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

TABLE 3. Injury rate ratios and 95% confidence intervals (Cl) by part of body classification amongSouthern Califomia Edison electric utility workers, adjusted for occupation, age, and Job experience,1980-1992

Injury Ratio of rate ratio Female

Number Of Injuries Number of Days Lost (females/

Lost Days

Part of Body Males Females Males Females males) 95% Cl to MaleAll head and neck 5,604 684 15,607 4,146 1.3 1.16-1.39 2.18Neck 840 186 8,399 2,862 1.8 1.53-2.22 1.54All upper extremities 7,178 1,205 12,943 7,493 1.5 1.38-1.59 3.45Hand/wrist 2,220 448 4,643 5,551 1.7 1.49-1.89 5.92Shoulder 889 133 7,706 1,033 1.2 1.00-1.50 0.90Back 4,665 731 59,705 9,751 1.1 1.01-1.20 1.04All lower extremities 6,342 1,396 34,247 9,669 2.1 1.97-2.25 1.28Hip 304 89 3,348 454 2.6 1.88-3.58 0.46Knee 1,908 382 22,200 5,333 1.7 1.48-1.93 1.20Ankle 1,186 295 5,135 1,198 2.4 2.03-2.73 0.94Body systems 756 175 9,081 2,679 1.3 1.06-1.53 1.27All Injuries 31,892 5724 183,014 50,169 1.7 1.53

Sex Differences in Work-related Injury Rates among Electric Utility WorkersMichael A. Kelsh and Jack D. Sahl

Sex Differences in Work-related Injury Rates among Electric Utility WorkersMichael 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

Number of Injuries Number of Lost Days Injury Lost Days

Type of Injury Males Females Males Females Ratio F/M 96% Cl to Male

Fractures 718 78 13,943 1,638 1.2 0.9-1.5 1.08

Surface wounds 8,586 1,676 12,536 3,127 1.8 1.7-1.9 1.28

Bums 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

Cumulative trauma 139 96 1,951 4,417 3.6 2.4-5.3 3.28

Mental stress 78 48 2,410 1,971 2.9 2.0-4.3 1.33

Poisoning 251 92 634 56 1.5 1.1-2.0 0.24

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!