Joan has been employed for twelve years as an administrative assistant at AXZ Company. On December 3, 2007, Joan notice a pain in both of her hands, initially she dismisses the pain and continues working. One week later the pain is now radiating up to her elbow. She stops at the pharmacy and purchases a bottle of over the counter pain medication, her symptoms seem to go away. On January 4th, she experiences pain in her elbow, neck and shoulder, again she dismisses the pain and continues working. By the end of the day Joan is in a lot of pain, she is having a difficult time doing her work. She tells her supervisor about the pain and he suggest that she make an appointment to see her doctor.
Joan contacts her primary physician and schedules an appointment. During the examination, Joan describes her symptoms and relays that it is worse when she is at work. She tells the doctor that she does a lot of typing and she is using a manual hole punch to make training manuals for her boss. The primary physician examines Joan and advised her that she may have tendonitis or carpal tunnel syndrome – he tells her to file a workers’ compensation claim with her employer because her symptoms appear to be work related.
The next day Joan tells her manager that she may have carpal tunnel syndrome based on the evaluation completed by her primary doctor. The manager reviews the paperwork from Joan’s primary doctor and completes the Notice of Injury.
The manager contacts the workers’ compensation insurance carrier and reports the claim to them. Joan is told to make an appointment with the occupational clinic that treats the employees who work for AXZ Company.
Joan Enters the Workers’ Comp System:
Joan has her first appointment at the walk-in clinic on January 23, 2008. The physician evaluates her and concurs with the primary doctor that Joan may have tendonitis or possible carpal tunnel syndrome. He prescribes a conservative treatment plan – brace for both wrist, physical therapy two times per week for 2 weeks and a prescription for anti-inflammatory medication. Joan is schedule for a follow up appointment in 3 weeks.
Three weeks later Joan return to the walk-in clinic, she relays that she is feeling a little better but her hands are still a bit stiff. Her employer has reduced the amount of typing she has to do and they have reassigned the hole punching job to someone else. The doctor orders two more weeks of physical therapy and advises Joan to continue using her brace. She is schedule to return to the clinic in three weeks.
Joan returns to the walk in clinic on March 11, 2008 – she tells the doctor that she is feeling much better, in fact she is almost back to normal. The doctor discontinues her therapy and advises her to wear the brace if she has any symptoms. She is discharged – Full Duty with a 0% permanent impairment rating.
You Know This is Not Over – Right?
Joan returns to work – she is back to her regular job and she is back to making training manuals for her manager. Gradually her symptoms return, again Joan ignores the warning signs and continues to type and hole punch. Two months after her last appointment at the walk-in clinic, Joan is back with significant deterioration in both arms, tenderness and pain radiating from her shoulder to her wrist.
Joan is immediately referred to an orthopedic hand specialist for an evaluation. The hand specialist orders a nerve conduction study and confirms that Joan has carpal tunnel and ulnar neuropathy. She is schedule for surgery.
Was there a delay in her diagnosis?
Yes, based on her original symptoms the nerve conduction study could have been order earlier to rule out the carpal tunnel syndrome or confirm her diagnosis.
What did the employer do wrong?
This employee reported an injury that is repetitive, reporting the claim to the insurance carrier is only half of the process. It is imperative that the employer evaluate the employees job tasks to determine the root cause of the employees problem.
70% of all claims are related to productivity and workplace conditions. The Notice of Injury does not capture the daily routines that can be contributing to the employees symptoms.
Carpal tunnel claims are 34% more likely to transition from medical only to lost time increasing the cost by 300%.
When the employee received the Full Duty release the employer assumed that she was totally better, this was a false assumption.
Best Practices:
- Repetitive injuries require additional evaluation – employers should evaluate the job tasks to determine if they are contributing to the employees symptoms. For example – the manual hole punch machine could have been replace with an electric automatic machine. A simple solution that is cost less than carpal tunnel surgery.
- Based on Joan symptoms, some diagnostic testing should have been ordered to thoroughly evaluate her symptoms and provide a definitive diagnosis. Everyone focuses on reducing claims cost – if the carpal tunnel diagnosis was made earlier and the employer made adequate adjustments to the job tasks – Joan’s condition may have improved, avoiding her subsequent surgery.
- When the employee was released to return to work full duty the employer should have continued to monitor her symptoms to make sure she was transitioning back into her regular routine successfully.
Sometimes, we rush to get the Full Duty Release and forget that the employees symptoms were not thoroughly evaluated.
Tags: carpal tunnel, workers compensation claims cost, medical treatment and workers comp
Twitter
Skype