Tag Archives: pain

Opioids And Doctor Choice

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Chicago Mayor Rahm Emmanuel said in 2008 that “You never let a serious crisis go to waste.” In the context of opioids and workers compensation this could mean reforms to workers compensation systems beyond drug formularies If solving the opioid crisis means limiting the number of doctors who can prescribe opioids, then there will be fewer doctors who will treat workers compensation cases.

Additional licensure and certifications aren’t unheard of in the world of occupational health. In 2016, the Federal Motor Carrier Safety Administration implemented a new rule that only doctors on their registry can perform DOT Physical Examinations for truckers and other professional drivers. This reduced the number of doctors who can perform those examinations. 

When I testified on LB 408, a bill that would have implemented drug formularies for opioids under the Nebraska Workers’ Compensation Act, some doctors were testifying that there was little training in regards to prescribing opioids. Though an opioid prescription registry like the DOT examination registry wasn’t proposed, you could certainly see it proposed as a solution to the opioid problem.

By limiting the numbers of doctor who handle workers’ compensation claims through additional licensing requirements, injured employees will have fewer choices for medical treatment and are more likely to have their employer control their care.

Evidence shows that the workers compensation system has made some contribution to the opioid crisis. According to a 2015 report by the Bureau of Labor Statistics over 3.5 million employees were injured at work. Half of those injuries required the employee to miss sometime from work. A study of employees in 25 states done by the Workers Compensation Research Institute revealed that 55 to 85 percent of employees who missed at least one week of work were prescribed at least one opioid prescription.

When I testified on LB 408 the consensus among the doctors testifying on the legislation was that injured workers were more vulnerable to narcotic addiction than other patients who are prescribed narcotic pain medication. Scientific studies give some credence to these conclusions. Workers compensation claims can cause economic insecurity. According to an article in Scientific America, Addiction rates for opioids are 3.4 times higher for those with incomes under $20,000 per year than they are for employees making more than 50,000 per year.

But that article also shared studies that state that pain pill prescriptions are not driving the opioid epidemic. Patients with pre-existing addiction issues are more likely to become addicted to opioids and 75 percent of those who develop opioids start taking opioids in a non-prescribed manner. Furthermore, only 12 to 13 percent of ER patients who are treated for opioid overdoses are chronic pain patients.

Workers’ Compensation is traditionally an area of the law that is controlled by the states. Regulation of drugs is generally an area reserved for the federal government. Any laws imposing additional hurdles or requirements upon doctors who prescribe opioid drugs may have to come from the federal government.

The offices of Rehm, Bennett & Moore, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

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Hoping That the Revolution in Medical Care Reaches Injured Workers

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Imagine a cross between a FitBit and a TENS Unit (Transcutaneous Electrical Nerve Stimulation) that can control, on demand, issues that hurt workers face: anxiety, pain, PTSD symptoms.

That combination might not be as far-off science fiction as a person would think.

Wearable medical devices are making remarkable advances, according to respected workers’ compensation commentator Robert Wilson.

“We are only scratching the surface of what may be possible,” he predicts. “Wearable devices that can dispense medication, provide biofeedback and can both monitor and adjust a patients vitals are very real possibilities. Devices such as these will improve quality of life with real time application and treatment, and that ‘improved experience’ will help our industry drive better results at an ultimately lower cost.”

A real-life example of these advancements is an app called myBivy, which was originally developed to help veterans with PTSD sleep better by disrupting the physical “symptoms that precede night terrors.” The app is being developed by a team that “Tyler Skluzacek, a student at Macalester College” in St. Paul, Minnesota, began when he was inspired to help his father, a veteran of the Iraq War. The app is in its testing phases now and is estimated to “officially launch between March and May” of this year. Since “7-8 percent of Americans will experience PTSD at some point in their lives” and “11-20 percent of post 9-11 veterans are estimated to have PTSD,” it’s pretty obvious how the app may help those who have developed PTSD through a work-related injury sleep better. I look forward to hearing more about this particular app for sure.

This app meets Wilson’s criteria of how wearables need to evolve to be the most helpful to those who can benefit the most from them.

“To be really effective and successful, the wearable revolution needs at least one more evolution,” Wilson wrote. “An evolution that takes this medium from that of casual observer to mobile clinician; from simple data collector to partner in health. That is when we will see real benefits and results from wearable technology in all health delivery systems.”

I am hopeful that the relentless cost-containment efforts of the “Workers’ Comp Industrial Complex’ will not inhibit these creative efforts, so injured workers and their loved ones will be able to benefit from these advances very soon.

The offices of Rehm, Bennett & Moore, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

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Will It Hurt My Workers’ Compensation Case to Get a Job?

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accommodations“Will getting a job hurt my case?”

I hear this question on a regular basis from my workers’ compensation clients. In my experience, the answer is almost always “no.” But if you do find alternate or part-time employment during your workers’ compensation case, you need to keep track of and disclose your earnings.

Why working when you are injured can help your case:

  1. Working helps your credibility with doctors and judges:
    Doctors and judges are the two most important people in your case, because the doctors drive the medical evidence and the judge weighs that evidence. Ultimately, those decisions come down to a doctor or judge’s determination of your character. A judge is going to give the benefit of the doubt to someone who is trying to help themselves. That’s also why complying with doctor’s orders and rehabilitation programs helps your credibility in court.
  2. Just because you’re working doesn’t mean that you are not significantly or even totally disabled:
    Maybe your company is bending over backward to keep you. Maybe a sibling or a parent has you working at their business. In situations like that, a court is going to understand you are earning wages beyond your real potential to earn wages. You may also be enduring tremendous amounts of pain to maintain employment. In cases like that, especially if you had a good employment record and complied with your doctor’s orders, the fact that you are working through pain could very well help your credibility.

How to hurt your case when you work:

  1. Not disclosing your wages and employment:
    This is especially true if you are working while receiving temporary disability benefits or unemployment benefits. This makes you look dishonest, and you might be committing fraud in many states. Additionally, once you are in the legal process, you normally have a duty to disclose that information to your employer/insurer anyway. Even if a judge believes that you inadvertently forgot to turn over this wage information, you are still making it more difficult for your attorney to win you benefits.
  2. Clearly working beyond your medical restrictions:
    Let’s say a doctor takes you off work as a nurse because you can’t lift more than 25 pounds and bend and twist on a regular basis, but you keep working as a CrossFit instructor, where you regularly do heavy lifting that involves bending and twisting. If you are that person, don’t call our law firm. Though employee fraud is a very small percentage of overall fraud, conduct like that would likely be workers’ compensation fraud. Again, working can help with your credibility in a workers’ compensation case, but being dishonest about that work can hurt your case.

If you have questions about specifics in your or a loved one’s workers’ compensation case, please contact an experienced workers’ compensation lawyer.

The offices of Rehm, Bennett & Moore, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

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NPR: Brain Affects Pain

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Brain_powerPain and chronic pain is a topic that many of our clients experience as a reality every day. This fairly recent National Public Radio report gives more details about what some of the research shows in reference to the brain and pain.

Although the headline in the original article is a flop, as people are often wrongly told “it’s all in your head,” the brain is a really important part of how the body feels, understands, and reacts to pain.

There are some potential lessons to be applied to injured workers, clients with personal-injury cases, and others who are associated with our law firm. However, as is the case with all research, be sure to speak with both your lawyer and medical professionals who know about your situation before making changes to a treatment plan.

“Our perception of pain is shaped by brain circuits that are constantly filtering the information coming from our sensory nerves, says David Linden, a professor of neuroscience at Johns Hopkins University and author of the new book ‘Touch: The Science of Hand, Heart, and Mind,’” according to the NPR article.

But sometimes those filters work differently than expected, such as when Complex Regional Pain Syndrome affects a client, an issue written about on this blog by firm partner Todd Bennett.

“The brain also determines the emotion we attach to each painful experience, Linden says. That’s possible, he explains, because the brain uses two different systems to process pain information coming from our nerve endings.

“One system determines the pain’s location, intensity and characteristics: stabbing, aching, burning, etc.

“‘And then,’ Linden says, ‘there is a completely separate system for the emotional aspect of pain — the part that makes us go, “Ow! This is terrible.” ’

“Linden says positive emotions — like feeling calm and safe and connected to others — can minimize pain. But negative emotions tend to have the opposite effect,” according to the NPR article.

A study that associate Jon Rehm recently referenced showed how the context of being appreciated at work made a difference to certified nursing assistants who were injured at work.

“… Higher-paid CNAs were injured less frequently than lower-paid CNAs. The study indicated that organizational factors really drove injury rates among CNAs. In other words, in settings where CNAs are truly valued, paid fairly and trained, the injury rates are lower. But if CNAs are treated as low-wage, high-turnover cogs in a machine, then injury rates are higher,” according to his blog post.

Finally, according to the NPR article, there is some evidence that because of how the brain interacts within different parts of itself, “that at least some people can teach their brains how to filter out things like chronic pain, perhaps through meditation,” said Stephanie Jones, an assistant professor of neuroscience at Brown University.

If you have questions about how this information can apply to your situation, please contact an experienced lawyer.

The offices of Rehm, Bennett & Moore, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

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