The book’s topics are organized into the following chapters:

  1. Workers Compensation Insurance Fundamentals
  2. Cost Containment Basics
  3. Training and Building Commitment
  4. Roles & Responsibilities Best Practices
  5. Reporting the Claim
  6. Post Injury Response Procedure
  7. Communication with Employees
  8. Working with Your Insurance Adjuster and TPA
  9. Safety and Loss Control
  10. Wellness Programs
  11. Return to Work and Transitional Duty
  12. Other Indemnity Cost Containment Measures
  13. Directing Medical Care
  14. Medical Cost Containment
  15. Fighting Fraud and Abuse
  16. Rehabilitating the Injured Employee
  17. Managing Prescription Drug Use and Abuse
  18. Claims Resolution and Settlements
  19. Federal Employees Compensation Act (Bonus Chapter)




Join the Workers Compensation Roundtable via

Worksite Healthy Sleep Program: Helping Employees Sleep One Z at a Time

Robin Kobayashi 65x57By Robin E. Kobayashi, J.D., LexisNexis Legal & Professional Operations


The CDC reports that 30 percent of civilian employed U.S. adults, which equates to 40.6 million workers, lack sufficient sleep. These adult workers are sleeping less than 6 hours a day, when the recommended amount of sleep is 7 to 8 hours a day. The CDC survey showed a 34.1 percent rate of short sleep duration among workers in manufacturing compared with all workers combined. About 44 percent of workers who worked the night shift experienced short sleep duration compared to 28.8 percent of day shift workers. Workers with high rates of short sleep duration included 69.7 percent of night shift workers in transportation and warehousing and 52.3% of health-care and social assistance workers.


The lack of sleep may lead to the development of chronic diseases and conditions such as diabetes, cardiovascular disease, obesity, and depression. In addition to soaring health care costs to treat these chronic diseases and conditions among workers, businesses must also contend with safety issues and lost productivity.


A new study published in the Journal of Occupational and Environmental Medicine points out that chronic sleep deficits can cost up to $3,156 per employee. The problem is how to reach workers who could benefit from healthy sleep guidelines and healthcare. The study examined a novel approach to how businesses can deliver an effective healthy sleep program through a workplace wellness facility.



Cognitive-Behavioral Therapy


According to the study, there have been numerous studies on the effectiveness of cognitive-behavioral therapy for insomnia (CBT-1) to help people sleep better both short- and long-term. CBT-1 even carries an evidence-based medicine “stamp of approval” for treatment of chronic primary insomnia and comorbid insomnia symptoms. CBT-1 covers “sleep hygiene, stimulus control, guided imagery, self-talk (cognitive restructuring of dysfunctional thoughts about sleep), meditation, and relaxation techniques”, among other things.


As the study indicates, the question then becomes how to deliver CBT-1 effectively to employees?



How The Study Was Set Up


A voluntary 8-week worksite-based healthy sleep program was set up at the Mayo Clinic Dan Abraham Healthy Living Center to help employees gain knowledge of factors that influence sleep as well as gain skills and behavioral techniques to improve their sleep. The participants completed questionnaires about their sleep behavior, energy level, sleep problems, bed partners, use of sleep medication, daytime performance, stress level, caffeine habits, napping, etc., both before and after the completion of the sleep program.


Eight, one-hour live participatory sessions covering CBT-1 were held, with seven of those sessions delivered by wellness coaches. Participants were given skill-building exercises such as guided imagery, muscle relaxation, sleep hygiene, meditation, and yoga, and their assignments included, among other things, keeping a sleep log, attending classes in meditation and yoga, and identifying self-talk related to sleep.


The study analyzed the outcomes for 53 individuals covering the period 2010 through 2012.



Key Facts About The Participants


  • 2% of the participants were female
  • Median age was 56.4 years
  • 9% were married
  • 2% worked day shifts
  • Average body mass index of 26.6 kg/m
  • 6% of the participants were employees
  • 17% of the participants were spouses or domestic partners
  • 4% of the participants were students, retirees, or volunteers at the medical center



Key Findings Pre- And Post- Healthy Sleep Program


  • Poor quality sleep: Decrease in poor quality of sleep from 5 nights on average per week to 3.5 nights on average per week
  • Impact on job performance: Slight decrease in sleepiness impacting job performance from 2.5 days on average per week to 2 days on average per week
  • Feeling rested: Increase in average rating of 3.9 (10 = always) for feeling rested after a night’s sleep to 5 (out of 10)
  • Knowledge about sleep: Increase of average rating of 4.9 (10 = extremely knowledgeable) for knowledge about sleep to 6.9 (out of 10)
  • Trouble getting asleep: Decrease of average rating of 5.5 (10 = always) for trouble getting asleep to 3.8 (out of 10)
  • Trouble staying asleep: Decrease in average rating of 7.0 (10 = always) for trouble staying asleep to 5.8 (out of 10)
  • Ability to deal with sleep problems: Increase in average rating of 4.4 (10 = extremely confident) in ability to deal with sleep problems to 6.3 (out of 10)



Study Limitations


The study examined a small group of people who voluntarily participated in the healthy sleep program. The authors believe that a larger study with more diverse samples is needed.



OCCUPATIONAL MEDICINE PERSPECTIVE: Leslie J. Hutchison, MD, MPH, FACOEM, of HLM Consultants notes that although the article does not indicate the cost of the program, he believes the savings cited can carry over multiple years without repeated training. “The significant positive effects of the intervention suggest that other interventions are likely to increase the impacts on job performance, further decreasing sleepiness impacting job performance,” explains Hutchison. “Follow-up study of this group might define residual problems that could be addressed in further training or other interventions.”





The study results show the benefits of a healthy sleep program where workplace wellness coaches are used and sleep experts help design and deliver the program in a group setting. The participants reported an improved quality of life, more energy at work and at home, and a significant decrease in stress. The study also underscored the importance of participants having more confidence in their ability to deal with their sleep problems after completing the program, as this could lead to behavior change.


© Copyright 2015 LexisNexis. All rights reserved. Reprinted with permission.




Author Robin E. Kobayashi, J.D., Workers’ Compensation Practice Area Lead at LexisNexis. She is the site coordinator for the LexisNexis Legal Newsroom Workers’ Compensation Law. She has been a Sr. Legal Editor at LexisNexis specializing in workers’ compensation law for over 28 years. She also serves as the Editor-in-Chief of theLexisNexis Workers’ Compensation eNewsletters and the Co-Editor-in-Chief of Workers’ Compensation Emerging Issues Analysis, a 50 state survey of workers’ comp legislation and trends. Contact:

British Quilt Firm Designs Fine

As one British quilt maker discovered, authorities will design a significant fine for you if your safety standards are not up to par.

The Middleton employer was fined recently after a worker suffered severe injuries when his right hand was trapped in a moving machine.

The 60-year-old, from Rochdale, who did not want to be named, was carrying out maintenance work on a pillow filling machine at Comfy Quilts Ltd in Stakehillwhen the incident happened in July of 2013.

The company, which designs and manufactures pillows, quilts and other bed linen, was prosecuted in late May by the Health and Safety Executive (HSE) after an investigation found it had not provided suitable safe systems of work or adequate training for maintenance workers.


Incorrect Procedures Lead to Two Months Missed Work

Trafford Magistrates’ Court heard that the worker was attempting to rectify a problem with the pillow filler. The fixed guards had been removed to allow access, but correct procedures to isolate the power supply had not been followed and his right hand was trapped in the machine as a result.

He lost a significant amount of skin and badly fractured his thumb, which had to be pinned following surgery. He was unable to return to work for two months and could then only undertake light duties.

HSE served an Improvement Notice at the Stakehill site in the aftermath of the incident and also carried out an inspection of the company’s other site in Middleton. This resulted in further Improvement Notices being served, all highlighting the general lack of knowledge about the importance of machinery guarding.

The court was told Comfy Quilts Ltd made several changes to its working practices following the incident, including making and publishing risk assessments for working on each machine at the site, and formally implementing procedures and training for maintenance staff.

Comfy Quilts Ltd, of Stakehill Industrial Estate in Middleton, was fined more than $20,000 and ordered to pay a little more than $1,200 in prosecution costs after pleading guilty to a breach of Section 2(1) of the Health and Safety at Work etc. Act 1974.



Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%.  Contact:


©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.





SUBSCRIBE: Workers Comp Resource Center Newsletter

New South Wales Doesn’t Take Workplace Safety Lightly

As officials in New South Wales (Australia) are noting, businesses and workers need to be very careful when working with electricity and power lines after recent analysis from WorkCover showed there had been two electrocutions and 14 electric shocks in a recent 12-month period.


WorkCover NSW General Manager of Work Health and Safety Division John Watson said examples from August 2012 to August 2013 have included electric shocks, through to deaths.


“In one instance a worker was installing air-conditioning at a petrol station when the wiring he was working with was still energized and he received an electric shock. Tragically, he passed away in hospital,” Watson said.


“In another case, a plasterer was installing a ceiling fan when he accidently cut through energized wiring receiving an electric shock which caused him to fall about 2.4 meters off his ladder also causing bruising.”


As a result, Watson urged businesses and workers to take the steps needed to make sure everyone comes home safe at the end of their shift.


As Watson pointed out, “Working on or near electrical installations can be dangerous, and that’s why workers and businesses need to take precautions and always use a licensed electrician for all electrical installation work. Although all situations are different, what’s important is that there are basic ways to improve electrical safety.”



Equipment Needs to Be Tested and Tagged


Watson noted that in “conditions that involve exposing electrical equipment to moisture, heat, vibration, mechanical damage, corrosive chemicals and dust, ensure that that the electrical equipment is regularly tested and tagged and that the equipment is used in association with an RCD (Residual Current Device/ Safety Switch).”


Watson said special consideration must also be taken when working near overhead and underground power lines.


“You don’t need to come in contact with the power line to result in electric shock or arc flash burns. It is important that workers, equipment, material and plant remain at safe distances from overhead and underground electric lines,” Mr Watson pointed out.


While court action is generally only used in the most significant safety breaches, Watson said WorkCover can and does prosecute businesses that fail to adequately protect their workers.


“Under work health and safety laws, workplaces must have systems in place to prevent workers being shocked or electrocuted,” Watson noted.



Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%.  Contact:


©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.





SUBSCRIBE: Workers Comp Resource Center Newsletter

Better Decisions in Workers Compensation And Other News Tidbits

CE and CLE Programs from Ringler Associates and CEU Institute

Have you heard about the new continuing education initiative from Ringler Associates? Ringler Associates and CEU Institute have teamed up to provide courses for CE (continuing education) and CLE (continuing legal education). In this podcast, Ringler Radio host Larry Cohen and co-hosts, Duke Wolpert and Gayle Christen talk with special guest, Jill Benner, Executive Director of the CEU Institute, about these programs available to you on a wide range of topics including Negotiations, Ethics, Navigating Medicare Interests, Workers’ Compensation and Structured Settlements, Liability Cases and Structured Settlements, with others in development. Listen to the Podcast



CMS Announces Updates to Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide

An updated Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide has been posted and is available in the Downloads section of the Workers Compensation Medicare Set Aside Arrangements (WCMSA) What’s New page. This version documents the current WCMSA review process and provides more detailed information on the actions performed by the Workers’ Compensation Recovery Contractor (WCRC). Read more…



Medcor On-Site: Isn’t It Nice To Stay In?

Assess employee injuries at the worksite to determine if employees should seek off-site care. Check out the short video



Better Decisions in Workers’ Compensation

While Americans represent only 4.5% of the world’s total population, we consume 85% of the world’s narcotics. In fact, narcotics make up one-third of the cost and utilization of all medications in workers’ compensation. While these drugs can be an important part of the treatment for work-related injuries, the impact of the widespread use of narcotics is a major area of concern for payers. Read more…



GENEX Case Manager Scholarship Award Winners Announced

GENEX Case Manager Scholarship Award recipients were announced this year on May 8. This program was created in 2012 to promote the awareness of the case manage¬ment profession, and to support the next generation of nursing school graduates. The philanthropic program awards $100,000 in total scholarship funds to nursing schools nominated by GENEX Case Managers who graduated from those institutions. There can be anywhere from two to five schools selected each year. Read more…



Author Michael B. Stack, CPA, Director of Operations, 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. Contact:


©2013 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

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

Massachusetts Employer Cited By OSHA As Repeat Violator

A pair of worksites in Massachusetts recently came under fire from the Occupational Safety and Health Administration (OSHA)


Repeat violator Twin Pines Construction Inc. of Everett, Mass., was cited for willful, repeat and serious violations of workplace safety standards at worksites in Plymouth and Reading, Mass. The wood framing contractor faces a combined total of $336,200 in proposed fines following inspections by OSHA’s Braintree and Andover area offices begun in March.


The Plymouth inspection was initiated March 15 after a worker suffered broken ribs and leg injuries when an un-braced wooden roof truss system collapsed around him at a worksite located at 1 Shinglewood. The Reading inspection was opened the same day after OSHA received a complaint about possible safety hazards at the 1 Jacobs Way jobsite.


At the Plymouth worksite, OSHA found that the trusses were not adequately braced during their installation, exposing employees to being struck by them. The workers were also exposed to falls of up to 12 feet during the installation of the trusses. Inspectors identified an impalement hazard from uncovered anchor bolts and additional fall and struck-by hazards from a misused ladder and uninspected and untagged rigging. These conditions resulted in OSHA issuing Twin Pines two willful, two repeat and four serious citations with $196,200 in proposed fines. The repeat violations stem from similar hazards cited by OSHA in 2009 and 2011 at jobsites in Walpole, Mass. and Portsmouth, N.H.


OSHA found employees at the Reading worksite working without fall protection while framing exterior walls, making final deck attachments, constructing leading edges and receiving construction building materials. This lack of fall protection exposed them to falls of from 10 to 20 feet. As a result, OSHA issued two willful citations, with $140,000 in fines, to Twin Pines.



OSHA Says Recurring Problems Lead to Major Fines


“The large penalties proposed in these cases reflect the gravity and recurring nature of these hazards, and demonstrate this employer’s knowing, active and ongoing disregard for its workers’ safety,” said Marthe Kent, OSHA’s New England regional administrator. “Falls remain the number one killer in construction work. Employers who deliberately and repeatedly fail to supply and ensure the use of effective fall protection safeguards are repeatedly gambling with their workers’ lives.”


Twin Pines Construction Inc. has been placed in OSHA’s Severe Violator Enforcement Program, which mandates targeted follow-up inspections to ensure compliance with the law. OSHA’s SVEP focuses on recalcitrant employers that endanger workers by committing willful, repeat or failure-to-abate violations. Under the program, OSHA may inspect any of the employer’s facilities if it has reasonable grounds to believe there are similar violations.


A willful violation is one committed with intentional, knowing or voluntary disregard for the law’s requirements, or with plain indifference to worker safety and health. A serious violation occurs when there is substantial probability that death or serious physical harm could result from a hazard about which the employer knew or should have known. A repeat violation exists when an employer previously has been cited for the same or a similar violation of a standard, regulation, rule or order at any other facility in federal enforcement states within the last five years.


Twin Pines Construction Inc. was given 15 business days from receipt of its citations and proposed penalties to comply, meet informally with OSHA’s area director or contest the findings before the independent Occupational Safety and Health Review Commission.



Author Michael B. Stack, CPA, Director of Operations, 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. Contact:


©2013 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

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

Senior Nurse Review Can Be Cure For Chronic Pain Cases

Treatment for pain is the overall largest component of medical treatment in workers’ compensation claims yet often adjusters do not know how to use nurses effectively in the pain control scenario. Pain often presents the biggest challenge to medical providers who repair torn ligaments or fractured bones with ease but struggle to provide proper pain management for injured employees.


Pain is defined by the International Association for the Study of Pain as:  “An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”



No Tests Can Measure the Level of Pain Experienced


Pain is unique to each individual. No tests can measure the level or the intensity of pain an injured employee experiences. Unfortunately, an injured employee prone to malingering, now has an easy avenue to avoid returning to work.


The level of pain cannot be tested by the treating physician. Common practice is to ask the injured employee to rate the pain on a level of zero to ten on a 10-point scale. A zero rating indicates no pain and 10 rating indicates pain preventing any body movement or function. Injured employees who do not want to return to work normally rate their pain higher on the 10-point scale than actually being experienced.


A medical provider determines the location of pain by various neurological tests involving touching and pressing key points on the limb or body and by requesting the injured employee to make various movements. This type of examination allows the physician to test reflexes, sensation, coordination, movement, and balance. Based on these tests plus the observations of the employee’s facial expressions, total body movements, and gait, the medical provider pinpoints the spot within the limb or body where the pain is originating.


The medical provider uses various technologies to identify the cause of pain. The most common ways include electromyography (EMG) and nerve conduction studies. The EMG gives the medical provider guidance in identifying which nerves or muscles are impacted by weakness or pain. Nerve conduction studies measure a nerve’s electrical system and allow the medical provider to determine if there is nerve damage.

Pain is most often described as either acute or chronic. Acute pain is sudden pain an employee feels immediately when a laceration, burn, or other occurrence causes damage to the skin, internal tissue, or bones. Chronic pain is on-going pain an injured employee feels over an extended period of time. Some medical providers define chronic pain as pain lasting more than six months from the date of injury. Others define chronic pain as pain lasting longer than the expected healing time for the injury.


Chronic pain is often described as ‘burning,’ ‘shooting,’ ‘aching,’ ‘stabbing,’ or like an ‘electrical shock.’ Chronic pain is also described in terms of stiffness, soreness, and tightness. Chronic pain can be at any level on the 10-point pain scale. Other medical issues are experienced by those suffering from chronic pain including the inability to sleep, depression, anxiety, and fatigue. The severity level of chronic pain is influenced by psychological and environmental factors.



Skilled Senior Nurse Reviewer Should be Assigned to Chronic Pain Cases


Proper management of chronic pain is often needed after a failure of surgery and other medical treatment methods are used to relieve an injured employee’s pain. When an injured employee is dealing with chronic pain, consider assigning a senior nurse reviewer (a nurse case manager with extensive clinical experience, at least 15 years) working for a medical management company to the injury claim.


Proper treatment of chronic pain requires a multidisciplinary approach to medical management. A skilled senior nurse reviewer working with a multidisciplinary team of board certified physicians can evaluate the treatment plan of the employee’s medical provider, recommend changes in the treatment plan if needed, or, in conjunction with the medical management company’s clinical panel, create a customized chronic pain management treatment plan for the injured employee.  The team should be setting up goals for what should be accomplished and holding regular discussions on progress.  An area that is often overlooked is screening and monitoring of the injured employee throughout the process.



Senior Nurse Reviewer Works with Medical Provider on Pain Management


The senior nurse reviewer continues to work with the injured employee and the employee’s medical provider, monitors the medical treatment, and follows up on the employee’s recovery progress. If changes are needed in the chronic pain management plan, the senior nurse reviewer works with the medical provider and the multidisciplinary team of the medical management company to revise the pain management program.


If you have long-term claims where the focus of the medical treatment is dealing with chronic pain, we can assist. Please contact us for a referral to a medical management company.



Author Michael B. Stack, CPA, Director of Operations, 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.  Contact:


©2013 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

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

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