Workers Comp, Car Accident, Slip and Fall Doctors

In Indiana, a subsequent injury resulting from a worker’s blocked vision due to his wearing a bulky medical device for his compensable injury can be compensable.

Case name: Moorehead Electric Co., Inc. v. Payne, No. 93A02-1105-EX-457 (Ind. Ct. App. 12/29/11).

Ruling: The Indiana Court of Appeals held that a worker was entitled to benefits for the reinjury of his shoulder.

What it means: In Indiana, a subsequent injury resulting from a worker’s blocked vision due to his wearing a bulky medical device for his compensable injury can be compensable.

Summary: A worker injured his shoulder during the course of his employment for an electric company. The company provided him with benefits and authorized two surgeries. The worker was instructed to wear a bulky shoulder brace 24 hours per day. The worker was attending a wedding reception when an individual carrying a rod with a large bag walked toward him and wedged himself between the worker and his wife. To avoid being struck by the rod and bag, the worker stepped to the right. His foot hit a raised grate surrounding the base of a tree, causing him to fall and reinjure his shoulder. The worker’s shoulder brace blocked his view of his foot and the raised grate on the sidewalk. The worker had a third shoulder surgery. The company refused to pay workers’ compensation benefits for the third surgery and additional disability benefits. The Indiana Court of Appeals held that the worker was entitled to benefits.

The parties did not dispute that the worker’s initial shoulder injury arose out of and in the course of his employment. The company argued that the causal connection between the original work accident and the second incident was broken by an intervening act of the individual forcing the worker to quickly move out of the way to avoid being struck by the individual and the rod and bag he was carrying. The court disagreed, finding that the reinjury was a proximate cause of the original injury.

The court found that the worker’s ability to walk was impeded by the bulky shoulder brace he was required to wear. The brace contributed to his fall. The court also concluded that the worker was not negligent when he stepped to the side to remove himself from the individual’s path.

Read more at the WorkersComp Forum homepage.

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A sharp reader pointed out a potential problem in the state’s plan to relocate the Workers Compensation Board from its offices on Park Street in Albany to 328 State Street in Schenectady: the law dictates that its “principal office” must be in Albany.

Here’s the relevant section of law:

§  146.  Offices of the board. The principal office of the board shall
  be in the city of Albany.  There shall be also an office in the city  of
  New  York  and  at  such  other  place  or places in the state as may be
  required properly and conveniently  to  transact  the  business  of  the
  board.  The  board may meet and exercise any or all of its powers at any
  place in the state.

The e-mail from WCB Executive Director Jeffrey Fenster announcing the change to employees makes note of this, saying the Board “will continue to maintain a presence in the City of Albany.” But a paragraph earlier in that missive, which we posted yesterday, Fenster describes a move of WCB’s “primary administrative offices” to Schenectady. I’m unclear how this will be reconciled, and exactly what the “presence” will entail. For example, whether Fenster will remain in Albany.

Fenster referred a call to his spokesman, who e-mailed this statement in Fenster’s name, and wouldn’t elaborate further about that “presence.”

“Any move being considered by the Board is in compliance with existing law and regulations,” Fenster said. (Phew.) “Further, any move will result in significant cost savings to the state. Additional details will be provided in the future when the move is finalized.”

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NEW ROCHELLE, NY — Jake Ballard was hoping it wasn’t serious when he went down with a left knee injury in the fourth quarter of the Super Bowl.

After the 21-17 win, he was initially encouraged to hear that the feeling was he injured his meniscus.

But after undergoing an MRI, the tight end got much worse news with a torn ACL.

“I was pretty surprised,” Ballard said after an autograph signing for Steiner Sports. “[After] the MRI, the doc came in with a look on his face and I just knew it wasn’t my meniscus. So it was pretty frustrating.”

General manager Jerry Reese said Ballard and tight end Travis Beckum will likely start the 2012 season on the physically unable to perform list. Beckum tore his ACL in the Super Bowl as well.

“Six-to-eight months and they’re going to try and make it for the beginning of the season but if not a good chance at PUP,” Ballard said of an optimistic timetable for recovery. “I definitely don’t want to go out there too early and hurt it again so if I get eight, nine months to prepare, I’m fine with that.”

“Clint Sintim came back too early and he might not have been ready and he hurt it again,” Ballard added of the linebacker who tore his ACL in the preseason after tearing his ACL in December of 2010. “So we’re going to play it by ear and I’m going to bust my butt to try and make it by the beginning of the season.”

Both Beckum and Ballard will undergo surgery on Feb. 21. It was a bittersweet ending to a breakout season for Ballard. He emerged as Eli Manning’s top tight end, replacing Kevin Boss.

But Ballard injured his right PCL late in the season and fought through it in the playoffs.

Tearing his ACL in the fourth quarter of the Super Bowl was painful in more ways than one.

“It’s the biggest game of anyone’s life,” said Ballard, an exclusive rights free agent who will re-sign with the team. “To get hurt in it and can’t contribute in the end when the game’s on the line, it’s like a nightmare. But they came through in the end and we still got that ring.”

Ballard tried to get back into the game and attempted to run on the knee on the sideline before falling in pain.

“Probably the worst pain I’ve ever had in my life,” he said. “But what was I going to do? Not try to go back in?”

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GREENBURGH, N.Y. – (AP) — The New York Knicks say they expect Carmelo Anthony to miss a week or two with a strained right groin.

Anthony was hurt Monday, leaving after six minutes of a 99-88 victory over Utah and continuing an injury-plagued season.

Anthony has missed three games with various ankle, wrist and hand injuries and shot poorly in a handful of others while playing through the pain.

The All-Star forward leads the Knicks with 22.3 points per game.

Copyright 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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NEW- Physical Therapy and Physical Rehabilitation

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Mitchell, a provider of technology, connectivity and information solutions to the property & casualty claims industry, announces enhancements to the  SmartAdvisor Utilization Review (UR) Decision Manager, a solution that integrates utilization review decisions within the bill review process, empowering insurance claims payers with the ability to reduce unauthorized treatment losses, improve efficiency with automated and accelerated treatment decisions, and optimize investment in ut5ilization review technology.

“The Mitchell SmartAdvisor UR Decision Manager, like all our claims management solutions, is continually enhanced and improved in order to substantially increase straight-through processing rates,” says Nina Smith-Garmon, senior vice president and general manager of Mitchell’s workers’ compensation division. “The UR Decision Manager automatically applies utilization review recommendations to a bill, allowing manual intervention only when needed, which enabled one of our clients to reduce medical bill processing time by an impressive 30.6 per cent. The market interest for UR Decision Manager is strong and we look forward to working with our clients to help them improve operational efficiency.”

The solution offers insurance payers further improvements in operational and financial efficiency with the ability to customize UR exceptions at the client, policy or claims systems level; automate compliance with New York and California treatment guidelines; and access an enhanced user interface with more granular visibility into bill entry and explanations of review (EOR) applied UR decisions.

In addition, SmartAdvisor supports the integration of third-arty systems such as Unimed, DataCare, CID Management and others into the UR Decision Manager, in order to simplify and optimize claims handling while containing costs.

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Last August we discussed lawsuits brought by over 75 ex-football players against the National Football League. The players sought unspecified amounts of damages for head injuries sustained over the course of their careers. The players alleged that the NFL knew of the harmful effects of multiple concussions as early as the 1920s, but kept that information from players until 2010. Riddell, the helmet maker, was also named in the lawsuit as a defendant.

These lawsuits are still pending and a hearing was recently held in Miami to determine whether the cases, which were filed in various federal courts, including Atlanta, Miami, New York and Philadelphia, should be consolidated into a multidistrict region. One interesting issue in this case is the possibility that the NFL will claim that the terms of the collective bargaining agreement between the league and the players should apply to the players’ head injuries, thus requiring the players to seek compensation via more traditional outlets such as workers’ compensation and disability benefits and the NFL’s medical and long term care plans.

As explained in a Workforce.com article about this lawsuit, according to an attorney representing many of the players,  the concussions and other head injuries suffered by the players were sustained in ways unrelated to typical workforce dangers…

http://www.jdsupra.com/post/documentViewer.aspx?fid=40441e89-db9f-4600-bf53-698c99cc9c42

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Sports Medicine Specialist Dr. Victor Khabie Emphasizes Prevention for Young Athletes

(HealthNewsDigest.com) – Carmel, NY, – Wrestling as a sport can be traced back to the ancient Olympics and has been practiced throughout the world in many forms and styles ever since. Today, wrestling is offered at various levels, from youth wrestling in middle school through high school, college and the Olympics. It’s a sport for people of all sizes, both male and female, and competition rules that pair athletes against each other according to their weight class reduce the risk of injury.

Nevertheless, injuries do occur. According to sports medicine specialist Dr. Victor Khabie of Somers Orthopaedic Surgery and Sports Medicine Group, “Wrestling is an intense and demanding sport, requiring a great deal of muscular endurance and strength. And it is a contact sport in which the body is contorted into many different positions, putting the muscles and joints under great stress. Overall conditioning, proper technique and the right equipment are essential to prevent injuries.”
According to Dr. Khabie, who serves as team physician for several schools, “As with all sports, injury prevention must be a primary goal of all participants, coaches, and trainers. The wrestler should be coached and supervised at all times, stressing proper technique, proper equipment and discipline to avoid injury. Coaches and referees need to strictly enforce rules to encourage safe wrestling technique and the use of proper safety gear and equipment.

At both the high school and collegiate levels, wrestling ranks second only to football in injury rate. Most injuries are not serious and are similar to those seen in other sports: bruises, scrapes, strains and sprains. The most serious wrestling injuries affect the shoulder, knee and neck and are most commonly caused by forcing a joint beyond its acceptable range of motion.

The majority of upper body and shoulder injuries in wrestlers are caused by the combination of leverage and twisting during competition. Rotator cuff pain is common in young athletes, usually caused by muscle strains and tears that arise from overuse. An acute tear is more serious and might result in wrestling from falling on an outstretched arm. The most common traumatic shoulder injury in wresting in young people is dislocation, in which the head of the upper arm bone comes out of the socket, either partially or completely. Shoulder strengthening exercises, braces and, in some cases, surgery may be recommended to prevent recurrence.

Dr, Khabie adds that shoulder flexibility should be an essential goal of a conditioning program. “Wrestling-specific workouts for the shoulder should include both weight-bearing and non-weight-bearing exercises. Weight-bearing exercises such as push-up variations improve the stability of the joint. Also, rotator cuff strength, endurance and proper muscle balance should be addressed.”
Knee injuries constitute a significant number of all wrestling injuries. During a match, the knee may be twisted and turned in many different directions.

The ligaments supporting the knee are under a great deal of stress trying to hold the knee together and may be stretched or torn. The anterior cruciate ligament (ACL), the posterior cruciate ligament, and both the lateral and medial collateral ligaments are subjected to external forces that could cause tearing. The ACL is the most commonly sprained in wrestling. A partial tear will require immobilization, ice, and rest to help with recovery. A complete rupture may require surgery and many weeks of recovery.

Prepatella bursitis, the inflammation of the sac (bursa) located in front of the kneecap (patella), is caused by the front of the knee constantly hitting the mat. It is treated by anti-inflammatory medication, ice, and rest.

The meniscus is a “C”-shaped disc made of tough cartilage and is very important for absorbing shock between the femur (thigh bone) and the tibia (shin bone). Most injuries to the meniscus occur from a hit or other direct trauma to the knee. Sudden turning or twisting motions of the knee may also cause a tear. Serious meniscal tears typically require surgery that either repair the tear or completely remove the torn portion of the ligament. It may take 6-8 months to fully recover after surgery.

Maintaining strength of the quadriceps and hamstrings, as well as flexibility through the lower extremities, can help prevent injury to knee ligaments. The best way to prevent bursitis is to wear knee pads during practices and competitions. Knee pads help to limit the stress on the knee and reduce the force of any direct impact to the front of the knee.

Neck injuries can be caused by throws, especially those done incorrectly, and holds where the wrestler’s head is caught at an awkward angle. The cervical vertebrae are often forced into vulnerable positions, which can result in several types of neck injuries. Most are strains, sprains and whiplash (hyperextension) injuries. However, every neck injury should be treated as a spinal cord injury until ruled out by a medical professional. Spinal immobilization is the most important step in treatment. This will help prevent future damage to the spinal cord if it is involved. Dangerous holds and “slamming” moves should be avoided to prevent neck injuries. Some coaches teach wrestlers to keep their heads up when performing take-downs, to avoid compression or flexion of the spine, which can lead to serious injury.

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If you have employees, then you have Workers Compensation[i] (work comp). It is one of the most basic forms of insurance a company has yet often comes with the most questions from my clients. There are a lot of misconceptions with Work Comp that lead to a lot of poorly managed programs. Over the next few weeks we’ll try to will focus on a series of work comp topics.

Addressing:

• The basics / History (today),
• Loss prevention,
• How to report and manage a claim,
• Importance of a return to work policy,
• How you can dispute a claim
• Understanding what is an Experience Modification factor and how it affects your premium.

There are varying reports but some point to the first history of Work Comp in the states as being adopted in Wisconsin back in 1911. Prior to Work Comp the only source of compensation for an injured worker was through the courts. As an injured worker, it put you in a compromising position taking your employer to court  in an attempt  to prove their negligence. Today’s Work Comp laws are “no-fault”. Simply meaning employers give up the right to defend and sets up exclusive remedy for employee. They no longer have to prove negligence but they can also no longer come back and sue employer.

That’s the history here are the basics. Work Comp base premiums are compiled through an equation derived from the amount of payroll per job function within your business.  Each job function is assigned a class code rate per $100 of payroll.  These rates are set by the state using a three year average loss ratio factor for each class code.  

Example:

A small sales organization will have a sales force and clerical office back-up. Their rate might look something like this:

• Outside Sales : Class Code 8742, Rate $.77, Payroll $350,000 = $2,695 in premium
• Clerical support: Class Code 8810, Rate $.30, Payroll $75,000 = $225[ii] in premium

This is the base premium. Then your personal rating history is factored into the equation with your Experience Modification factor (a future topic). This is how you compare to your competitors in your specific industry. Once this is totaled you add in a small Terrorism Charge and Catastrophe Provision Charge (since 9/11 this is mandatory on all Work Comp policies to help fund future incidences and not crippling the insurance industry). Last you have your paper filing charge from the state the expense constant. This is a flat $220 regardless of if you pay $200,000 in premium or $2,000.

So if your premium’s are determined by rates set by the state and your loss history how do companies compete for your business? This is the question you need to be asking your agent.

The answer is in the form of dividends paid out post audit and more impotently services provided. What types of loss prevention, risk management strategies can they help implement that will directly affect cutting your bottom line (also a topic for a future article).

I’m looking forward to contributing to this series on Workers Compensation over the next month. The goal is to shed some light on a serious topic, help give insight to long term cost savings solutions, create a safe working environment for your employees and as always help you understand what your paying your insurance company for.

For more information on workers compensation in the state of Wisconsin checkout www.wcrb.org

Good luck and stay safe.

[i] All employees working for an employer (other than farmers) with three or more workers are protected immediately by the Worker’s Compensation Act. Employers with fewer than three workers come under the law if they pay wages of $500 or more in any quarter of a calendar year. Their workers are covered 10 days after the end of that quarter. Farm workers are covered if the farm employer has six or more employees on 20 or more days in a calendar year.

[ii] Minimum premium would apply to a work comp policy $900 at inception, if it audits out less the least amount of   exposure would be $220. 

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