Medical Marijuana and Arizona Workers Compensation By Rachel Brozina, Esq., Lester & Norton

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1 In this issue Winter/Spring 2013 THE OFFICIAL PUBLICATION OF AWCCA, INC. Medical Marijuana and Arizona Workers Compensation By Rachel Brozina, Esq., Lester & Norton Medical Marijuana and Arizona Workers Compensation... Page 1 Let the AWCCA Job Referral Line Work for YOU!... Page 4 State Legislators Across U.S. Reform in Dispensing of Opioids... Page 5 ICA to Hold Fee Schedule Hearing... Page 5 NCCI Study Analysis: Effects of an Aging Workforce... Page 6 Red flags in back pain When to worry and what to do... Page 10 Arizona voters passed the Arizona Medical Marijuana Act ( AMMA ) in November 2010, and since then, the Arizona Department of Health Services ( ADHS ) has developed a medical marijuana program to administer the certification of qualifying patients and license the dispensaries. The first dispensary was opened in December 2012, after Maricopa County Attorney Bill Montgomery unsuccessfully challenged ADHS s authority to license marijuana dispensaries. Mr. Montgomery has appealed the court s ruling and continues to argue that the AMMA is in violation of the federal Controlled Substances Act. In the meantime, however, the AMMA is in effect and patients who hold a valid medical marijuana card are protected from state prosecution for using marijuana. This presents concerns for employers, carriers, and third-party administrators in the workers compensation industry, so my intent with this article is to inform you about how the AMMA works and what it allows and disallows. The Construct of the Statute The purpose of AMMA is to protect seriously ill patients from state prosecution for using medical marijuana under their doctor s recommendation. It allows a qualifying patient to possess up to 2.5 ounces of usable marijuana or 12 marijuana plants. ADHS only issues medical marijuana cards to qualifying patients, and in order to be deemed a qualifying patient, the individual must suffer from a debilitating medical condition. The statute defines a debilitating medical condition as follows: A. Cancer, glaucoma, HIV+, AIDS, hepatitis C, ALS, Chrohn s disease, Alzheimer s, or the treatment of these conditions; B. A chronic or debilitating disease, medical condition, or its treatment that produces: a. Cachexia or wasting syndrome b. Severe and chronic pain c. Severe nausea d. Seizures e. Severe and persistent muscle spasms The physician that prescribes marijuana must make or confirm the diagnosis of a debilitating medical condition, and must examine the patient regarding the debilitating medical condition within 90 days Continued on page 2

2 of prescribing marijuana. The physician must also review the patient s medical records for the past 12 months to evaluate the patient s responses to other forms of treatment. Finally, the physician must fill out a document to attest that the patient is likely to receive a therapeutic benefit to alleviate the effects of the debilitating condition. ADHS will permit one dispensary for every 10 pharmacies permitted each year. The dispensaries must be operated as not-forprofit entities, and must contract with an Arizona-licensed physician to act as its medical director. ADHS does not provide a list of dispensaries to the public; rather, it will provide a list to a qualifying patient when it assigns the person a medical marijuana card. Impact on Employers The AMMA precludes Arizona employers from discriminating against marijuana cardholders in hiring, termination, or imposing employment conditions. However, if an employer is at risk for losing benefits under federal law, it is not Medical Marijuana continued from page 1 precluded from discriminatory practices. Furthermore, employers cannot penalize a cardholding employee for a positive drug test, unless the employee used, possessed, or was impaired by marijuana on the employer s premises or during the employee s working hours. In other words, the mere fact that a cardholding employee s drug test is positive for marijuana metabolite is not sufficient for the employer to penalize the employee. In the absence of evidence that the employee used or possessed the marijuana on the premises or during working hours, there must be evidence that the employee was impaired by marijuana. Because our statute is relatively new, we have not had any cases that lend us guidance as to what constitutes impairment. ADHS has an online verification system that employers may access to verify whether an employee s marijuana card is valid. However, employers access to the system is limited to verifying a card that the employee produces; employers cannot access the system to check whether it is employing any cardholders. Impact on Workers Compensation Benefits It has already been established that a workers compensation claim cannot be denied solely on the basis that an injured worker has marijuana (or alcohol or other drugs) in his/her system. As long as the necessary risks and dangers of the employment cause or contribute to the injury, the claim is compensable even in the face of a positive drug test. (See Grammatico v. Industrial Comm n, 117 P.3d 786 (2005)). If an injured worker is prescribed marijuana for an industrial injury, does the carrier have to pay for or reimburse the injured worker for the marijuana? Because our statute is relatively new, we have not had an opportunity to see how this plays out in our workers compensation arena. However, our neighbor to the west recently took this issue up. Continued on page 3 Your Link to the Arizona Work Comp Industry! If you re looking for information on AWCCA membership, upcoming events, past issues of The Examiner, links to AWCCA sponsor websites or contact information for AWCCA Executive Committee Members, be sure to visit For quick access to the most current AWCCA news, remember to bookmark in your internet browser. Page 2

3 Medical Marijuana continued from page 2 In Cockrell v. Farmers Insurance and Liberty Mutual Insurance Company, an injured worker sought to have the California Workers Compensation Judge order the carrier to reimburse him for the costs associated with purchasing marijuana that had been prescribed by a physician. The evidence showed that the injured worker had complications with using Oxycontin, so the marijuana was intended to replace that medication. The judge awarded the injured worker reimbursement for the purchase of marijuana, and the carrier was ordered to pay the value of the medication that the marijuana was intended to replace (Oxycontin). The carrier appealed the judge s decision, citing to a provision in California s medical marijuana statute that provided that the statute does not require a governmental, private, or any other health insurance provider or heath care service plan to be liable for any claim for reimbursement for the medical use of marijuana. (See Health and Safety Code Section (d)). The Appeals Board remanded the matter back to the lower level for the judge to make a determination as to how that provision applies to the case. Thus far, a decision on this point has not been published. The AMMA includes a specific provision that is very similar to the California provision cited above. Our statute indicates that it does not require private or public health insurers to reimburse a patient for the costs associated with the use of marijuana. Although our statute does not require the carrier to pay for or reimburse for the cost of marijuana, it does not necessarily preclude an injured worker from seeking reimbursement in a workers compensation matter because the use of marijuana could be deemed a medical benefit under our workers compensation statute. It is worth noting that federal law (the Controlled Substances Act) does not recognize the medical use of marijuana and it prohibits the cultivation, sale, distribution, and possession of marijuana under any circumstance. A pertinent question is whether our Administrative Law Judges interpret the interplay among the Controlled Substances Act, the Arizona Medical Marijuana Act, and the Arizona Workers Compensation Law to permit our judges to order a carrier to pay for medical marijuana. In the meantime, SCF Arizona has publicly announced its position on this issue and it will not cover the cost or reimburse injured workers for the use of medical marijuana. The impact of AMMA on our workers compensation system is yet to be determined, but with over 35,000 medical marijuana cards issued and a handful of dispensaries open for business, it will serve us all well to be aware of potential complications. The Arizona Department of Health Services has an excellent website for the Arizona Medical Marijuana Program. You can access it at medicalmarijuana/ For further information, please contact Rachel Brozina at , or via at: rachel@lesternortonlaw.com Page 3

4 Let the AWCCA Job Referral Line Work for YOU! You re a claim manager whose senior examiner just quit to compete in the new reality TV show The Voice of Workers Compensation. Or, you re a doctor whose office manager just resigned to put together an exploratory committee for her 2016 presidential campaign. How are you going to fill those positions? Simple: contact AWCCA s new Job Referral Coordinator Linda Barton to post your open positions on the AWCCA s Job Referral Line. Whether you re an employer looking for the perfect new hire, or an adjuster, private investigator or voc rehab consultant looking for a new employment opportunity in the work comp industry, AWCCA may be able to help. As a no-cost service to employers in the Arizona workers compensation community, companies looking to hire claims adjusters, supervisors, managers or support staff can post job openings on the AWCCA website. Additionally, individuals seeking positions as adjusters, supervisors, managers or support staff employees can post short professional bios on the AWCCA website. Further, the Job Referral Line can also be used by medical professionals, vocational rehabilitation companies, private investigators, IME or DME companies or any other insurance-related organization that has a job opening. And, industry professionals looking for employment in any insurance-related field can post their bios using the AWCCA s website*. The AWCCA offers an excellent, cost-free way to match up qualified employees with ANY job opportunities in the Arizona workers compensation industry. To post an job opening or an employment bio, or to learn more about the AWCCA s Job Referral Program, contact AWCCA Job Referral Coordinator Linda Barton via at barton_linda@msn.com. *Note: The AWCCA Job Referral Line is a service provided for individuals seeking employment with an organization in the Arizona workers compensation industry. It is not a forum for vendors to advertise their qualifications, goods or services. AWCCA reserves the right to screen, edit or reject all Job Referral Line submissions based on this criteria. AWCCA Mission Statement: The purpose and objectives of this association shall be to promote the general welfare of its members by developing close relationships among those engaged in the handling of workers compensation claims; to promote cooperation by mutual exchange of experiences and information and discussions thereon and, to educate its members. The Examiner is published quarterly by AWCCA, Inc., P.O. Box 44941, Phoenix AZ, All articles appearing in this publication contain the opinions of the authors and not necessarily the opinions of AWCCA, Inc., its officers or editors. AWCCA, Inc. encourages the submission of new ads and articles, subject to editing. Signed letters to the editor are welcome. AWCCA, Inc. seeks to provide a forum for the free exchange of ideas and opinions. Neither Snow, Nor Rain Yes--you can still contact AWCCA the old school way, via the U.S. Postal Service! All U.S. mail correspondence including checks, membership applications, hard copies of Letters to the Editor of The Examiner and other items addressed to the organization or its officers should be sent to: AWCCA, Inc. P.O. Box Phoenix, AZ Page 4

5 The National Conference of Insurance Legislators (NCOIL) agreed at its Spring Meeting to develop best practice strategies for states debating possible reforms to curb opiod abuse. NCOIL s move to develop guidelines instead of model legislation came after discussion at a special session in Washington D.C. NCOIL is a national organization of state legislators whose main public policy interests are insurance legislation and regulation. Most NCOIL legislators either State Legislators Across U.S. Reform in Dispensing of Opioids chair or are members of committees responsible for insurance legislation within their respective state legislatures. Arizona is a general member, but not a contributing member of NCOIL. According to NCOIL Workers Compensation Committee Chairman Representative Bill Botzow of Vermont, opioid abuse is a growing epidemic that reaches across state lines and may be impossible to address with any single approach. Because states are in different places in their efforts to address opioid abuse, the appropriate role for NCOIL is to lay out guidelines for states to consider as they develop their state-specific reforms. In light of legislative discussions at the special meeting, the proposed best practices will likely address a number of issues including prescribing practices, funding, drug monitoring program reforms, and data sharing. Draft guidelines will be considered at NCOIL s July 11 Summer Meeting in Philadelphia, Pennsylvania. ICA to Hold Fee Schedule Hearing The Industrial Commission of Arizona (ICA) will hold its 2013 Fee Schedule hearing on April 17, 2013 at 10:00 a.m. in the first floor auditorium of the ICA offices, located at 800 W. Washington Street in Phoenix. The Commissioners will listen to public comments in addition to considering a report prepared by Commission staff as a preliminary document created as a foundation for discussions during the hearing process. The document can be viewed online at: ica.state.az.us/director/dir_2013_ FS_preliminaries.aspx. Page 5

6 NCCI Study Analysis: Effects of an Aging Workforce By Shala Morley, Special for The Examiner The National Council on Compensation Insurance (NCCI), a U.S. insurance rating and data collection bureau specializing in workers compensation, recently conducted a study to address widespread industry concern over the impact of the baby boomer generation postponing retirement, thus aging the workforce and creating the potential for adverse impact on workers compensation loss costs. The study, which indeed confirms the labor force s share of older workers is increasing, analyzes frequency and severity across multiple age groups, identifies factors accounting for the differences in severity between each age group, and compares the combined effects of frequency and severity for each age group to determine costs per worker. Share of Older Workers Increasing Study data shows workers over 45 years old account for an increasing share of the U.S. workforce. This group, commonly referred to as baby boomers, was divided into two separate groups for data collection purposes. Cumulatively, the 45-and-older share increased from 34 percent of the workforce in 2000 to 42 percent in Separately, the share of workers 65 and older is growing but remains small, increasing from about 3 percent of the total workforce in 2000 to just fewer than 5 percent in 2010, while the 45- to 54-year-old group has continued to increase modestly. Notably, researchers conclude if the shares of older workers are increasing, the shares of younger workers must be decreasing. This is most evident for workers 35 to 44. Continued on page 7 Page 6

7 NCCI Study Analysis: continued from page 6 Frequency Across Different Age Groups NCCI researchers note two key findings from their frequency analysis. First, upon analyzing occurrence of injury of full-time (40 hours per week) workers from 1994 to 2009, a decline in frequency has occurred for all age groups; second, the marked differences among age groups in the early 1990s had largely disappeared by In 1994, the incidence rate for 20- to 24-year- olds was 300 per 10,000 full-time equivalent workers, while the rate for the 55- to 64-year-old group was 200 injuries per 10,000. In 2009, although reduced, those numbers were comparable at 97 and 93 injuries per 10,000, respectively. In terms of frequency relative to older workers, the injury rate for workers aged 55 to 64 was 16 percent lower than frequency for all workers in 1994, but 1 percent higher in These findings prompted researchers to conclude the differences in injury frequency among age groups clearly have narrowed. Researchers offer that one likely question is whether the narrowing in frequency of injury is due to a change in the types of jobs held by younger workers throughout the study period. That question was addressed by analyzing the days away from work across all age groups and occupations; all showed very similar results. Researchers concluded while the occupational mix may have changed among age groups, all jobs are much safer and do not affect frequency of injury. Continued on page 8 ACCELERATE YOUR RETURN TO WORK Accelerated Rehabilitation Centers 690 S. Cooper, Gilbert AZ, On-site FCEs Work hardening Return-to-work conditioning ASTYM Headache Program John F. Fierro, ATC, Facility Manager, Sports Performance Specialist PUTTING PATIENTS FIRST REHAB ( ) acceleratedrehab.com Page 7

8 Severity Across Age Groups The study analyzed both indemnity and medical severity. Key findings are as follows: Severity has been increasing over time for all age groups and typically is higher for the older age bracket. Relative differences in medical severity by age have continued, but have somewhat narrowed. Medical severity for the 55- to 64-year-old group was 25 percent above average in 1995 and 17 percent above average in 2008; meanwhile, medical severity for the 20- to 24-year-old group was 31 NCCI Study Analysis: continued from page 7 percent below average in 1995 and 23 percent below average in Overall, data shows that both indemnity and medical severity have exhibited steady increases over time, with severity for older claimants costing more. Medical costs were more than 50 percent higher for older workers. From 1996 to 2007, the average medical cost for claims severe enough to warrant temporary indemnity for 20- to 34-year-olds was $5,073; 45- to 64-year-olds averaged $7,649, a 51 percent difference. Differences in leading types of injuries are a major factor in differences in severity by age. Older workers tend to have more rotator cuff and knee injuries, while younger workers are most often treated for back and ankle sprains. On the indemnity side, higher wages are a key factor leading to higher claim costs for older workers; in terms of medical costs, more treatments per claim are a factor. Continued on page 9 Page 8

9 NCCI Study Analysis: continued from page 8 Combined Effects (Costs per Worker) When researchers took into account both frequency and severity data to determine costs per worker, the data showed that when differences in wages were accounted for, total cost differences by age shrink across the board. The overall conclusion of the study was that the baby boomer generation does not necessarily pose an adverse impact on the work comp industry, as all groups of workers aged 35 to 64 showed similar costs per worker. From a workers compensation perspective, the higher costs are offset by the higher premium due to higher wages of older workers. NCCI concludes, Overall, the findings can be viewed as reassuring, in that an aging workforce may have less negative impact on loss costs than originally thought. The complete report can be accessed at It s more than pain management It s about restoring your quality of life Scottsdale Tempe Glendale Gilbert Page 9

10 Red Flags in Back Pain When to Worry and What to Do By Issada Thongtrangan, M.D. Spine Specialist, Valley Orthopedics Most back pain is benign but some isn t. Five or six times a year, I treat a patient who s progressed from backache to paraplegia over a few months, via discitis or cancer or cord/cauda equina compression. My experience is not unique; these issues are recognized around the world and we will review some red flags which will help protect the patients from delayed treatment. INCIDENCE According to the U.S. Bureau of Labor Statistics, there were 4.2 million nonfatal occupational injuries and illnesses reported by private industries in Sprains and strains accounted for approximately 42 percent of injuries and illnesses requiring time away from work. The body part most often involved in these injuries was the trunk, and 63 percent of injuries to the trunk involved the spine. As many as 90 percent of persons with occupational nonspecific low back pain are able to return to work in a relatively short period of time; however some aren t and need more attention especially those who have red flags. As long as no red flags exist, the patient should be encouraged to remain as active as possible, minimize bed rest, use ice or heat compresses, take anti-inflammatory or analgesic medications if desired, participate in Continued on page 11 ARIZONA VOCATIONAL CONSULTING & FORENSIC SERVICES, INC. LOSS OF EARNING CAPACITY RECOMMENDATIONS LABOR MARKET RESEARCH JOB ANALYSES (DOI AND POST INJURY) VOCATIONAL REHABILITATION PLANS/COUNSELING SPANISH/ENGLISH INTERPRETING Phone: (623) Fax: (623) W Carefree Highway #1-150 Phoenix, AZ Website: Lisa A. Clapp, MA, CRC, CEA - Vocational Consultant /Certified Earnings Analyst Mirna Payan, CCMP, CPDM, WCCP - Senior Bilingual Employment Specialist Jennifer Carmody, MA, CRC -Vocational Consultant/Labor Market Consultant Paul L. Wilson, MA, CRC - Vocational Consultant/Labor Market Consultant Robert Tremp, MA, CRC, CLCP - Vocational Consultant/Certified Life Care Planner Page 10

11 Red flags in back pain continued from page 10 home exercises, and return to work as soon as possible. PATHOLOGY AND NATURAL HISTORY Imaging pathology is very common and usually false (positive), meaning that it s not indicative of a source of symptoms. Odds are 50/50 that a claimant who was lumbarasymptomatic before an on-the-job injury will have major degenerative abnormalities in any imaging study from x-rays to MRI, that don t hurt one bit. That s why we ve all been taught that acute spine imaging is useless and generally it is. That bone spur or degenerated disc or spondylolisthesis seen in an injured worker s x-ray was almost certainly there last week too, when the claimant felt fine! Even acute structural spine disease gets better in most cases by hand of God, and time. Acute sciatica from disc hernia resolves within weeks in percent of cases. Seventy percent of acute symptoms from spinal stenosis or spondylolisthesis resolve within a few months, and even insufficiency fractures heal 70 percent of the time to become asymptomatic within three to four months. COST Spine care is costly, but we know that a small minority (10 percent) of patients who have recurrent or chronic pain generate 90 percent of the cost. Most of these have nonspecific pain, usually major secondary gain motives, and a big behavioral component to their pain; and honestly most of the treatment applied here has been shown to be ineffective. The elite, Continued on page 13 Work Comp Specialist: Same day appointments for acute patients Complex fracture work Revision fracture surgery Post traumatic reconstruction Surgical orthopaedic care Prompt second opinions Same-day reports (includes physical therapy and work restrictions) Bilingual staff Extended visit times (each patient receives up to 40 minutes of scheduled appointment time) Please visit our website: sonoranorthotrauma.com Anthony S. Rhorer, MD Board Certified ABOS Director Orthopaedic Trauma, SHC Orthopaedic Trauma Surgeon 3126 N. Civic Center Plaza, Scottsdale, AZ fax Page 11

12 KEEP LIFE IN MOTION LIVE LIFE WITHOUT PAIN The Center for Orthopedic Research and Education, The CORE Institute, began practicing in 2005 to deliver comprehensive orthopedic care, one patient at a time. Our fellowship-trained physicians provide specialized care in the areas of surgical, non-surgical and rehabilitative hip, knee, shoulder, elbow and ankle procedures, joint replacement, sports medicine, arthroscopy, fracture management, orthopedic traumatology, hand and wrist procedures, complex articular cartilage restoration, musculoskeletal oncology, foot and ankle reconstruction, physical medicine and rehabilitation, comprehensive spine care and pain management. Whether it s for work or play, we understand that you want to get back to your life sooner. The CORE Institute team is dedicated to providing technologically advanced surgical techniques and rehabilitation in six locations in Arizona. With stateof-the-art research labs, less-invasive surgery, onsite MRI and physical therapy, we truly provide excellence in patient care. 24/7 APPOINTMENT SCHEDULING Patients now have the ability to schedule an appointment 24 hours a day, 7 days a week by simply contacting our office at the number below CENTRAL PHOENIX GILBERT MESA NORTH PHOENIX PEORIA SUN CITY WEST

13 Red flags in back pain continued from page 11 evidence-based healthcare flagship Cochrane Collaboration s metaanalysis website ( org) uniformly reports little longterm benefit from virtually all back care treatments with the probable exception of well-done cognitive behavioral therapy (CBT) which doesn t mean that every chronic back pain patient is a hypochondriac; it just means that many patients benefit from therapeutic assistance with understanding and coping mechanisms. So, most cases get better without intervention, but some don t. There are several very real structural spine pathologies that can benefit greatly from acute diagnosis and care. Things like discitis and metastatic lesions and chronic cauda equina syndrome are population-rare, but all too common in a referral spine practice like mine, and the history is almost always one of tragically delayed diagnosis and compromised outcomes including paraplegia and death from missed opportunities for early care. There are relatively few spine surgeons out there but many primary caregivers, so the burden of screening naturally falls on general and family practitioners, or in the case of the injured worker, it can fall on the urgent care physician. A lot can be achieved by remembering the usual profile of benign back pain, and also by knowing and recognizing some red flags for low back pain, which can be identified by asking just a few simple questions. Continued on page 14 Page 13

14 Red flags in back pain continued from page 13 THE PROFILE OF BENIGN BACK PAIN Benign chronic or recurrent back pain generally presents around the 40s, most often in the lumbar region of males who do heavy physical work and who have a history of work injuries or other trauma. The pain episodes are generally of stable or consistent intensity; it gets better with rest/lying down (it s mechanical ); there are no neurological or constitutional symptoms; and while there may be work and activities disability, there is almost never a locomotor disability. THE RED FLAGS So, one red flag is a history of onset at age either > 50 or < 20 years. A second is the absence of a trauma/ injuries history (i.e. the spontaneous onset of pain). The third red flag is pain located outside the low back region where cancers and fractures and infections are actually quite rare. A history of significant trauma should be a fourth red flag for fracture, but too often isn t. Any patient with a history of cancer (there s red flag number five) who presents with new-onset low back pain should be considered as metastatic until proven otherwise. And anybody with a history or high risk of immunosuppression identified AIDS or HIV, recreational needle drug users, taking steroids or immunosuppressants has a discitis until proven otherwise (that s red flag number six). Another red flag frequently missed (number seven) is history of neurological symptoms, like numbness/tingling or claudication (i.e. I can only walk a short distance or time before my back pain forces me to stop ). Physicians shouldn t depend on concrete neurological findings on physical exam such symptoms are often delayed and by then, it s often too late. The history is enough to alert an examining physician, but he or she must ask for it. Incredibly, just about every year I see a patient who gets to the point where they re crawling around the house on hands and knees from pain, but because they don t have a weak ankle or numb toe, they don t get referred. Constitutionality is red flag number eight the backache patient who is losing weight or having fevers should be taken very seriously indeed. Night pain is less of a concern. We used to think that pain at night was a red flag but it s been conclusively shown that s not so. Pain that isn t mechanical, that persists even when lying down, can be red flag number nine. The final red flag, number ten, is a history of rapidly escalating pain. These patients with chronic benign Continued on page 15 ARIZONA ORTHOPEDIC SURGICAL ASSOCIATES AOSA A Divison of OSNA, PLLC Shoulder & Knee Surgery Total Joint Replacement Arthroscopic Surgery Trauma & Fracture Care Phone Fax Steven R. Kassman, M.D. Diplomate American Board of Orthopedic Surgery N. 51st Ave., Bldg. 4 Suite 124 Glendale, Arizona (NE corner of 51st Ave. & Beardsley/101) 1840 W. Maryland Ave. #C Phoenix, Arizona Page 14

15 Red flags in back pain continued from page 14 back pain often have a slowly escalating analgesic requirement as their livers respond to the stress challenge of metabolizing their prescribed drugs and they become habituated. But that evolves over months and years. When injured workers need more and more drugs daily or weekly, there s often something very bad going on. WHAT TREATING DOCTORS SHOULD ASK: A screening can be done in just a few seconds. How old are you? (1st red flag) Where s the pain? (3rd) How did it start, with no injury (2nd) or serious trauma? (4th) Any history of cancer (5th), immune suppression or recreational drug use? (6th) Neurological symptoms? (7th) Fever or weight loss? (8th) Does it get better when you lie down, or not? (9th) Is it pretty stable in intensity or is it worse than it was last week? (10th) WHAT IF SCREENING IS POSITIVE? As long as no red flags exist, an injured worker should be encouraged to remain as active as possible, Continued on page North Central Avenue, Suite 1200 Phoenix, Arizona Phone: FAX: CorVel Provides The Following Services Enterprise Comp is CorVel s Workers Compensation solution. Services include Claims Administration and Managed Care Services leveraging CorVel s rules- based technology and multiple range of services: FNOL Claim Management PPO Patient Triaging Bill Review Document Management Pharmacy Program CorCase Patient Management Services On- site, Field Case Management and Telephonic Case Management Vocational Rehabilitation Nurse Liability Claim Reviews CorVel s PPO Network Exclusive access to Arizona s Blue Cross Blue Shield Network Access to a national network of more than 500,000 providers MedCheck Medical Bill Review Services Fee Schedule, Usual & Customary Bill Review for Workers Compensation, Auto, Liability, and Group Programs PPO Discounting/Re- pricing Utilization Review Services Check Writing Services Extensive and transparent reporting capabilities CareIQ IME Program Board Certified Physicians Wide Range of Medical Specialties Peer Reviews Record Reviews Discounted IME Rates CareIQ Ancillary Services Discounted Durable Medical Equipment Imaging Services Transportation Translation Page 15

16 Red flags in back pain continued from page 15 minimize bed rest, use ice or heat compresses, take anti-inflammatory or analgesic medications if desired, participate in home exercises, and return to work as soon as possible. Patients whose answers raise red flags should be referred immediately to a qualified spine surgeon and/or appropriate subspecialties. However, some of the red flags might indicate a pre-existing condition and not a work-related injury. By understanding this we can channel the patients to the right doctor very quickly with less confusion in regard to work-related injury vs. pre-existing injury CONCLUSION Keep all these red flags in mind because all injured workers with back pain are not the same. We should identify these red flags and refer as indicated to prevent a disastrous consequence. Some of the red flags indicate work-related injury but some don t. This is very important to differentiate industrial-injuryrelated conditions from pre-existing conditions. Be sure the physicians you re relying upon pay attention to detail. For information on how to contact Dr. Thongtrangan, go to: www. arizonaspinedoctor.com or www. valleyorthoaz.com Post-acute Care and Rehabilitation Options for Every Stage of Recovery Comprehensive treatment and support for people of all ages with brain, spinal cord and other life-altering injuries and medically-complex illnesses Phoenix Scottsdale 5301 E. Thomas Road Phoenix, AZ 6512 E. Ludlow Drive Scottsdale, AZ CareMeridian s 31-bed facility in Phoenix offers a 1:4 staff-to-patient ration and individual care plans to support individuals with brain and spinal cord injuries, as well as medically and orthopedically complex needs. CareMeridian Phoenix has received accreditation from the Joint Commission on Accreditation of Healthcare. For more information, contact Karen Christiana, LPN, Regional Director of Business Development, CareMeridian.com CareMeridian Scottsdale provides supported living services to participants who have been discharged from a hospital or other more intensive facility with a brain or spinal cord injury, but still face challenges as they work towards increased independence and community integration. CareMeridian Scottsdale is now accredited by CARF, the Commission on Accreditation of Rehabilitation Facilities. Page 16