Monday, June 1, 2009

What about Pain and Workers' Compensation? (Part 2)

I know when I injured my foot (acute pain) and when I suffered from recurrent migraines (chronic pain), work was very often out of the question. Even with medications (and sometimes because of them), the mental resources taken up dealing with the pain meant I had little capacity for other activities including work, school and even family.

The reality of pain related to work injuries means that many workers for some time post injury are unable to do anything except deal with their injury. While many workers' compensation insurers will insist they do not compensate for pain, one look at their medical bills they pay will prove otherwise. At WorkSafeBC, I looked at the medications we paid for in 2006 and found seven of the top 20 claims were narcotic analgesics and accounted for 50% of the dispensed drugs paid for on accepted claims.

When pain becomes a chronic part of a permanent disability, workers' compensation legislation, policy and practice have taken varying approaches to 'objectify' pain so it can be compensated.

In British Columbia, the Rehabilitation Services and Claims Manual Volume II
section 39.02 describes two types of 'Chronic Pain':

  • Specific chronic pain - pain with clear medical causation or reason, such as pain that is associated with a permanent partial or total physical or psychological disability.
  • Non-specific chronic pain - pain that exists without clear medical causation or reason. Non-specific pain is pain that continues following the recovery of a work injury.

Where a WorkSafeBC determines that a worker is entitled to compensation for chronic pain, an amount equal to 2.5% of total disability may be granted.

California takes a different approach. In case of permanent disability, the worker may be awarded from 0 to 3% of whole person impairment for pain.

In the American Medical Association's Guides to Evaluation of Permanent Impairment, 6th Edition, [AMA Guides, 6th] 'Pain-related Impairment' uses a 15 question questionnaire that generates a point rating based on ten points per question. Those with 70 or fewer points are considered to to have no or mild pain and receive nothing. Those with 71 to 100 points are considered to have moderate pain and receive 1%; Severe (101 to 130 points) get 2% and Extreme 131 to 150) receive 3%.

Deciding on some percentage for impairment due to pain is one thing but how that translates into the real world of work is another. There appears to be no one best way to assess let alone obviate the effects of pain. Many workers' compensation authorities will authorize pain management programs for the most severe cases.

Advances in science, medicine and statistics are likely to improve our measurement of pain and provide more insights into its causes. New techniques and medications will be developed to manage pain. Each advance has the potential to help injured workers but there are likely no simple pathways to a perfect system for assessing and compensating for pain.

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