Posts Tagged ‘ptsd’

“No, Edith, There is No Sanity Clause”

Tuesday, December 22nd, 2009

You probably never heard of Gilby, North Dakota, population 226. Edith Johnson, 56, worked as a teller in the town’s bank, which, somewhat surprisingly, has been robbed three times. Edith was in the bank during two of the robberies. The last one was especially traumatic: she was handcuffed and placed face down on the floor with a sawed off shotgun pressed against her head. After this incident, she became too afraid to return to her job. Diagnosed with post-traumatic stress syndrome, she filed for workers comp. The claim was denied. North Dakota, like many other states, will pay a “mental” claim only if it is precipitated by a physical injury.
Edith has an attorney and is appealing the denial of her claim. Given the way the law is written, she is unlikely to prevail.
The irony, of course, is that with just a bit of coaching at the time of the incident, it would have been easy for Edith to collect comp. All she would have had to do is complain about a pain in her wrist and shoulder, caused by the handcuffs and the awkward position on the floor. Even without objective medical evidence, these physical complaints would have opened the door to her claim of post-traumatic stress.
Coming from a small town and working as a bank teller, Edith is undoubtedly the soul of rectitude. She is not about to tell a lie. Unfortunately, she is up against the letter of the law, which, in North Dakota, is very clear. Workers Safety and Insurance director Bryan Klipfel explains the denial: “A post-traumatic stress disorder that is directly related to a physical workplace injury may be compensable if it can be shown that it was primarily caused by the physical work injury, as opposed to all other contributing causes.”
Letter and Spirit
Edith’s dilemma reminds me of the scene in the immortal Marx Brothers movie, “A Night at the Opera.” Groucho (Otis. B. Driftwood) and Chico (Fiorello) are discussing the proposed language of a contract. Every time Chico objects, Groucho tears the page from the contract.
Fiorello: Hey, wait, wait. What does this say here, this thing here?
Driftwood: Oh, that? Oh, that’s the usual clause that’s in every contract. That just says, uh, it says, uh, if any of the parties participating in this contract are shown not to be in their right mind, the entire agreement is automatically nullified.
Fiorello: Well, I don’t know…
Driftwood: It’s all right. That’s, that’s in every contract. That’s, that’s what they call a sanity clause.
Fiorello: Ha-ha-ha-ha-ha! You can’t fool me. There ain’t no Sanity Clause!

With that impeccable logic, the Insider wishes the beleagured Edith and the citizens of Gilby all the best and we bid our readers a splendid holiday. Every week we try to invoke the “sanity clause” in risk management and workers comp. It’s not always easy. We sincerely hope that Santa – whether or not he exists – rewards you for all the good that you have done this year.

(Cannon) Fodder for a Friday: The Fate of Foreign Interpreters in Iraq

Friday, December 18th, 2009

How would you like a job that pays $12,000 a year, where 1 percent of the workforce is killed annually and hundreds of others are seriously maimed? I didn’t think so. You would probably take a pass on working for Titan Corporation (now part of L-3) as an interpreter for the U.S. armed forces in Iraq. The L-3 website promises that “as a member of the L-3 Communications team, you will be exposed to the most exciting career adventures situated on the cutting edge of technology.” Alas, it’s not just the technology that is cutting edge. The roadside bombs cut pretty deeply, too.
We read in the Los Angeles Times about the sad fate of translators in Iraq. There are about 8,000 in all. Over the five year period from 2003 to 2008, 360 were killed. Those who were lucky enough to survive were often shipped to Jordan for treatment. The workers comp benefits fell under the Defense Base Act and were administered by AIG, among others. (See our previous blog here.) According to some of the wounded, they were offered a stark choice: accept a proposed settlement (which absolved the insurer of any future costs) or be shipped back to Iraq, where retaliation and death awaited former employees of the U.S.
The Times article describes the life of Malek Hadi, an Iraqi national who lost a leg and several fingers in a roadside bombing. He now struggles to survive in Arlington, Texas. At first, he was unable to collect any benefits:

Internal AIG documents indicate that a claims examiner withheld Hadi’s benefits in an effort to force him to accept the lump sum. Hadi was “clearly entitled” to benefits, a different AIG examiner wrote in a memo dated August 2008. The company had not paid because the previous examiner “was trying to get the claimant to decide whether to settle his claim,” the memo said.

Malik now receives the maximum monthly disability benefit – a whopping $612 per month. He has been diagnosed with post-traumatic stress syndrome, but AIG has refused to cover any treatments. Perhaps they are waiting for a second opinion from the company shrink? Meanwhile, Malik will just have to deal with it!
Former insiders at AIG describe how the game is played:

“If you’re missing one piece of documentation, you got denied,” said Colleen Driscoll, who oversaw the handling of interpreters’ insurance claims for L-3. “These guys get murdered coming and going to work, and AIG turns them down because they don’t have a letter from the insurgents.”

Driscoll, a former United Nations refugee official, left L-3 in 2007. She said the cause was a dispute with company executives over treatment of injured interpreters.

She and another former L-3 official, Jennifer Armstrong, said their experience suggested that 10% to 20% of the company’s Iraqi workers who should have received benefits were denied.

AIG stock is currently trading at the equivalent of about $1.40 a share. It would be nice to think that this was the market’s judgment on the way things are being handled in Iraq, but that, of course, has nothing to do with it. The market, not exactly known for its humanitarian concerns, is punishing AIG for financial – not ethical – sins. Indeed, the market might well approve of the way the injured, the maimed and the dead are being squeezed in this mockery of a benefits program. After all, indemnity and medical expenditures are being kept as low as possible and that can only help support AIG’s battered bottom line.

Promising PTSD and TBI research holds hope for better treating injured veterans

Wednesday, November 11th, 2009

On this Veteran’s Day, here’s a salute to all the veterans and active military service members out there. In the shadow of the horrific events at Fort Hood, this day of commemoration takes on a particular poignancy.
Here at Workers Comp Insider, we have a tendency to view things through the lens of dis-ability and the restoration work-ability because that’s the nature of what it is that we do. So we were particularly intrigued to read about new research that is offering hope to unlock some of the secrets of post traumatic stress disorder (PTSD) and traumatic brain injuries (TBI), two of the most frequent and debilitating types of injuries sustained in Afghanistan and Iraq.
Powerful new scanning techniques are allowing doctors to see how the brain changes with such injuries, and doctors are learning that there are many similarities in these injuries, including symptoms like memory and attention problems, anxiety, irritability, depression and insomnia. This leads researchers to believe that the two disorders share brain regions.

“A brain processing system that includes the amygdala — the fear hot spot — becomes overactive. Other regions important for attention and memory, regions that usually moderate our response to fear, are tamped down.
“The good news is this neural signal is not permanent. It can change with treatment,” Hayes says.
Her lab performed MRI scans while patients either tried to suppress their negative memories, or followed PTSD therapy and changed how they thought about their trauma. That fear-processing region quickly cooled down when people followed the PTSD therapy.
It’s work that has implications far beyond the military: About a quarter of a million Americans will develop PTSD at some point in their lives. Anyone can develop it after a terrifying experience, from a car accident or hurricane to rape or child abuse.”

These physical signs that tests are revealing hold the potential to greatly enhance a physician’s ability to accurately diagnose and treat PTSD – an illness that is often unrecognized and untreated. While there is heightened awareness of PTSD, it can be difficult to diagnose and there are limitations for establishing accurate prevalence rates.
Additional Resources on PTSD and TBI
National Center for PTSD – with resources for veterans, the general public, providers, and researchers
Veterans: where to get help for PTSD
Post-Traumatic Stress Disorder (PTSD) – from the National Institute of Mental Health
Post Traumatic Stress Disorder Gateway
Defense and Veterans Brain Injury Defense Center
Traumatic Brain Injury Information Page – from the National Institute of Neurological Disorders and Stroke (NINDS)
Traumatic Brain Injury – from the CDC

Health Wonk Review’s Confederations Cup Edition

Thursday, June 25th, 2009

The most recent edition of Health Wonk Review – the Confederations Cup Edition is freshly posted at Jason Shafrin’s Healthcare Economist. Where else can you get the week’s highlights of soccer and health care policy all in one place? Quite appropriate because as the health care issue heats up, the debate is getting to be more and more like a contact sport. Keep score with posts from the blogosphere’s best & brightest health care policy wonks.
Fire sale – Want to buy a book of workers comp business? Ante up your billion dollars and it may just be yours. According to a story by Patricia Anne-Tom In Insurance Journal, Gov. Arnold Schwarzenegger is proposing to sell a portion of California’s State Compensation Insurance Fund. The SCIF wold remain as the insurer of last resort.
Summer reading – We are happy to learn that Risk Management Magazine recently began offering free online access to their excellent publication. May and June issues are now available online. And as we’ve previously mentioned, you should also check out their blog, Risk Management Monitor.
And for another free read, the School of Business Law, Curtin Business School of Perth Australia has announced that the first edition of The International Journal of Social Security and Workers Compensation is published and can be downloaded at no charge. This is an online double-blind peer-reviewed journal which focuses on strengthening international discourse in the areas of social security and workers compensation, including the provision of disability support. The publication is edited by professors Robert Guthrie and Marius Olivier.
PTSDDispelling the Myths About Post-Traumatic Stress Disorder (PTSD) & Other Psychological Health Issues – about 8% of the U.S. population (approximately 24 million people) will develop PTSD at some point in their lives. Among military veterans, PTSD is quite common. Approximately 30% of Vietnam War veterans experience PTSD over the course of their lifetimes, and recent data compiled by the Rand Corporation suggest that approximately one in five service members who return from deployment operations in Afghanistan and Iraq have symptoms of PTSD or depression. Learn more about the myths associated with PTSD and review common employment questions.
Forensic accounting – How are property, casualty, and fidelity claims being influenced by the credit crisis? In an article in this month’s issue of Claims Paul McGowan discusses the role that forensic accountants are playing during the credit crisis.
Barnyard animals, gang members and comp – In a recent post on his blog, Roberto Ceniceros reminds us of the vast array of work-related issues that workers comp addresses – including such wildly disparate issues as gang shootings and farm animals run wild.

AIG in Iraq: A Cruel Way to Make a Buck

Tuesday, April 21st, 2009

AIG has been in the news mostly for its ingenious method of losing money: insuring the riskiest possible financial transactions and tanking after these risks go bad. But give the biggest insurance company in the world some credit. They still know how to make money the old fashioned way: collecting premiums and denying claims. To be sure, this strategy is not easy to do in the states, where public scrutiny is never more than a phone call away. But it works rather effectively in Iraq.
T. Christian Miller from Propublica and Doug Smith from the LA Times have described in great detail how AIG transformed Iraq into a business opportunity with an enormous upside. AIG is the predominant workers comp carrier in the war-torn country, insuring civilian workers. When these workers are injured – and the injuries can be devastating – AIG has routinely denied their claims for basic medical care, artificial limbs and desparately needed counseling for post-traumatic stress syndrome. More than 1,400 civilian workers have died and 31,000 have been wounded or injured in the two war zones.
Insurers have collected more than $1.5 billion in premiums paid by U.S. taxpayers and have earned nearly $600 million in profit, according to congressional investigators. That’s nearly 40 percent profit after expenses – an unheard of loss ratio in the states.
Collect and Deny
The AIG strategy is deceptively simple: first, charge exorbitant fees for premiums, roughly 100 percent of a worker’s pay. (Don’t feel sorry for the companies paying these premiums; they are fully reimbursed by taxpayers.) Then, accept all the small claims and fight almost any claim involving lost time (more than four days of disability). Delay, delay, delay. Never make a payment until ordered to do so by a court.
The denial rate on serious claims is pretty astonishing: about 44 percent. How could you argue that any injury – let alone a serious one – is not work-related, as civilian employees are in Iraq for one purpose, supporting the war effort? In addition, fully half the claims for PTSD are denied. All this in the context of a war where catastrophic injuries are all too common and legitimate PTSD is as prevalent as cuts in a glass factory. How many state-side workers have watched co-workers blown to pieces by roadside bombs? Do you think that such incidents might qualify as PTSD?
AIG used the argument of extremely high-risk working conditions to boost the premiums. Then they turned around and used the strategy of denial to boost profits. Who says capitalism is dead?
I suppose you could argue that this reporting is just piling on poor AIG.The behemoth just cannot catch a PR break. Oh, well, dear reader, don’t waste too much energy feeling sorry for AIG. After all, you are paying for AIG big time: in the bailout that exceeds $200 billion; in the war-based premiums that generate profits nearing 40 percent; and in all likelihood, in the social costs of caring for devastated civilian employees, who have so much difficulty accessing the comp benefits to which they are entitled.
AIG may not know diddly about the risk in risky financial vehicles, but they certainly know how to make money in conventional comp insurance. Of course, it helps that the injured workers are so invisible, like obscure figures in a desert sand storm, struggling blindly to find some kind of shelter in a harsh and unsympathetic world.

News Roundup: trouble in FL; medical apartheid; exclusive remedy in NJ; regulators caving, and more

Monday, April 14th, 2008

Trouble brewing in Florida – Joe Paduda of Managed Care Matters is looking at a proposed regulation in Florida for hospital reimbursement and he is not liking what he sees. He says its a situation that is likely to “scare the pants off you.”
Medical apartheid – Richard Eskow of Sentinel Effect posts about recent studies by the Robert Wood Johnson Foundation and the Harvard School of Public Health, which show extreme disparities in medical care for whites and black. Of the studies, the South Florida Times states: “… elderly black and Hispanic patients often received substandard care for common but serious conditions like heart attacks, congestive heart failure and pneumonia. Researchers say their data suggests that the nation’s healthcare system is racially and ethnically segregated, not just for the elderly, but across the board.”
Troubling questions about regulators and public health interests – are regulators who are charged with protecting the health and safety of American workers and the general public succumbing to political and corporate pressure? Liz Borkowski of The Pump Handle blogs about a CBS investigation into why why the Centers for Disease Control slashed its Beryllium Study. In raising the question of whether officials ceded to political and corporate pressure in downscaling a health study of residents living near Brush Wellman’s largest beryllium-manufacturing plant, CBS questions whether the CDC “put politics before public health concerns.”
Recent reporting in the Las Vegas Sun investigates OSHA’s practice of reversing its findings and cutting fines for employers involved in construction fatalities. Reporters found nine instances where penalties for safety violations related to these fatalities had been scaled back after OSHA officials met privately with contractors. This reporting is the second part of a two-part series on construction deaths in Nevada. The first segment entitled Pace is the New Peril looks at a recent building boom that has claimed the lives of nine workers in sixteen months.
Exclusive remedy prevails in NJa suit for damages against a NJ employer was dismissed by the state’s superior court in the case of a driver who was struck by a vehicle while unloading supplies from his truck. The employee had sued claiming gross negligence on the part of his employer as well as the company where the delivery occurred, stating that he had not been provided cones or flares and had alerted his employer about the safety problems that existed at this particular delivery spot. In so deciding, judges said there was not enough evidence in the case to show the companies “deliberately intended to harm (Dadura) or knew that the consequences of its inaction were substantially certain to result in harm.” In most states, there is a very high bar for piercing exclusive remedy – employer negligence would have to reach a level of being intentional or certain.
Combustible Dust bill – Last week, a House Education and Labor Committee passed a bill that would require OSHA to issue an interim final standard regulating combustible industrial dust within 90 days and a finalized standard within 18 months. This progress represents only one hurdle however – the bill still must gain House and Senate approval in the face of significant opposition.
Soldiers suffering high rate of mental health problemsThe New York Times reports that army leaders are concerned about the mental health of soldiers who face multiple deployments to Iraq. More than 197,000 have deployed more than once, and more than 53,000 have deployed three or more times. According to an Army survey of combat troops sent to Iraq for the third or fourth time, more than one in four show signs of anxiety, depression or acute stress. This means that American employers should expect a high rate of PTSD for citizen soldier veterans when they return to the workplace.

Return to work and disabled vets

Wednesday, March 12th, 2008

The Iraq and Afghanistan theaters of war represent the largest deployment of civilian soldiers since WWII. Of the 1.5 million troops that have served, approximately one in every four is a National Guard member or a Reservist. While the Uniformed Services Employment and Reemployment Rights Act offers legal job protections, the road back will not be an easy one for many veterans. Many have suffered profound and life-changing physical injuries; many also face less obvious wounds – Iraq and Afghanistan Veterans of America estimate that about one in three Iraq veterans will face a serious psychological injury, such as depression, anxiety, or PTSD:

These psychological injuries exact a severe toll on military families. Rates of marital stress, substance abuse, and suicide have all increased. Twenty percent of married troops in Iraq say they are planning a divorce. Tens of thousands of Iraq and Afghanistan veterans have been treated for drug or alcohol abuse. And the current Army suicide rate is the highest it has been in 26 years. One of the goals of any disability program is to help the injured party to recover and to return to their normal lives, including return to work. This is true whether the injury occurred in the workplace, at home, or on the battlefield. Work is not only vital for economic security, for most of us it is also a core part of our identity, an integral part of our lives. A good return to work program can be restorative on a financial, emotional, and psychological plane. Both in the short term and over the longer term, employers will play a vital role in helping veterans readjust to civilian life. This requires that employers have awareness of the many challenges that veterans face and the willingness to provide the resources to support a successful transition.
Enter the Workplace Warrior Think Tank, a coming together of The Disability Management Employer Coalition, several of the nation’s premier insurers, employers, and military and veteran participants with the purpose of helping veterans to ease the transition from the war to the workplace. The group examined challenges and opportunities facing returning employees and identified employer-based resources and strategies. The end product is a useful guide for employers, Workplace Warriors: The Corporate Response to Deployment and Reintegration Highlighting Best Practices in Human Resources and Disability Management (PDF). The guide includes a list of best practice recommendations to help returning vets reintegrate in the workplace. These include such things as celebrating the employee’s return to the workplace, recapping changes that occurred while he/she was gone, and training supervisors to be aware of certain red flags that might indicate a problem. The group also emphasizes that the availability of effective EAP services can be critical to successfully helping veterans to face the many psychological problems that are common in the aftermath of war service.
It’s great to hear about the efforts of the think tank and their recommendations for employers – please help to distribute the guide and raise the issue because as the report notes, “Repercussions and delayed effects of the war experience will be felt in the workplace for decades to come.” Hopefully, this will be the first step in many by leaders in our industry to dedicate resources and attention to this important issue.
For more information and resources:
The Corporate Response to Deployment and Reintegration – this is the full report from Workplace Warriors, available through DMEC.
Wounded Warriors is a blog that collects veterans coverage from the McClatchy Washington Bureau, McClatchy Newspapers, and other sources. It’s a good source of news for items that affect returning vets and their families.
Resources for returning veterans and their families – from the Substance Abuse and Mental Health Administration.
Veterans and Military Health – from MedlinePlus
Iraq and Afghanistan Veterans of America – since 2004, the nation’s first and largest group dedicated to the Troops and Veterans of the wars in Iraq and Afghanistan, and the civilian supporters of those Troops and Veterans.

To hell and beyond: Dave Holland’s terrible story

Tuesday, August 28th, 2007

Survival stories are a magnet for many and I am no exception. Whether they be stories of people who escaped death by seconds in the World Trade Center, shipwrecked sailors who spent weeks on a life raft, or cancer survivors who prevailed, there’s something inspiring and fascinating about the indomitable will to survive against all odds. But no prior accounts quite prepared me for the utterly gruesome story of Dave Holland’s survival of a work-related accident. Be warned, unless you are a physician or someone similarly inured to severe injuries, his story of being scalped by an industrial drill is a difficult read.

Three years on, sleep still comes uneasily. His head hits the pillow and he flashes back: Caught up in the spinning and metallic screaming and the wet cracklepop sound of tearing flesh. The coppery tang of blood. The thing dragging him closer. The fear and the pain.

Beyond the sheer horror of his story, the article resonated on many levels: the medical miracle that was his survival; the window into the fierce will to live that kept him alive; the detailed account of the steep toll of an industrial accident, both when it occurs and in the aftermath; and the case history of post traumatic stress disorder. In reading this, it’s also hard not to wonder about his co-workers. How does one return to the workplace after witnessing an event of this kind? How does one get over the fear of the environment?
Dave’s survival may make him unique, but an injury of this nature is unfortunately not unique. I recall sharing a table with claims managers at an insurance trade event a number of years ago, and losing my appetite as they exchanged stories of “worst claims” cases they’d handled, such as scalpings and deglovings. Machine-related injuries are commonly recorded as caught or crushed injuries or the more prosaic contact with objects and equipment. These types of accidents result in about 18% of all work fatalities each year, as well as tens of thousands of injuries that do not result in death, such as Dave’s.
In reading other reports of “caught or crushed” injuries, there are some recurring themes: The worker is often working alone. The worker often wasn’t trained to use the equipment, or hadn’t been alerted to the dangers. The worker was often young. The equipment often didn’t have safeguards, or sometimes those safeguards had been manually overridden by either worker or boss. Hair and loose clothing were often the first point of contact. Ponytails and braids are particularly troublesome – a few strands may give way, but a thick plait that is caught could well be a death sentence.
There’s not a lot more to say beyond what Dave’s story already imparts: workers, be safe – speak up if you have unease or need training, and don’t work with hazardous equipment while alone. Employers, ensure that your workers are safe – you don’t want a Dave Holland on your conscience.

Thoughts in the aftermath of a tragedy

Wednesday, April 18th, 2007

Our hearts go out to the Virginia Tech community in their time of mourning. What a terrible event and what a sad reminder that life is short and and can be snatched from us and those we love at any moment in the most unlikely of circumstances. Perhaps the best memorial we can offer to the deceased is to redouble our efforts to live with kindness and goodwill. That, and to reach out and hug our loved ones.
Be alert for your employees’ reactions to this event. A horrible incident like this can take a psychic toll on many – even those who are remote observers with no actual connection to the event can suffer emotional stress. This is particularly true for those who have previously been involved in episodes of violence. Events of this nature can rekindle or exacerbate post-traumatic stress disorder for people unrelated to the actual event. For others, it can bring repressed fear and anxiety to the surface. The continual media drumbeat 24/7 and focus on sensational details can add to general distress.
In the aftermath of this and other horrors, we seek to make sense of senseless events. It’s natural that many would look to find someone or something to blame beyond the deceased perpetrator. Right now, many are looking to the university’s security procedures and questioning why the campus wasn’t locked down after the first shooting. That’s a valid question. Of course, it’s easy in hindsight to say what should have been done, but the reality can be more complex, so we will need to wait for the investigation to answer this and many other questions. Certainly, Columbine delivered some hard lessons about how things could have been handled better to minimize loss of life. Recommendations from follow-on Columbine investigations have been adopted by law enforcement personnel nationwide, and may already have saved lives.
The psychology of security
Can a community of 30,000 ever be securely locked down against a deliberate and cunning killer? Bruce Schneier presents a sober look at the issues of risk management and security in his excellent article, The Psychology of Risk. He points out that security is both a mathematical reality that can be calculated and a feeling based on psychological reactions to both risks and countermeasures. In regard to the latter, he notes:

* People exaggerate spectacular but rare risks and downplay common risks.
* People have trouble estimating risks for anything not exactly like their normal situation.
* Personified risks are perceived to be greater than anonymous risks.
* People underestimate risks they willingly take and overestimate risks in situations they can’t control.
* Last, people overestimate risks that are being talked about and remain an object of public scrutiny.

He goes on to present several examples of how and why people exaggerate some risks and downplay other risks, often in complete disregard to the mathematical realities. These perceptions influence our expenditures of time and effort:

“Why is it that, when food poisoning kills 5,000 people every year and 9/11 terrorists killed 2,973 people in one non-repeated incident, we are spending tens of billions of dollars per year (not even counting the wars in Iraq and Afghanistan) on terrorism defense while the entire budget for the Food and Drug Administration in 2007 is only $1.9 billion?”

Noting that absolute security is an impossibility, Schneier frames the matter of relative security as a trade-off. We measure the time, expense and inconvenience of a given security measure against our perception of the risk. If that perception is faulty, it’s an irrational trade off that doesn’t do much to increase our security.
After a tragedy, emotion often prevails over dispassionate rationality. Thus we can’t carry shampoo on planes and we strip down to almost our skivvies in airports. Does that make us safer or does it just make us feel safer? It’s unlikely that any measures can be thorough enough to guard us from a random determined killer in our midst. Efforts might be better spent trying to determine the root causes of why there are so many random determined killers in our midst.
Schneier’s article presents interesting, well-framed ideas in well-written format. Whether you work in the business of risk or just live in a risky world, it’s worth a read.