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11/30/2012 in Medical Conditions, Treatment
Numerous “red flags” can be found associated with increased incidences of delayed recovery following a compensable injury.1. Receipt of compensation for a past injury.2. Medical visits increased prior to accident.3. Frequently canceled medical appointments.4. Reports of having “had the feeling of impending doom” prior to the accident and/or nightmares about the accident.5. High absentee rate before the injury.6. A history of doctor “shopping”.7. Reluctance to cooperate with treatment.8. Pending litigation.9. Inconsistent or non-organic physical findings.10. History of alcoholism or drug abuse.11. Evidence indicating early dependency needs were not met (history of starting work at a very young age or by being a later born child in a large family).12. Family history of disability.13. Recently divorced or other recent crisis.14. Physical disability disproportionate to injury.15. Demonstrating concerns about ability to continue working or inadequate retirement savings in older workers.If present, these factors do not necessarily indicate a claimant will suffer from delayed recovery but suggest a higher risk, and these claims should be followed more closely.For more information please visit www.MedicalSystemsUSA.com
The reported incidence of work-related carpal tunnel syndrome has skyrocketed; however, many cases have an underlying systemic cause. A methodical investigation--including appropriate imaging studies and laboratory testing--can differentiate symptoms that are primarily occupational from those with associated medical illness or obesity. Syndrome DefinedA syndrome is a constellation of signs and symptoms useful in establishing a differential diagnosis and pointing the physician in the direction of an appropriate management plan. In the case of carpal tunnel syndrome (CTS), however, this definition is often forgotten. Indeed, clinical features suggestive of median nerve entrapment are often managed as a single entity that is assumed to have a clear, recognized etiology. Exhaustive research by George S. Phalen in the 1950s and 1960s, and others since then, has demonstrated that many common systemic conditions (e.g., diabetes mellitus, thyroid disease, rheumatoid arthritis, osteoarthritis of the wrist, gout, obesity, and even pregnancy) may provoke symptoms of hand pain, numbness, burning, or tingling with or without the additional impact of work-related trauma. Yet in today's medical climate, there is often a rush to judgment. Patients presenting with hand symptoms may be incorrectly diagnosed as having CTS caused by conditions in the workplace. Claims SkyrocketingSince 1985, when the U. S. Occupational Safety and Health Administration (OSHA) accepted that there were "traumatogens" in the workplace and demanded that repetitive motion disorders be reported, the recorded incidence of cumulative trauma disorders has skyrocketed. About 277,000 cases were reported in 1997, compared with fewer than 50,000 in 1985.CTS has been the fastest growing category, recently accounting for more than 40% of all work-related disabilities. An estimated 26,000 CTS patients in the United States undergo surgical decompression each year. Median time lost from work is about 32 days per patient, more than for any other cause, including back pain. Why so Much Lost Time?Undoubtedly, one reason why so much work time is lost is that treatment is often unsuccessful. Many patients either do not have CTS or have CTS as part of another, undiagnosed medical condition that accounts for most of the problem. The underlying condition usually is never addressed, largely because our workers' compensation system provides such powerful incentives for declaring any median nerve disorder to be job-related. In Nevada, for example, even a successfully treated case of occupational CTS may merit a permanent partial disability award of $25,000 or more. Since many patients presenting with hand symptoms are poorly paid factory or farm workers with no group health insurance, workers' compensation may represent their only hope of getting treatment. Consequently, the patient may file a claim even when the physician suspects that the real problem lies elsewhere. Patients who do not respond to basic measures such as splinting and anti-inflammatory medication ultimately may undergo decompression surgery--at considerable expense to employers and taxpayers. Causation IssuesFollowing on the work of Phalen, a number of investigators have suggested that occupation is more likely to be an aggravating factor than the primary cause of CTS.  When Peter A. Nathan and Richard C. Keniston studied cohorts of workers' compensation patients, industrial workers, and control populations in both the US and in both the United States and Japan, they found that variables such as age, obesity, wrist dimensions, and physical inactivity were stronger risk factors for CTS than workplace factors such as repetitious or forceful hand use.John R. Schottland and colleagues determined that median nerve conduction latencies were no different among poultry processing workers than among candidates applying for their same type of jobs. Nortin M. Hadler surveyed the world literature on the subject and concluded that all of the major studies describing a cause-and-effect relationship between work and CTS were seriously flawed.  These are many compelling reasons to question the validity of a CTS diagnosis being attributed to work related causes. For more information visit www.MedicalSystemsUSA.com
11/17/2012 in News
CDATA[Injured workers should know what rights they have and what limitations claims handlers have with regard to their claim of injury.  Many appropriate resources are available through the internet to assist injured workers with their Worker’s Compensation injury claim by providing information that is nonbiased and beneficial for all parties involved. The Department of Workforce Development provides information on their website which guides workers through the process.  This information is provided in a question and answer format and can be helpful to someone not familiar with the system. One can find information on filing a claim, the flow of a claim, returning to work, vocational resources available, claim denial, what to expect at a hearing, finding the employer’s worker’s compensation carrier,  and the rights and responsibilities of the injured worker. It is the best site our research has found to provide nonbiased information concerning an injured worker’s rights and responsibilities under Wisconsin Worker’s Compensation and can be found at the following address:  http://www.dwd.state.wi.us/wc/default.htm. Another good internet resource is the Wisconsin State Law Library at http://wsll.state.wi.us/topic/laborlaw/workerscomp.html.  This site contains a wealth of information on Wisconsin Worker’s Compensation geared to educate employees and employers alike in a nonbiased way through providing factual information about the Worker’s Compensation system.  It contains links to various sites, which direct to the Wisconsin Department of Workforce Development, the Wisconsin Office of the Commissioner of Insurance, and links to various Worker’s Compensation statutes and administrative codes.Workerscompensation.com provides Worker’s Compensation information, news, and contact information for employees, employers, insurers and medical providers.  On this site, rules, statutes, forms and professional help relate to workplace injuries and disabilities in the state of Wisconsin. Findlaw.com is also another resource for injured workers looking to obtain information about Worker’s Compensation.  The site provides an overview of Worker’s Compensation, benefits and returning to work, employer’s responsibilities and a frequently asked questions section. While the information provided on the site is great educational information, the goal of this website is to ultimately refer the injured worker to an attorney who can handle their case. All of these sites provide good information for an employee looking to obtain a solid education about the Wisconsin Worker’s Compensation system and their rights and responsibilities under Worker’s Compensation statutes and administrative codes. A multitude of websites are geared toward the topic of Worker’s Compensation, however many do not pertain to Wisconsin or Wisconsin law.  Additionally, it is sometimes difficult to navigate through information geared to assist employees versus information geared toward employers.  Certainly the majority of information provided on the internet for injured workers is geared to sell them a service.FOOD FOR THOUGHT:  It may be that many injured workers retain attorneys because they lack the necessary knowledge of the Worker’s Compensation system to confidently navigate themselves through the system.  Knowledge of the system and how it operates may actually serve to cost-effectively settle Worker’s Compensation claims.This knowledge can be a powerful tool in the quick resolution of claims.  It has been statistically proven that IME’s can help temper claims, closing them at a faster pace; but the knowledge in this scenario is often obtained on behalf of the employer/insurer.  It would be interesting to know what effect increased knowledge on behalf of the employee would have on the system. For more information please visit http://www.medicalsystemsusa.com
The ProblemThe incidence of low back and neck pain is pervasive throughout society and represents a major reason for time lost from work, costing the American economy billions of dollars per year between medical care, lost wages, and benefits. Most of these lost resources are utilized by a small minority of patients. Lost time due to occupational back injuries represents a challenge to the medical industry, and the insurance world to provide early, effective treatment. The proper approach is to provide cost effective care while improving the quality of patient care and facilitating a successful and quick return to activity by the patient.BackgroundMany patients with back problems seek early care with their primary care physician or medical generalist rather than enlisting the assistance of a spine specialist.  As a result, these patients are frequently treated symptomatically without the benefit of a defined algorithm for effective testing and treating. Studies such as MRI’s are frequently ordered when unnecessary, and patients can go weeks or months before a proper diagnosis is derived and appropriate treatment initiated.This approach is counterproductive in an industrial setting where the injured worker has a propensity for further injury and extended lost time from work, without effective care.GoalsThe goal for treatment in work related spinal injuries is to provide early intervention that identifies an accurate working diagnosis and is coupled with effective treatment modalities.  The evaluation of the patient must involve the use of established algorithms ordering tests only when necessary and avoiding wasteful testing that is not medically necessary, and does not alter the course of early treatment. Early control of pain along with effective mobilization of the patient through aggressive physical therapy provides the most effective means to quickly return patients to the work place.The ultimate goal is to return the patient to their previous level of function in society. Although it is not always possible to provide 100% resolution of the problem, it is possible to maximize one’s functional capabilities through pain control and aggressive rehabilitation. It is a well-documented fact that extended time lost from work decreases the likelihood of a successful return to the workplace.Types of Injuries and TreatmentThe overwhelming majority of injuries in the work place involve simple strains and strain type syndromes. These represent simple soft tissue related injuries that are time limited in scope and do not represent long term injuries. They are easily and effectively treated with proper early intervention. This includes interruption of the pain cycle while encouraging progressive activity levels to effectively and quickly return patients to the work place. This approach typically involves the prudent use of anti-inflammatory medication in conjunction with aggressive back reconditioning, streaming function, and strengthening.All too frequently, patients are placed on extended courses of passive modalities, which leads to extended time lost from work with further rehabilitation of the patient. Some patients develop disc related injuries, most typically a herniated disc. Most disc herniations can be treated nonoperatively and frequently improve in a period of 46 weeks. Treatment modalities again include the prudent use of medication, effective rehabilitation, and injection therapy for the control of pain. The only indication for emergent surgery involves progressive neurologic deficits.  In a select group of patients, comprehensive nonoperative treatment fails requiring surgical intervention.The advent of microsurgical procedures of the spine represents a major advance for the treatment of herniated discs. This is typically undertaken as an outpatient procedure with early mobilization of the patient, facilitating early active rehabilitation. Patients typically are successfully returned to work in a limited capacity soon after surgery with improved long term results. The combination of outpatient surgery coupled with early aggressive rehabilitation results in significant cost savings to the carrier.Failed Back SurgerySurgery should only be undertaken when there is effective correlation between a patient’s complaints, physical examination, and imaging studies. The absence of complete correlation of all factors significantly decreases the likelihood of a successful surgical outcome. Failed back surgery represents a major proportion of expense in the treatment of work related injuries.  The greatest likelihood of success is with the initial procedure. Revision spine surgery holds a more guarded prognosis and should only be undertaken by those who are highly trained in this more demanding procedure.RehabilitationEarly mobilization of the patient in conjunction with control of pain represents the cornerstone of treatment. The initial step is to obtain a pain free range of motion followed by back strengthening and reconditioning. The goal is to ultimately return the patient to prior functional levels and minimize the likelihood of recurrent injuries.ConclusionThe effective treatment of back related injuries involves the coordination of care by a spinal specialist trained in the effective diagnosis and treatment of spine related injuries. Early intervention resulting in an accurate working diagnosis, coupled with well-trained academic decision making, is the most effective way to return patients to their pre-injury level of function.Coordination of care with the case manager, clinical specialist, and employer is mandatory for a successful outcome. If things are not working within the timeframe originally projected, or there are other unresolved issues pushing end of healing out further than expected, an IME may be indicated. For more information please visit www.MedicalSystemsUSA.com
When is it more appropriate to refer a case to a neuropsychiatrist and when should the case go to a neuropsychologist?  By definition, the word “neuro” (nerve) leads one to believe that the most common condition treated by both specialties is brain disorder or injury.  Not only do the two specialties sound similar in name, neuropsychologists often work together with neuropsychiatrists in the assessment and treatment of brain injuries or disorders, causing even further confusion between the two specialties.Simply put, Neuropsychiatrists are medical doctors, who are able to prescribe medications.  They assess and treat psychiatric symptoms associated with brain dysfunction or lesions.  These lesions may include conditions such as traumatic brain injury, cerebral vascular disease, seizure disorders, Alzheimer’s disease, Parkinson’s disease, brain tumors, alcohol/other substance abuse induced organic mental disorders, developmental disorders involving the brain, as well as infectious and inflammatory diseases of the central nervous system.  Neuropsychiatrists can provide information concerning the usefulness of specific medications, the development of an effective treatment plan, appropriate work restrictions, expected healing plateau issues, and determining a diagnosis(es).Conversely, neuropsychologists cannot prescribe medications and possess an advanced doctoral degree referred to as a Ph.D. or Psy.D. They assess the relationship between brain and behavior and utilize psychological tests and assessment techniques to determine the extent of any possible behavioral deficits following a brain injury.Neuropsychologists, in an evaluation setting, can provide valuable data in the measurement of extent of brain injuries or disorders through extensive psychological testing and assessment. Neuropsychologists can identify the extent of psychological involvement and provide a diagnosis(es), as well as the determine work restrictions and permanent partial disability.While both specialties may be equally qualified to evaluate brain injuries, the specialty you choose should depend on the individual merits of your case.For more information please contact info@MedicalSystemsUSA or visit our website at www.MedicalSystemsUSA.com
An IME Cover Letter alone can determine the difference between a great report and a mediocre report. The best choice for authoring the cover letter is always the claims handler who is dealing with case-related issues on a daily basis, reviewing medical records as they come in, and maintaining regular contact with the employer and employee.  NO ONE KNOWS THIS CASE BETTER THAN THE CLAIMS HANDLER—which means no one can do a better job of conveying the facts than you!By following the steps below, you can help ensure that you receive a complete and accurate IME report:
  • Be specific—Ask specific questions in order to receive specific answers about your claimant’s injuries.  Cover letters should never contain generic, check-box questions that are asked of every type of injury; this will only lead to generic answers and may not accurately reflect this situation.
  • Be proactive—If there are certain records or a specific aspect of the claimant’s history you would like the doctor to address in his report, ask him to discuss them specifically in the report! We rightly assume all IME doctors thoroughly      review case documentation, interview the claimant and conduct a complete physical examination.  In many cases we are probably correct.  But, with a single bullet in our case defense chamber can we take the chance that the IME doctor is indeed taking all the proper steps to evaluate the claim?
  • Be time sensitive—If you have a deadline, take another chance to remind the doctor of this date in your cover letter and be sure to send the cover letter at least a week in advance of the IME.
  • Be clear—Make sure the questions you pose to the doctor are actually asking what you mean. Well thought out questions, which are easy for a medical professional (who is NOT an attorney), to understand are imperative to avoid misunderstandings and answers to questions you did not ask.
Do you have any other suggestions for a strong IME Cover Letter? Let us know! Email LeighAnn@MedicalSystemsUSA.com or contact us through our website at www.MedicalSystemsUSA.com.]]>
10/12/2012 in Treatment, Medical Conditions
Spinal degeneration is a normal part of the aging process. Research shows that 90% of males over the age of 50, and 90% of females over age 60 have radiographic evidence of degeneration. This degeneration progresses with age and occurs in all of the structures comprising the spinal unit, including intervertebral disks, facet joints, and the connectingligaments. Other factors can influence the rate of spinal degeneration. Among those are environmental factors (such as cigarette smoking or disk injury), and physiologic factors (genetics). Areas of degeneration are likely to be dispersed across the spine and generally correspond to the mechanical stresses produced by spinal motion and posture. Research indicates that the process of spinal degeneration can be hastened by performing tasks involving heavy labor. On the other side of the spectrum, lack of activity can also hasten the degenerative process. Statistically, there is an increased frequency of spinal pain and disk herniation in heavy laborers. It appears that regular moderate exercise is important to slowing down degenerative affects. DEGENERATIVE EFFECTS ON BACKINJURIESSpinal degeneration can contribute to the severity or slow down the healing process of a back injury. Likewise, a back injury can also hasten the degenerative process. Fortunately, the advancement of diagnostic technology has greatly enhanced the ability to determine the length of presence and severity of spinal degeneration. This makes it easier for doctors to determine how the symptomatology and healing process of the injury is affected by the degenerative process. DETERMINING PERMANENCYIn cases where the claimant has sustained permanency for an injury with diagnostically documented degenerative changes, it is important that the doctor assessing permanency delineates between any preexisting degeneration which may be present and the claimed work injury. This becomes more complicated in cases where claimants are performing heavy labor. Degeneration could be prematurely caused or accelerated beyond its normal progression depending upon the length of time the heavy labor was performed. Often, this is dependent upon the type of work performed and the length of time it was performed. The medical professional also needs to consider the role environmental factors, physiological factors, and the claimant's age play in the degenerative process.THE IMEWhen obtaining IME's for back injury claims, it is important to address any preexisting conditions and/or occupational exposure in your cover letter to the evaluating doctor. Point out any preexisting degeneration you may be aware of, let the doctor know if the claimant has a history of performing heavy labor (make sure you let the doctor know if it was for your employer, or a previous or subsequent employer). Also let the doctor know of any environmental or physiological factors you are aware of. These important dynamics will assist the IME doctor in the determination of causation as well as permanency issues.Providing medical documentation is imperative. If you have any records which discuss preexisting degeneration or previous back injuries, those need to be specifically highlighted for the IME doctor in the cover letter. It would be extremely beneficial if those records could be obtained an provided for the IME. Typically, these types of cases are scheduled with orthopedic surgeons; however, neurosurgeons are qualified to conduct IME's for back injuries as well. For most cases, it would be suggested to schedule with an orthopedic surgeon unless it is an injury to the cervical spine. For more information about the reasoning behind this go to www.MedicalSystemsUSA.com or call 1.800.261.3278.]]>
10/12/2012 in Medical Conditions, Treatment
How many of us have either heard of or suffer from Restless Legs Syndrome (RLS)? The numbers are probably low on both counts. People suffering from RLS may experience an urge to move their legs followed by an uncomfortable feeling such as a creeping or crawling feeling or even tingling, cramping, burning or flat-out pain. And for those of you wanting a good night sleep, that might be a problem, because RLS often takes place late in the day or at night. Let's look more closely at the seldom heard of ailment, Restless Legs Syndrome. What is Restless LegSyndrome?RLS is a neurological disorder that is characterized by unusual sensations in the thighs and calves. The sensations may feel like insects crawling on the skin, burning or tugging. The abnormal sensation may be bothersome, irritating and even painful. The best way to alleviate these sensations is to move the legs in a rapid and repetitive fashion.Activity seems to lessen the symptoms and many times, the symptoms are worse at night. How common is RLS?About eight percent of all Americans suffer from RLS, which equates to about 12 million people. This figure may be low, as this is a fairly common condition that may go undiagnosed and unreported. It is interesting to note that there is a hereditary factor associated with RLS and that 50 percent of all cases have a genetic association among family members. What causes RLS?There continues to be research into the causes of RLS and several answers are speculative.There are no known specific causes. As previously noted, there is a hereditary predisposition. It has been shown that patients with RLS may suffer from anemia and low levels of iron. There may be some underlying medical conditions that contribute to the symptoms such as kidney disease, diabetes, Parkinson's disease and peripheral neuropathy (numbness). During pregnancy, women may experience the symptoms during their last trimester. Lastly, certain cold medications, anti-seizure medications, psychiatric medications, some blood pressure medications and anti-nausea medicines may also worsen the condition. How is this diagnosed?At present, there is no specific diagnostic test that will confirm RLS. A patient must have a comprehensive history taken and a physical examination by a health care provider. There are no blood tests that will aid the diagnosis. After all underlying medical conditions have been ruled out; four basic criteria must be met. These criteria include: 1) desire to move limbs when there is an associated unusual sensation 2) symptoms that are worse at rest and improved with activity 3) motor restlessness 4) symptoms that are worse at night when trying to sleep. The International RLS Study Group has developed these criteria important to develop a regular pattern for sleep, avoid exercise just prior to bedtime, avoid the use of alcohol, and be sure to allow for relaxation at bedtime, avoiding complicated mental tasks.For more information visit www.MedicalSystemsUSA.com or email LeighAnn@MedicalSystemsUSA.com]]>
10/12/2012 in News
Check out these interesting work related facts:1. Up to 25% of hospital keyboards carry the MRSA infection.2. Apples are more effective at keeping people awake in the morning than caffine.3. On an average work day, a typist's fingers travel 12.6 miles.4. By law, employees do not have to wash hands after sneezing.5. More American workers (18%) call in sick on Friday as opposed to any other day of the week. Tuesday has the lowerst percent of absenteeism (11%).6. The state with the highest percentage of people who walk to work is Alaska.7. More than 50 million Americans said they had a disability; for 32.5 million of them, the disability was severe.8. The rate of fatal and major injuries in firms employing fewer than 50 employees is over twice the rate in firms employing more than 1,000 people.9. About 60% of fatal injuries to workers occur in construction, transport and storage, agriculture, forestry and fishing.For more information visit www.MedicalSystemsUSA.com
An informative weekly series for the benefit of those managing claims of injuryThank you for allowing us to share this educational series with you. As we've seen, cost of service, years of experience and training are not always good indicators of a successful case manager.People-skills are really the key to cost-effective and successful case management. Look for the following skills and abilities in your next case manager:
  • The ability to evaluate and coordinate
  • Follow-up and follow-through
  • Excellent communication skills
  • Good interpersonal and intra personal communication
  • An outstanding talent for negotiating and motivating
Sometimes, something as simple as feeling an instant rapport with the case manager can be an excellent sign that they will be successful.We hope you enjoyed this series. Look for a new series coming your way soon!For more information visit our website at www.MedicalSystemsUSA.com or call 1.800.261.3278

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