Posts Tagged ‘catastrophic injuries’

Risk, creeping catastrophics, fraud, obesity, pachydermodactyly, and more

Wednesday, June 13th, 2012

Risk Roundup – Cavalcade of Risk #159 – Early Edition is posted at My Wealth Builder. We’d like to highlight Jason Shafrin’s post as particularly noteworthy for our readers: Healthcare Costs to Rise by over 7 percent in 2013.
Creeping catastrophics – Our colleague Mark Walls has a good article in Business Insurance on Creeping Catastrophic Claims – How to Spot Them and Stop Them. “These claims start out like any other case, usually with a back, knee or shoulder injury. However, because of a series of events, they end up costing the employer hundreds of thousands of dollars. These developmental claims share many common characteristics that, if identified and addressed in a timely manner, can prevent significant adverse development of the claims.”
Big bucks fraud – John D’Alusio unpacks the AIG debacle and explains how it hurts us all in his post Gaming the Workers Comp System at Workerscompensation.com.
Ergonomics of obesity – What does obesity look like to a workplace ergonomist? “Increased obesity in the workplace means more arthritis, larger waist circumferences, additional work limitations, compromised grip strength, decreased lower limb mobility and medical risks. Obese employees might be more vulnerable to falls and their manual material handling ability may be compromised. Obesity also can impact self-esteem, motivation, absenteeism, presenteeism, premature mortality and more.” More at Ergonomic Strategies for Managing Obesity in the Workplace
Case Law – The Tennessee Supreme Court found for an employer in a statute of limitations case involving PTSD. The employer argued that the statute of limitations clock began ticking when the event that caused the trauma occurred (viewing the bodies of two co-workers killed on the job), but the court found that the statute of limitations does not begin to run until an employee discovers the injury and, in this case, the employee did not know he had PTSD until some time after the workplace deaths occurred.
DOL Transparency – In 2011, the Department of Labor proposed a rule strengthening safety provisions for children under age 15 who work on farms. The rule had a parental exemption so that kids could still work on family farms. Apparently, industry pressure led DOL to withdraw the rule. DOL also removed the proposed rule from its website and Celeste Monforton posts that Government transparency groups are asking the Labor Dept to restore info scrubbed from website.
Texting while driving – Steve Yahn of Risk & Insurance looks at how Companies Fight Against Texting and Driving. He notes, “Gavejian and other experts who work with companies to develop cell phone and texting policies said that businesses need to first assess how technology is used in their workplace on a daily basis.”
Food processing hazard – A new report describes two cases of poultry workers who developed chronically swollen knuckles, the hallmark sign of a rare skin condition known as pachydermodactyly: Hand deformities turn up in poultry workers, report finds.
Other noteworthy news

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Traumatic brain injuries (TBI): in the workplace and in the field

Thursday, March 11th, 2010

The Brain Injury Association reminds us that March is Brain Injury Awareness Month, so it was timely to see that our colleague Peter Rousmaniere has an important piece on brain injury recovery in the current issue of Risk Management magazine: Gray Matters: The Employer’s Role in Brain Injury Recovery. It is important for two reasons: it sheds light and hope on the issue of traumatic brain injuries and the improved prospects for recovery, including return to work; and it serves as an illustration of some important differences between workers compensation and group health
The article notes that each year, 50,000 Americans die of a traumatic brain injury and 235,000 are hospitalized. There really aren’t good statistics to tell us the prevalence of work-related brain injuries. Although there are better statistics available for what Rousmaniere calls “the signature wound of today’s wars,” many think that the estimate of 320,000 war-related traumatic brain injuries may be on the low side.
The good news, as Rousmaniere documents with examples, is that with proper medical care there have been great advances for a type of injury that was once written off as lost cause: “In the past, many adults with work-related traumatic brain injury were simply warehoused. But with advances in treatment and care strategies, including an employer that is ready and willing to help in gradual return to work, many survivors of severe brain injury can regain most of their former way of life.”
Part of the challenge is early identification, rapid response, and aggressive treatment early in the injury, and aggressive recovery goals. Patients who are treated in the workers comp system, where care is often managed and coordinated and where insurers and employers aggressively advocate for recovery and return to work, often have an advantage over those patients treated under group health. With workers compensation, employers/insurers have financial responsibility for the life of a claim and, therefore, more incentive to work towards maximum recovery. Rousmaniere cites a case manager who says, “You have a workers compensation brain injured patient who is in the same hospital room as a nonworkers compensation patient, and the difference in resources is like night and day.”
Rousmaniere cites examples of successes, along with best practices that contributed to those successes – including the important role that the employer can play in maximizing recovery, some of the challenges that occur, and some of the best practices:

As with all successful brain injury recoveries, job coaching is a critical phase that demands employer participation. Rehab counselors often make the trip with the worker back to her or his workplace. Memory failure, a signature feature of brain injury, is sometimes best treated, in part, at the physical site of the employer. So for several months, the vocational specialist helps the worker find ways to organize the day, reinforce memory and work with others. In this way, the patient’s prospects for recovery are greatly improved.

Department of Defense embarks on more aggressive brain injury screening program
Rousmaniere discusses the prevalence of war-related TBI and some of the promising medical advances. He cites the recovery of reporter Bob Woodruff, perhaps one of the cases that we are all most familiar with due to the news coverage. After returning to his job as a reporter, Woodruff became an advocate for our soldiers in the field, developing a ReMIND, a foundation to provide resources and support to injured service members, veterans and their families.
In speaking of his own recovery, Woodruff praised the quality of the care and support that he received, but saw with dismay that such treatment and recovery resources were not always available to service members with similar injuries. He saw the military culture as often stigmatizing or impeding screenings, and treatment options being limited once a vet returned home. That’s why the Department of Defense’s recent policy announcement is such welcome news: head-injury evaluations will be mandatory for all troops who suffer possible concussions. Moving to an incident-based response is a significant change from prior protocol, which depended on service members to self-identify with a complaint. The weakness in this approach is that service members are highly mission-focused and can shrug off complaints that can later prove to be serious problems.
America’s Heroes at Work is a U.S. Department of Labor project that addresses the employment challenges of returning service members living with Traumatic Brain Injury (TBI) and/or Post-Traumatic Stress Disorder (PTSD). The resources and links pages are particularly helpful – and a good resource for employers who are working with either vets or non-vets who are recovering from TBIs.
TBI resources
Brain Injury Association of America
Survivors’ Voice
Traumatic Brain Injury Survival Guide
Brain Injury Resource Center

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Cavalcade of Risk & other workers’ comp news briefs

Thursday, November 5th, 2009

Debbie Dragon or Wise Bread hosts this week’s Cavalcade of Risk, which she dubs the “the How Much Assurance Does Your Insurance Offer edition.” As usual, a good source of some of the best biweekly risk-related posts in the blogosphere!
OSHA – frequent citations – OSHA recently announced its Top 10 Enforcement Citations. For a more generic, non-company specific view, see the top 10 lists for the most frequently cited standards and the standards with the highest penalties. To narrow down to information to an industry SIC code, a state, or a size of employer, see the interactive frequently cited OSHA standards page.
Montana Supreme Court – Montana’s Supreme Court ruled that workers’ compensation benefits for permanently and totally disabled workers are meant to assist them for their “work life,” and not into retirement. Writing for the 5-2 majority, Justice William Leaphart stated that, “By acting to terminate benefits as it does, (the law) rationally advances the governmental purpose of providing wage-loss benefits that bear a reasonable relationship to actual wages lost.”
Chronic illness – This week, Roberto Ceniceros has featured a pair of posts related to chronic illness on his Comp Time blog. The first highlights a research report from the Integrated Benefits Institute in which nine in ten workers reported one or more chronic health problems. The report is based on 27,000 employee surveys. In his second post, Ceniceros explores the issue of wellness programs as they relate to chronic illness and workers comp. He makes the point that an increasing number of employees may be getting better health care attention after reporting a comp injury, but that is likely true mostly for employees of large, sophisticated employers.
Related to this issue, Peter Rousmaniere writes about “the elephant in the room” in his column in Risk and Insurance, noting that co-morbidities — such as obesity, depression, diabetes, sexual trauma, smoking, and drug addiction — derail the recovery of injured workers and pose challenges for claims adjusters and case managers. He makes the point that the the workers’ compensation courts are more inclined today to rule that insurers “own” the comorbidity that impedes recovery, as evidenced by the recent weight-loss surgery rulings.
Long road to recovery – the Pocono Record features the story of John Capanna’s long, slow recovery from a severe industrial injury. John was severely burned and disfigured in a flash explosion at an oil refinery some 30 years ago. It’s a story of courage and strength. Thanks to SafetynewsAlert for pointing us to this story.
Saving lives through safety – Robert Hartwig, president of the Insurance Information Institute, makes the case that insurers don’t get enough credit for saving lives with safety research in this month’s National Underwriter. Among the points that he makes: “Today, workers’ comp insurers are a primary source of loss control expertise for millions of American businesses – with tangible results. Consider that in 1926, an employee working in a manufacturing setting had a 25 percent chance of being injured on the job. In other words, one-in-four workers suffered injuries each year. In 2008, the odds were only about 5 percent, or just one-in-20.”
Ferreting out fraud through social networking – Attorney Molly DiBianca discusses risks entailed in using Facebook to investigate employee fraud, suggesting guidelines to ensure employer protection.
Quickies
Surgical Fire Prevention
Who is the authorized employee for Lockout/Tagout?
Lack of paid sick days may worsen flu pandemic
Your forklift questions answered
More forklift questions, more answers

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Spouse as Caregiver: To Pay or Not to Pay

Wednesday, July 8th, 2009

Serious workplace injuries often turn spouses into caregivers. So the question becomes, are their services compensable under workers comp? As is so often the case, it depends upon where you live.
The Supreme Court of Arizona recently decided a case in the spouse’s favor (Sabino Carbajal v.Industrial Commission of Arizona). In 1999, Sabino, working for Phelps Dodge, suffered a serious injury, resulting in cognitive problems and partial paralysis on his right side. He required full-time supervision and intermittent attendant assistance. The carrier paid for nursing aides during daylight hours. At all other times, Sabino’s wife took charge of his care: this included giving him his medication in the morning; specially preparing his food; cleaning him when he was returned from day care soiled; and moving him between his wheelchair and his bed, the toilet, or his recliner.
In their deliberations, the Arizona Supremes examined practices in two other states. They looked first at Virginia, where the courts have denied reimbursement to spouses for home health care services (Warren Trucking v. Chandler, 277 S.E.2d 488). In Warren, the claimant’s wife helped him bathe, shave, and put on braces, and she prepared his meals, drove the car, and maintained the household. When the claimant lost consciousness, his wife revived him.
The Virginia court concluded that under the statute, to qualify as compensable “medical attention,” the spouse’s care must, among other requirements, be “performed under the direction and control of a physician” and be “the type [of care] usually rendered only by trained attendants and beyond the scope of normal household duties.” The court rejected the spouse’s claim because the care rendered by the wife was not prescribed by a doctor and was not “of the type usually rendered only by trained attendants.” I suppose that when the wife revived her husband, she was just acting as a good samaritan.
NOTE: Workers in Virginia may well wonder whom the comp statute is designed to protect. We recently blogged an absurd provision of the law which precludes payment to brain injured employees who have the misfortune of surviving catastrophic injuries. Virginia seems to go out of its way to construct “rigid frameworks” that preclude compensation for the families of seriously injured workers.
Empathy in Action
Arizona justices also looked at case law in Vermont, where a similar set of circumstances led to a very different conclusion. In Close v. Superior Excavating Co. (693 A.2d 729), the claimant received a severe head injury and required 24-hour supervision. The claimant’s wife cared for him at home, including “administer[ing] and monitor[ing] his medications[,] . . . alter[ing] the doses [of medication,] . . . log[ging] . . . her husband’s behavior[, and] monitoring her husband’s seizure activity and responding appropriately.”
In concluding that the wife’s services were compensable, the Vermont court rejected the “rigid framework” of Warren, noting that “it “would . . . conflict with [its] longstanding practice of construing the workers’ compensation statute liberally.”
The Arizona court restated the aim of workers comp: rather than pushing the notion of spousal duty deep into the area of custodial care, the court “places the burden of injury and death upon industry.” The Arizona court overturned rulings at the commission and Appeals court levels. They found that Mrs. Carbajal routinely performed work that others were paid to perform and that these duties were necessitated by workplace injury. Therefore, she is entitled to reimbursement. It will be interesting to see how the comp commission comes up with a dollar value for her services: will she be reimbursed for “time on task” or is she “on call” and working whenever other paid help is not available?
When workers suffer catastrophic injuries, their families suffer loss beyond measure. The quality of life changes for everyone, not just the injured worker. If the question is “to pay or not to pay” for the onerous burdens placed on spouses, the answer, in Arizona and Vermont at least, is to pay.

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