Work Comp and the ER Doctor Part 3

Sunday, October 13, 2002 | 0

In our first article we took a look at the great diversity of workers' compensation cases that the Emergency Room Doctor (ED) sees. Our second article reviewed how work comp systems differ from other systems, and why the ED doctor's first report has such a huge impact on an injured workers' comp claim future. Now we will finish with practical tips for the ED physician to keep in mind when working an industrial injury.

Besides promptly and completely reporting the details of any work injury or illness, the ED physician should document a succinct history of how the injury occurred, including the patient's job title, activity at time of injury, location at time of injury, mechanism of injury, and equipment involved in the accident. These details become imminently important in the future in the event that the worker's status as an industrial injury is challenged by the carrier.

While ED physicians are not responsible for deciding whether an injury or illness qualifies for WC compensation or for predicting disability, the initial medical report is one of the first documents that is relied upon by the claims examiner for making that decision. The first report is also important to the physician who assumes ultimate follow-up care. Details of WC reporting requirements differ from state to state. ED physicians should be familiar with the local forms and protocols and clerical personnel also should know local reporting requirements.

Often whether an injury qualifies for work comp status is not clear at the initial presentation. If there is even a possibility of industrial status, the ED physician should collect complete insurance information, including WC carrier and primary medical insurer, and if there is an industrial element to the injury the bill and a copy of your report should be submitted to the industrial carrier.

The ED physician needs to understand that a work related injury or illness can take on many permutations, and needs to be aware that just because work wasn't the SOLE cause of an injury or illness doesn't mean that it is not covered by workers' compensation. Those in the industry like to say that if even just one percent of the injury (with vary few exceptions) is related to work then the injury or illness is properly covered by work comp.

Some of the more common work-related injuries that present to EDs include eye trauma (eg, abrasions, contusions, burns, metallic and nonmetallic foreign bodies, fractures, ruptures, lacerations), head injuries (eg, open and closed, major and minor), fractures, dislocations, spinal injury (ranging from fracture to uncomplicated muscular strains), amputations, serious and minor hand injuries, burns, and electrocutions.

Also common are complaints such as overexertion (with possible exacerbation of underlying cardiovascular or pulmonary disease), dehydration, hypothermia, frostbite, or heat stroke. Victims of workplace violence, including gunshot wounds, stab wounds, or blunt trauma, are also more likely to end up in the ED first.

The ED will also see patients who may have had serious exposure to radiation, toxic chemicals, or infectious agents (eg, blood-borne pathogens). Be aware of potentially serious occupational allergies, work-related motor vehicle accidents, or even complaints of a stress-related syndrome, such as exacerbation of anxiety, related to workplace events.

If the ED physician believes the illness or injury is the result of an unresolved hazardous condition or exposure at the work site, the physician has the duty of informing the appropriate authorities to protect other workers or the public. Hazards may include toxic gas leaks, radiation leaks, chemical exposures, electrical hazards, and malfunctioning industrial machinery. Appropriate authorities may include the plant supervisor or safety officer, the public health department, the utility company, and the local emergency medical services (EMS) command.

When a work comp patient is ready to be discharged particular attention must be paid to activity restrictions. Activity restrictions may or may not be followed in the work place, and if there is any doubt about the ability of the employer to accommodate a restriction upon discharge then your report should clearly state that the patient should be considered temporarily disabled if such restrictions cannot be met. Additional communication to the employer may be necessary for the physician to understand whether a return to work with restrictions is even appropriate. Examples of specific restrictions pending follow-up care might include lifting no more than 20 lb, no kneeling or squatting, no keyboarding, no use of the left hand, or no driving. The patient's supervisor is responsible for accommodating the restrictions or keeping the patient off duty pending further care.

However, if there is doubt about whether the patient can return to work or if your are certain the patient should not be working, discharge the patient without work clearance. Written and verbal discharge orders for the patient to promptly obtain appropriate follow-up care should issue. It is inappropriate and contrary to the patient's and employer's best interests for the ED physician to prescribe a long period of inactivity or off-duty status before seeking follow-up care.

While follow-up care may be restricted to a specific list of participating providers, usually including orthopedists, ophthalmologists, internists, physical therapists, and occupational medicine specialists the ED physician nevertheless has a responsibility to ensure an appropriate referral to the correct provider(s). Referring a patient away from designated providers is likely to delay care and benefits and to cause frustration for the patient, as would be the case in any managed care situation. In states where there is no preferred provider system for WC, ED physicians should refer the patient to any appropriate specialist. Similarly, if the ED physician feels a particular patient requires referral to a particular nondesignated specialist, his or her referral should clearly document the reason.

The ED physician has a unique place in work comp cases and as we have seen, can often be a deciding factor in the future of a patient's work comp rights.

Authored by Denyse Shaw of Comp Pro Insurance Services, matching vendors to the specific needs of administrators and carriers. She can be reached at 916-944-7870, or by e-mail at denysekshaw@earthlink.net.