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Who Wins and When?
“Win” does the case end?
• Physician: Case ends when all is done that can be; patient lost to
follow-up; patient is on autopilot to a determined outcome
• Worker: When wholeness is achieved both economically and
physically.
• Missouri: 2 years after last visit to w/c provider
• Employer: When productivity, moral, and workforce is restored
• Insurers: Motivated to get off books; limit long term liability; case
closure; do the right thing; “Pay what we owe.”
• Attorney: ?
• System: W/C Case ends at point after which minimal change over
course of the following year is expected
“Win” does the case end?
• Physician: Case ends when all is done that can be; patient lost to
follow-up; patient is on autopilot to a determined outcome
• Worker: When wholeness is achieved both economically and
physically.
• Missouri: 2 years after last visit to w/c provider
• Employer: When productivity, moral, and workforce is restored
• Insurers: Motivated to get off books; limit long term liability; case
closure; do the right thing; “Pay what we owe.”
• Attorney: $
• System: W/C Case ends at point after which minimal change over
course of the following year is expected
“Win” does the case end?
• Physician: Case ends when all is done that can be; patient lost to
follow-up; patient is on autopilot to a determined outcome
• Worker: When wholeness is achieved both economically and
physically.
• Missouri: 2 years after last visit to w/c provider
• Employer: When productivity, moral, and workforce is restored
• Insurers: Motivated to get off books; limit long term liability; case
closure; do the right thing; “Pay what we owe.”
• Attorney: ?
• System: W/C Case ends at point after which minimal change over
course of the following year is expected
Case closure begins…
• Application for employment
• Hire strong young men?
• Hire healthy workers
– Smokers
– Obesity
– Chronic disease
Case closure begins…
• Application for employment
• Hire strong young men?
• Hire healthy workers
– Smokers
– Obesity
– Chronic disease
Sex Differences in Work-related Injury Rates among Electric Utility Workers
Michael A. Kelsh and Jack D. Sahl
TABLE 3. Injury rate ratios and 95% confidence intervals (Cl) by part of body classification among
Southern Califomia Edison electric utility workers, adjusted for occupation, age, and Job
experience,
1980-1992
Injury
Ratio of
rate ratio
Female
Number Of
Lost
Injuries
Number of Days Lost (females/
Days
Part of Body
Males
Females
Males
Females
males)
95% Cl
to Male
All head and neck
5,604
684
15,607
4,146
1.3
1.16-1.39
2.18
Neck
840
186
8,399
2,862
1.8
1.53-2.22
1.54
All upper
extremities
7,178
1,205
12,943
7,493
1.5
1.38-1.59
3.45
Hand/wrist
2,220
448
4,643
5,551
1.7
1.49-1.89
5.92
Shoulder
889
133
7,706
1,033
1.2
1.00-1.50
0.90
Back
4,665
731
59,705
9,751
1.1
1.01-1.20
1.04
All lower
extremities
6,342
1,396
34,247
9,669
2.1
1.97-2.25
1.28
Hip
304
89
3,348
454
2.6
1.88-3.58
0.46
Knee
1,908
382
22,200
5,333
1.7
1.48-1.93
1.20
Ankle
1,186
295
5,135
1,198
2.4
2.03-2.73
0.94
Body systems
756
175
9,081
2,679
1.3
1.06-1.53
1.27
All Injuries
31,892
5724
183,014 50,169
1.7
1.53
Sex Differences in Work-related Injury Rates among Electric Utility Workers
Michael A. Kelsh and Jack D. Sahl
TABLE 4. Injury rate ratios and 95% confidence Intervals (Cl) by selected type of Injury among
Southern California Edison electric utility workers, adjusted for occupation, age, and Job
experience,
Ratio of
1980-1992
Female
Type of Injury
Fractures
Number of Injuries
Number of Lost Days
Injury
Males
Males
Ratio
F/M
96% Cl
to Male
Females
Females
Lost Days
718
78
13,943
1,638
1.2
0.9-1.5
1.08
8,586
1,676
12,536
3,127
1.8
1.7-1.9
1.28
974
92
7,948
560
1.2
0.9-1.5
0.75
Object in orifice
2,483
172
312
30
0.9
0.8-1.1
1.39
Sprains/strains
10,467
1,805
98,928
22,148
1.4
1.3-1.5
1.30
139
96
1,951
4,417
3.6
2.4-5.3
3.28
78
48
2,410
1,971
2.9
2.0-4.3
1.33
251
92
634
56
1.5
1.1-2.0
0.24
Surface wounds
Bums
Cumulative trauma
Mental stress
Poisoning
Case closure begins…
• Application for employment
• Hire strong young men?
• Hire healthy workers
– Smokers
– Obesity
– Chronic disease
Case closure begins…
• Pre-placement
– Job matching
– Strength testing
– Culture of collaboration
• Pre-placement and post accident drug testing
• Accepting that complaint is legitimate then
verify!
• Transparency in seeking the underlying
problem
Case closure begins…
• Pre-placement
– Job matching
– Strength testing
– Relationship building
• Pre-placement and post accident drug testing
• Accepting that complaint is legitimate then
verify!
• Transparency in seeking the underlying
problem
Case closure begins…
• Pre-placement
– Job matching
– Strength testing
– Relationship building
• Pre-placement and post accident drug testing
• Accepting that complaint is legitimate then
verify!
• Transparency in seeking the underlying
problem
Case closure begins…
• Pre-placement
– Job matching
– Strength testing
– Relationship building
• Pre-placement and post accident drug testing
• Accepting that complaint is legitimate then
verify!
• Transparency in seeking the underlying
problem
Reasons for hiring attorney
• Employee does not know what to expect
• Fearful for themselves and families
• Controversy develops between
employee/employer or employee/adjuster
Keys to Closure
• Case management intervention before
expectations and patterns have developed
• Early diagnosis/aggressive diagnostics
including MRI (careful!)
Keys to Closure
• Maintain communication with employee
even if off work
• Identify and alleviate employee’s concerns
• Move quickly towards normalcy by closing
case, settling, and moving on.
Avoid These Mistakes!
•
•
•
•
•
Provide immediate care
Late reporting
Ignoring the employee
Under reporting compensation
Not complying with restrictions
Summary
•
•
•
•
Hire right demographics
Hire healthy workers
Pre placement drug testing
Pre placement job matching and strength
testing
• Post accident drug testing
• Early diagnosis; set expectations
• Early closure and move on!