June 19, 2019

Be on Alert for “Red Flag” Symptoms in Back Injury Cases

A significant number of work injuries in Georgia involve back injuries.   Unfortunately if you are being treated by a “posted panel” doctor, your treatment may be delayed or not taken seriously.  In this video, I discuss certain “red flag” issues that demand immediate treatment with a spine specialist whose focus is your well being.

 

Insurance Adjuster Attempts to Use Nurse Case Manager Against Injured Worker’s Interests

illegal actions by workers compensation adjusterThis past July, I discussed on this blog issues related to the participation of a nurse case manager in a Georgia Workers’ Compensation claim.   In that post I pointed out that insurance adjusters sometimes assign a nurse case manager to a particular claim.  The nurse case manager is not an adjuster, and they do not deal with issues related to wage benefits.  Instead, they deal with the medical component of your case only and a nurse case manager can be helpful in setting up medical appointments, coordinating transportation to and from doctor’s visits and working out issues with prescriptions.

Issues arise when the nurse case manager tries to influence your doctor about signing off on a return to work release or suggesting to the doctor that he include in his reports statements which say that your pain has subsided and that you are doing better.  Some nurse case managers even try to influence the drug prescriptions written by the doctor.  Others appear at each one of your appointments and try to stay in the room when your doctor examines you.  You have the absolute right, by the way, to insist that your nurse case manager step outside during your examination and conversations with your doctor. [Read more…]

Company Doctor Uses X-Rays Instead of MRI and Misses Herniated Disc


MRI ScanOften, when a worker injures his back on the job, the human resources manager will take down a claim and refer the worker to an industrial clinic for evaluation and treatment. All too often, the industrial clinic or other posted panel doctor will take X-rays, perform some basic neurological tests, then release the worker back to full duty work after a day or two of rest.

I often get these cases four to six weeks later when the injured worker finds himself unable to work because of severe back pain and limited mobility.   In some instances the injured worker faces pressure and even harassment from his employer due to his decreased productivity, and when I get the case, the employer/insurer may try to argue that any serious injury to the employee may have happened at home instead of at work.

Recently I represented a very nice young man in a back injury case that clearly demonstrates why X-rays are insufficient to evaluate back pain.

My client is a 31 year old man whose job involved installing and reinstalling fence posts.  Starting at 8 AM, my client, using a sledge hammer, loosened fence posts by breaking up their cement foundations, cleaned the post base, then reinstalle the post with fresh cement.  Beside using the sledge hammer, my client had to carry heavy buckets of cement and pour them in to holes in the ground.

By 2 PM that day, my client felt a “pop” in his back when he tried to lift the sledge hammer and he felt radiating pain in both legs.  He reported the injury to his supervisor, who referred him to an industrial clinic.  The clinic doctor took X-rays which described “mild disc space narrowing at L4-5” but no other impairment. [Read more…]

Case Study: Bilateral CTS and Workers’ Compensation

Repetitive motion injuries

Repetitive motion injuries result from the repeating tasks required by certain jobs. It is also referred to as RSI or Repetitive Strain Injuries or Repetitive Stress Injuries and involves the musculoskeletal and nervous systems. These injuries can result from a number of factors such as:

  • awkward and sustained positions
  • forceful exertions
  • pressing against a hard surface (or mechanical compression)
  • repetitive tasks
  • vibrations

Non-specific arm pain and upper limb work-related disorders are also included where RSI’s are concerned. In many cases of this nature, it is apparent that psychosocial and physical stressors play a significant role in these types of injuries.

RSI Symptoms

Patients who have been diagnosed with RSI typically experience the following symptoms:

  • lack of endurance and weakness
  • pain experienced in the arm, back, hands, shoulders, and/or wrists
  • pain that worsens with activity

When you contrast RSI injuries with CTS injuries, the symptoms of the latter tend to be both diffuse and non-anatomical in nature. It crosses the proper distribution of nerves and tendons as well as not being characteristic of specific discrete pathological conditions.

Ms. A and her bilateral CTS case

Ms. A is a candidate for bilateral CTS surgery due to injuries incurred from a bilateral injury to her upper extremities while performing her job. Her job required a great deal of repetitive arm and hand work as she cut and made fiber optics. Despite experiencing pain in her upper extremities, she continued to work until she was no longer able to. Her employer referred her to Dr. S who began treating her with physical therapy. When her conservative care and PT didn’t relieve her pain, she was referred to Dr. B.

Dr. S splinted her arms and put her on “light duty” status. Unfortunately, there was no light duty work for her on the job and she could no longer perform regular work, so she was sent home and remains on full disability (temporary total disability) to this day.  Dr. S ordered an MRI for Ms. A and it revealed that she had lateral epicondylitis partial thickness tearing in the proximal common extensor tendon. The proposed treatment is an initial surgery on Ms. A’s right elbow. Once the right elbow heals, she will have surgery on her left elbow.

Ms. A is now considering whether or not to settle.   On one hand, there is a high degree of  uncertainty with regard to the nature, extent and future cost of future medical care.   Often settlement values are higher when the insurance company is facing open ended medical costs.  On the other hand, if my client settles and her future medical needs involve multiple surgeries and physical therapies, even a settlement of $100,000 or more will not adequately compensate her.  This dilemma of whether and when to settle is one of the more difficult decisions for a significantly injured workers’ compensation claimant.

Case Study: Auto Accident While On the Job

Case Study: Private investigator sustains 2 separate injuries while on the job

“Mr. L,” a private investigator, received significant injuries when he was working a case in bad weather. He was involved in a serious automobile accident when he lost control of his vehicle and crashed into a large pine tree. His airbags deployed and his vehicle was damaged on both sides. As a result, he incurred injuries to his cervical spine, chest, left arm, right elbow, and right shoulder.

He would be treated for his injuries in the local ER and then released into the care of two doctors (Doctors M and N) where he would receive necessary follow-up care. The condition of his cervical spine could not be treated by Doctors M and N, so he was referred to Dr. S for specialized care and further testing. Dr. S performed a CT scan and an EMG. During this time, Mr. L continued to work his PI job when he was confronted by a police officer, arrested, and then handcuffed in the process.

As the arresting officer handcuffed him, he forced the man’s neck and shoulder into a position which resulted in further injury to Mr. L, therefore creating further problems for him! At this time, Mr. L went into the care and treatment of Dr. P, an orthopedist. Dr. P immediately discovered the injuries that Mr. L received during the arrest and diagnosed them as “a right C 6-7 radiculopathy; herniated disc and stenosis at C5-6; as well as a partial rotator cuff tear of the right shoulder.”

In September of 2005, he was referred to a surgeon who would perform “anterior cervical discectomy and fusion with plating.”  The surgeon also placed him on what is called a “no work” status. In other words, he was forbidden from working since he was always in pain and movements that were typically performed on the job could no longer be made. He began receiving regular TTD payments of $394.52. Additionally, he was treated with a bone stimulator to assist with the fusion part of his treatment.

In addition to the bone stimulator, Mr. L was also being treated by having to wear a hard neck brace for the ensuing several months. Additionally, he was prescribed numerous medications including Celebrex, Reglan, and Ultracet because of his intense pain and his limited ROM or Range of Motion. To this day, Mr. L continues to live with neck pain and according to Dr. D, the extent of the damage to the man’s cervical spine is now a source for the chronic pain he has been diagnosed with.

Mr. L continued living in pain and a restricted ROM because of the torn rotator cuff in his right shoulder. He continues to be under the care of Doctors A and P. At that time, arthroscopic surgery was performed on the injured shoulder which didn’t relieve his pain or his symptoms. Despite the fact that Mr. L attempted to go back to work as a PI, it was immediately apparent that the injuries to his right arm and shoulder would cause significant pain so he could not properly perform his job any longer.

At this time, Dr. P also performed another surgical procedure wherein Mr. L was anesthetized and the doctor tried to manipulate his shoulder in order to relieve his pain. To this date, he still encounters pain and discomfort when driving. Everything to this point had failed to ease Mr. L’s symptoms despite his continued medication and therapy. He was then referred (again) to Dr. A for a consult and then a decided-upon treatment. At that point in time, a post-surgical MRI revealed the full extent of Mr. L’s injuries.

Dr. A performed three different procedures including surgery to repair his torn rotator cuff. After this time, Mr. L went to Dr. M for an IME (independent medical examination) where several things were documented such as:

  • constantly aching shoulder
  • pain encountered with movement overhead
  • rotator cuff issues

Mr. L continues to need medication and ongoing pain management. Neither post-surgery medications nor therapies have helped Mr. L live without pain or limited ROM. He is restricted with the amount of hours that he can perform functions including:

  • standing
  • walking
  • sitting
  • reaching overhead
  • lifting
  • pushing
  • pulling

    He can occasionally bend, crouch, kneel, or stoop; drive no more than 30 minutes at one time; and cannot operate dangerous machinery because of his pain medications.

    Since his last surgery, Mr. L’s medical condition has not changed very much and after reading through the medical records I discussed with Mr. L the advisability of settlement.   Mr. L had indicated to me that while he would not be resuming his career as a private investigator, he was exploring other avenues to earn money.  Because he had been a private investigator, he readily understood that the insurance company would likely put  him under surveillance and that if he was seen engaging in any significant activity, the insurer would move to cut off his benefits.  We decided that this was a good time to settle and after several weeks of negotiation the insurance company agree to pay well over six figures.

    Case Study: Back Injuries and Workers Compensation

    The prevalence of on-the-job back injuries

    According to government statistics,  nearly 20% of all the work-related injuries involve back injuries and back pain, especially lower the back area.   The cost of these work injuries continues to soar – currently estimates put the cost of treatment and lost productivity at nearly $20 billion annually.   Not surprisingly many of the cases I see involve some form of back injury – ranging from cervical (neck) damage to lumbar and thoracic (mid to lower back) injuries.   In my experience, quick diagnosis and treatment can greatly improve the chances of a more complete recovery.

    General causes of back injuries

    Back injuries can result from numerous causes including:

    • Heavy lifting
    • Remaining in the same position for too long and too often
    • Repetitious activities and movements
    • Stressful lifestyles

    Back braces and modified lifting techniques can help but not prevent back injuries.

    The back injury case of Mr. S

    Mr. S worked for a company that owned several large trucks.   The company was selling several of its trucks and Mr. S’s supervisor directed him to show the truck to a potential customer. Mr. S was attempting to push open the hood of the truck when the hood (weighing 300 lbs.) detached and fell on him, pinning him to the floor.  Mr. S  began experiencing pain in his lower back as well as radiating pain in his leg.

    This accident was witnessed by both the potential truck buyer and Mr. S’s supervisor, who instructed Mr. S to go to one of the posted panel doctors.   Upon arriving at the doctor’s office, Mr. S noted that the line of patients was out the door and since he did not want to sit around and wait, he decided to return to work and took pain medication before returning to the job. Mr. S continued working for the next 4 months, relying on over the counter pain pills to reduce his pain.  At no point did he ever actually meet with a doctor.

    Around 4 months later, Mr. S again injured his back while working on a truck.  This time, he felt a definite “pop” and his legs went numb.  The supervisor again sent Mr. S to a  posted panel doctor who took Mr. S off work and began conservative treatment (prescription pain pills and physical therapy)  When Ms. S was unable to perform the exercises during physical therapy, the panel doctor ordered an MRI.  The MRI revealed several bulging discs as well as 2 herniations with impingement on the spinal cord.

    The panel doctor then referred Mr. S to an orthopedist for surgery.   Mr. S was not impressed with the surgeon and he emailed me with his story to ask if he had any options.   I suggested to him that if I was dealing with the same injury I would want to be evaluated by a specific neurosurgeon, and I also explained what Mr. S could expect in terms of rehab and case settlement.  At that point, Mr. S retained me to serve as his lawyer.

    Once I was retained I contacted the insurance adjuster and suggested that we agree that Mr. S should be seen by a neurosurgeon who I know to be very capable.  The adjuster agreed (to my surprise) and my client underwent a multi-level fusion, which my client underwent.

    There was one other interesting twist to this case – at the time my client was seen by the original panel doctor for the second time, the adjuster assigned a nurse case manager to assist with my client’s care.  For those of you who are not familiar with the role of the nurse case manager, she is a nurse who works on behalf of the insurance company to facilitate care.  Sometimes, nurse case managers can be helpful in cutting through red tape – such as getting diagnostic reports like MRI films to a doctor. In other instances, the nurse case manager can interfere with treatment by advocating on behalf of the insurance company – for example I have seen cases where a nurse case manager attempted to influence a treating doctor to return a claimant to work too early.

    Years ago, the insurance company had a right to assign a nurse case manager.  Under current law that right exists only in catastrophic cases.  Otherwise the claimant (usually through counsel) can terminate the involvement of the nurse case manager.

    In this case, we had to do just that.  The nurse case manager was attending my client’s medical exams and she was pressuring the surgeon to speed up the rehabilitation process.  I felt that her motivation and value were in question and I advised the adjuster that we no longer needed her services.

    Case Study: Workers Compensation for Severe Ankle and Foot Injuries

    Welcome to the 7th installment of my summer long series on Georgia Workers’ comp case studies. In the following case study, I discuss a recent workers compensation case involving a severe ankle and foot injury.

    Severe ankle and foot injury Workers’ Compensation case

    This case involved an ankle injury incurred by woman (Mrs. K) who worked in a warehouse environment.   While moving a bulky 250-pound steel panel, Mrs. K and her co-workers paused to rest after moving the steel panel only about 10 feet.   The panel became extremely unsteady and fell on her Mrs. K’s foot, snapping and breaking the ankle and foot.   Mrs. K was immediately rushed to her local hospital’s ER where she would undergo surgery to stabilize and immobilize the fracture.

    After her surgery, Mrs. K was referred to a physician from the posted panel of physicians who saw her 3 days after her surgery.  Despite the severity of her fracture, the panel physician did not take X-rays to evaluate the union of the bones, nor did he conduct any nerve function tests to evaluate any possible loss of function.  Instead he left the cast on and prescribed pain medications.

    After just over a week living in intense pain, Mrs. K.  found me through my web site and retained me to represent her.  After reviewing the medical record, it was obvious to me that Mrs. K needed additional surgery and she needed a surgical consult quickly.  I contacted the insurance adjuster and persuaded the adjuster to refer my client to a foot and ankle specialist.   The foot and ankle specialist diagnosed the foot fracture as a “displaced” fracture, meaning that another surgery was needed and that plates and screws would have to be used to stabilize the foot.  This, of course, means that a third surgery likely would be necessary to fully or partially remove this hardware.

    Because of the delay in getting Mrs.  K to the appropriate physician, she suffered complications – ecchymosis (skin discoloration) up the leg to her knee and neuropraxia (loss of nerve function) throughout her foot.    In my opinion, these complications would not have occurred, or would have been less severe had the 2nd surgery been performed earlier than it was.

    Mrs. K is still recovering from surgery.   Her job had required her to stand, squat, lift and stand, and she cannot perform the duties of her past job.  Rehabilitation is proceeding slowly and I estimate that she will be out of work for at least 6 to 8 months.

    Mrs. K has not yet had her second surgery and it is not clear to me how invasive that second surgery will be.   I expect that we will make a settlement demand either before or after the second surgery.

    In my view, this is a case in which the insurance company’s delay and their reluctance to get Mrs. K to the right doctor quickly on what was clearly a surgical case will dramatically increase the settlement value of this case.  More importantly, I am of the opinion that my client’s health was compromised by the insurer’s delay, not to mention the unnecessary suffering she experienced.   I further suspect that had she waited 3 or 4 weeks before hiring me, a second surgery would not have been scheduled as the initial panel doctor seemed oblivious to the severity of this injury.

    This case illustrates the importance of recognizing that medical treatment under workers’ compensation can be substandard and inadequate.  The panel doctor’s motivation and loyalty was not to his patient, but to the insurance company.  Ironically, the panel doctor’s failure to act will end up costing the insurance company more money.