Pain Scale Tests – Part Two

Posted on Friday, May 7th, 2021 at 12:12 pm    

This is the second part of our discussion on the use of pain scale tests in North Carolina and Virginia workers’ compensation cases. As a reminder, pain scales are a way that doctors and others interested in your workers’ compensation case try to measure your pain. The results of pain scales test can affect your right to continued treatment and other work injury rights, such as pain management treatment.  

Pain scale tests are “self-reporting.” This means they’re easy to administer and are generally clerical in nature. Most patients just use a pen or marker and respond to questions on a written sheet of paper. The scales can confirm a worker’s injuries. The scales can also help show if a worker isn’t credible. 

The results may be compared to objective tests. The results may also be compared to prior pain scale tests which means workers need to be extra-careful to given honest answers. The doctors and your employer will look for inconsistent answers.

We discussed many of the pain scale tests in part one of this discussion. Here are a few more common pain scale tests.

The McGill Pain Questionnaire

According to Pain Scale, the McGill Pain Questionnaire (MPQ):

  • Is a subjective test that attempts to measure the quality and intensity of your pain.
  • There are three general categories:
    • Sensory. This part of the MPQ focuses on how you feel at this moment – the moment you answer the question. Different descriptors can be used. Points are awarded depending on which descriptor you select.
    • Affective. “Affective descriptors are used to understand how an individual’s pain changes with time.” “The MPQ asks about how alcohol, stimulants, depressants, exercise, and weather affect an individual’s pain levels. It also goes more in-depth to decipher if distraction lessens the pain.”
    • Evaluative. There are six questions such as “What word describes your pain right now?” or “Which word describes your pain at its worst?”. Workers/patients who say mild get one point. Workers who say their pain causes discomfort are assigned two points – and so on.
  • Uses 78 words to describe your pain. Different point values are given to different words.
  • The questions are divided into 20 different categories including:
    • Temporal
    • Spatial
    • Constrictive pressure
    • Thermal
    • Brightness
    • Dullness
    • Tension
    • Autonomic
  • Is used to treat and monitor pain – and for other reason.
  • Was developed at McGill University in Montreal, Canada.

Pain, Enjoyment and General Activity Scale (PEG)

Another common pain scale test is the Pain, Enjoyment and General Activity Scale (PEG). Pain scales are used to help assess the severity of your pain, whether treatments are working, and what types of other treatments may be needed. Pain scales such as the PEG scale are sometimes used to help determine whether you have a permanent impairment and/or whether and how your pain should be categorized according to American Medical Association guidelines.

How does the PEG scale work?

There are three pain-related questions:

  1. What number (a range is given from 0 to 10) describes the intensity of your pain – during the prior week? If you answer 10, you’re stating that you experienced a lot of pain during the period week. A 5 indicates a moderate amount of pain. A 0 means you didn’t experience any pain.
  2. What number describes how much your pain (during the prior week) interfered with your ability to enjoy your life. A high number indicates that the pain prevented you from doing the things you enjoyed such as walking and enjoying your family. A low number indicates minimal or no interference.
  3. What number (again with reference to the prior week) describes how your pain impacted your “general activity.” General activity suggests doing the things you enjoy and also the things you have to do (like taking out the trash or other errands) even if you don’t enjoy them. General activity can also include essential activities like eating and sleeping. Again, 0 indicates no impact while a 10 indicates a major impact.

The test is graded by finding the average – adding up the three numbers and then dividing by three.

The PEG test can be answered in your doctor’s office. The test can also be answered on the phone or at your home. The test can be used at different intervals in your recovery. It can also be used for different types of pain. For example, it can be used to determine how well your physical therapy is going. The PEG test can also be used to help your doctor understand how well any prescribed medications are working.

If the numbers aren’t improving, that suggests the rehabilitation isn’t working. So be careful, the employer will look to see if your physical therapy is helping. If therapy isn’t helping, the employer (or the insurance carrier for the employer) may seek to terminate the therapy.

The pain scores should improve after you take the medication and stay stable as you continue to take the prescribed medications.

North Carolina and Virginia workers’ compensation lawyer Joe Miller has been fighting for injured workers for more than 30 years. He works to verify your medical injuries. He fights to ensure the employer doesn’t terminate your right to medical treatment or work loss benefits before you’re healthy enough to return to work. To speak with an experienced workers’ compensation lawyer, call lawyer Joe Miller, Esq., at 888-667-8295 or fill out my online contact form to schedule an appointment. 

Employees in North Carolina and Virginia can also now fill out our New Electronic Case Review. The link is a new way of communicating with clients that we’re offering – to allow workers to contact us remotely during the pandemic.

Pain Scale Tests – Part One

Posted on Monday, May 3rd, 2021 at 12:08 pm    

One of the difficulties in workers’ compensation cases is trying to measure the worker’s pain. Many parts of a medical diagnosis are objective. Disorders can be seen on X-Rays, CT scans, and MRIs. Diseases and other medical problems can be seen when doctors read blood test and other lab test results like stress tests. Medical problems can be confirmed when doctors perform surgeries.

Still, for many types of pain such as chronic pain, the medical disorder is very subjective. In other words, no one except you knows the level of pain that you are feeling on a day-to-day basis. One person may be able to return to work with a severe injury while an employee with a similar injury may need continuing medical rehabilitation or pain management

To try to fine-tune how much pain a worker is in, physicians and health care providers often use questionnaires and surveys to analyze the degree of pain a worker has. Workers should review with experienced North Carolina and Virginia work injury lawyers how to prepare for and respond to some of these surveys. 

There are different pain scales for different parts of the body. There are also different pain scales for different injuries and different symptoms. 

What are the types of pain scales?

According to Pain Scale, there are two kinds of pain scales – unidimensional and multidimensional. Some of the common types of scales include the following. These pain scales help when an analysis of pain by objective tests isn’t complete and when pain is expected to vary from patient to patient or worker to worker.

Unidimensional pain scales. These scales focus on the intensity of your pain.

  • The Visual Analog Pain Scale (VAPS) and the Numeric Rating Scale (NRS) are discussed later (or in the second part of this topic).
  • A categorical pain scale uses visual or verbal descriptors to help workers and patients focus on the level and degree of their pain.
    • Verbal pain scale. The descriptors use words such as “mild,” “moderate,” “severe,” “discomforting,” “distressing” and excruciating,” to describe pain levels. A worker who takes this type of test chooses the adjective/word that best corresponds to the intensity of their pain.
    • Visual pain scale. Here the workers/patients respond to faces that show the level of pain. While they’re often used for children, adults can use them too.

Multidimensional pain scales. These pain scales are less common but often provide a more complete analysis of your pain. We discuss the McGill pain questionnaire in more detail later. The two other types of multidimensional pain scales are:

  • Initial pain assessment tool. This survey shows a diagram of the human body. The patient marks where their pain is on the diagram, and then answers “a series of questions regarding the characteristics of their pain, the expressions of their pain, and the effects of their pain on everyday life.”
  • Brief pain inventory. This test examines the intensity of pain you felt or experienced over the past 24 hours.

What is the Visual Analog Pain Scale Test?

VAPS is used for workers and other categories of adults. It tries to measure your level of pain. 

The VAPS test, and many other similar tests, usually use a scale from 0 or 1 to 10 or 100. If you have no pain, you enter the lowest number (0 or 1). If your pain is unbearable, you enter the highest number (10 or 100 – depending on the scale). The VAPS scale is displayed on the written page with a horizontal line for the full scale and vertical lines that correspond to the numbers on the scales. 

The VAPS test is simple. There’s just one question and one answer. Workers can either enter a number or just mark the spot on the scale the fits with their amount of pain. For example, if your pain is right in the middle, you’ll answer with a 50 on a 0-100 scale or mark the midpoint of a graph that has the 0 at one end and the highest number at the other end.

What does the score mean?

The VAPS score uses these general guidelines for analyzing the severity of your pain:

  • 0-4. No pain.
  • 5-44. Mild pain.
  • 45-74. Moderate pain.
  • 75-100. Severe pain.

These classifications make a difference. They can be used to determine:

  • What type of medical treatment you require;
  • How long you might reasonably need the treatment
  • Whether you can return to work
  • Whether you have a permanent disability.

Some of the issues involved with the VAPS scale and other pain scale tests

Workers need to understand that their answer doesn’t exist in a vacuum. Your medical provider will know the results of your imaging tests, lab tests, and any other tests. The doctor will have conducted a physical and oral examination.

If your answer as to your level of pain is not consistent with other tests and reviews, your answer affects your perceived credibility. On the other hand, everyone has different levels at which they respond to pain. The objective tests are generally given much more weight than the answers to surveys and questionnaires.

Patients need to understand issues such as:

  • Am I answering how much pain I have – when I’m medicated or when I’m not medicated?
  • Am I answering the question – just after I’ve had physical therapy or when I haven’t had physical therapy yet?
  • Am I answering these questions relative to other types of injuries or just this injury?

Of course, if your doctor has not ordered the proper kinds of diagnostic testing, then there is no way to match the symptoms to the findings. 

For example, if you should have had a lumbar MRI, but your doctor never ordered one, then your doctor may be unaware that you have a severely herniated disc in your lumbar spine from your work injury. This may lead the therapist or Functional Capacity Evaluator to assume you are exaggerating your symptoms (in other words lying to make yourself look worse) and say so in his or her report. We once had this situation. 

In this particular case, the Functional Capacity Exam evaluator assumed the client was faking when she said she had severe shooting pains as well as numbness down her leg, and severe back pain. He of course stated there was “no objective testing” to support these severe symptoms, resulting in an opinion that she was “malingering,” (i.e. faking), which in turn, lead to a very unfavorable report. 

Fortunately, the client had health insurance which allowed her to “work around” her treating doctor and go to a different physician, who ordered a lumbar MRI, which revealed a herniated disc which required surgery. The client was vindicated, underwent surgery and we ended up obtaining a very good settlement for her. 

North Carolina and Virginia workers’ compensation lawyer Joe Miller has helped thousands of injured workers through the work injury claims process. He does more than assert your legal rights and document your injuries. He guides workers through the tests and strategies that insurance companies  and employers may use to try to limit or deny your claim. To discuss any questions you have about the workers’ compensation process and to speak with a strong advocate, call lawyer Joe Miller, Esq., at 888-667-8295. or use my online contact form to schedule an appointment. 

Employees in North Carolina and Virginia can now fill out our New Electronic Case Review. The link is a new way of communicating with clients that we’re offering – to allow workers to contact us remotely during the pandemic.

Types of Knee Injuries

Posted on Thursday, March 11th, 2021 at 12:21 pm    

Knee injuries happen at work for many different reasons. Workers may be injured in a car accident, they may be hurt if something falls on their leg, they slip and fall, or they may be hurt through for many different reasons such as twisting, pulling, or moving their leg in the wrong direction at the wrong time. Knee injuries may be due to chronic issues or they may be due to an acute injury. 

The knees have four primary components: bones, cartilage, ligaments, and tendons. The femur, called the thighbone, is located at the top of the knee joint. The shinbone, the tibia, is at the bottom of the knee joint. The patella, kneecap, is the part of the anatomy that covers the point between the femur and tibia meeting point. Cartledge is the tissue that helps cushion the knee joint bones. Ligaments protect the bones from impact. 

According to Medical News Today, the ligaments act like ropes holding the bones together and stabilizing the knee joint. The “tendons connect the muscles that support the knee joint to bones in the upper and lower leg.”

Some of the many types of knee injuries that workers need treatment for include the following. 

Fractures

The bone in the knee joint that is most commonly broken is the patella. Other bones in the joint may break too. Breaks are usually due to some type of forceful trauma. Surgery may be required to treat the fracture. 

Anterior cruciate ligament (ACL) injuries

These injuries are fairly common for athletes.  They can also make life very difficult for employees. The ACL provides stability for the knee joint. Injuries often require surgery which can take months or even up to a year to properly heal and that’s only with extensive physical therapy.  A grade one ACL sprain is a mild injury. A grade three ACL is a complete tear. 

Dislocation 

A knee dislocation occurs when the knee bones are not properly aligned. For example, a bone slips out of place. Falls in construction accidents and car accidents are common causes of knee dislocations.

Meniscus tear

This refers to torn cartilage in the knee. Cartilage helps provide a cushion between the bones such as the thighbone and the shinbone. Usually, when there is a sudden meniscus tear, the worker will hear or feel a pop followed by pain, tightness, and swelling. 

Bursitis 

The bursae are “small fluid-filled sacs that cushion the knee joints and allow the tendons and ligaments to slide easily over the joint.” When the sacs swell and become inflamed, that condition is known as bursitis. 

In general, bursitis can be treated with self-help-care. In some cases, an antibiotic is required. In some cases, a procedure to withdraw the excess fluid, called an aspiration, is required. 

Tendonitis

Tendonitis (inflammation) is called patellar tendonitis when it affects the knee. The knee-tendon connects the shinbone to the kneecap. A properly functioning patellar tendon allows the worker to perform physical activities including running and jumping. For that reason, tendonitis is also called jumper’s knee. While it affects athletes, it can also affect any active person including employees. 

Tears of the tendon 

Tears or overstretching of the tendon may occur when a worker falls or is struck by an object in or around the knee.

Collateral ligament injuries 

Collateral ligaments connect the shinbone to the thighbone. While they are also a common athletic injury, collateral ligament injuries can occur at work. 

Posterior cruciate ligament injuries

The posterior cruciate ligament is located at the back of the knee. It is one of the many ligaments that connect the thighbone to the shinbone. This ligament keeps the shinbone from moving too far backward.” This type of injury occurs when there is a forceful impact while the knee is bent.

Knee injury treatments

Medical News Today recommends seeking medical care for any knee injury as soon as possible. While you’re waiting -the RICE method of rest, ice, gentle compression, and elevation is suggested. You should especially seek medical care if:

  • You can’t move your knee
  • You have a limp
  • You hear a popping noise when your knee gives out
  • You have terrible pain in the knee

Some of the many types of treatments for knee injuries that workers need, according to Orthoinfo, include the following. 

  • Nonsurgical treatments. Nonsurgical treatments vary depending on the severity of the injury and your general health condition. Sample treatments include:
    • Physical therapy. This treatment generally consists of exercises to help strengthen the knee and the muscles around the knee. You may need to immobilize your knee with a brace or a cast. You may also need to learn how to use crutches so you don’t put weight on the injured knee. 
    • Drugs like aspirin, ibuprofen, and other nonsteroidal anti-inflammatory medications or in some cases, narcotic medications may provide some relief. 

 

  • Surgical treatment for knee injuries. Many knee injuries require surgeries. Some are done arthroscopically, meaning the surgeon typically makes three small holes in the knee through which instruments, including a camera, are inserted to conduct the surgery. This is advantageous as it is minimally invasive compared to open knee surgery. 
  • Should more conservative treatments and surgeries fail, ultimately what may be required is a partial or total knee replacement. Knee replacements are essentially artificial joints comprised of titanium and plastic parts that are surgically inserted to take the place of the knee portions being replaced. Many of our clients report good pain relief as well as restored function after recovery from such surgeries. The disadvantage is that it is irreversible. Once your natural knee parts are cut out and removed, there is no putting them back. 

The time to recover from a knee injury can range from a few weeks to a few months depending on the severity of the injuries. Some workers never suffer a permanent injury because they never regain the full use of their knee.

North Carolina and Virginia workers’ compensation lawyer Joe Miller has been fighting for injured workers for 32 years. He works with your physicians to fully document and verify your medical condition and the types of treatment you need. He’s helped thousands of employees obtain full recoveries including payment of their medical expenses includes visits with physical therapists and other therapists. He fights to get you all the lost income benefits the law allows. To discuss your knee injury workers’ compensation case with a seasoned workers’ compensation lawyer, call lawyer Joe Miller, Esq., at 888667-8295 or complete my online contact form to schedule an appointment. 

Employees in North Carolina and Virginia can also now fill out our New Electronic Case Review. The link is a new way of communicating with clients that we’re offering – to allow workers to contact us remotely during the pandemic.

Types of Shoulder Injuries

Posted on Wednesday, March 10th, 2021 at 12:17 pm    

Workers are constantly using their shoulders in many jobs such as industrial work, construction work, and agricultural work. Nurses, waitresses, and many other employees also regularly use their shoulders at work. Injuries to the shoulders generally happen either through some sort of acute incident such as a fall, tear, a forceful blow to the shoulder, or another immediate event. Shoulders can also be damaged over time through constant wear and tear. That one extra movement at work can affect a weak shoulder by causing a lifetime of chronic pain. 

The different kinds of shoulder injuries that are work-related

The shoulder consists of a ball and socket joint. There are many different types of injuries that can happen according to the Mayo Clinic. Some of these types of injuries are the following: 

    • A broken clavicle or collarbone. The clavicle bone connects your shoulder blade to the upper part of your breastbone. Fractured collarbones can take months to heal after they are properly set by your physician. In some cases, surgery is required to repair the fracture. 
    • Brachial plexus injury. A brachial plexus injury. According to the Mayo Clinic, this injury happens when the shoulder nerves are compressed, stretched, or there is a tear from the spinal cord. 
  • A shoulder dislocation. This painful injury happens when the “upper arm bone pops out of the cup-shaped socket that’s part of your shoulder blade.” With prompt medical treatment, many workers do recover from a shoulder dislocation. However, once a shoulder is dislocated it becomes likely that the employee may suffer subsequent dislocations. 
  • Tears of the rotator cuff. This part of the shoulder is composed of muscles and tendons. Rotator cuff injuries may require surgery. Workers generally need to take a fair amount of time off to work with physical therapists to manage the continual pain. Workers who have a rotator cuff injury will have difficulty lifting objects and using their shoulder in any way until the rotator cuff injury is repaired. 
  • A separation of the shoulder. The ligaments effectively hold the shoulder blade and the collarbone together. There are different types of separated shoulder injuries that are graded based on their severity. The least severe separated shoulder injury consists of stretched ligaments. The most severe type of separated shoulder injury is when the ligaments are torn. A common self-help treatment is rest, ice, and the use of pain relievers. 

 

Another common type of shoulder injury that may occur through work is called a tear of the labrum, fibrous tissue.  Other types of shoulder injuries include impingement syndrome, otherwise known as frozen shoulder and avascular necrosis (death of bone tissue due to limited blood flow), and sprains.

Treatments for shoulder injuries 

Employees who suffer any type of shoulder injury should save seek medical help. If an accident causes the shoulder injury, then workers should go to their nearest emergency room to obtain a diagnosis and an initial treatment plan. Some of the doctors that employees with shoulder injuries treat with after the initial review at the emergency room are the following: 

  • Orthopedic surgeons. These physicians diagnose injuries to bones, muscles, ligaments, and other parts of the shoulder. They repair fractures and tears, treat dislocations and separated shoulders, and provide medical help for the full range of shoulder injuries. 
  • Pain management doctors. Workers who suffer shoulder injuries may also seek help from pain management physicians to treat their pain, typically after the surgeon has done everything he or she can do, but there remains residual pain. 
  • Physical therapists. Most workers who have a shoulder injury, whether or not they’ve had surgery, will normally need to spend numerous sessions with a physical therapist. The therapist provides exercises that helped to strengthen the shoulder and the muscles around the area of the injury. Treatments can take weeks or months before the worker is able to return to his/her job. In some cases, workers may need to trade for a longer period of time. 

Workers with any type of shoulder injury will often have difficulty performing routine personal tasks such as eating, sleeping, brushing their hair, driving, or any type of household activity. The same thought applies for their ability to do their work. Most workers who have a shoulder injury need to stop working until their pain and shoulder injury are properly treated. Even when workers do return to work, they may need to work subject to physical restrictions such as not lifting objects that weigh more than 20 pounds.

Some shoulder injuries, particularly in older workers, may not be amenable to repair, or the repairs may not provide sufficient relief or restoration of function, and accordingly may require what is known as a reverse shoulder replacement

Workers who suffer shoulder injuries are generally entitled to the following benefits in North Carolina and in Virginia:

  • Payment for all reasonable and necessary medical bills;
  • 2/3rds of their average weekly wages until their injury reaches the stage of maximum medical improvement (MMI);
  • Workers who return to work with restrictions are normally entitled to 2/3rds of the difference between their average weekly wage before their injury and a lower wage after they return to work – that they may be paid because of their job restrictions, otherwise known as temporary partial disability payments;
  • If there is a permanent injury, there may be additional possible benefits the injured work may be entitled to for permanent partial impairment to the injured body part, which insofar as the shoulder would be called either the  right or left upper extremity. 

As a recent case shows, attorney Miller fights aggressively for his clients. This fight includes efforts by the physicians hired by the employer’s insurance company who may argue your shoulder injury is due to a pre-existing condition.

North Carolina and Virginia workers’ compensation lawyer Joe Miller has helped thousands of injured workers obtain just recoveries. He understands just how life-altering a serious shoulder injury can be. He works with your physicians to ensure that you get the medical help you need – and that your employer does not force you back to work before your injuries have been treated and healed. To review your shoulder injury claim or any other work injury claim with a seasoned workers’ compensation lawyer, call lawyer Joe Miller, Esq., at 888-667-8295. or use my online contact form to schedule an appointment. 

Employees in North Carolina and Virginia can also now fill out our New Electronic Case Review. The link is a new way of communicating with clients that we’re offering – to allow workers to contact us remotely during the pandemic.

Reasons Workers Treat with Orthopedists

Posted on Wednesday, February 17th, 2021 at 11:06 am    

Orthopedists are medical specialists who help to correct bone and muscle deformities such as fractures. They treat the musculoskeletal system. Orthopedists are surgeons who also provide a range of non-surgical medical care. Workers often need the help of orthopedists when they fall, when a body part is crushed (such as in a forklift accident), when something drops on them such as tools from a scaffold, or due to a host of other reasons. In some cases, there is some overlap as between orthopedists and neurosurgeons, most typically in the case of spinal injuries. This is because in addition to bones, the spinal processes that make up the spinal column contain, surround, and protect the spinal cord, which is the main “trunk” or nerve which provides the body with feeling and function. Then again, there are orthopedists who specialize in spinal surgery. 

In any event, some of the common reasons workers need orthopedic care include the following:

  • Carpal tunnel syndrome. According to the Mayo Clinic, “the carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of your hand. When the median nerve is compressed, the symptoms can include numbness, tingling, and weakness in the hand and arm.”
  • Dislocated shoulder. A shoulder dislocation is called a subluxation. While rare, shoulder dislocations do occur. Surgery may be required in severe cases.
  • Osteoarthritis and bursitis. Osteoarthritis happens when your cartilage wears down as you age. Bursitis involves the part of your body that cushions your muscles, and other body parts – near your joints. Bursitis is the inflammation of these cushions (called bursae). Despite the fact that these conditions may exist without any trauma, in the context of a workers’ compensation case, it is often a trauma that aggravates these dormant or asymptomatic conditions that are now very painful. 
  • Plantar fasciitis. The Mayo Clinic defines plantar fasciitis as heel pain which “involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).”
  • Sprains. Most people sprain some part of their body during their lifetime. Standard treatments include rest, ice, and compression. 
  • Stress fractures. These breaks usually aren’t as painful as traditional bone breaks. They normally occur through wear, tear, and stress instead of due to a single accident. The most common parts of the body that suffers stress fractures are the ankle and feet.
  • Tennis elbow. This injury is normally due to repetitive motions that damage the tendons near the elbow. Unfortunately, unless aggravated by a trauma, other than carpal tunnel syndrome, repetitive stress injuries are generally not covered by workers compensation. 
  • Torn ligaments and the meniscus in the knee. These injuries, which are common to athletes, also happen to workers. According to the Mayo Clinic, a torn meniscus can be due to any activity that causes a worker to forcefully rotate or twist a knee. The anterior cruciate ligament (ACL) may tear requiring surgery an extensive rehabilitation. The meniscus is the cartilage around your knee. A healthy meniscus allows your knee to move freely. If the knee does not respond to less invasive surgeries, depending on your age and the condition of the knee, a total or partial knee replacement may be an option. 
  • Torn rotator cuff. This injury involves the tendons and muscles near the shoulder joint. The rotator cuff keeps “the head of your upper arm bone firmly within the shallow socket of the shoulder”
  • Ankle Injuries/fractures. During falls from heights, these injuries can be severe and debilitating. One of the worst is known as a pylon fracture, where essentially the leg bone smashes down into the foot bones and almost completely destroys them. Usually, an orthopedic doctor who specializes in foot and ankle surgery will perform an internal fixation surgery with plates and screws. Fortunately, medical technology has improved in recent years to the point that many foot and ankle specialists are now doing ankle replacements. 

Fractures that happen due to workplace accidents

The human body has more than 200 bones. The human hand, alone, has 27 bones. 

Bone fractures, such as leg fractures, are generally categorized in the following ways according to the Mayo Clinic:

  • Open (compound) fracture. Here, the broken bone pierces the skin. Surgery is normally required for several reasons including reducing the risk of an infection.
  • Closed (simple) fracture. Here, the broken bone does not penetrate the skin.
  • Incomplete fracture. “This term means that the bone is cracked, but it isn’t separated into two parts.”
  • Complete fracture. Here, the broken bone snaps “into two or more parts.”
  • Displaced fracture. “In this type of fracture, the bone fragments on each side of the break are not aligned. A displaced fracture may require surgery to realign the bones properly.”

Another type of fracture, called a greenstick fracture, is more common in children who are less likely to be employees. With this type of fracture, “the bone cracks but doesn’t break all the way through.”

What are the treatments for fractures?

Doctors will normally conduct an oral and physical examination if they suspect a fracture. They’ll use X-Rays to locate where the break is, the type of break, and the severity of the break. In some cases, an orthopedist may order a CT scan or an MRI.

The treatments vary depending on the type and severity of the break. A common initial step, according to the Mayo Clinic, is to use a splint to immobilize the leg. If a worker has a displaced fracture, the orthopedist may need to “manipulate the pieces back into their proper positions before applying a splint — a process called reduction. Some fractures are splinted for a day to allow swelling to subside before they are casted.”

A splint or cast helps to immobilize the broken bone. Broken bones, such as broken legs, may require six to eight weeks to heal. During this time, the worker may need to work with a physical therapist to learn how to use a cane or crutches. It’s important not to put any weight on the broken bone and to restrict the movement of the bone so the bone can heal properly.

An orthopedist may recommend over-the-counter pain medications, “such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) or a combination of the two. If you’re experiencing severe pain, your doctor might prescribe stronger pain medications.”

Depending on the location of the break, the type of break, and the severity of the break; workers will likely need physical therapy after the cast or splint is removed. The full rehab process can take months or longer.

Possible surgery for broken bones

Orthopedists may need to use rods, screws, plates, or other devices to ensure the bones stay in the proper position while the fracture heals. Usually, this type of surgery is known as an “Open Reduction Internal Fixation” (ORIF) surgery. Many of our clients undergo these types of surgeries. The recovery period after these surgeries can be long. These devices, according to the Mayo Clinic, are generally used for:

  • “Multiple fractures
  • An unstable or displaced fracture
  • Loose bone fragments that could enter a joint
  • Damage to the surrounding ligaments
  • Fractures that extend into a joint
  • A fracture that is the result of a crushing accident
  • A fracture in particular areas of your leg, such as your thighbone”

Joe Miller Esq. has been fighting for injured workers for more than a quarter of a century. He works with and reviews detailed medical records experienced orthopedists, physical therapists, and other healthcare provides to properly assess your workplace injuries, the need for surgeries or other medical care, and the time and treatments you’ll need to return to good health. To discuss y our North Carolina or Virginia work injury case, call me at 888-667-8295. or fill out my online contact form to make an appointment. 

Workers can also complete our New Electronic Case Review. It’s a new type of communication method for our clients that we’re offering – to allow workers to reach us remotely.

The Benefits of Physical Therapy After a Workplace Accident

Posted on Monday, February 15th, 2021 at 11:04 am    

Most employees who suffer a workplace accident begin their medical treatment with a visit to their local ER. Workers who suffer a spinal cord injury, a traumatic broken injury, compound fractures, and other serious injuries often need immediate surgery. Workers with chronic pain or acute pain often need to visit with a pain management doctor. In addition to treatment by physicians, these workers and most injured workers also need to treat with physical therapists.

One of the aims of physical therapy is to strengthen some parts of your body to minimize the pain in other parts of your body. Experienced physical therapists can workers select the correct exercises for their injuries and help workers manage their pain and recover from their injuries.

What is physical therapy?

Physical therapy is a rehabilitation process in which therapists evaluate your physical abilities and limitations. Physical therapists generally have some medical training but they are not physicians. Physical therapists respond to your concerns by developing a plan of exercise, massages, and other methods to help you recover from your injuries.

In addition to addressing your pain issues, physical therapists focus on your range of movement and your ability to functionally use various parts of your body. Physical therapists also focus on helping you regain strength and endurance. Once there’s a clear plan (which may be adjusted as you work with the therapist) – you may work with the therapist as his/her location. You will likely also be able to do some exercises and activities at your home.

Many therapists include stretching exercises among other exercises. The therapist may also provide hands-on treatments in addition to continually encouraging you to stay with the treatment plan.

How does Physical therapy help injured workers?

According to Medical News Today, physical therapy is used to treat many different types of conditions (many of which may be due to work) including:

Some of the benefits of physical therapy include:

  • Better mobility. Many workers have difficulty with simple tasks. They find it hard to stand, move, walk, or sit – prerequisites for doing most jobs. Some activities like driving may not be possible if, for example, one of your arms or legs is in a cast. The inability to perform routine tasks also affects your home life too.

Physical therapists help you regain movement and functionality through exercises that generally strengthen your joints and muscles and stretch them so you can move more freely. While you’re exercising and receiving treatments, your physical therapist may also help you with assistive devices. For example, a physical therapist may help you walk using a cane or crutches.

Physical therapy is often used when workers suffer chronic pain or repetitive stress injuries. 

  • Helping you avoid surgery. Many employees who suffer workplace accidents understand that their options for managing their pain generally include medications and physical therapy. If these treatments still cause an unbearable amount of pain, the employee will likely review whether there are any surgical solutions to their pain. Surgeries include risks. Most people prefer to avoid surgery if at all possible. One aim of physical therapy is to help reduce your pain so you can live with the exercise and treatment routine instead of having surgery.

According to Medical News Today, other benefits of physical therapy include:

  • Improving your balance
  • Pain management
  • Preventing falls
  • Age-related disorders

Physical therapists may also help with arthritis.

Insurance companies and physical therapy

Most employers understand that workers do need physical therapy to help them recover – so workers can do their job again. Unfortunately, most insurance companies for employers often fail to appreciate just how many sessions an employee needs with a physical therapist to see improvement. Many insurance companies, after a specific number of visits (such as 10 visits) or a specific period of time (such as 3 months) will request that the worker undergo a defense independent medical examination (IME). Usually, the doctor who conducts the IME is a company doctor who will quickly say that your injuries have healed well enough that you should be able to return to work.

Experienced workers’ compensation lawyers help injured workers who need continual physical therapy when employers try to terminate their medical care and force them back to work – in two ways.

  • First, we advise workers on what to expect at the IME. For example, we review which questions are likely to be asked and what physical tests the physician is likely to conduct
  • Second, we work with your authorized treating physician. Normally, a doctor recommends that you receive physical therapy. We show your physician the report from the doctor who conducts the IME. Often, your doctor can point out the flaws in the medical report. Often, your doctor will be able to explain why you still need to treat with your physical therapist. In any event, both the Virginia Workers Compensation Commission and the North Carolina Industrial Commission typically favor the reports of your treating doctor over the defense IME doctor. 

In some cases, your physician may allow you to return to work – but with restrictions. These restrictions can include such things as not being required to lift items that weigh more than 20 pounds. The restrictions may also be conditioned on your right to continue your physical therapy visits.

One of the things that can ruin a workers’ comp case is where an injured worker treat his or her  prescribed physical therapy in a casual way, by missing physical therapy appointments and failing to re-schedule. This is a huge mistake and could lead to an Application to Terminate Benefits in Virginia or a Form 24 in North Carolina from the defense due to your failure to follow your doctor’s medical treatment plan and that could mean the end of your case.  Accordingly, please make sure you attend all of your PT appointments to the best of your ability. 

North Carolina and Virginia workers’ compensation lawyer Joe Miller has been fighting for injured workers for 31 years. He’s helped thousands of employees obtain full recoveries including payment of the medical bills they need to recover. In many of these cases, the workers need to treat with a physical therapist. To discuss your work injury claim with a seasoned workers’ compensation lawyer, call lawyer Joe Miller, Esq., at 888-667-8295. or fill out my online contact form to schedule an appointment. 

Employees in North Carolina and Virginia can also now fill out our New Electronic Case Review. The link is a new way of communicating with clients that we’re offering – to allow workers to contact us remotely during the pandemic.

Hand Injuries and Workers’ Compensation

Posted on Friday, January 8th, 2021 at 12:17 pm    

Hand injuries are common in many different types of jobs. Workers who do outside labor such as construction or agricultural work often suffer injuries due to the machines/tools they work with and thy types of tasks they do. Workers who work inside can suffer injuries due to repetitive use. Workers in almost every field from industrial workers to healthcare workers at some point in their career are likely to injure their hand – often severely enough that they can’t work until (and if) their hand mends.

Some of the machines that can cause severe hand injuries include saws, hammers, and assembly equipment.

Types of hand injuries

Some of the common types of hand injuries that occur during work include:

  • Carpal tunnel syndrome. This injury is a repetitive stress injury that we’ve written about before – Carpal Tunnel Syndrome and Workers Compensation (joemillerinjurylaw.com). Carpal tunnel syndrome normally affects the wrist and the hand. Many officer workers and restaurant workers (such as waitresses) are likely to develop carpal tunnel syndrome.
  • Burn injuries. Workers, such as kitchen workers and restaurant workers, are regularly exposed to flames, steam, boiling liquids, and other terms of thermal burns. Electric burns can occur when an electrical current runs through an electrician’s hand. Chemical burns can occur when industrial, construction, agricultural, or other workers handle hazardous substances which spill on or seep into the skin of the hands as the worker uses their hands to manipulate the or use the chemicals.
  • Fractures and other types of blunt trauma injuries bones. Orthopedists regularly need to provide medical care (including surgeries and setting the fractures) for workers who break a finger of any one of the 27 bones in the human hand. Breaks or crushing injuries can occur if a heavy object falls on the worker’s hands, if the worker’s hands are pinned between two objects, or due to improper use of tools and machines.
  • Lacerations. Cuts to the hand can be due to working with any type of sharp object, when glass sprays into their hands during a collision, or for many other reasons.
  • Punctures. Doctors, nurses, and anyone who works with a sharp object (such as carpenters who work with hammers and nails on a regular basis) may suffer a puncture to the skin of the hand – when the sharp object penetrates their skin.

Other hands injuries include rashes and irritations of the skin

According to MedExpress:

  • 44% of hand injuries involve lacerations and cuts – accounting for over 60,000 injuries in 2017. Many victims require stitches and other treatments.
  • “Crushes caused almost 27,000 hand injuries in 2017, making them the third most common cause of hand injuries.”
  • Fractures, sprains, and tears “accounted for 21 percent of all reported workplace hand injuries in 2017.”

Employer safety suggestions to help minimize the risk of hand injuries

There is no requirement that an injured worker prove that an employer was negligent or that the employer failed to follow federal, state, or local safety protocols. If you are injured at work, you have the right to seek work loss and medical benefits – whether the employer was at fault or wasn’t at fault.

Still, nobody wants to lose time from work and seek medical help if they can avoid it. Some of the many ways employers can help ensure the safety of their employees – when it comes to avoiding hand injuries include:

  • Providing quality safety equipment. Gloves with the proper amount of insulation (or gloves made out of the proper materials such as latex) can help reduce the risk of certain types of hand injuries – such as lacerations, punctures, and some types of burn injuries. Employers should review what types of gloves could help workers who regularly are in danger of any type of hand injury.
  • Educating the worker about safety issues. Often, education is needed for workers who work with specific types of machinery or equipment. These courses can help explain the dangers of each type of machine or tool. The courses can explain when their hands are in the most danger and what steps can be taken to reduce those risks. Workers should be taught which chemicals can cause severe burn injuries, for example, or how to properly work with certain types of sharp instruments.
  • Explaining the importance of communication. Many hand injuries could be avoided if supervisors and co-workers communicate with you – so you know when to get out of the way, when to stop working so they can work, and when other workplace factors increase the risks of hand injuries.

Workers’ Compensation for Hand Injuries

All workers who suffer hand injuries are entitled to work loss benefits if you injury you hand due to a workplace accident or due to an occupational illnesses. Your North Carolina or Virginia workers’ compensation lawyer can explain when you can file a claim for a repetitive stress injury to your hand.

Temporary work loss benefits for hand injuries generally include payment of all your medical bills and about 2/3 of your average weekly income while you can’t work.

If you can’t use your hand (or any fingers or your thumb) at all, or in part, after you’ve reached the point of maximum medical improvement (no additional medical care is likely to improve your hand) – you may be entitled to permanent disability benefits according to North Carolina or Virginia law. For example, if your hand is amputated, you can seek permanent disability benefits in both states.

An experienced work injury will work with you and your doctors to help ensure that the employer doesn’t force you back to work before you can do your job.

Virtually every worker needs functioning hands in order to do their job. Our experienced North Carolina and Virginia work injury lawyers have been fighting for employees for more than 25 years. We’ll explain your rights and fight to get you all the compensation and medical care you deserve. To reach lawyer Joe Miller, Esq., call me at 888-667-8295. or fill out my online contact form to schedule an appointment. Workers now can also complete our New Electronic Case Review. It’s a new way of communicating with clients that we’re offering – to allow workers to contact us remotely.

When Are Workplace Injuries Not Covered by Workers’ Compensation?

Posted on Wednesday, December 16th, 2020 at 9:53 am    

Most people automatically assume if they are injured at work that they’re covered by their state’s workers’ compensation laws. And, for the most part, that’s true. If you slip and fall or suffer some other accident at work, in most cases, you should be covered. If you are loading very heavy items into a cart and wrench your back, you should be covered. If a forklift tips over or malfunctions, and you are injured, you should be covered.

In workers’ compensation cases, there is no need to prove fault. Generally, if you’re hurt while doing your job, you should be entitled to have all your medical bills paid by your employer’s insurance company and approximately 2/3rds of your wages while you are temporarily totally disabled for up to a maximum of 500 weeks, or if you become permanently or partially disabled. Permanent partial disability benefits are paid for a specific number of weeks. 

As with every rule, though, there are many exceptions. There are a few situations where your injuries will not be covered – in some cases, because your employer is not required to be insured, in other cases because of some misconduct on your part, and in others, because the injury you suffered is not considered to have arisen out of your employment.

The Employer is not Required to Carry Workers Compensation Coverage

Unless the employer has more than three employees who are regularly employed in the business, then they are not required to carry workers compensation coverage. 

The most common scenario where this issue comes up is with construction companies. The employer will actually have many more than 3 workers who regularly work for the employer, but the employer will claim that everyone is an independent contractor. Oftentimes, this is actually not the case. When you analyze the situation, you begin to realize that all of those “independent contractors” are treated no differently than an employee would be treated. They show up at a specific time every day. They are required to follow the rules and directions of the boss. They generally work nowhere else except the employer. The employer supplies all of the equipment for the job. No matter what they employer calls them, these workers are employees and must be covered. 

So what happens if the employer has no coverage? In North Carolina, unless the employer was somehow at fault, you are out of luck, unless there was a general contractor over the employer who was insured. Sometimes you can find coverage there. 

In Virginia, if there was no insurance with the general contractor, the Commonwealth of Virginia maintains something called the Uninsured Employer Fund which is designed for just such situations. They will stand in the place of the insurance company and pay the claim. Of course, after the fact, they will go after the employer and attempt to recoup their payments. 

NOTE: Just because your employer does not have more than 3 employees in the business DO NOT ASSUME that he does not have coverage. IF the employer ELECTS to purchase coverage, then even though the employer was not REQUIRED to carry coverage, that coverage will invoke all of the rights of the Workers Compensation Act and if you are hurt on such a job, you will be covered by the Act. 

We particularly tell construction workers who own their own business and do construction work themselves: Please, please buy coverage for yourself and your workers if you can find a way to afford it. We have seen too many lives ruined for failure to purchase coverage. 

Pre-existing conditions

If a pre-existing physical condition is the sole cause of your injuries and it’s the pre-existing condition that causes the injury, then you may not be covered. For example, if an employee has severe osteoarthritis, that condition can damage and cause pain in various joints such as the hands, hips, knees, and spine. If you are working and your knee buckles – even though you didn’t fall or didn’t come into contact with any object – then a physician may conclude that nothing at work caused your knee pain – your knee pain is due to your arthritis and nothing else. 

This situation is different than if you slip and fall because the floor is wet and then hurt your knee. A doctor might say that part of your pain in your knee is due to the osteoarthritis – but since the wet floor caused your fall, you can claim workers’ compensation benefits. The good news about pre-existing conditions is that it is rare that a claim will fail because of them. This is because in Virginia, so long as th the injury caused a sudden mechanical change in your body, then if any portion of your disability comes from that injury, no matter how slight, then the entire injury and treatment for it is compensable. 

Many other conditions may be caused by events at work that are personal to the worker and weren’t caused by work. In these cases, the employer will contest your right to workplace benefits.

Personal risk

There are some injuries that the workers’ compensation board or courts may consider non-compensable because they’re due to a personal risk that the employee assumes. For example, if a worker starts a fight with a co-worker, especially if it is over personal issues between them, then that worker will not be able to file a work injury claim for all the burn injuries and respiratory injuries he suffers. The victim of the assault, however, would normally have the right to file a workers’ compensation claim – provided that the reason for the fight was not personal, but work-related in some way. 

Deviations from work

Some employees who are working for their employer take time off to run personal errands. For example, a salesperson who is on the road may take time out to go shopping for something. If that worker is then injured (suffering bone fractures) by falling on the parking lot asphalt, the employee may not be able to claim worker’s compensation benefits to treat with an orthopedist to mend the broken bones– because he/she was injured while deviating from his/her work assignment. The trip to the retail store was not related to his/her work and thus would not be compensable.

Recreational injuries

Recreational activities include activities that are not generally considered part of a workers’ daily job requirements. These activities can include company softball games or outside picnics where workers mingle with other people. Injuries while playing a game or just serving food at a picnic do happen. 

Whether the injury is considered related to work often depends on a few factors such as:

  • Was the participation in the recreational activity mandatory? If everyone at work has to partake in the activity, that suggests that the employer should be responsible if you’re hurt while participating in the recreational activity.
  • Does the participation affect your employment? If the employer makes clear that participation makes you seem like a team player and that participation can help you be promoted, then those factors indicate that the activity was work-related
  • Did the employer provide the source of the recreational activity? These days, many companies offer gyms where employees can work-out. If the employer provides the ability to do the recreational activity – and encourages you to work out for your health – those factors suggest the activity is work-related.

If, on the other hand, a few workers decide to get together for a few beers after work and one worker trips and falls while carrying the beers, that would likely not be considered to be in the course of employment.

Virginia Claims: Failure to Prove the Injury Arose from a Risk Associated with Employment-No Such Requirement in North Carolina

Virginia, unlike North Carolina, has an additional requirement that the injury must be caused by a risk associated with employment. The most classic scenario is a fall down the stairs. In North Carolina, this would be considered a compensable work accident. 

In Virginia, a risk analysis is conducted. What was the employee doing at the time of the fall down the stairs that created a risk that was different from someone in the public who also fell down the stairs? If the answer is nothing, there is no risk of employment and no compensable case. On the other hand, if the employee had his or her hands full with work-related items that made it hard to see or grasp the railing? Or did the employee have some slippery substance on the bottom of his or her shoes that was from a factory floor? Were the stairs themselves somehow defective, such as worn out or missing anti-slip guards on the stairs? Those all would qualify as risks of employment.  

Another example would be someone who wrenches his or her back while performing work duties, such as picking up a light item off of a shelf, turning around and placing it in a box.  The worker is not lifting anything heavy, but suddenly feels a sharp, severe pain in the back resulting from that specific movement at work. In North Carlina, particularly with respect to back injuries, all that is required is that the injury occur as a result of a “specific traumatic incident” of the work required. Accordingly, it would likely be compensable. 

 In Virginia, such a case would not be found to be an “accident” or a result of a risk associated with employment. Anyone could lift a light item off of a shelf and suffer this same injury. It would therefore not be considered a risk of employment and therefore not a compensable accident in Virginia. 

Willful Misconduct, Intoxication and Violation of a Safety Rule

If you engaged in willful misconduct at the time of the accident such as intentionally inflicted injury, you may not recover. Also, if you were found to have been intoxicated at the time of the accident in either Virginia or North Carolina, you may not recover anything. Note that intoxication does not only mean being over the legal limit of .08 BAC in VA.  If fellow employees or supervisors testify that they smelled alcohol on your person on the day of the accident and you were exhibiting signs of intoxication, then that may be sufficient to say you were intoxicated. The intoxication must be found to have been a proximate cause of your accident. 

In North Carolina, the intoxication need only be found to have caused the employee to “lose the normal control of his or her bodily or mental faculties, or both, to such an extent that there was an appreciable impairment of either or both of these faculties at the time of the injury.” 

Insofar as violation of safety rules, to bar a claim in Virginia, the employer must show that the rule was one that was enforced across the board by the employer and that its violation was a proximate cause of the accident. So if the employer at a roofing company says you failed to follow the well-known rule about tying off with a safety rope and harness when working at heights, and yet that same morning your boss and co-workers also alighted and worked on the roof without tying off, that would be a rule that was not generally enforced. They cannot apply it for the first time to you, in order to prevent you from receiving benefits. Another commonly brought up rule is failure to wear seat belts in auto collision.  If the employer had such a rule but never informed the injured worker about it, and never enforced it, that rule may not be used selectively against an injured worker. 

In North Carolina, violation of safety rules by the injured worker will typically not bar or prevent a claim, but will reduce the weekly compensation payment to the injured worker by 10%. 

Each case is different. You should not assume that you don’t have a case. There may be good reasons why you can assert a claim. The best course of action if you are injured at work or doing anything that might be work-related is to speak with an experienced North Carolina or Virginia workers’ compensation lawyer. Often, there is a very fine line between having a viable claim and not having a claim. 

North Carolina and Virginia workers’ compensation lawyer Joe Miller Esq. understands when injury accidents at or related to work are compensable. He’s helped thousands of injured and ill workers get the compensation they deserve. Attorney Joe Miller has been fighting for injured workers for more than 31  years. For help with any work injury claim, speak with an experienced North Carolina and Virginia workers’ compensation attorney. You can reach attorney Joe Miller, Esq., at 888-667-8295. or complete our  online contact form to schedule an appointment. You can also complete our New Electronic Case Review. It’s a new way of communicating with clients that we’re offering – to allow workers to contact us remotely and submit a claim for consideration, even after hours. 

What is Maximum Medical Improvement?

Posted on Tuesday, December 15th, 2020 at 9:52 am    

When you’ve been hurt at work, there comes a time when continuing to treat with your doctors doesn’t improve your medical condition. When additional medical treatments won’t improve your medical condition and the healing process is stopped – you’ve reached the point of Maximum Medical Improvement (MMI). 

This does not mean that you no longer require medical treatment such as pain management. It just means that according to the opinions of your doctors, you are unlikely to improve your permanent outlook with additional treatment. 

Workers have the right to get medical treatment for any injuries they suffer due to a workplace accident. Most workers start with a visit to an emergency room doctor or they see a physician designated by the workers compensation insurance company, or in some cases, their personal physician. Depending on the type of injury and the severity of the injury, injured workers may need surgery. They often need to see a specialist; maybe several specialists to address their work injuries.  Injured employees often treat with physical therapists, occupational therapists, and/or rehabilitation therapists. Some workers also need to see a psychologist and/or psychiatrist.

Employees who are injured at work who suffer a compensable claim have every right to try to maximize their health and minimize the consequences of their injury at work. During the time they are working to improve their health, they are entitled to have the insurance company for the employer pay their medical bills and generally, 2/3rds of their average weekly wages for the time their authorized physician holds them out of work or for a maximum of up to 500 weeks.  Some injuries completely heal with time – such as many minor fractures. Other injuries never completely heal and may require the insertion of hardware or other drastic methods of repair. 

Maximum medical improvement is an important milestone in an injured worker’s case for a number of reasons: 

  1. It enables your doctor to refer you for a Functional Capacity Examination to determine whether you have any permanent, physical restrictions due to your injuries; 
  2. It enables your doctor to refer you for a Functional Capacity Examination to determine whether you have any permanent partial impairment in any specific body parts you may have injured in your accident;
  3. It is generally a signal to all parties that a potential settlement may be on the horizon; 
  4. It is generally a signal to the defense that they may want to engage you in a program of vocational rehabilitation after the results of your FCE come in. 

MMI evaluations

When workers reach MMI, several evaluations need to take place.

  • The first evaluation is whether you have reached the point of MMI. Often employers will argue that you’ve reached MMI in order to force an early settlement or try and force you back to work or to try to cut off your right to your 2/3rds share of your average weekly wages. You have the right to challenge any claim you’ve reached MMI if you still think medical treatment can improve your health. Normally, the doctor who is treating you makes the initial determination of when you’ve reached MMI. 
  • The treating doctor, in some cases, may be a “company doctor” meaning  he/she does have some bias towards getting you back to work per the insurance company’s wishes. 
  • In North Carolina, if you disagree with a determination that you’ve reached MMI, you have the right (with the help of an experienced North Carolina compensation lawyer) request an independent medical examination (IME). The IME is a medical review done by another physician of your choice. Unfortunately, there are no such provisions in Virginia; however, if you can afford to see a different physician, you can pay for the examination yourself. 
  • After the MMI determination by your physician, the second step is usually for that physician to order a Function Capacity Examination (FCE) by a licensed physical therapist’s office equipped for such exams. This evaluation is to determine if you can return to work with workplace restrictions. A typical workplace restriction is that you can work but you can’t lift or move any objects that weigh more than 20 pounds. 
  • After the FCE occurs, some employers may decide to adjust or accommodate your work routine so you can work with these restrictions. This way, you can earn your salary; however, this accommodation does not come without risks. Note that If the employer reduces your pay because of the workplace restrictions, you should be able to continue to receive pay loss benefits – but the benefits are adjusted to reflect 2/3rds of the difference in pay between your pre-injury wages and your new wages. 
  • If the employer doesn’t have a job for you that you can do based on your work restrictions, then you can continue to receive your 2/3rds per week disability payments. In Virginia, if you are not under an Award for benefits, or if your claim in in North Carolina, if your employer cannot accommodate your restrictions, you must look for a job you can do with those restrictions. If you are under an Award in Virginia, then you are under no obligation to look for other work. The burden shifts to the employer in cases of an Award to find you work and if they choose to do so, this is done via vocational rehabilitation. 
  • Oftentimes, the FCE also includes a portion of the exam which is designed to decide whether you are eligible for permanent partial disability or permanent partial impairment (PPI) benefits. When you’ve reached MMI, the treating doctor, after reviewing this portion of the FCE report, will normally also assign an injured worker a Permanent Partial Disability (PPD) or Impairment rating (PPI). Here, the physical therapist is performing tests on your injured body part to determine if you there exists a permanent disability in the injured body part. Based on that evaluation, the physical therapist— and later your doctor– will assign a percentage rating to that disability (called an impairment rating). 

 

An example of a permanent partial disability/impairment is the loss of function of a hand. An impairment rating is an assignment of the severity of that loss of hand such as 90%. This means you’ve lost 90% of the function of your hand. If you are entitled to permanent disability benefits, the amount of the benefits (a specific number of weeks such as the maximum of 200 weeks for the hand– what North Carolina law permits) is multiplied by the impairment rating. So, if you would normally be entitled to 200 weeks for a permanent disability and you have a 90% impairment rating, you will be entitled to 90% of 200 – or 180 weeks. Note that this is NOT in addition to any weeks you remain out of work. 

  • After you have reached MMI and these evaluations occur is typically a good time to determine whether you want to consider a lump sum settlement. If you are unable to return to your former job and so far you are unable to find alternate employment or the insurance company has not been able to find any for you, then you have the potential for a maximum of 500 weeks of payments ahead of you. These potential future weeks, along with the value of the medical side of your claim can then form the basis of a lump-sum settlement demand by your attorney. 

If, on the other hand, you have returned to work at a job at or higher than your pre-injury wages, and you have been determined to have a permanent partial disability and an impairment rating, then the number of weeks as determined by that percentage, plus your future potential medical treatment would be the basis of your attorney considering and possibly negotiating a lump-sum settlement (called a clincher agreement in North Carolina). In a lump-sum settlement, you’re a negotiated portion of what potentially is due to you in the future (the 2/3rds’ wages and medical bills) in one payment to you, so you control the money. The risk, of course, is that there is no do-over if your medical bills are more than you anticipated. On the other side, the risk to the insurance company is that you will, in fact, get better, require little further treatment,  and find a good job on your own, in which case would not have ended up paying you what they paid out in settlement. 

 

An experienced work injury lawyer will advise you about the pros and cons of a lump-sum settlement in your particular circumstance. 

It’s important to understand that you are still entitled to seek medical help – after you reach MMI – and to have the employer pay for that medical care. The key requirement is that the medical care must be needed to help ensure your medical condition doesn’t worsen. Many patients, for example, who have chronic back pain due to their workplace injury need pain management or orthopedic maintenance so their back pain doesn’t get worse.

You should also understand that if you are in an accepted claim or under an Award, the burden to switch from temporary total disability benefits to permanent partial disability benefits, or from temporary total disability benefits to a termination of benefits, is on the employer.

Talk with a seasoned North Carolina and Virginia workers’ compensation lawyer today

North Carolina and Virginia workers’ compensation lawyer Joe Miller Esq. understands that many employers try to push workers to return to work before they’re healthy. He works with your doctors and independent doctors to help assess your medical difficulties and concerns. When you reach maximum medical improvement, he also works to assist your doctors in determining whether you have a permanent partial or full disability as you look to your future.  To discuss your worker’s compensation case, call attorney Joe Miller, Esq., at 888-667-8295. or fill out our online contact form to schedule an appointment. You can also fill out our New Electronic Case Review. It’s a new way we’re offering so workers can contact us remotely.

CDC Recommendations for Hearing Protection During Your Lifetime

Posted on Monday, November 9th, 2020 at 10:39 am    

Several doctors published a report on the website of the Centers for Disease Control and Prevention (CDC) in 2018 explaining how hearing affects workers during their lifetime.

Across the globe, one in three people have a measurable loss of hearing. “1.1 billion young persons are at risk for hearing loss attributable to noise exposure.” Some of the occupations that place people at risk of hearing loss including manufacturing, construction, and mining. “Loud noises can cause permanent hearing loss through metabolic exhaustion or mechanical destruction of the sensory cells within the cochlea.”

Whether loss of hearing constitutes a disability is based on the worker’s communications needs and ability to perform his/her job tasks. Workers such as police and air traffic control workers need high and middle level frequencies to do their hearing-critical jobs.

Occupational Noise-Induced Hearing Loss

“A recent analysis of 2011–2012 National Health and Nutrition Examination Survey (NHANES) data estimates that approximately 14% of U.S. adults aged 20–69 years (27.7 million persons) have hearing loss. After adjustments for age and sex, hearing impairment was nearly twice as prevalent in men as in women; age, sex, ethnicity, and firearm use were all important risk factors for hearing loss. “

About 22 million workers are exposed to dangerous noise levels at work according to the CDC’s National Institute for Occupational Safety and Health (NIOSH). The prevalence of hearing loss can be as high as 25% of the workforce depending on the job types. Some sectors such as forestry, agriculture, warehousing, transportation, fishing, hunting, and utility work seem to have benefited from hearing protection where the risk decreased according to comparing studies from 2006-2010 to studies for 1986-1990.

Workers such as firearm and aircraft workers can be exposed to as much as 140 decibels above pressure level (dB SPL). They require noise reduction devices of 30-50 dB. Even though there are occupational guidelines for hearing protection, many workers suffer hearing loss because their earmuffs and earplugs don’t fit properly.

Nonoccupational Noise-Induced Hearing Loss

Insurance companies for the employers may argue that a workers hearing loss is due to non-occupational causes. Recreational hunting, shooting, personal music players, loud noises at concerts, woodworking, and motorsports are known to have high-risk noise levels. 

“Persons with normal hearing can detect sounds equally soft at all frequencies. When hearing is damaged by noise, the hearing test will show a loss of acuity in a narrow range of middle to high frequencies (3–6 kHz) with better hearing at both lower and higher frequencies. Often, the earliest sign is a notched configuration in the audiogram.”

Many workers and people with hearing loss due to non-work causes actually think their hearing is excellent or good – which means they’re not aware of their hearing loss. Sadly, while much hearing loss is preventable, many workers and nonworkers fail to take preventive steps. The report states that “70% of persons exposed to loud noise in the past 12 months had seldom or never worn hearing protection.”

Worldwide hearing loss statistics

According to the World Health Organization (WHO), about 360 million people have a disabling (unable to work) hearing loss. About 328 million adults are affected. 56% of males are affected. “It is estimated that approximately 320 million persons aged >65 years will have hearing loss by 2030 and approximately 500 million by 2050.”

American prevention efforts

The CDC report states that hearing loss programs should go beyond traditional services – such as diagnosis, treatment, and research.” The initiatives should also “focus on epidemiologic surveillance, health promotion, and disease prevention.” This type of approach can lead to better prevention strategies and better ways to manage hearing loss.

One such program is called: Dangerous Decibels. This program has helped people with both hearing loss and tinnitus (ringing in the ears). The program’s three main strategies are:

  • Turn it down
  • Walk away
  • Protect your ears

The program, which began for just youths, now works for adults and members of the military. A study of children in the US, New Zealand, and Brazil affirmed the effectiveness of the program. The program is used in all 50 states, the four US territories, and 41 nations. The program includes online games such as Jolene – a program which measures “music-listening sound levels and aids in educational outreach for hearing health.

The CDC has its own hearing loss and communication products. “NIOSH promotes the Buy Quiet and Quiet-by-Design programs, designed for employers to take an inventory of their potentially harmful loud tools and replace them with quieter ones.” NIOSH also developed the Safe-in-Sound Excellence in Hearing Loss Prevention and Innovation Award which recognizes individuals and companies for successful hearing loss programs. In 2015 United Technologies was one of the companies recognized – for reducing the rate of employee exposure to hazardous noise by 80%.

“NIOSH recommends an 85-dB limit for an average daily 8-hour exposure and a 3-dB exchange rate, which means that each increase of 3 dB in exposure level reduces the recommended exposure time by half. Thus, an 88-dB exposure limit is recommended for up to 4 hours and a 91-dB exposure limit for 2 hours.”

Two World Health Organization (WHO) hearing loss initiatives are:

  • World Hearing Day. This day is observed on March 3. It aims to increase the awareness of hearing loss amount professionals, communities, and policymakers.
  • Make Listening Safe Initiative. This initiative focuses on personal audio systems.

Some of the ways workers can protect themselves for noise include:

  • Lowering volumes
  • Taking breaks
  • Using better quality consumer products
  • Reductions in time of exposure to loud noises
  • Hearing protection devices which fit properly 

North Carolina and Virginia workers’ compensation lawyer Joe Miller Esq. has been fighting for workers who suffer occupational illnesses or workplace accidents for more than 25 years. He works with experienced hearing physicians to verify your inability to work due to hearing loss or your inability and/or your need to use hearing devices for work and for your daily activities. He’ll fight to ensure your hearing loss is fully compensated and the cost for medical care and protective devices is paid. To review your rights with an experienced work injury lawyer, call North Carolina and Virginia lawyer Joe Miller, Esq., at 888-667-8295. or complete my online contact form to or our online case evaluation form to see if you may have a compensable workers compensation claim. 

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