Charles Powell Blog http://www.fortheinjured.net/blog/ Charles Powell Blog en-us 2012 Charles Powell, All Rights Reserved, Reproduced with Permission http://www.fortheinjured.net/blog/ Sat, 19 May 2012 04:48:59 GMT Charles Powell Blog http://www.fortheinjured.net/images/logoprint.gif http://www.fortheinjured.net/blog/ <![CDATA[Overuse Syndrome After-A-Job-Injury is Reportable, Treatable, and Compensable.]]>

Every healthy person knows what happens when we overdo it.  What happens if you double your exercise, if you double the grocery shopping, if you work an 80 hour week? 
 
Sometimes the result is more than temporary soreness and temporary fatigue.  Sometimes the result is overuse syndrome.
 
“Overuse syndrome” is exactly what it sounds like.  It is a “syndrome” -- a collection of symptoms -- pain and restriction in ligaments, tendons, muscles or affected nerves involving an entire joint or region, as a result of “overusing” beyond biological design, over the intended physiological body limits. 
 
OVERUSE ON THE JOB
 
In the case of Robin Brown-Williams vs. General Electric Transportation, Opinion No. 02-10WC (January 20, 2010), the employee had a “benching” job that required her to engage in sustained posturing so that while there was no direct trauma, there was repetitive overuse injury to the neck, right arm, elbow and wrist.  The Department of Labor stated:
 
“… Claimant’s job involved not just repetitive motion, but also sustained posturing, force in vibration.  In that context, I am convinced that the neck pain claimant noted…was not an isolated event.  To the contrary, it comprised a symptom of work-related overuse involving her entire right upper extremity.”
 
 
OVERUSE AFTER-A- JOB-INJURY, WHICH CAUSES NEW INJURY
 
Overuse syndrome after-a-job-injury is an imbalance of load on one side of the body. 
 
Instead of unloading the groceries using two hands, all the groceries are loaded and unloaded and brought into the residence with just one hand and one arm.  Instead of writing notes in a class for vocational rehabilitation with the injured dominant hand, all writing is done with the non-injured non-dominant hand which has never been use to do any writing before.  The “overused” limb or joint begins to feel sore, painful, achy.  As “overuse” continues, the non-injured limb begins to bother the patient, and things get very difficult day by day. 
 
There’s just one problem: The limb that is “overused” and painful wasn’t the one originally injured.  Is it also reportable?  Most employees mistakenly believe it will not be covered under workers’ compensation.
 
Armed with the mistaken belief that his overused joint can’t be claimed, the injured employee talks to the doctor about the injured limb.  But the injured employee does not see any sense in bringing up the overuse syndrome in the non-injured limb.  Though not unreal, the overuse syndrome is untold, unreported and unknown.
 
In most cases, the employee brings up an overuse after-a-job-injury problem only when it becomes practically impossible to use the overused joint or limb anymore, or when the overused limb or joint is so inflamed or is so painful that the employee can hardly stand it, and then asks about what the physician can do.  Insurance companies are tempted to exploit the absence of discussion up until that point, the absence of examination up until that point, the absence of documentation in the medical records. 
 
Overuse syndrome after-a-job-injury is compensable.  That’s because Vermont workers’ compensation claim law requires the workers’ compensation insurer to pay for the reasonable medical expense of overuse syndrome as long as the doctor confirms that it is “related to” the work injury. 
 
Physicians are familiar with overuse syndrome, and quickly understand when injured employees decide to mention that “this other arm” or “this other shoulder” is “really sore now.”  They quite convincingly establish that the non-injured limb or joint would never have developed tendonitis, inflammation, nerve damage, etc., if the original work injury had never occurred.  Put another way, if the reason why the limb is being “overused” is due to the fact that it is trying to make up all of the work that the injured arm can no longer do, then it is related to the work injury and it is compensable. 
 
In a case of overuse syndrome after-a-job-injury called J.D. vs. Putney Paper Co., Opinion No. 1308WC (April 8, 2008), the primary injury was to the left arm, which led to overuse of the right:
 
“…following a referral by Dr. Beehler, Claimant was examined by Edward J. Orrechio, MD, a neurologist.  Dr. Orrechio reported that Claimant had several medical issues with his right upper extremity, all related to overuse of the right arm, which is related to the original injury to the left upper extremity.  Dr. Orrechio diagnosed and reported that Claimant had (1) a primary shoulder issue, (2) epicondylitis, and (3) carpal tunnel syndrome. … At Defendant’s request, Claimant was examined by Donald M. Kinley, MD, an orthopedic surgeon (Kinley IME).  Dr. Kinley concluded that Claimant was suffering from overuse syndrome of the right upper extremity and required carpal tunnel surgery.”
]]> http://www.fortheinjured.net/blog/overuse%2Dsyndrome%2Dafter%2Da%2Djob%2Dinjury%2Dis%2Dreportable%2Dtreatable%2Dand%2Dcompensable%2Ecfm www.fortheinjured.net-73521 Fri, 20 Jan 2012 08:00:00 GMT <![CDATA[Less Than a Month on the Job? Consider Your "Rate of Hire."]]>

Temporary total disability benefits (weekly wage benefits) must be paid when a Vermont employee is injured on the job and cannot yet return to work.  It’s sometimes referred to by the nickname “weekly wage benefits” and the amount is two-thirds of your gross pay.  More specifically, two-thirds of your “average weekly wage” is to be paid each week that you are out of work and still expected to improve. 
 
Average weekly wage is normally determined by looking at the past six (6) months of earnings history (26 weeks) and entering on a specific Vermont Department of Labor form (called a Form 25 Wage Statement).  The workers’ compensation insurance company and the employer are responsible for filing the Form 25 Wage Statement, so that there is a record of how they calculated your “average weekly wage.”  It’s supposed to be by a process of adding up the 26 weeks of earnings and then divided by the 26 weeks to equal an average weekly wage.
 
There are some details to the calculations in the event there are any weeks which the employee worked less than a half a week.  There are other details, such as the inclusion of any housing allowance.  Bonuses and tips are also to be included.  If the employee worked for a second or third employer, the earnings from other employment, generally, are included in the calculation of the average weekly wage for the work injury, even though the injury occurred at the one employment.
 
But for employees who had only been on the job for a month or less, there is a risk that averaging just the one to three weeks would be unfairly low.  If you have worked less than a month on the job, you can consider Rule 15:
 
Rule 15.0000 AVERAGE WEEKLY WAGE; CALCULATING TEMPORARY TOTAL AND PERMANENT PARTIAL COMPENSATION RATE
 
…
 
15.4240 If the claimant has been employed for fewer than 4 weeks at the time of his or her injury, such that by the reason of the shortness of the time during which he/she has been in the employment it is impracticable to compute his or her average weekly wage in accordance with subsections 15.4210 and 15.4220 above, then the gross wages of a comparable employee working in a similar capacity under like conditions for the twelve weeks prior to the injury shall be used instead. If wages of a comparable employee are not available, the claimant's agreement with the employer as to both expected hours per week and rate of pay shall be used to determine the average weekly wage.
 
In an actual case, an employee was hired at a good hourly rate and was hired to work 40 hours per week.  In his first week, however, scaffolding collapsed on the job.  He suffered a very serious injury including permanent partial disability from the job injury.  The workers’ compensation insurer and employer chose to pay weekly wage benefits at a “minimum” rate, and the employee agreed, not realizing the existence of Vermont Department of Labor Rule 15.4240.  The employee hired our firm.  He was later successful in turning that around.  He was successful in getting a higher weekly compensation check and retroactive payments, based on his rate of hire.  Rule 15.4240 made a difference in payments of thousands of dollars which the employee should have received, and eventually did.
]]> http://www.fortheinjured.net/blog/less%2Dthan%2Da%2Dmonth%2Don%2Dthe%2Djob%2Dconsider%2Dyour%2Drate%2Dof%2Dhire%2Ecfm www.fortheinjured.net-73501 Fri, 20 Jan 2012 08:00:00 GMT <![CDATA[Imbalance of Power -- Remembering Dr. Martin Luther King, Jr.'s Wisdom]]>

Martin Luther King, Jr. once gave a talk about why an adversary uses injustice. 
 
"... .  And when we were in jail in Birmingham the other day, the white wardens and all enjoyed coming around the cell to talk about the race problem. And they were showing us where we were so wrong demonstrating. And they were showing us where segregation was so right. And they were showing us where intermarriage was so wrong. So I would get to preaching, and we would get to talking—calmly, because they wanted to talk about it. And then we got down one day to the point—that was the second or third day—to talk about where they lived, and how much they were earning. And when those brothers told me what they were earning, I said, "Now, you know what? You ought to be marching with us. [laughter] You're just as poor as Negroes." And I said, "You are put in the position of supporting your oppressor, because through prejudice and blindness, you fail to see that the same forces that oppress Negroes in American society oppress poor white people. (Yes) And all you are living on is the satisfaction of your skin being white, and the drum major instinct of thinking that you are somebody big because you are white. And you're so poor you can't send your children to school. You ought to be out here marching with every one of us every time we have a march."
 
http://mlk-kpp01.stanford.edu/index.php/encyclopedia/documentsentry/doc_the_drum_major_instinct/
 
Sometimes an insurer's representative talks and behaves in a way that makes you feel, yes, like he/she is superior and you are inferior. 
 
It may be that the insurer's representative feels important because he/she has a job and you don't; or that he/she is in good health and you are not; or he/she has income, health insurance and security, and you do not; or that he/she has never filed a claim, but you have filed a claim and are asking for benefits; or because he/she's had a good night sleep and is clear-thinking, but you have been unable to sleep since your injury the way you need to, and you are struggling to express yourself.
 
A good person's sense of importance can be confused with power.  Importance doesn't come from power.  A wrong sense of importance shows itself by its own works: prejudice, impatience, and lack of compassion.

According to Dr. King, it's natural for everyone to desire a sense of importance.  It’s actually good to desire importance.  But what kind?


 
]]> http://www.fortheinjured.net/blog/imbalance%2Dof%2Dpower%2Dremembering%2Ddr%2Dmartin%2Dluther%2Dking%2Djr%2Ds%2Dwisdom%2Ecfm www.fortheinjured.net-73164 Mon, 16 Jan 2012 08:00:00 GMT <![CDATA[Pre-existing conditions -- images, categories and analysis]]> A crack in a teacup is the image used by a health care provider to describe a pre-existing condition. Often the term “pre-existing condition" means different things to different people, so picture is helpful.
 
A cracked teacup, says the provider, is still able to hold tea.  It does not leak.  It does not cease to function.  It's useful.  You can still drink tea whether that crack is there or not.
 
However, if something new happens and that crack is aggravated or made worse by some incident, like if it's dropped a second time or banged a second time, then something has permanently changed. The teacup now has more than a crack, and has a leak.  A leaking cup can no longer function.  It is no longer useful to anyone who would employ it to drink tea.  It is disabled.
 
“Pre-existing” conditions can also be described by another image, the image of the straw which breaks the camel’s back. The camel can do a lot of work, whether it has an excellent back or whether it has a bad back.  It can still carry luggage. It can still carry its owner. It can still do work and come to work day after day.  But the introduction of one last straw can make all the difference between continuing to work and breaking down.  That's the straw that is responsible for causing the camel’s back to break.
 
A worker can come to perform his or her job day in and day out, and that worker may have "pre-existing" conditions or impairments. But there may come a time when a new injury, occurring at the workplace, causes that pre-existing condition to become different, so much that the worker can no longer continue to carry out his or her job duties due to the new injury.  That is considered, under the law, as an "aggravation" of a "pre-existing" condition.  The law says that if the work activity produced a new crack that caused the teacup to leak, or a new straw caused the camel’s back to break, then work is responsible and Worker's Compensation insurance must cover the disability and pay for the medical expense another benefits to help respond to the worker’s new injury.
 
Department of Labor opinions tend to categorize “pre-existing” conditions into 3 kinds.  First, there is “recurrence.”  Second, there is “aggravation.”  Third there is “flare up.”  A fourth category deals with a particular kind of pre-existing condition known as “progressively degenerative.” 


Here below are excerpts from a 2011 decision in the case of Badger vs BWP Distributors and Maynard’s, Op. No. 05-11WC (March 25, 2011), a decision by the Vermont Department of Labor which discusses these pre-existing condition categories:
 
"In workers' compensation cases involving successive injuries during different employments, the first employer remains liable for the full extent of benefits if the second injury is solely a “recurrence” of the first injury — that is, if the second accident does not causally contribute to the claimant's disability.  Pacher v. Fairdale Farms, 166 Vt. 626, 627 (1997).  If, however, the second incident aggravates, accelerates or combines with a pre-existing impairment or injury to produce a disability greater than would have resulted from the second injury alone, then in that case the second incident is an “aggravation, “ and the second employer becomes solely responsible for the entire disability at that point.  Id. at 627-628.

"Beyond either a recurrence or an aggravation, there is a third category as well — the “flare-up.” In a flare-up, a distinct new injury worsens a pre-existing condition, but only temporarily, following which the condition returns to its baseline.  Cehic v. Mack Molding, Inc., 2006 VT 12 Par.10. The finding of a distinct new injury precludes a conclusion that it is a recurrence. Id. The finding of a return to baseline precludes a conclusion of aggravation “because the injury, once resolved, did not ‘causally contribute’ to any increased disability.” Id, quoting Pacher, supra."


For pre-existing conditions which naturally progress, such as arthritis and osteoarthritis, the Vermont Department of Labor has the following standard: “Where a claimant's pre-existing condition is a progressively degenerative disease, the test for determining work-related causation is whether, “due to a work injury or the work environment ‘the disability came upon the claimant earlier than otherwise would have occurred.”’  Stannard v Stannard Co., Inc, 175 VT 549, 552 (2003), citing Jackson v True Temper, 151 Vt 592, 596 (1989). While exacerbated symptoms alone may not be enough to establish causation, nevertheless “the acceleration rule must be looked at in relation to the overall condition of the body, particularly as it relates to [a claimant's] ability to work and function.” Id., citing with approval City of Burlington v. Davis, 160 VT. 183, 186 (1993) (Dooley, J., dissenting)."  
]]> http://www.fortheinjured.net/blog/pre%2Dexisting%2Dconditions%2Dimages%2Dcategories%2Dand%2Danalysis%2Ecfm www.fortheinjured.net-72879 Wed, 11 Jan 2012 08:00:00 GMT <![CDATA[Permanent Impairment -- Spine and Non-Spine Use Different Ratings under Rules]]>

Calculating the amount of money for an injured employee's permanent impairment is by a 3-part formula.

For spine impairments, you take the % of impairment found by the doctor.  Second, you multiply it by 550 weeks.  That tells you how many weeks' worth of checks the insurer must pay.  Third, you multiply those weeks times your weekly compensation rate.  For example, if you have a 6% whole person impairment to your neck, a 6% rating of the spine is multiplied by 550 weeks = 33 weeks.  If your weekly compensation rate is $656.36 you multiply your weekly rate by the 33 weeks.  $656.36/wk x 33 weeks = $21,659.88.

For non-spine impairments, it is the same 3-part formula (above), except using 405 weeks instead of 550.  An 11% whole person impairment involving the arm and hand (i.e., non-spine impairment) is calculated by multiplying 11% times 405 weeks = 44.55 weeks.  If your weekly compensation rate is $656.36 you multiply it by the 44.55 weeks = $29,240.84. 

But for injuries involving permanent impairments to both spine and non-spine, you have to calculate the number of week's worth of checks for each.

Vermont Department of Labor Rules 11.2200 through 11.2300 provide the method for calculating the number of weeks of claimable benefits in cases where there is impairment of both spine and non-spine:
 
“11.2200 All permanent partial disability compensation for permanent partial impairment to a body part, system, or function, other than the spine, which is addressed in paragraph 11.2300 of this rule, shall be based on the employee's percentage of impairment of the whole person multiplied by 405 weeks.
 
11.2210 When a compensable injury results in permanent impairment to more than one body part, system or function, not including the spine, the whole person rating shall be determined using the conversion chart in the most recent edition of the A.M.A. Guides to the Evaluation of
Permanent Impairment.
 
11.2220 When a compensable injury results in permanent impairment to more than one body part, system or function including the spine, the whole person rating shall be determined by:
 
     11.2221 determining the whole person rating without the spine and converting it to the percentage of 405 weeks as provided above;
 
     11.2222 determining the impairment to the spine as provided in paragraph 11.2300 of this rule below;
 
     11.2223 adding the weeks determined in paragraphs 11.2221 and 11.2222 together.
 
11.2300 The Back or Spine. In the event of injury resulting in permanent impairment to the back or spine, not amounting to permanent total disability under 21 V.S.A. § 644, the employer shall pay compensation based on the employee's percentage of impairment to the whole person multiplied by 550 weeks.”
 
(emphasis in red added)
 
For example, a case involving multiple injuries from an employee's fall, there were permanent impairments to the elbow, wrist and ulnar.  These were non-spine.  But the employee also sustained permanent impairment to the neck.  This was spine.

Calculation of the non-spine impairment needs to be done separately and independently from rating of the spine. 

The calculations should be as follows:


 
Non-Spine (Elbow, wrist and ulnar)11% whole person x 405 weeks =44.55 weeks of benefits
Spine (Neck)6% whole person x 550 weeks =33 weeks of benefits
 Total Weeks Owed, Per Rule 11.222377.55 weeks


In an actual case, the worker's compensation insurer sent to the employee a letter enclosing a so-called Form 22 “Agreement for Permanent Partial Disability Compensation.”  The adjuster was offering an agreement of only 64.8 weeks. 

It seems that the adjuster erroneously took the combination of percentages for spine and non-spine (16%) and multiplied it by the number of weeks for only non-spine injuries (405 weeks), as the math comes out exactly so:  16% x 405 weeks = 64.8 weeks. 

The difference is quite significant.  The insurer's offer of 64.8 weeks of benefits at the employee's weekly rate of $656.36/wk = a total of $42,532.13. 

The correct calculation, which should have been offered, is 77.55 weeks at the weekly rate of $656.36 = $50,900.72. 

The insurer’s offer would have shorted the injured employee $8,368.59! 
]]> http://www.fortheinjured.net/blog/permanent%2Dimpairment%2Dspine%2Dand%2Dnon%2Dspine%2Duse%2Ddifferent%2Dratings%2Dunder%2Drules%2Ecfm www.fortheinjured.net-72687 Sat, 07 Jan 2012 08:00:00 GMT <![CDATA[Spinal Cord Stimulator Device Candidate? Weekly Checks Continue]]>
           Spinal cord stimulators are medical devices, supplied by more than one competitive durable medical equipment supplier, intended to improve the daily life of persons suffering from severe chronic pain.  The basic function of a spinal cord stimulator is to “scramble” the pain messages being sent from the nerves at the injured area of the body before the pain messages reach the brain.  The scramble is by means of the stimulator device which introduces electronically regulated stimulation.  The patient experiences a reduction in sensation of pain and some substitution of tingling sensations in the place of pain.  It is not intended to eliminate or cure pain, but rather to provide significant further improvement.

            Vermont Department of Labor Rule 2.1200 defines “Medical End Result” (also sometimes referred to as “Maximum Medical Improvement”) as “The point at which a person has reached a substantial plateau in the medical recovery process, such that significant further improvement is not expected, regardless of treatment.”  The workers’ compensation insurer is allowed to stop weekly wage benefit checks at that time, provided it follows the proper notice form under Rule 18.1200 giving adequate, written medical documentation of medical end result and at least seven days’ notice.

            But the injured employee who is a proper candidate for a spinal cord stimulator is not at medical end result and the workers’ compensation insurer should not be permitted to stop weekly wage benefits until either the procedure is attempted or the patient declines.  That is the position of the Vermont Department of Labor in the case of Luff vs. Rentway (2010) and in Bruno vs. Directech Holding Company  (2010).  That means the injured employee’s weekly wage benefit check (“temporary total disability benefit”) should not be stopped by the adjuster where the injured employee is a proper candidate for a spinal cord stimulator.
]]> http://www.fortheinjured.net/blog/spinal%2Dcord%2Dstimulator%2Ddevice%2Dcandidate%2Dsignificant%2Dfurther%2Dimprovment%2Dreasonably%2Dexpected%2Ecfm www.fortheinjured.net-72614 Thu, 05 Jan 2012 08:00:00 GMT <![CDATA[Permanent Impairment -- Installments or Lump Sum?]]> A permanent impairment rating is usually paid in weekly installments if the injured employee has not returned to work.  A request for lump sum payment requires review and approval by the Vermont Department of Labor, per Rule 19:

Rule 19.0000 LUMP SUM PAYMENTS

19.1000 Retroactive compensation shall be paid in a lump sum.

19.2000 Permanent disability compensation may be paid in a lump sum upon request to and approval by the commissioner.  The claimant's request for a lump sum payment must be in writing and must state the amount and the reason(s) for the lump sum request.  All parties must have notice and an opportunity to be heard before a lump sum payment may be ordered.

19.3000 The commissioner may approve a lump sum payment if it is in the best interests of the claimant.  In evaluating the claimant's request the following are considered positive factors in approving a lump sum:

19.3010  The claimant and/or the claimant's household receives a regular source of income aside from any workers' compensation benefit;

19.3011  The lump sum payment is intended to hasten or improve claimant's prospects of returning to gainful employment;

19.3012  The lump sum payment is intended to hasten or improve claimant's recovery or rehabilitation;

19.3013  The claimant presents other evidence that the lump sum award is in their best interests.


19.4000 A lump sum payment of permanent total disability benefits beyond three hundred and thirty weeks may only be granted with the agreement of all interested parties and approval by the commissioner.


19.5000 A lump sum payment shall not be approved if:

19.5010  The award was based upon a hearing decisin for which an appeal has been filed and the employer or insurer objects to the payment of the lump sum; or

19.5011  The claimant is best served by receipt of periodic income benefits; or

19.5012  The payment is intended to pay everyday living expenses; or

19.5013  The lump sum payment is intended to pay past debts.

]]> http://www.fortheinjured.net/blog/permanent%2Dimpairment%2Dinstallments%2Dor%2Dlump%2Dsum%2Ecfm www.fortheinjured.net-72613 Thu, 05 Jan 2012 08:00:00 GMT <![CDATA[Why the Insurance Adjuster Denies a Case of Complex Regional Pain Syndrome]]> Complex Regional Pain Syndrome is a diagnosis which describes a condition of damage (usually in the arm or leg) to the body’s ability to regulate sensitivity to pain, and damage to the body's ability to regulate the skin temperature, sensitivity, color, moisture, swelling, as well as hair and nail growth.  It is a syndrome studied by doctors since at least the Civil War when victims of wounds did not improve but worsened with “pain out of proportion” as well as the other abnormalities to the skin.  Doctors for a long time called it Reflex Sympathetic Dystrophy.
           
The American Medical Association publishes a Guide book for physicians to measure how much permanent change occurs from Complex Regional Pain Syndrome. Vermont workers’ compensation law uses the Fifth Edition.  Page 343 provides a definition of Causalgia, one type of CRPS, as a “burning pain that develops in a distal extremity following trauma to a peripheral nerve.”  But when measuring how much permanent impairment results after a patient has reached maximum improvement, Page 496 of the AMA Guide provides a requirement of at least eight of the following local clinical signs:  “skin color: mottled or cyanotic; skin temperature:  cool; edema [these are referred to as vasomotor changes]; skin dry or overly moist [referred to as sudomotor changes]; skin texture:  smooth, non-elastic; soft tissue atrophy:  especially in fingertips; joint stiffness and decreased passive motion; nail changes:  blemished, curved, talon-like; hair growth changes:  fall out, longer, finer [referred to as tropic changes]; radiographs:  trophic bone changes, osteoporosis; bone scan:  findings consistent with CRPS [referred to as radiographic signs].”  The problem with using these criteria to decide if the correct clinical diagnosis is CRPS is that the Guide book is intended for assessment of permanent impairment, in other words when all treatment has been completed for the purpose of giving significant further improvement.  Most practicing physicians treating CRPS patients will readily state that the AMA Guide book criteria should never be used as a strict rule for determining whether the diagnosis is or is not CRPS, nor should the AMA Guide book criteria be used as a basis to withhold treatment until at least 8 of the AMA permanent criteria have developed.  Insurers and their medical experts nevertheless utilize the AMA Guide book to oppose new cases, when treatment has begun but not been completed.  

Another publication, known by the name Harden Criteria, has its own list of signs for determining Complex Regional Pain Syndrome.  Unlike the AMA Guide Book, Harden is supported by a group called International Association for the Study of Pain (IASP).  Harden Criteria consider both past reported findings and also findings at examination.  Under the Harden Criteria there must be continuing pain which is disproportionate to any inciting event and there must have been a report of at least one symptom in three of the four following categories (A) Reports of Hyperesthesia and/or Allodynia [so-called Sensory Category]; (B) Reports of Temperature Asymmetry and/or Skin Color Changes and/or Skin Color Asymmetry [so-called Vasomotor Category]; (C) Reports of Edema and/or Sweating Changes and/or Sweating Asymmetry [so-called Sudomotor/Edema Category]; and (D) Reports of Decreased Range of Motion and/or Motor Dysfunction (weakness, tremor, dystonia) and/or Trophic Changes (hair, nail, skin) [so-called Motor/Trophic Category].  In addition at the time of the evaluation there must be displayed at least one sign in two or more of the following categories:(A) Evidence of Hyperalgesia (to pin prick) and/or Allodynia (to light touch) and/or Temperature Sensation and/or Deep Somatic Pressure and/or Joint Movement [so-called Sensory Category]; (B) Evidence of Temperature Asymmetry and/or Skin Color Changes and/or Skin Color Asymmetry [so-called Vasomotor Category]; (C) Evidence of Edema and/or Sweating Changes and/or Sweating Asymmetry [so-called Sudomotor/Edema Category]; (D) Evidence of Decreased Range of Motion and/or Motor Dysfunction (weakness, tremor, dystonia) and/or Trophic Changes (hair, nail, skin).  Finally, there must be no other diagnosis that better explains the signs and symptoms.  Even this study was the subject of a recommendation internally for a new category called CRPS-NOS where a patient might not meet all of the presentation ("display") evidence at a single examination.
           
The insurance adjuster is severely challenged when having to decide whether to accept a diagnosis of CRPS, and is under pressure because of the issue of money.  Treatment of Complex Regional Pain Syndrome is expensive, usually including physical therapy, occupational therapy, multiple prescriptions over lengthy and sometimes indefinite timeframes, nerve blocks, stellate ganglion blocks, psychological and psychiatric care for depression the patient experiences from the severe pain and disability caused by CRPS, as well as further treatment intervention strategies such as Ketamine infusions and spinal cord stimulator trials and implant surgeries with maintenance of the device.  Compounding the insurance adjuster’s decision is the above choice of criteria used to decide whether to accept the diagnosis of CRPS as the correct one.  The adjuster’s information initially is usually limited to medical records of treatment.  Medical treatment usually begins with more common diagnoses at first, such as sprain, suspected fracture, or severe contusion.  Treatment notes typically show x-rays to be negative, no fracture, a full range-of-motion except for limitations due to the patient’s report of pain.  Often weeks, or months, of conservative treatment is shown to have failed to improve the injury and in fact the patient is reporting and demonstrating worsening levels of pain despite little objective proof to support it.  There is no pain-o-meter, or other device to confirm the severe levels of pain from CRPS.
           
The injured employee usually has never heard of CRPS.  The injured employee is having severe burning pain, often with some of the above signs, yet nothing seems to help the injured employee get better.  Often the patient's participation in physical therapy makes the pain significantly worse when moving the arm or leg, and continued movement seems counter-intuitive to the patient.  "If this makes it even more painful to use it, why am I being told to do it anyway?"  The injured employee usually is as frustrated and confused by the presentation of symptoms as family members and even some treating clinicians until there is enough communication and enough examination for the physicians to consider the diagnosis of CRPS. 
]]> http://www.fortheinjured.net/blog/why%2Dthe%2Dinsurance%2Dadjuster%2Ddenies%2Da%2Dcase%2Dof%2Dchronic%2Dregional%2Dpain%2Dsyndrome%2Ecfm www.fortheinjured.net-72388 Tue, 03 Jan 2012 08:00:00 GMT <![CDATA[Why is the Workers' Compensation Check Not Here?]]> Contact the adjuster who is responsible for issuing the check.  Ask your question.  Write down her/his response.  Ask the date the check was "issued."  Ask if the checks are on "repetitive pay" where the adjuster sets dates during which the insurer automatically ("repetitive") issues a check at the exact same day of the week, week after week, until expiration.  Ask when the repetitive pay is currently set to expire.  If an adjuster offers to "stop payment" on a check that was issued but hasn't arrived, ask for explanation.  How soon will the "replacement" check be issued?  What is the insurer's information for your current mailing address?  Keep the stub portions of your checks so you have critical information on the insurer's past performance -- period covered, date issued, amount, etc.  Vermont statute 21 VSA Section 650(e) provides that if the weekly benefit is not paid within 21 days after becoming due "...in cases where the overdue benefit is not in dispute, 10 percent of the overdue amount shall be added and paid to the employee, in addition to interest and any other penalties."
]]> http://www.fortheinjured.net/blog/why%2Dis%2Dthe%2Dworkers%2Dcompensation%2Dcheck%2Dnot%2Dhere%2Ecfm www.fortheinjured.net-72371 Mon, 02 Jan 2012 08:00:00 GMT <![CDATA[Can You Get Your Old Job Back After a Vermont Workplace Injury?]]>
The law requires most employers to offer the next available "suitable" position.  It is called "reinstatement."  21 VSA Section 643b.  However, not all employers have to abide by this rule. For this to apply, an employer must have 10 or more employees, and the injured worker would have to return to work within two years of his workplace disability date.

However, if there is not another job option available, the worker may have to look elsewhere for work that he can physically perform.

During this time, the injured worker may be entitled to vocational rehabilitation and possibly continued compensation.
If you were injured on the job in Vermont, call a qualified Vermont workers' compensation lawyer at the Law Office of Charles Powell to talk about your potential case in a free discussion at 877-295-7773.
]]> http://www.fortheinjured.net/blog/can%2Dyou%2Dget%2Dyour%2Dold%2Djob%2Dback%2Dafter%2Da%2Dvermont%2Dworkplace%2Dinjury%2Ecfm www.fortheinjured.net-68178 Sat, 03 Dec 2011 08:00:00 GMT