Personal Injury Assessment - Essay Example

Personal Injury Assessment Introduction Every employed worker is protected by workers’ compensation for any job related injuries or illness. Accordingly, it is important that employers and employees should have an understanding of what workers’ compensation insurance is. It has been known that the system of the workers’ compensation is based on an exchange that occurs as a compromise between the employers and the employees, in which the latter are entitle to receive “prompt, effective medical treatment for on-the-job injuries no matter who was at fault and, in return, are prevented from suing their employers over those injuries.” The medical health provider is entitled to provide an evidenced-based medical treatment proven to cure or relieve medical illness and injuries (Injured Worker Information, 2000). These types of treatment are provided in a set of guidelines and are adopted by the primary treating physician of the industrially-injured worker. At present, employee’s have their injuries cared for by a doctor in a Medical Provider Network (MPN) or a Health Care Organization (HCO). Most of the injured workers recovered fully from the industrial-related injuries. However, there are also injured workers who continue to suffer from the sequelae of the injury. Methods of verification for Personal Injury Assessment In this case, it is indicated that the plaintiff sustained a back injury at work. In workers’ compensation, it is a must that an injured worker is required to report the injury to his immediate supervisor. Moreover, reporting the case promptly to the employer prevents future problems and further delays in receiving full medical benefits. It should be noted that the injury must be reported to the employer within 30 days from the time of the injury. The supervisor must provide the industrially-injured employee an “Employee Claim for Workers’ Compensation Benefits” form, which is to be submitted by the employee or his authorized person to the employer within twenty four hours from the time of the injury. The supervisor is also required to fill a “Report of Injury to Employee” form within twenty four hours upon notification of the injury, which is to be submitted to Workers’ Compensation Program Coordinator. A copy of the “Report of Injury to Employee” must be submitted to Environmental Health and Safety (EH&S) for review and follow-up (Injury and Illness Prevention Program Department Plan, 2006). In cases of emergency, the employee should go to the nearest emergency room facility for immediate treatment, and being the injured worker should inform the employer immediately after the treatment. Otherwise, he should inform his employer of the injury before seeking any medical care. Upon notification, the employee should be provided a first aid treatment in the site if available; otherwise he must be brought to the company clinic for treatment. The examining physician is required to sign a Doctor’s First Report of Injury or Illness once the initial assessment and treatment of the patient is made. (If you Have an Injured Employee, 2007). The designated medical provider (DMP) would assess the patient and the extent of the injury, provide the necessary treatment plan, estimated time required for recovery as well as the work status of the patient (whether the patient be allowed to return to work, or be placed in work modification or on temporary total disability). For a medical treatment to be considered correct, the medical health provider should follow that an injured person must receive a treatment that is adopted from the medical treatment guideline as follows; "scientifically based, nationally recognized, and peer-reviewed" (Department of Industrial Relation FAQ, 2007). It is further noted that the employer is responsible for arranging the medical treatment of the patient within 30 days. Industrially-injured workers who are placed under temporary total disability should be provided recompense by the workers’ compensation appeals board or by the insurance of the company, and sometimes, both. An industrially-injured worker must be provided the necessary treatment and is entitled to receive 100% of necessary medical expenses which includes hospital care, physician fees, diagnostics, laboratories, and prescriptions. Furthermore, the patient’s treating hospital or the physician must be authorized by the employer or by the insurance company. The patient is allowed to receive treatment as long as it is medically necessary. In some cases, the treatment plan of a physician should be reviewed by a third party hired by claims administrator. This process is called Utilization Review. It is a must that patients being placed under temporary total disability are entitled to receive a monthly compensation, which is equivalent to about to two-thirds of the employee’s regular income from the Workman’s Compensation for loss of income. The duration of the patient’s disability would depend on the extent of the injury. The patient is required to report to his primary treating physician every 45 days for assessment of any progress of treatment. By then, the physician will decide whether or not to extend the patient’s disability. There are several factors to consider that may influence the duration of the disability of the Claimant. These are: Psychological factors, age, complications caused by the injury, patient’s medication, and individual variation. In Psychological factors, prior experience of the patient with injury/illness must be taken into consideration. In addition to this, fractures, dislocations, sprains and strains, and surgical procedures should also be taken into consideration, for this will greatly affect the duration of patient’s disability (Factor Influencing Duration of Disability, 2000). In this case, a dispute came up when the Workman’s Compensation had made a letter to the plaintiff, indicating that he must return to work and the payment would be cut off. It should be known that it is the duty of the primary treating physician to order a return to work prescription base on his assessment. Furthermore, the doctor has to address this disagreement in which the plaintiff’s and defendant’s attorneys have to request for an agreed medical examination. Otherwise, the Claimant should submit for a qualified medical examination (QME) and to some extent, a deposition proceeding should be requested. Treatment Plan: An injured worker must be treated in a holistic manner, and is entitled to receive a prompt treatment from the medical health provider. It is the goal of every treating physician to assess the injured worker, and to provide a management plan for the patient. The patient must be assigned to a Primary Treating Physician (PTP) whose primary responsibilities are as follows: (1) Decide the type of medical care the injured worker should receive; (2) Determine when the patient can return to work; (3) Identify the kind of work the patient can safely do while on recovery; (4) Write medical reports that would affect the benefits that the patient will receive; and (5) Refers the patient to other specialists. The patient is required to report to his PTP every 45 days for an evaluation. Moreover, the patient must be referred to other specialists that could integrate their knowledge in treating the patient. A referral must be made to the following: Spinal Surgeon, to assess the extent of the patient’s back problem; Neurologist, to identify any nerve involvement; Psychiatrist, to assess any psychological involved that resulted from the injury; and to the Physical Rehabilitation Medicine Specialist to provide the necessary rehabilitation program. The patient should also have an access to diagnostic studies and laboratory examinations to further investigate his case. These include x-rays, MRI and CT scans of the cervical, upper and lower thoracic, and lumbar spines, respectively. An Electromyography and Nerve Conduction Study must be performed by a Neurologist. The patient must also be referred to physical and occupational therapists for a rehabilitation program, and to a Chiropractor. Summary of Court Testimony The Claimant who is suffering from a work-related injury to the back must be provided the necessary treatment so that he will be able to return to the work force within the short period of time. The working philosophy on treating the Claimant is to promote functional restoration approach, that is, to have the Claimant return to his normal activity, including work. Workman’s Compensation is supporting the goal of treating the Claimant, that is “to maximize the injured workers functional abilities to the pre-injury condition, if possible, and enable an early return to work, preferably with the pre-injury employer” (Treatment and Assessment, 2000). In some cases, there are injured workers who recover longer than what should be expected. No worker being placed on temporary disability would like to be disabled for life. However, it must be taken into consideration that some factors contribute to the Claimant’s condition. To name, the age of the patient delays the healing process of the patient. A Claimant suffering from an industrially-induced back injury might have progression of disease symptoms such as radiating pain to the lower extremities, and therefore needs further treatment. Back injury is a serious industrial injury that should be addressed with a proper medical and orthopedic treatment. Failure to do so would lead to progression of illness that would further delay the healing process, and eventually lead to complications and chronic disability. Chronic disability is inevitable as there are factors that contribute to the delay in returning to work (Treatment Philosophy, 2000). The Claimant should not be obliged to return to work without the clearance of his primary treating physician. It is the duty of the physician to assess the Claimant’s physical and mental status, whether or not he is capable enough to return to the workplace. It is also the duty of the primary treating physician to prescribe the work status of the claimant, whether to allow him to return to his regular or modified work duty. In this case, it was cited that the three physicians and a chiropractor can testify that the Claimant is not ready to return back to work. Furthermore, an injured worker cannot return back to work without receiving a prescription from the primary treating physician ordering a return to work. The physician knows the physical and the psychological well-being of the patient. The Claimant has been accused for malingering. A request for an agreed medical examination in the field of psychiatry must be granted to prove that the Claimant is guilty for such accusation. If medically possible, the Claimant will be referred to an orthopedic specialist to further evaluate the injury. Furthermore, a timeline for a return to work program should be made available to the patient. Psychosocial and pain management issues should be taken into consideration as Claimants who are suffering from work-related injuries oftentimes suffer a significant psychosocial problem and pain that interferes immediate recovery. Thus, psychological assessment must be made available, and a support group system must also be provided. The Claimant is also entitled to receive a retraining and return to work information prior to being released to the workplace. Studies have shown that Claimants who are released back to work by the primary treating physicians have the best outcome and recovers fully from the injury as well as from the loss of income (Miller, 2003). A petition for reconsideration from final orders must also be submitted to the Workers’ Compensation indicating to review the case of the Claimant. It has been known that the Claimant is still suffering from the back injury sequelae that prevented him from returning to his regular work duty. Text Cited Miller, J. (2003). 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