Category Archives: Doctors And Medical

Doctors And Medical

Neck and Shoulder injurIes – Which is it, or is it both?

Neck and shoulder injuries can present with physical symptoms which could be caused by either a neck or shoulder injury. Diagnosis can be complicated if the injured person reports that they suffered an injury to their neck or shoulder because that is where they feel the ache or pain. In fact, it could be one or the other, or both.

An aching shoulder may not be due to the shoulder, and a sore neck may not indicate a neck issue. The neck and shoulder are intimately connected by multiple nerve pathways and injuries in one area often results in referred pain to the other. Thus the importance of a thorough medical exam of both neck and shoulder by your doctor is key to getting an accurate diagnosis and appropriate treatment program.

Work-related complaints of the arm, neck and shoulder develop as a result of repetitive movements, awkward postures and impact of external forces such as work with vibrating tools. These conditions severely hamper the working population, and in WA state, lost work days due to neck, arm, and shoulder represent 60% of workers’ compensation claims (WA L&I).

Our firm has encountered many cases where an incomplete diagnosis early after an injury led to legal complications down the road when an effort was made to obtain allowance of an additional condition under a claim. Often, the initial diagnosis is a shoulder injury but only later is it discovered that a neck injury is also involved. Now, the Department of Labor and Industries, through its ongoing program of medical education seminars, will address this common dilemma – is it the neck, or the shoulder?

The Occupational and Environmental Medicine Grand Rounds Lecture series will cover this topic on February 20, 2020 in Seattle, with a simultaneous viewing event in Olympia. Read the full release, here, for more information, including details about the two physicians that will speak at the event. This lecture may be of interest to you, even if you are not a doctor. The cost is only $50 and includes a light meal.

Doctors And Medical, government, Workers Compensation

Reversing A Century Of Progress – Are We Back In Upton Sinclair’s Jungle?

Many workers no longer have paid sick days.

Today’s post comes from guest author Rod Rehm from Rehm, Bennett & Moore.

Health Care Is Just The Beginning

At a time when a flu epidemic is exploding out of control, killing thousands of people, forty-two million Americans have no sick leave. Many of these people are lower paid, often work part time, and continue to work when ill because they can’t stay home to recover without losing their income. I am shocked and dismayed that many hard-working folk are forced to work when sick because staying home is not economically possible. Making matters even worse, these highly vulnerable workers often have no employer-provided health insurance so even serious illnesses go untreated, putting us all at a higher risk for infection from a contagious worker, like a server in a restaurant, for whom taking an unpaid day off is impossible.

…the trend toward low pay, long hours and few benefits is getting stronger.

I fear that if the current trends continue, the lives of the millions of Americans who struggle at low-paying jobs will remain miserable, desperate and be lacking in real hope. It appears that the trend toward low pay, long hours and few benefits is getting stronger. At the turn of the 20th century when Upton Sinclair wrote “The Jungle,” describing immigrants struggling in Chicago, the jobs were more physical, dangerous and just plain disgusting. However, millions of “New Jungle” workers still struggle and suffer today.

Class Warfare

After over 100 years of progress, the American middle and lower classes are under constant attack. The efforts to limit rights of workers are ongoing and supported by big business. Every day I read of measures being introduced in state legislatures to limit access to and decrease the benefits of workers’ compensation. The right to collective bargaining is being attacked as well. Local elections are overrun by anonymous innocent-sounding Super PACs funded by 21st Century versions of robber-barons who are using their wealth and power to squeeze out a few more dollars in profits to add to the tens of billions of dollars already sitting in their bank accounts. These are not job creators, they are their own personal wealth creators. Income equality is at an all-time low in the United States, and the trends are getting worse.

How can this be happening in 21st century America? How can we call ourselves civilized? Can we really allow such maltreatment of workers and disregard public health in what we call an “advanced,” “modern,” and frequently, an “exceptional” county?

A Path Forward

We are not without hope, though. Crusaders like Senator Elizabeth Warren are working hard to reverse the trends and preserve the American Dream for future generations. But our protectors are few. We cannot assume that someone else is looking out for us. We must engage with government at the local, state and federal levels so that the voices of regular working folk are not drowned out by a cabal of rogue billionaires trying to keep score by increasing their own personal fortunes at the expense of working people. I fear that if we sit by passively, our children will all be working in the New Jungle, America will have lost its middle class, and with it, the American Dream will be a distant memory. The time to act is now.

Doctors And Medical

How To Manage Worry Without Medication

There are strategies that can make worry more manageable.

For the last few weeks we’ve been talking about the very real medical dangers of worry. For injured or disabled workers, worry can add an additional and very significant burden on the body. In this post, we’ll talk about some of the ways that worry can be treated or even avoided.

Much of the time treatments are simply medications that increase GABA. Cognitive therapy is prescribed depending upon insurance coverage. Addressing the physical and mental effects of excessive worry can aid in recovery from an injury or disability and can increase levels of success in vocational retraining efforts. In rare cases, worry and anxiety can become permanent fixtures in a person’s life, and the effects of this condition can result in ratable permanent impairment. But, the greater part of lay and scientific literature lists non-medicine tips to reduce worry, fear and anxiety to a more modulated level, thereby providing some relief from this constant invader that often creates unproductive and hurtful periods in life.

Here, summarized, are six tips cited in the literature to help manage worry without medication:

  • Separate out toxic worry from good worry: Good worry amounts to planning. Toxic worry is unnecessary, repetitive, unproductive, paralyzing, frightening, and in general, life-defeating.
  • Get the facts rather than letting your imagination run away. Analyze the problem and take corrective action.
  • Develop connectedness in as many ways as you can: family, social, information and ideas, organizations and institutions. Never worry alone.
  • Touch and be touched: in addition to massage therapy, seek out hugs and laughter – being around children or family can help.
  • Be good to yourself. Exercise, eat well, get enough sleep, meditate, do yoga and be aware of over consumption of substances detrimental to your health, such as alcohol.
  • Sing, read, cry, do what you love, look for what’s good in life and don’t sweat the small stuff.

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.