Tag Archives: workers’ compensation

6 Solutions for WC’s Compounded Medications Issue

September 26, 2018 by 

“There is no such thing as an FDA-approved compound medication.” That statement from myMatrixx Chief Clinical Officer Phil Walls underscores one of the main criticisms of these medications; while the drugs within the mixtures may all be FDA-approved, the specific combinations have not been tested and verified.

Safety is just one concern, however. The other is cost; they generally workers preparing medications for article, Compounded Medications — 6 Solutions to Address a Nagging Issue for WCare priced significantly higher than similar, FDA-approved drugs or the sum of their underlying medications.

Both the utilization and the average cost of compounded medications in the workers’ compensation system has decreased in recent years. However, there are still pockets of excessive use. Stakeholders need to maintain a steady and continued focus on efforts to curb the unnecessary use of these pharmaceuticals.

Problems Cited

Compounds are a mixture of drugs intended for a specific patient’s use. According to an FDA report, they are beneficial only in limited circumstances; such as when other medications have failed, a patient is allergic to some of the inactive ingredients or has difficulty swallowing.

The federal agency inspected compounding facilities and noted the following “troubling conditions” that could lead to widespread harm of patients:

  1. Toaster ovens used for sterilization.
  2. Pet beds near sterile compounding areas.
  3. Operators are handling sterile drug products with exposed skin, which sheds particles and bacteria, among many others.

Latest Stats

Compounded medications are not considered first-line therapy for pain or other common conditions of injured workers according to industry guidelines, such as evidence-based medicine guidelines from Work Loss Data Institute, American College of Occupational and Environmental Medicine, and many other state-specific guidelines.

Compounds are available in many applications but are used in workers’ compensation most often as topical products for pain management. Usually, compounded medications are excluded from workers’ compensation formularies, and require prior authorization before they are dispensed to an injured worker.

[SEE FULL STORY HERE]

Orchestrate A Culture of Quickly Reporting Workplace Injuries

September 27, 2018 by 

band in front of shipping containers for article, Orchestrate A Culture of Quickly Reporting Workplace InjuriesAn important role of the claims management team is to coordinate with employers and defense interests to make sure quickly reporting workplace injuries is a top priority of your organization.  It is easier for claims to be evaluated and decisions regarding primary liability to be made in an effective and efficient manner when injuries are quickly reported.  There are many steps claims management teams can make to develop important work injury compliance steps, which includes the use of evolving technology.

Emphasis the Importance of Reporting Workplace Injuries

There are several steps that employers can make to ensure workers’ compensation claims are reported in a timely manner.  This starts with developing a culture of understanding on the part of the employees.  This goes beyond making sure the proper posters are displayed in the workplace:

  • Make all new employees aware of workers’ compensation information at the time of hire. This includes providing documentation to new hires about the name of the company’s workers’ compensation insurer and other contact information;
  • Provide documentation on how work injuries should be reported and the information needed to make a report of injury; an
  • Ensure that the employer has a contact person to make sure the First Report of Injury is filed timely with the workers’ compensation insurer. In some instances, employers and their staff are unsure how the process generally works.  Making sure these persons understand the process is important.

All workers’ compensation insurance carriers and third-party administrators can provide information to their insured on these processes.

[SEE FULL STORY HERE]

Conservative Care for Shoulders

By Mary O’Donoghue, Chief Clinical and Product Officer, MedRisk

 BY 

Mary O’Donoghue, Chief Clinical and Product Officer, MedRiskShoulder pain is one the most common musculoskeletal problems in workers’ compensation, second only to low back pain. In fact, it is even more prevalent in some industries. Like low back pain, shoulder pain has been shown to respond well to conservative care, especially physically therapy.

Strenuous work, including heavy lifting over a long period of time, carrying, pulling, or pushing can cause shoulder pain and problems. The type of repetitive overhead arm motion that warehouse workers, flight attendants and construction workers perform also contributes to shoulder issues.

Symptoms include pain at rest and when lifting and lowering the arm or with specific movements. Some patients feel weakness when lifting or rotating the shoulder or experience a crackling sensation when moving the shoulder in certain positions. Limited range of motion and/or pain associated with internal and external rotation and forward flexion can indicate a partial thickness tear of the rotator cuff. Another symptom is painful abduction, which is the movement away from the median plane of the body. Full-thickness tears are indicated by weakness of external rotation and abduction.

Until recently, surgery was the common approach to rotator cuff tears and similar shoulder injuries. Now, guided by research, clinicians are adopting more conservative methods. This usually involves a combination of physical therapy and temporarily modifying activity, such as avoiding heavy lifting or sustained overhead use of the arms.

[SEE REST OF STORY HERE]

11 Ways Supervisors Can Enhance Your Workers’ Compensation Program

Supervisors are critically important to the effectiveness of your injury management program. They are often the first person on the scene of a workplace accident and may know the injured worker better than anyone else in the organization. They set the tone for how well the injured worker responds and engages in the recovery process.

Employees in charge of other workers who view their role in the workers’ compensation process as just an annoyance do a disservice to injured workers and the organization. Employers should take steps to ensure supervisors appreciate the value of the workers’ compensatioin case of workplace injury poster for article, 11 Ways Supervisors Can Enhance Your Workers’ Compensation Programn program and have a thorough understanding of how they can positively contribute to it.

 

Injury Response

While some organizations have detailed step-by-step plans in place for handling workplace injuries, many don’t; or even if they do, most employees are typically not well versed in the protocol. That’s why it is imperative to continually train supervisors on all the various aspects of the workers’ compensation system and how they fit into it.

For example, if one of your workers went to his supervisor after sustaining an injury, how would the supervisor respond? Would he know, or have a list of steps to follow, a medical provider to treat the worker, if needed? Would he know to address the worker’s medical needs first?

Here are some of the initial procedures supervisors should have down pat:

  • Get injured worker medical attention. First and foremost, make sure the worker gets medical attention if needed. If so,

Where to go

  • How to get the worker there; i.e., should he drive himself, and, if not, who should drive him
  • What, if anything to take with him
  1. Communicate appropriately. Extensive research has been done on the impact of a supervisor’s language and tone toward an injured worker. Questioning the truthfulness of the worker, for example, can have a dramatic impact on outcomes. Negativity threatens the worker and research has shown the odds are there will be twice as many days out of work than if there is a positive response from the supervisor.
  2. Whom to contact. Is there a department/person/number the organization has for reporting injuries? For example, is there a nurse triage system in place?

    {SEE FULL STORY HERE]

Lower Back Pain and Better Outcomes

09/08/17     Safety National

Millions of dollars are spent annually on treating low back pain (LBP). It accounts for one third of all occupational musculoskeletal injuries and illnesses resulting in work disability. At the 2017 CWC and Risk conference a panel of experts discuss lower back pain and the latest research.

Illustration representing lower back pain for article, Lower Back Pain and Better Outcomes

Conservative treatment options

There is no magic bullet. There is moderate evidence for multiple forms of conservative treatment. Acute lower back pain(LBP) treatment options include reassurance, remain active, heat, manipulation and acupuncture.

Meds can include NSAIDs or muscle relaxants (not opioids). Chronic LBP options are exercise, mindfulness based approaches, cognitive behavioral therapy, multidisciplinary rehab. Meds can include NSAIDs, tramadol. Bed rest is not advised. Physical agents and modalities are of unproven benefit to justify their costs in patients with acute LBP. There is evidence against traction for acute LBP but there is some support for chronic LBP. There is building evidence for stratified care based on risk profile that includes psychological and physical characteristics. Some patients may need a little more than reassurance and simple education. Others may need more advanced “psychologically informed” rehabilitation.

Central sensitization is becoming better understood and represents significant changes within the nervous system. This may require multidisciplinary care that includes specialized physical rehab and pharmacotherapy. People with uncomplicated LBP who are first sent for MRIs are more likely to receive a surgical or injection intervention, require specialty care or visit to an emergency system and LBP related medical charges were higher. MRIs can trigger catastrophic thinking and disability beliefs.

The Power of Words

Words can:

• Reassure or frighten

• Signal interest or not

• Build trust /confidence or distrust or insecurity

• Create expectations – positive or negative

• Grow relationships or not

Words are most powerful when you are seen as a credible authority (benevolent, trustworthy and expert in the matter at hand. When you are familiar with and respect the worker’s specific situation: What are they wondering or worrying about, and what they want to accomplish.

University of California – WorkStrong program

The WorkStrong program is a University of California system-wide program developed with the expertise and collaborative support of UC staff in wellness programs, occupational health and recreational services. It is designed to promote recovery and prevent future workplace injuries. Each UC campus has its own unique program to suit the needs of the employees on its campus. All campuses offer the core services of WorkStrong, which include a 6 month gym membership, exercise guidance and nutrition counseling, while each campus offers their own unique programming to suit the needs of its campus.

Some of the program benefits include:

• Post-rehab wellness program (pre- and post-body composition assessments included)

• Pre- and post-flexibility/mobility and strength assessment

• Flexible hours geared towards what works best for you

• Focused on functional strength for your workplace

[SEE FULL STORY HERE]

Torque Tool Use

09/06/17        Maureen Graves Anderson

Homer Simpson Tool Safety poster for article, orque Tool UseRecently I was asked about safe torque levels when using electrically, pneumatically, or hydraulically powered screwdrivers or wrenches. These tools are often used in assembly jobs in the manufacturing industry.

Basically, torque is a measure of the turning force on an object. A person holds the tool in place while the tool delivers a specified amount of force, measured in English units, inch-pounds (Newton-meters [nM] in the metric world). As the tool delivers the force, the body braces against the force. When the specified force is reached, the machine stops abruptly. It is this jerking reaction force that causes the problem – over time this repeated force can cause musculoskeletal disorders (MSD). How much force, torque in this case, can a person safely handle? The amount of torque force that a person can tolerate over the course of day varies greatly. Overall, strength, age, sex, posture, grip size and type are all factors that determine tolerance to torque forces.

For healthy adults, we know the range of the maximum voluntary contraction (MVC), the measure of strength for this type of force. But that tells us only the maximum a person can generate. This is not a good indicator for someone repeatedly doing this type of work. For that, we need to modify the MVC with a percentage. 14% of MVC is used for intermittent static contractions and 8% for continuous static contractions over the course of day. So doing the math, I calculate that for 95% of women, the range is 6.7 inch-pounds to 14.6 inch-pounds, with 10.66 inch-pounds being the average. For 95% of men, the range is 13.6 inch-pounds to 21.3 inch-pounds, with 17.6 inch-pounds being the average.

What do you do if the torque tool generates more force than a person can comfortably handle over the course of the day? There are two approaches: engineering controls and administrative controls. Engineering controls should be the first line of defense. Here are a few options:

  • Reaction arm for conventional tool: When a torque tool reaches its specified force, it abruptly stops. A reaction arm transmits the force to the frame rather than the human body. It is interesting that the industry recommends torque reaction arms for forces greater than 12 pounds; this is a pretty good estimate for males. For women, I recommend using these torque reaction arms for forces greater than 10 inch-pounds. There are many on the market, click here for an example.
  • Pulse tools: These tools apply the force by pulsing, and are very quiet and do not require a reaction arm. However, they are more expensive upfront and require more maintenance. In the long run, they may be cost-effective depending upon how they are used.

    [SEE FULL STORY HERE]

Reducing Work Comp Cost via Focus on Cultural Competence

illustration of multi colored hands for article, Reducing Work Comp Cost via Focus on Cultural CompetenceThe changing American workforce requires workers’ compensation professionals and stakeholders to step outside their comfort zones and challenge stereotypes and bias.  This includes the ability to work with people from different ethnic backgrounds to promote a workplace dedicated to safety.  Achieving  cultural competence requires full engagement from leaders within the company and insurance carriers.

 

Common Cultural Barriers to An Effective Work Comp Program

The great American melting pot continues to change.  This includes immigration from different parts of the world with people who seek their pursuit of happiness and a better life in the United States.  These changes impact workers’ compensation programs based on barriers that need to be broken down.  Common barriers include:

  • Mistrust of the government, including courts and government officials. Workers’ compensation programs involve a component of government involvement, including industrial commissions and judges.  A mistrust of these officials can impact how immigrants perceive justice.
  • Perceptions within one’s community by ethnic groups following a work injury. Even in instances where an injury is temporary, there is an underlying stigma attached in some communities that transcends the confines of the law and a workers’ compensation act.  Lack of self-worth following an injury trickles down to prolonged medical care and receipt of indemnity benefits.
  • Inherent risk of injury to new immigrant populations. Countless studies demonstrate non-white and/or non-English speaking populations suffer work injuries at a greater frequency than Caucasian and/or English speaking populations.  Like immigrants from Europe in the late 1800s and early 1900s, today’s immigrants tend to have fewer transferable job skills as whole and gravitate toward positions resulting in a higher frequency of injury.

Your Workers Travel Where?

07/07/17 Julius Young

A recent California Court of Appeals decision deals with the issue of how and when an insurance carrier can rescind a workers’ compensation policy.

fraud alert road sign for Californai Workers' Compensation insurance fraud articleStudies prepared for CHSWC have shown that California is plagued with a large amount of employer premium fraud (see link at the end of this post). Sometimes it may be the hiding and misrepresentation of payroll data. Or it may be misrepresentations of the nature of work done by employees.

So clarity about how and when a policy may be rescinded is critical.

In Southern Insurance Co. v. WCAB (note that the case is designated as an unpublished opinion), the misrepresentation was about the distances trucking employees would be driving.

The employer, EJ Distribution (“EJ”), filed an online application with Southern Insurance Company in December 2008. Interestingly, the application was prepared by EJ’s insurance agent. The application listed the business as “local hauling” and also that EJ’s employees did not travel out of state or in excess of a radius of 200 miles.

However, the insurance policy itself did not have an exclusion based on location of injury.

Southern was not pleased when it received a claim that an EJ trucker had hurt his back while on a trip to Tennessee for EJ.

So Southern sent a letter to EJ rescinding the policy on the grounds of material misrepresentation or concealment of material facts in the application for insurance. Southern returned the policy premium paid by EJ.

A later investigation by EJ determined that EJ had been doing trucking operations beyond 200 miles for some time, but there was a lack of specific data uncovered as to when those out of state operations actually started. So Southern apparently did not have direct proof that out of state service was underway at the time of the January 1, 2009 policy inception.

[READ FULL STORY HERE]

6 Steps to Identify and Address Mental Health Challenges Early

April 20, 2017 by Leave a Comment

mental health issues at workThe days of focusing solely on an injured worker’s physical injuries are over. Savvy employers and payers are finding that ignoring behavioral issues can end up costing a boatload of money in delayed recoveries. Early intervention, good communication and worker advocacy are among the best practices to use.

Injured workers who have, or develop undiagnosed and untreated behavioral health issues are more likely to fall into the ‘creeping catastrophic’ claim pool; a simple meniscus tear that degenerates into a months- or years-long claim with multiple treatments and medications — and exorbitant costs.

Identifying and treating these issues is tricky. The stigma attached to mental health issues prevents many people from seeking treatment; providers and claims handlers are often unfamiliar with signs and symptoms; and payers may be reluctant to pay for something they believe is unrelated to the actual injury. However, it behooves employers and other payers to at least consider ways to target behavioral health issues among their injured workers.

Behavioral Health Issues

Behavioral health issues — also called mental health or psychosocial — include a variety of diagnoses. Anxiety and depression are the ones more commonly seen among injured workers.

In addition to an extended duration of the claim, some signs that may indicate a psychosocial issue is present include:

  • Pain develops due to non-medical issues.
  • Function does not improve.
  • Multiple providers are involved.
  • Visits to the emergency room with drug seeking behavior.
  • Overutilization of treatments.
  • Catastrophic thinking.
  • Perceived injustice, toward the employer or others.

There are myriad reasons why some injured workers develop psychosocial issues, related to such things as adverse childhood experiences, environmental stimuli or genetics. The important thing is to identify them and intervene as early as possible.

[READ FULL STORY HERE]

Man’s Cardiac Arrest Death Linked to Workplace Bullying

headshot of Evann GastaldoBy Evann Gastaldo,  Newser Staff
Posted Mar 30, 2017

(NEWSER) – Eric Donovan loved his job of 17 years at a Canadian nonprofit agency that runs group homes and programs for adults with intellectual disabilities. But during the final years of his life, that love turned to stress as Donovan felt he was being bullied by Nadine Hendricken, his supervisor at Queens County Residential Services.

bullying is not partt of the job, signThe stress got so bad he and his wife, Lisa, started fearing for his health.
On Oct. 31, 2013, he collapsed at home. He died days later of cardiac arrest at age 47. Now, Lisa has been awarded benefits after the Workers Compensation Board of Prince Edward Island determined that

Donovan’s death was linked to bullying and harassment in the workplace, the CBC reports. Eric Donovan had no pre-existing medical condition that would have caused his death, the board heard. The suit also claimed he had been forced to do unsafe work and work extra hours, the Guardian reported last year.

Continue reading Man’s Cardiac Arrest Death Linked to Workplace Bullying