Workers’ Comp 360: The Injury Itself

Dan Wynn, Former Workers’ Compensation Manager, Goodwill of Southern California 

There is blood on the floor, perhaps a manager has had to transport an injured worker to the emergency room (ER), or, worse still, the paramedics are on their way or have just arrived. That is followed by paperwork, reports, authorizations, and treatment during the initial reaction to the injury. But what if none of that ever happened? What if it was possible to avoid all of the aforementioned? The answer is probably it was not. As hard as all parties try, there will be injuries.

In my opinion, the greatest opportunity to save the applicant grief, pain, and agony is to either mitigate the severity or eliminate the chance of injury as much as possible. Many companies have issues with this philosophy as it is hard to show the return on investment (ROI) on an injury that never happens. In Corporate America, there is so much focus on the bottom line that there is a reticence or reluctance to invest large sums on prevention. With thin profit margins, one can understand the thinking behind those policies. Many companies make a feeble effort, a pitifully small investment, or ignore it until something catastrophic happens. Frequently, the bottom line is money.

The average reserve for a slip and fall injury that involves a surgical back and litigation is around one hundred thousand dollars. Within the savings of avoiding just one of that type of injury, there is more than enough for a good solid program to create education and awareness in the workplace for all of a company’s employees. If this does not happen then rest assured there will be an injury perhaps a catastrophic one, that could have dire consequences for employer and employee both. If we cannot prevent the injury or simply render first aid, then the Applicant goes into “the system”.

Employees also need to be aware of their surroundings at all times. The potential victim has the greatest potential for impacting the safety of the workplace. If there is a potential for injury and it is identified, then it can be corrected before an employee comes to harm. Employees noticing and reporting potential hazards can save either themselves or their colleagues from injury. Anyone who has had to go to the ER or urgent care can attest to what goes through a victim’s mind in route to obtaining care. How bad am I hurt? How much is this going to cost? How much is this going to hurt? How long will it take to get better? Oh my God, I have a trip coming, a wedding, how am I going to do this? 

Per the California Department of Industrial Relations “Workers' compensation benefits are designed to provide you with the medical treatment you need to recover from your work-related injury or illness, partially replace the wages you lose while you are recovering, and help you return to work. Workers’ compensation benefits do not include damages for pain and suffering or punitive damages.” They go on further and recommend “Make sure your supervisor is notified of your injury as soon as possible. If your injury or illness developed gradually, report it as soon as you learn or believe it was caused by your job. Reporting promptly helps avoid problems and delays in receiving benefits, including medical care. If you don’t report your injury within 30 days, you could lose your right to receive workers’ compensation benefits.”

Regardless of which state the injury occurs in, the preceding is good advice. Prompt medical care can, in many cases, can reduce an OSHA recordable injury to merely first aid. Once the injury has been reported, getting medical care is key to identifying and reducing the severity of the injury, if possible. In more severe injuries, more severe disability, and even a fatality can be averted by expediting treatment. Employers that have set up protocols or networks in advance to aid in that effort. It is especially important in less populated areas where the number of medical providers is sparse. Another key area that is of mutual benefit of all parties is for the injured worker and the employer to essentially hold each other’s hand through this experience. If the employer is supportive and helpful in the event of an injury, there is a greater opportunity to avoid or reduce litigation.

Per OSHA, first aid refers to medical attention that is usually administered immediately after the injury occurs and at the location where it occurred. It often consists of a one-time, short-term treatment and requires little technology or training to administer. First Aid examples per OSHA are:

• Using a nonprescription medication at a nonprescription strength
• Administering tetanus immunizations
• Cleaning, flushing or soaking wounds on the surface of the skin
• Using wound coverings such as bandages, gauze pads, etc.; or using butterfly bandages
• Using hot or cold therapy
• Drinking fluids for relief of heat stress
• Removing splinters or foreign material from areas other than the eye by irrigation, tweezers, cotton swabs or other simple means
• Drilling of a fingernail or toenail to relieve pressure, or draining fluid from a blister
• Using eye patches
• Removing foreign bodies from the eye using only irrigation or a cotton swab
• Using any non-rigid means of support, such as elastic bandages, wraps, non-rigid back belts, etc.
• Using finger guards
• Using massages
• Using temporary immobilization devices while transporting an accident victim

A recordable injury per OSHA is the following:

• 1904.7(b)(1)(i)
• Death. See § 1904.7(b)(2).
• 1904.7(b)(1)(ii)
• Days away from work. See § 1904.7(b)(3).
• 1904.7(b)(1)(iii)
• Restricted work or transfer to another job. See § 1904.7(b)(4).
• 1904.7(b)(1)(iv)
• Medical treatment beyond first aid. See § 1904.7(b)(5).
• 1904.7(b)(1)(v)
• Loss of consciousness. See § 1904.7(b)(6).
• 1904.7(b)(1)(vi)
• A significant injury or illness diagnosed by a physician or other licensed health care professional. See § 1904.7(b)(7).

Having medical in an industrial clinic rather than an ER in the majority of industrial injuries usually speeds up the delivery of care. ER treatment often means a long wait thereby defeating the time element for reducing severity of injuries. ER treatment also means increased costs to the employer, either directly or via premiums that will be charged by their insurance carrier. This comes back to affect the employees in decreased opportunities for increased wages, benefits, and advancement due to higher premiums or costs. Accurately identifying the true extent and scope also provides many of the same benefits.

Once the injured worker has “entered the system” and requires care the true challenges begin. The injured worker should be just as interested as the employer in getting care, recovering, and getting back to work. Once the initial diagnosis is made, the injured worker needs to make an important decision. “Can the physician treating me do what is necessary to get me healed and back to work?” That is an important question that the injured worker must ask. The next question that will need to be answered is “If this physician is not the right specialty, how do I find one? Picking the correct specialty is crucial to getting the right care. Many employers or carriers have provider networks, that is usually the best place to start.

We have met the injured worker and now we have an accident. With a little awareness, this could have been avoided. But, injuries do happen. If the employer acts quickly it may only result in a non-recordable first aid incident. If it is more serious, it is imperative that the appropriate medical care is obtained. The employer and the injured worker must now work together to get the employee healed so the employee can go back to work. It is in the mutual best interest of both to make that happen.