Early Diagnostic Testing Can Extend Claim Life and Cost

Medical diagnosticsDoctors are torn at times about the use of diagnostic testing shortly after an injury occurs.

Physicians of course want to rule out internal derangement before they start the patient on a treatment path.  Early physical therapy could do more damage than good should internal derangement be present.

The flip side to that statement is if the objective indicators are not present, and the testing is completed, it can validate the “injury” in the mind of the claimant.

Adjusters Are Often Put In Tough Position to Approve Testing

Adjusters are often put in a tough position on whether or not to approve testing just after an injury.  The claim is new, the adjuster has limited info, and doctors are usually not helpful in putting the pieces of the puzzle together.

Patients are also are very demanding. The presence of medical websites can impact a claim, and injured workers are not stupid.  They know what to tell the doctor in order to get what they want.  This is especially true in states where the carrier cannot direct care and the worker is free to treat with any doctor they choose.  The doctor chosen is likely their primary care doc, who they have known for years, and can probably request whatever they want and usually get it from them.

Take the normal everyday back strain injury.  The worker lifts up a box and feels pain in their lower back.  Upon examination, the patient has tenderness, pain, and limited range of motion.  They complain of acute pain, and they are demanding an MRI be completed.

This is the proverbial fork in the road.  If the patient has delayed reflex, subjective radicular pain in the legs, and subjective numbness, the doctor at times will be quick to grant the request of an MRI.

Why Is Conservative Treatment Not Applied First?

I do not agree with this stance.  If the injury just happened, why is conservative treatment not applied first?  Medication, work restrictions, and maybe conservative physical therapy should be completed first prior to any diagnostic testing being completed except the normal X-Rays. Continue reading Early Diagnostic Testing Can Extend Claim Life and Cost

Overview of California Workers’ Compensation System

California's Workers Compensation by the numbers - info graphicBy Safety National 06/12/2015
At the 2015 WCIRB Annual Conference, Dave Bellusci, WCIRB Chief Actuary, presented an overview of California’s workers’ compensation system from the WCIRB perspective.

• 2014 was the fifth consecutive year of double-digit premium growth in California. This has been driven both by increased rates and economic growth.

• California currently compromises 27.1% of the nationwide workers’ compensation premiums. This is down from over 35% of the national premiums before the SB 899 reforms in 2004.

• The percentage of premium growth attributed to higher rates dropped significantly in 2014. In 2015, it is expected that the major driver of premium growth will be higher payrolls.

• The top five insurers in California write 41% of the market. The market concentration in California is very comparable to other states.

• National insurers write 72% of the market in California, with the state fund writing 9% and California private insurers writing 19%.

• Rates right now are comparable to what they were back in 1978, but they are up 43% since 2008.

• There has been an 83% reduction in claims frequency over the last 50 years. The workforce is clearly safer today than it was in the past and there has also been a change away from an industrial based economy. Approximately one-third of this reduction is attributed to the change in occupation mix to less-hazardous jobs. Continue reading Overview of California Workers’ Compensation System

AED Failures: A Reminder that Maintenance is Vital

NOTE: If you have specific questions about AED’s, we encourage you to contact our associate (and AED expert), John Fowler

(805) 705-3631AED heart with lightning bolt logo

SCA News

WASHINGTON– More than 1,000 cardiac arrest deaths over 15 years are connected to the failure of automated external defibrillators (AEDs); battery failure accounted for almost one-quarter of the failures. The study was published online last week in Annals of Emergency Medicine (“Analysis of Automated External Defibrillator Device Failures Reported to the Food and Drug Administration”http://bit.ly/ox6YYr).
“Survival from cardiac arrest depends on the reliable operation of AEDs,” said lead study author Lawrence DeLuca, MD, EdD, of the University of Arizona Department of Emergency Medicine in Tucson. “AEDs can truly be lifesavers but only if they are in good working order and people are willing to use them.”
Researchers analyzed reports to the Food and Drug Administration (FDA) about all adverse events connected to use of an AED between January 1993 and October 2008. Of the 40,787 AED-related events reported to the FDA, 1,150 adverse events connected to fatalities were reported (3%). Almost half (45 percent) of failures occurred during the attempt to charge and deliver a recommended shock to the person in cardiac arrest. Problems with pads and connectors accounted for 23.7 percent of the failures and battery power problems accounted for 23.2 percent of the failures.
Sudden cardiac arrest is a leading cause of death in North America and Europe. Odds of survival decline by 7 to 10 percent per minute of delay in defibrillation. Even as AEDs have proliferated in public places such as airports and offices, bystanders are reluctant to use them. An Annals of Emergency Medicine study published earlier this year found that less than half of people in public places reported being willing to use an AED and more than half were unable to recognize one.
“AEDs are like any other piece of medical equipment: They can experience unexpected failures,” said Dr. Deluca. “I would recommend that people maintain AEDs as recommended by the manufacturer. If an unexpected device failure occurs it is vitally important to promptly contact both the manufacturer and the FDA. Then be sure to return the unit (and accessories such as pads or batteries) to the manufacturer immediately so that it can be analyzed and a cause for the failure identified and fixed.”
Read the abstract here.
SOURCE: American College of Emergency Physicians/ PR Newswire

Rheumatoid Arthritis Carries High Costs for Employers


Rheumatoid Arthritis chartEmployees with rheumatoid arthritis (RA) are more likely to have work absences, leading to high excess costs for employers, reports a study in the June Journal of Occupational and Environmental Medicine, official publication of the American College of Occupational and Environmental Medicine (ACOEM).

Jennifer H. Lofland, PharmD, MPH, PhD, of Janssen Scientific Affairs, LLC, in Horsham, Pa, and colleagues used national health survey data from 1996 to 2006 to estimate the impact of work absenteeism in employees with RA. According to the authors, “RA is a chronic inflammatory disease that leads to destruction of joints and is associated with severe long-term disability.”

In the sample of 90,000 working Americans, about 0.3 percent reported having rheumatoid arthritis. Nearly three-fourths of workers with RA were women.
Continue reading Rheumatoid Arthritis Carries High Costs for Employers

Understanding Medical Marijuana in Workers’ Compensation

By ReduceYourWorkersComp 05/28/2015

“Most states with legalized medical marijuana are struggling to chart of medical marijuana patients by statereconcile these laws with workers’ compensation program stakeholders seeking to promote “drug free” workplaces and other barriers imposed by federal laws and regulations.”

Over the last several years, more states have adopted laws that govern the use of marijuana for medicinal purposes.  While marijuana remains a Schedule I controlled substance under federal law, more states are considering it for legal use to treat work injuries.

What Do State Laws Permit

There are roughly 23 states that allow the use of marijuana for medicinal purposes.  The laws in these states vary on how they can be used.  In Minnesota, the use of this drug is limited to liquid, pill or vaporized forms.  The smoking of marijuana remains illegal.  In other states such as California, possession of marijuana is limited to a specific number of plants a person may cultivate and otherwise possess, and allows for state issued cardholders to smoke marijuana to treat a medical condition.

The conditions for which marijuana can be used also vary from state to state.  Most states allow for it to be used for the following conditions:

  • Most forms of cancer;
  • Glaucoma;
  • Tourette’s Syndrome;
  • Amyotrophic lateral sclerosis/Lou Gehrig’s Disease (ALS);
  • Seizures and epilepsy;
  • Severe and persistent muscle spasms;
  • Crohn’s Disease;
  • Terminal illness with a life expectancy of less than a year; and
  • Chronic pain conditions.

The use of medical marijuana for “chronic pain conditions” is a contentious issue as definitions or pain varies in each jurisdiction.  The required levels of pain to qualify are often subjective in nature, which can lead to abuse or de facto legalization for recreational use.

Conflict with Federal Law

States that currently allow the use of marijuana for medical (and recreational use) are in conflict with federal law and the Controlled Substances Act, which is found under Title 21 of the United States Code.


Safeway’s Program to Identify and Intervene with “At-Risk” Employees to Enhance Recovery


At the 2015 Natillustration for at-risk employeesional Council of Self-Insurers Annual Meeting, Safeway discussed their claims early intervention program.
The presenters were Anita Weir, Director of Medical & Disability Management and Denise Gillen-Algire, Director of Managed Care & Disability.

Understanding the Dynamics of Delayed Recovery:

  • A small number of claims drives a large percentage of the costs.
  • Clinically simple or routine claims are seeing increasing medical and indemnity costs due to poor recovery.
  • Some people develop persistent pain and delayed recovery due to non-medical psycho-social risk factors (poor coping skills).
  • Medical diagnosis legitimizes injured workers’ sense of distress (i.e. I have a disc bulge that is causing my pain).

Early Intervention Program Overview:

  • Initial pilot on low back claims (80 claims).
  • Clinical risk management screening questionnaire was given at the primary treating physicians office during intake.
  • Risk for delayed recovery was identified very early in the claim.
  • Additional disciplines including physical therapy or cognitive behavioral therapy were provided immediately.
  • Of those 80 claims in the pilot program, all returned to work and none had surgery.
  • Current program now screens all claims at two weeks post injury. This includes medical only and lost time claims.
  • Add on costs for screening tool and cognitive behavioral therapy is approximately $2,500.

Key Implementation Components

  • Cognitive behavioral therapy does not create a “psych” claim.  There are CPT codes for this therapy that do not create a psychological diagnosis code.

Continue reading Safeway’s Program to Identify and Intervene with “At-Risk” Employees to Enhance Recovery

FREE Stuff to Assist You in Controlling WC Costs

No strings attached. We’re just passing this along from those helpful folks at WorkersCompensation.com.

Free materials to help control your workers' comp costsThey are promoting their new Workers Comp “help club,” called COMPClub, and it certainly looks worth while (for a big $29/month). This is a reputable and well-regarded organization with a long history in the workers’ comp field.

FREE Workers’ Comp Cost Containment Gifts

Your Ultimate Guide To Mastering Workers’ Comp Costs – Mini Book

The Mini-Book is 20 pages, with each page summarizing a corresponding chapter of our comprehensive book. This booklet is in OUTLINE format, thus perfect for training programs and as a seminar follow-along handout. This booklet can be used as a stand-alone for training or promotions, or in conjunction with the
Comprehensive Guidebook.

10 Customized Get Well Cards

Get Well Cards are part of a positive, proactive communication strategy. As part of a comprehensive workers compensation program, employers should maintain close communications with injured employees to ensure they recover quickly, do not drop out of the workforce and and return to work rapidly.

Customize the Get Well Cards with your Logo and a special message below.

5 Workers’ Comp Cost Containment Articles

Download the Word documents along with a license to use the content of 5 popular articles from the Workers’ Comp Roundup blog.

  • 6 Work Comp Mistakes Employers Make
  • An Employer  Road Map For Work Comp Claim Management
  • Different Strategies for Return to Work
  • Fighting Fraud with a Special Investigation Unit
  • How to Communicate with Your Adjuster

An Epidemic of Fake Science


snake oil labelSacramento, CA – Medical treatment in the California workers’ compensation now requires that the treatment pass the scrutiny of “evidence based medicine” which means that scientific studies support the safety and efficacy of the requested care. That might seem like a straight forward process.

But, an article in Scientific American claims that false positives and exaggerated results in peer-reviewed scientific studies have reached epidemic proportions in recent years. The problem is rampant in economics, the social sciences and even the natural sciences, but it is particularly egregious in biomedicine. Many studies that claim some drug or treatment is beneficial have turned out not to be true. We need only look to conflicting findings about beta-carotene, vitamin E, hormone treatments, Vioxx and Avandia. Even when effects are genuine, their true magnitude is often smaller than originally claimed.

The problem begins with the public’s rising expectations of science. Being human, scientists are tempted to show that they know more than they do. The number of investigators – and the number of experiments, observations and analyses they produce – has also increased exponentially in many fields, but adequate safeguards against bias are lacking. Research is fragmented, competition is fierce and emphasis is often given to single studies instead of the big picture.

Much research is conducted for reasons other than the pursuit of truth. Conflicts of interest abound, and they influence outcomes. In health care, research is often performed at the behest of companies that have a large financial stake in the results. Even for academics, success often hinges on publishing positive findings. The oligopoly of high-impact journals also has a distorting effect on funding, academic careers and market shares. Industry tailors research agendas to suit its needs, which also shapes academic priorities, journal revenue and even public funding.

The crisis should not shake confidence in the scientific method. The ability to prove something false continues to be a hallmark of science. But scientists need to improve the way they do their research and how they disseminate evidence.