Work Injury Management

The physicians of SpineAbilene have been involved in the Texas Workers Compensation System since 1992 providing numerous lectures to employers and insurance adjustors. 

Our physicians have a focus of returning the injured employee back to work in the quickest amount of time!

Our physicians understand that treatment results, both surgical & non-surgical, outcomes including pain relief, time off work,& return to work are worse than non-work injuries and reflect poorer outcomes in  W/C population

Our physicians understand that work injury is a complex interplay between physical vs psychological aspects. Work injury initiates with a physical injury to the structure of the body. Psychological variables influence success vs failure.   Psychological factors not only effect work performance but recovery from injury. The stable, well adjusted employee will tend to navigate the W/C system well. The problem employee will usually become the work injury “headache”.

“Top 10 Ways to Lose Your Shirt in Workers’ Compensation”

10. Poor Employee Selection

  • Need a good work history
  • Must have a reasonable expectation of the employee possessing the physical capabilities to perform the job
  • In physically demanding jobs, measure necessary functions
  • Employee is unlikely to return to job after an injury if unable to perform necessary tasks prior

9.  “100% improved to be able to Return to Work”

  • Employee (employer) must be aware of unrealistic expectations, as some instances of pain just does not resolve.
  • Pain is subjective and DOES NOT correlate with body injury or with physical function
  • Focus on capabilities and function when cure is not possible
  • Some patients (employees) unwilling to accept this premise

8.  Lack of Modified Duty Available

  • The longer the employee is away from the workplace, the less likely he/she will return, therefore it is imperative that alternative work is available if you want to keep the employee
  • Out of work > 6 months, chances of returning back to work very low
  • There, “Don’t come back until you are 100%” is counterproductive  unless you wish to replace the employee
  • Off work tend to reinforce ongoing pain complaints

7.  Ergonomics of the Job can play a role in work injury especially if the employee is not physically matched to the job. 

  • Increased risk for injury: High force, high repetition, over-exertion, awkward postures, monotony, jobs requiring little concentration
  • Mechanize where possible, simplify tasks, rotate work activities
  • Trend your injuries- may help you assess areas at risk for further injuries

6.  Employee Relationship with Supervisor

  • The strongest predictor of acute back injury claims and chronic disability is an unsatisfactory employee appraisal rating by an immediate supervisor within 6 months (Bigos et al, Spine 1991)
  • Know your employees
  • Secondary (non-physical) factors such as dissatisfaction with work shifts, job monotony, stress & anger at home or work--- effect injury reporting and recovery rates

5.  Deny, Deny, Deny: Claim, Diagnostic testing, and/or Treatment can result in an angry worker/patient, DWC hearings, protracted difficult resolution

  • Timely efficient care is often more productive and cost effective than drawn out disputes creating an adversarial relationship
  • The patient often becomes more deeply entrenched in his/her symptoms in order to “prove legitimacy”
  • Carefully evaluate necessity of disputing routine injuries and care

4.  Surgery Does Not Always Cure

  • Fix it now society, immediate gratification
  • Expectation that one should never have to deal with pain or discomfort
  • Surgery can not “cut out the pain” it may correct underlying structural problems if it is related to the pain
  • X-ray and MRI are pictures of the appearance of structures but that does not necessarily predict the source of pain
  • Best chance of successful surgical outcome: Good patient, Accurate diagnosis where history, clinical exam, radiographic tests all correlate, Good surgical technique, and Progressive rehab concentrating on function
  • Work comp population:  1.4X more likely to undergo lumbar fusion
  • Once operated upon, one is 2X more likely to undergo 2nd operation
  • W/C and total knee replacements:  6X more likely to have fair to poor result
  • 7.5X more likely to require narcotics
  • 1 in 13 revisions will be successful

3.  Communication in Work Injury

  • All participants, the injured worker, the employer, the insurance company, and the physician (s) need to have uniform understanding of the work injury management to ensure a good outcome
  • The treating physician is the linchpin of effective or ineffective communication

2. The Work Comp Shuffle- Confused Disjointed Care

  • Patient is moved from initial emergency treatment through a series of physicians and specialists without a consensus of treatment
  • Kept out of work
  • Injured worker is confused and depressed by the various and conflicting opinions received from various doctors and physical therapist
  • The worker believes something is seriously wrong if no one can figure out his problem

1.  Treating Physician as Captain of the Ship

  • BEWARE of the physician who “dabbles” in work comp
  • The treating physician plays a powerful role in the injured worker’s first impression of their injury
  • If care is unfocused, ambiguous, and without direction; the injured worker will lose confidence in his care
  • Psychological factors will be enabled and reinforced
  • Multiple medical consultations and opinions will tend to complicate medical management
  • Must establish a diagnosis and clear treatment plan with expectations of outcome with patient
  • Must ensure that all therapists and docs understand treatment goals
  • Must provide consistent information to employer, and insurance carriers
  • Avoid lapses in medical care and  follow-up
  • Maintain work status as feasible