Monday, May 25, 2009

What about Pain and Workers’ compensation? (Part 1)

Pain. We all experience it. It can be mild or debilitating. Sometimes it can be controlled by medication but often, even with medication (or simply because of the medication) activities of daily living are just not possible.

With pain being such a common experience that accompanies injury and many illnesses, I thought I would look at how workers’ compensation systems deal with pain. The first place I looked was at the legislation and I was surprised that most workers’ compensation acts contain no direct reference to pain. Some make reference to “pain and suffering” but only in terms of what workers’ compensation systems will do with third party awards by courts for “pain and suffering”.

Nova Scotia’s Workers’ Compensation Act does make reference to Chornic Pain:

10A In this Act, "chronic pain" means pain
(a) continuing beyond the normal recovery time for the type of personal injury that precipitated, triggered or otherwise predated the pain; or
(b) disproportionate to the type of personal injury that precipitated, triggered or otherwise predated the pain,

and includes chronic pain syndrome, fibromyalgia, myofascial pain syndrome, and all other like or related conditions, but does not include pain supported by significant, objective, physical findings at the site of the injury which indicate that the injury has not healed.

So one Act tells us what Chronic Pain is and what Chronic Pain includes but not what pain is. Without a definition of pain in legislation, I looked to the medical and health profession. The International Classification of Disease (ICD9) has a code series for pain(338) and chronic pain (338.2) as well as chronic pain due to trauma (338.21) and ‘chronic pain syndrome (338.4). Again, that classified it but does not really define pain per se. As far as definitions go, I found many but one for pain and one for Chronic Pain that seem representative:

  • Pain: An unpleasant sensory and emotional experience associate with actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain - IASP)
  • Chronic Pain: pain that persists six months after an injury and beyond the usual recovery time of a comparable injury; this pain may continue in the presence or absence of demonstrable pathology. (Brock Smith, Report of the Chair of the Chronic Pain Panels [to the Workplace Safety and Insurance Board - WSIB], August 2000)

Most of us can identify with this definition of pain and most are likely to accept the later even without direct experience.

So, pain is real, even if it is not defined in legislation. And it is all too real to those suffering from work-related injury, illness and disease. How do workers’ compensation systems deal with pain? That’s a topic for the next post in this series.

Monday, May 11, 2009

Novel H1N1 Influenza A [swine flu] and Workers' Comp

The novel Influenza A/H1N1, also called “swine flu”, is in the news and may be a serious threat to human health but what, if anything, does this have to do with workers’ compensation authorities? Any statutory agency concerned with compensation and prevention has at least three aspects of its role to consider.

Like every other employer, it takes people to carry out the tasks and duties of the agency and workers’ compensation organizations have an over-arching responsibility for workplace health and safety. The beginning stages of an outbreak may not be the ideal time to be thinking about that role but it is critical that employers set expectations and communicate, in a timely and clear way, information and expectations to their employees. Questions will arise like “what do I do if I come in contact with someone who likely has the flu?” and “What should I do if a fellow staff member is showing flu-like symptoms?” are bound to arise. If you haven’t thought about these issues in advance, getting a coherent program in place is not only prudent, it is generally your responsibility as an employer. A good example of employee/contractor occupational health communication on this topic is the NASA notice on its website. In their policies discussed in a May 1 teleconference , the following actions were discussed
– “Send home” policies
– Liberal use of telecommuting [for 5 days]
– Self identification following travel to swine flu affected areas

Many workers’ compensation agencies have either a formal or informal prevention mandate. WorkSafeBC, for example, is the regulator, promoter and inspectorate for occupational health and safety in the province. Resources like the web page on Influenza which outlines the employer responsibility and the slideshow/video which provides practical guidance on proper hand washing are great examples of what needs to be done. The specific announcement for healthcare workers and employers regarding respiratory protection is a particularly useful and direct document for those who are among the most likely to be exposed to this biological agent.

Then there are the workers’ compensation claims that may arise. During the early stages of an outbreak, the nexus between the work and the illness may be easily and conclusively shown. Contact with the indentified index case or one of the chain of isolated cases or clusters where that contact arose in the course of and out of the duties related to the job are likely enough for a workers’ compensation claim to be accepted. Quarantine of otherwise healthy individuals may be advisable and even enforced by a health authority but it misses the essential requirements for a workers’ compensation claim.

Once any disease becomes community based and that direct connection between work and the development of disease is lost, the likelihood of a claim for compensation diminishes. The common cold is rarely an acceptable work-related illness because it is, well, common—in the community. The current novel Influenza A/H1N1 is not yet at that stage but there is a chance it could become community based where the risk of contracting the disease is about the same for everyone.

The latest Influenza A/H1N1 may not be the next serious pandemic virus but it already serves as a wakeup call for employers and workers’ compensation authorities to prepare and test plans for a local cluster in the office to a community outbreak or a full blown pandemic.

Friday, May 1, 2009

Thoughts on the IAIABC ACC in Baltimore

This post is a little behind schedule. I was in Baltimore last week at the IAIABC All Committee Conference and wanted to say something profound about one of the topics covered at that event. We discussed so many things: The impact of recession and recovery on workers’ compensation systems, self-insurance and bankruptcy implications for workers’ compensation regulators, plans for the 2009 convention, and the co-hosting of the 2010 International Forum on Disability Management in LA.

Each of these items could have easily filled a blog post (and might at some point in the future). As I started to write I realized there was a fundamental question being answered by mere fact that such a conference was happening: What is value of attending such multi-jurisdictional events?

In the grips of a recession, the obvious costs were the on the minds of many and prevented some from attending. To be sure, airfare and hotels and conference registrations cost money. Then there are the opportunity costs of having senior policy makers and administrators devoting their time and energies to activities outside their jurisdiction. Over and above these costs are the usual hassles of travel and inconvenience of being separated from family for a week. Despite these costs, powers that be weighed the costs and decided the benefits were of greater importance. Those in attendance at this conference were there because of intentional choices based on the premise: the benefits far outweigh the costs.

So what are the benefits? Conferences like this one provide valuable insight and information of immense value: early warnings, new ideas, feedback on what works and what doesn’t, intelligence on emerging trends and context for understanding developments elsewhere in workers’ compensation and prevention. And beyond the official agenda, the informal discussion and contacts create new networks to support information sharing and understanding.
These benefits have value. Those that attended learned first-hand about the challenges, successes and failures of those dealing with real life workers’ comp issues—lessons that may justify actions worth millions of dollars to a system or prevent the human costs associated with work-related injury, illness and disease. The organizations that chose to send delegates, participate in committee work and contribute to the dialogue obviously get that. And those who get it but are prevented from attending for other reasons contribute in other ways (participation via conference call and discussion forum, for example) and receive at least some of the benefits that way.

Increasingly, policy makers are being asked how their jurisdiction stacks up against others or what the implications of a new law or regulation introduced in another area might be in their own jurisdiction. The price of the ‘free’ information needed to answer those questions is participation in and support of organizations like IAIABC, AASCIF and AWCBC and the committees that are the driving force behind their work—a cost that is well worth the investment.