All posts by Jay Causey

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The Very Real Dangers Of Worry (Part 2)

Last week we posted on how worry can affect the lives of injured or disabled workers. In today’s post, we’ll talk about some of the specific effects of worry on the body.

The physical reactions to excessive fear and anxiety (worry) initiate a chain or cascade of pathological events by stimulating the amygdala area of the brain (fight/flight response), releasing neurotransmitters to the cortex. There, the fear or anxiety, whether real or imagined, is analyzed in detail and the analysis is returned to the amygdala where, in normal situations, the fear response is shut off by amino-butyric acid (GABA). GAD worriers may not have high enough GABA levels to shut off this pathway. Consequently, there are constant marked secretions of glucocortocoids and catecholamines that increase blood sugar levels. Marked levels of epinephrine and norepinephrine dilate blood vessels in skeletal muscles and other adrenergic (adrenal) stimulations that in turn create modifications in breathing, increased temperatures, sweating, decreased mobility of the stomach, bowels, and intestines, constrictions of the sphincters in the stomach and intestines.

Simply said, constant fear and anxiety result in debilitating amounts of stress hormones like cortisol (from the adrenal glands) and hormones that cause blood sugar levels and triglycerides (blood fats) to rise significantly. This process, if not shut off or modulated, can cause premature coronary artery disease, short-term memory loss, digestive problems, and suppression of the natural immune system. The scientific literature is now implicating constant stress, such as constant work stress or toxic fear and anxiety, in causing large weight gains in the midriff area which can greatly exacerbate orthopedic injuries, particularly of the spine or knees, and can lead to increased incidences of diabetes and cancer.

Worry causes increased mortality and morbidity. It is that simple.

For information on how to treat and avoid worry, check in with us later this week for the next installment in this 3-part series.

Workers Compensation

The Very Real Dangers Of Worry (Part 1)

Worry is increasingly pervasive in our society as insecurity about the economy and safety, nationally and personally, grows daily. Worry is compounded in the daily lives of those who are injured or disabled, as they struggle with the added burdens of medical costs and loss of income, all of which engenders a bleak outlook on their future.

“At its worst, [toxic] worry is a relentless scavenger roaming the corners of your mind, feeding on anything, never leaving you alone.” This was the description of “worry” by Edward M. Hallowell, MD, in Worry, 1997, with a 2002 introduction. (This study is still considered the “bible” in lay literature and often quoted in scientific research.) Long ago, Dr. Charles Mayo said, “Worry affects circulation, the glands, the whole nervous system and profoundly affects the heart.” Indeed, worry appears to be, at worst, of genetic origins, and to a lesser degree a learned or environmental response.

Hallowell defines worry as two types: toxic worry and good worry. He likens toxic worry to a virus, insidiously and invisibly attacking you and robbing you of your ability to work, your peace of mind and happiness, your love and play. On the other hand, good worry, or adaptive worry, is necessary to avoid real danger and life-threatening situations.

Worry is categorized as part of Generalized Anxiety Disorder (GAD) in most lay and scientific literature. The National Institute of Mental Illness (NIMH) defines GAD as people who go through the day filled with exaggerated worry and tension, even though there is little to provoke it. NIMH literature states that people with GAD anticipate disaster and are overly concerned about health issues, money, family problems or difficulties at work. GAD is diagnosed when a person worries excessively about everyday problems for at least six months. Worry, as part of GAD, is commonly treated with medication and cognitive therapy.

The everyday worry of the disabled or injured worker is direct, with anxiety and fear over money, physical abilities, medical care, vocational options, housing, food, and family disintegration. It does prey upon so many, compounding their physical health problems and environmental lives.

For more on the very real physiological implications of worry, check in next week for the next installment in this series.

Doctors And Medical

Take Note: You Can Now Be Billed for that Missed Appointment

Washington State has instituted a new rule that allows a workers’ compensation claimant to be billed by their regular doctor or medical provider for missed appointments. WAC 296-20-101(6) states:

Other than missed appointments for examinations arranged by the department or self-insurer, a provider may bill an injured worker for a missed appointment if:

(a) The provider has a missed appointment policy that applies to all patients without regard as to which insurer or entitlement program may be responsible for payment;
and

(b) The provider routinely notifies all patients of the missed appointment policy.

The implementation and enforcement of the policy is a matter between the provider and the injured worker. L&I is not responsible for the implementation and/or enforcement of the provider’s policy.

This allows the medical provider to bill their patient directly for missed appointment charges. The Department of Labor and Industries and/or Self-Insured Claims Administrator continues to be allowed to bill a claimant for any no-show or late-cancellation charges they incur when a claimant misses and appointment arranged by the agency.

Doctors And Medical, Workers Compensation

6 Tips To Combat Worrying, Stress & Anxiety

Worry is increasingly pervasive in our society as insecurity about the economy and safety, nationally and personally, grows daily. Worry is compounded in the daily lives of those who are injured or disabled, as they struggle with the added burdens of medical costs and loss of income, all of which engenders a bleak outlook on their future.

“At its worst, [toxic] worry is a relentless scavenger roaming the corners of your mind, feeding on anything, never leaving you alone.”  This was the description of “worry” by Edward M. Hallowell, MD, in Worry, 1997, with a 2002 introduction. (This study is still considered the “bible” in lay literature and often quoted in scientific research.) Long ago, Dr. Charles Mayo said, “Worry affects circulation, the glands, the whole nervous system and profoundly affects the heart.” Indeed, worry appears to be, at worst, of genetic origins, and to a lesser degree a learned or environmental response.

Hallowell defines worry as two types: toxic worry and good worry.  He likens toxic worry to a virus, insidiously and invisibly attacking you and robbing you of your ability to work, your peace of mind and happiness, your love and play. On the other hand, good worry, or adaptive worry, is necessary to avoid real danger and life-threatening situations.

Worry is categorized as part of Generalized Anxiety Disorder (GAD) in most lay and scientific literature. The National Institute of Mental Illness (NIMH) defines GAD as people who go through the day filled with exaggerated worry and tension, even though there is little to provoke it. NIMH literature states that people with GAD anticipate disaster and are overly concerned about health issues, money, family problems or difficulties at work. GAD is diagnosed when a person worries excessively about everyday problems for at least six months. Worry, as part of GAD, is commonly treated with medication and cognitive therapy.

The everyday worry of the disabled or injured worker is direct, with anxiety and fear over money, physical abilities, medical care, vocational options, housing, food, and family disintegration. It does prey upon so many, compounding their physical health problems and environmental lives.

The physical reactions to excessive fear and anxiety (worry) initiate a chain or cascade of pathological events by stimulating the amygdala area of the brain (fight/flight response), releasing neurotransmitters to the cortex. There, the fear or anxiety, whether real or imagined, is analyzed in detail and the analysis is returned to the amygdala where, in normal situations, the fear response is shut off by amino-butyric acid (GABA). GAD worriers may not have high enough GABA levels to shut off this pathway. Consequently, there are constant marked secretions of glucocortocoids and catecholamines that increase blood sugar levels. Marked levels of epinephrine and norepinephrine dilate blood vessels in skeletal muscles and other adrenergic (adrenal) stimulations that in turn create modifications in breathing, increased temperatures, sweating, decreased mobility of the stomach, bowels, and intestines, constrictions of the sphincters in the stomach and intestines.

The scientific literature is now implicating constant stress, such as constant work stress or toxic fear and anxiety, in causing large weight gains in the midriff area which can greatly exacerbate orthopedic injuries, particularly of the spine or knees, and can lead to increased incidences of diabetes and cancer.

Simply said, constant fear and anxiety result in debilitating amounts of stress hormones like cortisol (from the adrenal glands) and hormones that cause blood sugar levels and triglycerides (blood fats) to rise significantly. This process, if not shut off or modulated, can cause premature coronary artery disease, short-term memory loss, digestive problems, and suppression of the natural immune system. Continue reading 6 Tips To Combat Worrying, Stress & Anxiety →

Doctors And Medical, Workers Compensation

Medical Bills After an On-The-Job Injury – Do I Have to Pay Them? (PART 2)

Last week we shared a post about dealing with medical bills after an on-the-job injury. Our quick answer was that you most likely do not have to pay these bills, depending on your specific circumstances, which we discussed. So, let’s say that you don’t actually have to pay these bills, but you’ve already paid some of them. Here are a few more questions and answers.

What About Everything I Have Already Paid? Can I Be Reimbursed??

Question: My private insurance has covered the cost of my medical care while my workers’ compensation claim was in dispute. I have been making payments to my doctor’s office, too, for co-pay and other charges. Can I be reimbursed? What about my prescription costs?

Answer: Yes, you can be reimbursed for your expenses!

You can be reimbursed for medical expenses, prescription costs, travel expenses (when appropriate) and other costs once your workers’ compensation claim has been approved. In Washington State, though, the Department of Labor and Industries will only make payment to medical providers directly for services rendered, so you cannot receive direct reimbursement for payments to your doctor, physical therapist, chiropractor, etc… These providers will need to submit bills for services under the allowed claim, receive payment for those services, and then issue refunds to you and your private insurance carrier for payments previously made. This can be a difficult process, though, as the medical providers have already been paid, often at a higher rate than what is allowed under a workers’ compensation claim, so they often would prefer to not go to the hassle of rebilling for services they have already been paid for and then make refunds to you and/or your insurance carrier in excess of the workers’ compensation payments.

Prescription costs are easier to have reimbursed. If you have receipts, you can submit a Statement for Pharmacy Services form to request reimbursement. If you do not have your receipts, you can submit this form with a printout from your pharmacy of all filled prescriptions related to the claim. The printout and the form must be signed by the pharmacist to certify that you have paid for the claimed prescriptions. Reimbursement for pharmacy expenses will be paid to you directly.

Similarly, travel expenses can be claimed under certain circumstances. If the travel was at the request of the Department of Labor and Industries, or if travel greater than 30 miles round-trip was needed to see the closest appropriate medical provider, then you can request reimbursement of mileage at the State’s rate and some extra expenses, such as ferry fares, parking charges or meal expenses. The Travel Reimbursement Request form must be submitted using the appropriate code for the type of expense incurred and receipts must be provided to support the reimbursement request. As with pharmacy reimbursements, travel reimbursements are paid to you directly.

Doctors And Medical

Medical Bills After An On-The-Job Injury: Do I Have to Pay Them? (PART 1)

Question: I’m Getting Medical Bills, but I have a Workers’ Compensation Claim – Do I have to Pay Them?

Answer: No! Well, maybe…

If the bill you have received is for a balance due, left over after payment from the Washington State Department of Labor and Industries claim for services rendered by a medical provider, then you do not have to pay the bill. Under RCW Title 51 and WAC Chapter 296-20 and all of its provisions, the medical provider is required to accept payment from the workers’ compensation claim for services rendered as payment in full, and is not allowed to seek from the claimant payment of any additional balance. To be more specific, if a charge is billed to the workers’ compensation claim for a particular service and payment is made by the claim for that service in such a way that a balance remains for that same service, the medical provider is not entitled to payment from the claimant for that difference.

In contrast, if authorization for a medical service is denied under the claim completely, you may, under those circumstances, be required to make payment for any denied services. If you also have private medical insurance, your medical provider may be able to receive payment for treatment services denied under the workers’ compensation claim by submitting a bill for his or her services to the private insurance carrier.

To find out what you should do if you have already paid a medical bill for an on-the-job injury, check in next week for part 2 of this series.

Unemployment, Workers Compensation

Overpayment Of Unemployment Due To Payment of Workers’ Compensation Benefits – NOW WHAT?!?

Injured workers transition from time loss compensation under their workers’ compensation claim to unemployment compensation when they are released to return to work but do not have a job available to them. In many cases, disputes arise as to whether the release to work and termination of workers’ compensation payments is appropriate. Often, the worker tries to find physically-appropriate work while collecting unemployment compensation during the dispute process but, once their attorney secures payment of back benefits under the workers’ compensation claim, an overpayment of unemployment benefits has occurred due to the overlap between the two systems. When this happens, workers should:

  1. Notify the unemployment insurance system that they are continuing to seek payment from the workers’ compensation system, but that they are involved in an appropriate job search during the dispute process.
  2. Immediately share with the workers’ compensation attorney any notices or orders received from the unemployment insurance system. These are usually NOT mailed to the attorney of record in a workers’ compensation claim and the notices often have limited time periods within to file a protest or request for reconsideration of the determination.
  3. Hold in savings from the workers’ compensation payment the claimed unemployment overpayment amount during the dispute process until a final overpayment notice has been issued, or have the workers’ compensation attorney hold this amount in their trust account. If this is not possible, be prepared to enter into a repayment agreement with the unemployment insurance system once a final overpayment figure has been determined.
  4. Seek assistance from the workers’ compensation attorney to document all attorney fees and costs paid as part of the effort to obtain back benefits under the workers’ compensation claim. Submit this documentation to the unemployment insurance system and request a reduction in the claimed overpayment to take these attorney fees and costs into account.
  5. Continue to send any notices or orders to the workers’ compensation attorney.
  6. Once the overpayment has been repaid, check to see if the receipt of workers’ compensation back benefits changes your tax obligations. In many states, workers’ compensation payments are not taxable income, but unemployment benefits are taxable. If there is a significant payment of back benefits under the workers’ compensation claim, it may be worthwhile to file an amended tax return with the IRS to document the lower taxable income figure.

Workers Compensation

Can I Move To Another State If I Have A Workers’ Comp Claim?

Question: Can I move to another state even though I have a workers’ compensation claim in Washington State?

Answer: Absolutely!

Many claimants move to other states during the course of their workers’ compensation claims. Here are the top five things to consider when moving to another state:

  1. Tell your workers’ compensation attorney that you are moving, and update your contact information such as telephone number and address. Discuss any changes that may occur in your specific case after your move – changes in claim procedures or benefits, vocational retraining options, etc..
  2. Find a doctor in your new state that handles workers’ compensation claims from Washington. The Department of Labor and Industries offers a searchable list of providers in the United States, Mexico, Canada and other countries. Be sure to ask whether the doctor provides treatment to injured workers when making your appointment.
  3. As there is often confusion at the initial stages of treatment as to why a patient is seeing the doctor, be sure to tell your doctor that you have relocated and that you have an open, ongoing workers’ compensation claim from Washington State for which you need continuing treatment.
  4. Have your Notice of Decision authorizing your claim for medical treatment handy! This is how the doctor knows that he or she is allowed to treat you for your work-related injury. If you do not have a copy of that Notice of Decision or have lost it, ask your workers’ compensation attorney to send you a copy ASAP.
  5. Be proactive. This is your workers’ compensation claim: you have a right to your medical records. Ask for them after each visit! Give your workers’ compensation attorney the doctor’s contact information, including telephone number, fax number, and address. Get in touch with your workers’ compensation attorney if the doctor is having any difficulty getting your medical treatment paid for under your claim.

Latex Allergy

NIOSH Alerts Home Healthcare Workers About Latex Allergies

latex allergyToday’s post comes to us from our colleague Jon Gelman of New Jersey.

NIOSH (The National Institute for Occupational Health and Safety) has published a booklet to educate Home Healthcare Workers about preventing latex allergies. Latex products are made from natural rubber, and sensitivity can develop after repeated exposure. Limiting exposure to latex can help prevent allergic reactions for both home healthcare workers and their clients.

Once Natural Rubber Latex (NRL) sensitivity occurs, allergic individuals continue to experience symptoms, which have included life-threatening reactions, not only on exposure to NRL in the workplace but also upon receiving or accompanying a family member receiving healthcare services at inpatient as well as office-based settings.

In September of 1997, the Food and Drug Administration (FDA) issued a final rule requiring cautionary statements in the labeling of all medical devices that contain natural rubber likely to come in contact with humans. The rule provides that such products must contain the following cautionary statement in bold print: “Caution: This product contains natural rubber latex which may cause allergic reactions.” Additionally, the FDA issued Continue reading NIOSH Alerts Home Healthcare Workers About Latex Allergies →

Workers' Compensation Reform

The RETRO Program: There’s GOLD in Them Thar Hills!

The BIAW helps employers, not workers, save through RETRO. They also financially backed defeated gubernatorial candidate Dino Rossi.

Earlier this week we shared a post on the RETRO program, and the bureaucratic problems it will create that will be keenly and painfully felt by workers.

The RETRO Program has inserted a profit motive into a system designed to spread claims costs across the state as a whole. This profit motive has created a new industry in our state – the administration and oversight by independent groups of the administration and oversight of claims already performed by the Department of Labor and Industries. These independent groups shave a portion of an employer’s refund as payment of their fees with promises of reduced claims costs and increased rebates in exchange.

Some of these groups advertise their ability to gain rebates of 11%, 15%, 17% from premiums paid by the employer. One – The Building Association of Washington or the BIAW – advertises that it helped their employer clients receive refunds of 51.8% last year. To my eye, that is more than good claims practices. It is robbing the workers and tax payers of this state.

I can assure you that the workers who paid into our state-wide system through payroll deduction did not receive 51.8% refunds.

Our legislature is scrambling through an extended session to craft a budget for the coming biennium, facing the daunting task of cutting programs that provide essential services to the neediest members of our society. The Department of Labor and Industries routinely used excess premiums to invest as a means of lessening the cost of claims for everyone involved. With enormous rebates, though, they are instead running close to the bone.

Most RETRO groups provide review and analysis of workplace conditions and practices in an effort to prevent injury claims in the first place. Some, including the largest RETRO group in the state, the aforementioned BIAW, also take funds from employer rebates and convert them into huge lobbying efforts focused not only on reform of the workers’ compensation system but of the structure of our government overall.

The BIAW was a major financial backer of the defeated gubernatorial candidate in the last race, Dino Rossi, causing Continue reading The RETRO Program: There’s GOLD in Them Thar Hills! →