What Is A Workers’ Comp Vocational Consultant?

July 12, 2018 by 

Vocational consultants are not needed on most of your worker’s compensation claims; just the severe claims. When an employee has a level of permanent partial disability, to the point that the impairment from the injury will prevent the employee from returning to work, a vocational consultant is required.

Vocational Consultant Evaluates Ability of Injured Employee to Work

vocational rehabilitation consultant tee shirt for article, What Is A Workers’ Comp Vocational Consultant? A vocational consultant evaluates the ability of the injured employee to work and then assist the employee in finding employment within the physical limitations of the employee. The typical course of the vocational process is for the vocational consultant to perform a vocational assessment including vocational testing, perform a labor market analysis, a transferable skills analysis and assistance with job placement.

To access the injured employee’s ability to perform a different occupation, vocational testing is used. Testing to measure the employee’s educational achievement, aptitude, interests, and level of intelligence may be used to gauge what the employee’s skills are. These tests are the first steps in a vocational assessment for the employee.

The vocational assessment for each employee is done on an individualized basis. To make a complete evaluation of the injured employee’s abilities, the vocational consultant will:

  • Complete a detailed interview to obtain the employee’s background information on formal education, trade schools, prior work experiences, interests and hobbies
  • Based on the results of the detailed interview of the employee, a
    transferable skills analysis will be completed
  • Vocational testing to verify the level of the transferable skills the employee has will be completed


Updated Osteoporosis Screening Guidelines Released by USPSTF

The US Preventive Services Task Force (USPSTF) published its final recommendations this week on the screening of women for osteoporosis to prevent fractures. The updated guidelines include level B recommendations for the screening of women aged 65 years and older, as well as for younger women who have experienced menopause and also have an increased risk.

graph of osteoporotic fractures compared to other diseases for article, Updated Osteoporosis Screening Guidelines Released by USPSTF“Osteoporosis causes bones to weaken and potentially break, which can lead to chronic pain, disability, loss of independence, and even death,” the USPSTF said.

“Clinicians can help women avoid fractures by routinely screening those who are 65 and older, as well as younger, postmenopausal women at higher risk for osteoporosis — such as women who have low body weight, who smoke cigarettes, or whose parent has broken a hip.”

The final recommendations, which were published online June 26 in JAMA, apply to older adults without a history of prior fragility fractures or health conditions that could weaken bones.

The USPSTF noted that evidence was insufficient to determine whether men would benefit from osteoporosis screening to prevent fractures.

“While both men and women can develop osteoporosis, there’s less evidence to know whether screening and current treatments prevent fractures in men without a history of fractures,” USPSTF vice chair Alex H. Krist, MD, MPH, said in a news statement.

“More studies are needed that look at how well treatments work in men who have not had a fracture,” he said.

In updating its similar guidelines from 2011, the USPSTF conducted an evidence review of 168 articles on the issue of osteoporosis screening that were determined to be of fair or good quality.


Will Your Melanin Protect You From The Sun?

summer beach fun scene for article, Will Your Melanin Protect You From The Sun?For many people, the dog days of July mean grabbing an ice pop, lounging outside, and letting the summer sun hit your skin. And for people of color, we’re often doing those things sans sunscreen. After all, our melanin will protect us. Right?

Not so fast.

This week on Ask Code Switch we’re taking on a question from Liz Mitchell, from New York. She writes:

“Dear Code Switch,

I’m biracial, and my black family don’t use sunscreen – if anything they use oil at the beach. My white mom has always been all about sunscreen. I used to be like, ‘I got melanin, I’m fine.’ But my white grandpa died of skin cancer, and since then I’ve felt like I’m inviting the cancer into my body whenever I step outside. Sorry to be grim, but I’d love to hear other POCs thoughts and practices around skincare and skin cancer.



Hi Liz,

I hear you. I, too, grew up with a black dad who would laugh at the mere thought of sunscreen, and a white mom who needed to reapply seven times in an afternoon. And like you, for most of my life, I never really worried about protecting my skin from the sun. “Black don’t crack” wasn’t a phrase I really heard a lot growing up. If anything, it was “black don’t burn.”

That mindset is incredibly common. In 2006, John McCann, a columnist for the Herald-Sun in Durham, N.C., talked about how his family would get greased up before going outside. “This goes back to when I was a little kid, and momma used to slick me down with Vaseline,” he wrote. “Despite how hot it is…black people all over this country will lotion up before leaving the house. Got to get rid of that ash. … And yet we won’t use sunscreen.”

Now, there may be some legitimate thinking behind that. According to the American Cancer Society, melanoma (the most common form of skin cancer) is more than 20 times more common in white people than in black people in the United States, with black people being diagnosed at a rate of about 0.1 percent. Latinos fall somewhere in the middle, with about 1 in 172 people being diagnosed with melanoma in their lifetimes.

But those numbers don’t tell the whole story. A study in the November 2016 Journal of the American Academy of Dermatology found that even though white people are the most likely to get skin cancer, they also had the longest survival time after diagnosis. Black people, by contrast, had the shortest survival time. In other words, the black people who get melanoma are more likely to die from it than the people from other racial groups.

There are a few factors that might contribute to those statistics. For one thing, black people are often diagnosed at later stages of the cancer than people from other racial groups. That could be because we often don’t see ourselves as being at risk, so are less likely to check ourselves (or go get checked out) for suspicious lumps and moles. It could also be because medical professionals make the same assumptions, and are less likely to be on the lookout for signs of skin cancer in darker-skinned patients.

Jacqueline Smith is a member of the Melanoma Research Foundation‘s Board of Directors. She’s also a self-described dark-skinned black woman who has survived two bouts of melanoma.

Practical Tips for Implementing Urine Drug Testing

July 2, 2018 by 

urine testing kit for article, Practical Tips for Implementing Urine Drug TestingIdentifying and intervening with at-risk injured workers can save payers a bundle in workers compensation costs. These are the so-called “creeping catastrophic’ claims; the seemingly minor injuries expected to resolve within weeks that go south and before you know it, have been on the books for months or longer. They typically involve a variety of expensive medical procedures and medications, all of which are unsuccessful in alleviating the person’s pain.

This small fraction of workers’ compensation claims encompasses a majority of costs for payers. In recent years, the industry has done a better job of red-flagging these claimants earlier in the process. But an oft-overlooked tool to help is urine drug testing.

Urine Drug Testing helps physicians whether the patient is compliant with prescribed medications and/or using non-prescriber or illicit drugs.

But UDT has been ignored in many cases or overused in others. Using UDT judiciously can be a tremendous help.

The Stats

Recent research shows fewer than half the injured workers prescribed opioids received UDT – 17 percent to 50 percent. However, it also showed that of the top 5 percent of claims, UDT was conducted in 7 out of 10 physician visits.

Guidelines from the American College of Occupational and Environmental Medicine, the Official Disability Guidelines and the Washington State Interagency vary regarding UDT frequency recommendation. But they all call for UDT at baseline when opioids are initially prescribed, then at various times throughout the year based on the injured worker’s risk stratification. Those at low risk may only need UDT every six months to annually; while high-risk claimants might need to be tested monthly.

The testing provides objective information to support improved clinical decision making, and helps medical providers:


When does a condition become a medical issue?


Doctor shrugging shoulders for article, When does a condition become a medical issue?It has become a sign of legitimacy to call a personal problem “medical.”  This aims to distinguish the problem from those of morality or character.  It implies both that the problem is serious, and that it is unbidden and largely out of the sufferer’s control.  Unfortunately, it isn’t clear what exactly qualifies as “medical,” so this label serves more as a rhetorical device than a scientific finding.

Alcoholism is the paradigm and perhaps least controversial example.  Through the 19th Century, alcoholism was variously declared a disease, or a matter of will and character.  The disease model gained prominence in the 1930s and 40s with the “powerlessness” identified in the 12 Steps of Alcoholics Anonymous, as well as researcher E.M. Jellinek’s descriptions of progressive stages and subtypes of alcoholism.  The American Medical Association declared alcoholism an illness in 1956 and has endorsed the disease model ever since, partly as a strategy to ensure insurance reimbursement for treatment.

The model expanded to include other abused substances with the formation of Narcotics Anonymous in the 1950s, and as a result of widespread recreational drug use in the late 1960s and early 1970s.  The specialty of addiction medicine was first established in 1973 in California.  The American Society of Addiction Medicine now states: “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.”  Proponents of the disease model of addiction cite many documented brain changes and a plausible neuropathology, as well as the presence of genetic risk factors, cognitive and emotional changes, impaired executive functioning, and disability and premature death.  The model purportedly destigmatizes addicts — they are no longer “bad” or “weak” people — thereby making it more acceptable for them to seek treatment.

Nonetheless, the disease model of addiction remains controversial.  In addition to the existence of alternative models, the disease model itself has been criticized.  Some believe it removes personal choice and responsibility, and actually contributes to the problem of addiction.  Others cite surveys of American physicians who consider alcoholism more a social or psychological problem — even a “human weakness” — than a disease.  Critics note that about 75 percent of those who recover from alcohol dependence do so without seeking any kind of help, and that the most popular and recommended treatment, Alcoholics Anonymous, is a fellowship and spiritual path, not a medical treatment.


Know Two Types of Functional Capacity Evaluations (FCE)

When a physician is treating an employee for a back injury or other job related injury, the decision on when to return the injured employee to work is often a subjective decision. The physician who is unsure of the employees physical capability will often turn to the physical therapist for an objective opinion of the employees ability for work. The physical therapist will provide a Functional Capacity Evaluation (FCE) by administering various tests to determine the employee’s functional capacities and limitations.

illustration of physical therapist and patient for article, Know Two Types of Functional Capacity Evaluations

Comprehensive Examination and Evaluation

The FCE is a comprehensive examination and evaluation by the physical therapist that objectively measures the employees level of functioning. The testing will document the employees ability, or the lack of ability, to perform the essential job related task over a specific time frame. The FCE will provide objective information to the physician in several areas:

the employee’s functional abilities and job demands

  1. the disability evaluation
  2. when to return the employee to work
  3. whether or not the employee can return to the job held prior to the injury
  4. the employee’s functional abilities away from the job
  5. to information to design a rehabilitation plan, if needed
  6. the need for other medical intervention and/or treatment


Study finds popular health news stories overstate the evidence

Joy Victoryphoto of Joy Vcitory is Deputy Managing Editor of HealthNewsReview.org. She tweets as @thejoyvictory.

A new study confirms something we here at HealthNewsReview.org have been emphasizing for many years: Health news stories often overstate the evidence from a new study, inaccurately claiming that one thing causes another — as in drinking alcohol might help you live longer, facial exercises may keep your cheeks perky, and that diet soda might be a direct line to dementia.Info graphic of percentage of people who get health info on social media

The researchers looked at the 50 “most-shared academic articles and media articles covering them” in 2015, according to data from the NewsWhip database. Seven of the 50 studies were randomized controlled trials, the gold standard for “causal inference” in medicine (meaning, one can reasonably infer that an intervention caused an outcome, but not always).

The rest were observational studies, which is what it sounds like: Observing people and then seeing what happens to them (or what happened to them, if it’s looking at data collected in the past). They are not true experiments, with a control and placebo group. Sometimes, with lots of observational data–after longterm, repeated findings in thousands of people from different studies that used terrific methodology– the evidence becomes so strong that it can make sense to change public health or medical practice based on only observational data. Smoking and lung cancer is one such case. But it’s also clear that the literature has become littered with poorly done observational studies that make causal claims that cannot be supported.

They found a “large disparity” between what was written in the news stories compared to what the research showed:

  • “44% of the media articles used causal language that was stronger than the academic articles” (and many of those studies were overstated to start with).
  • “58% of the media articles contained at least one substantial inaccuracy about the study.”

X ‘may be caused by’ Y

One way that news stories can overreach is by inaccurately using language that implies x caused y:

  • “may be caused by”
  • “seems to result in”
  • “is caused by”
  • “is due to”


School System Summer Break – 4 Proactive Work Comp Tips

June 12, 2018 by 

Schools Out for Summer graphic for atricle, School System Summer Break – 4 Proactive Work Comp TipsInterested stakeholders in the workers’ compensation process are constantly seeking ways to reduce program costs.

One area includes the discontinuance of workers’ compensation benefits for school employees and teachers suffering from the effects of a work injury during the summer break period.  While statues and case law interpretations vary in each jurisdiction, employers and insurers are generally limited in their ability to discontinue or suspend various workers’ compensation benefits for school employees during this time of year – even if they have no plans of looking for work while under restrictions on their activity.

Schools Out – Time to Discontinue Work Comp Benefits?

While the school year typically runs from late August through late May, employees of school districts around the country sustain work-related injuries every day.  The ongoing effects of those work injuries do not magically disappear for summer break.  Sadly, those hot summer days a teacher, paraprofessional or administrative staff employee would like to spend at a beach, can be spent at home convalescing.  Proactive members of the claims management team might view this as an opportunity to discontinue ongoing wage loss and vocational rehabilitation benefits.  Unfortunately, this is often not consistent with many state workers’ compensation laws via case law interpretation.

One case on point comes from Minnesota, where a school district sought to discontinue ongoing wage loss benefits at the conclusion of a school year.[1]  The rationale for the discontinuance was based on the premise the employee did not intend to work during the summer months, and the result was no loss in wages.  A compensation judge rejected this argument and affirmed by the Minnesota Workers’ Compensation Court of Appeals.


The Impact of Fatigue and 10 Ways to Mitigate the Risks

If one of your employees is sleeping on the job, he may actually be doing you a favor. Lack of adequate sleep is a major risk factor for injuries, errors, and chronic diseases. In fact, ‘shiftwork sleep disorder’ has been deemed a carcinogen because of the increased risk of breast cancer.

worker fatigue poster for article, The Impact of Fatigue and 10 Ways to Mitigate the RisksThose most at risk are workers with frequent overnight shifts, rotating shifts, or early morning start times. While you may not be able to change the need for workers on shifts other than daytimes, there are strategies you can take that can help employees be less fatigued and save you significant amounts of money.

The Sobering Stats

Employers and payers are likely unaware of the stunning costs associated with workplace fatigue. Here are the numbers for a hypothetical Florida construction company with 800 workers:

 • Decreased productivity: $590,463

• Absenteeism: $249,962

• Healthcare: $458,075

The National Safety Council’s Fatigue Cost Calculator also estimates the number of employees likely suffering from specific sleep risks at this sample company:

• Obstructive sleep apnea: 101

• Insomnia: 69

• Restless Legs Syndrome: 40

• Shift work disorder: 1

‘Shiftwork sleep disorder’ occurs when a person’s internal clock becomes misaligned with his sleep/wake schedule due to shift work. Those affected may experience excessive sleepiness during night work and/or insomnia during daytime sleep.

The good news is the potential savings from taking simple actions to mitigate all these conditions are $625,250.


How to make sure your vacation isn’t a medical disaster

Recently while traveling overseas, I found myself in a predicament not often encountered nor taught to health professionals. I was requested to address an emergency at 30,000 feet in the air. This got us thinking: How many patients consider the possibility of a medical emergency in the air?

photo of person in beach chair with full body cast for article, How to make sure your vacation isn’t a medical disasterPeople with chronic illnesses and the older population (who find themselves retiring and having more time to travel) need to be prepared so their vacation isn’t ruined by a health crisis.

Below are a few tips to stay safe while traveling:

If you have serious medical conditions, be sure your travel companion is prepared to help in case of an emergency. In the event you lose consciousness you need someone to convey information to those on board trained to help you, primarily the flight attendants, or, if you are lucky enough, a medic, emergency medical technicians (EMT), nurse, nurse practitioner (NP), physician assistant (PA) or physician.

This cannot be overstated enough — pack ANY medications you might need in an emergency in a carry-on bag. This includes an epi-pen, albuterol, aspirin, nitroglycerin, antihypertensives, non-steroidal anti-inflammatory medications, insulin, glucose supplement, anti-emetics, oxygen, etc. If you’re not sure if you should carry certain medications on board, discuss it with your primary care physician prior to traveling. TSA states, “Medications in pill or other solid forms must undergo security screening. It is recommended that medication be clearly labeled to facilitate the screening process. Check with state laws regarding prescription medication labels.” Make sure to have plenty of medication for your trip, plan to have your primary care physician call these into the pharmacy at least one week prior to travel. Be prepared for anything. Most airlines only carry a basic first-aid kit, oxygen and a defibrillator.

If you have medical conditions, see if your primary care physician prior to take off for a travel clearance. If your physician detects early warning signs of illness then the risks of travel may far outweigh the benefit.

If you have serious food or environmental allergies (e.g., anaphylaxis — a multi-organ, life-threatening allergic reaction) alert the flight attendants as you board (and have your EpiPen!). Though awareness of serious allergies to peanuts has increased they are still served on some flights. Other commonly served food products include soy and wheat.