Soft Tissue Injury and the Ageing Workforce Is it Work-related? Dr Tom Lieng November 2010
Topics to cover What is an injury? What is STI? Work-related injury-expected outcome WorkCover NSW data Issues relating to age When is an aggravation considered work-related? Problems of current system Possible solutions?
The Injured Worker
What is an injury? WorkCover version: Injuries resulting from incidents, and all occupational diseases contracted or aggravated out of or in the course of a worker s employment. Certificate version: if the employment is a substantial contributing factor Internet search of work-related injury : not considered an injury if the injury would have developed at the time irrespective of work.
Classification of Employment Injuries Employment injuries is all injuries reported to NSW WorkCover. Consists of 3 categories: 1. Occupational diseases (21%) 2. Workplace injuries (70.3%) - RTA at work 1.8%, during work 85.5%, during work break (12.4%) 3. Other work-related injuries (8.7%)-away from work during recess period 6.1%, commuting accidents 93.9%
Expected outcome Priority one: to return to work with same employer/same duties (PID) Priority two: to return to work on alternative duties/same employer Priority three: to return to work on alternative duties/ different employer
The Treating Doctor
Workplace manual handling injuries 16,000 14,000 12,000 10,000 8,000 Series1 6,000 4,000 2,000 0 2001-2 2002-3 2003-4 2004-5 2005-6 2006-7 2007-8 2008-9
Injury cost in NSW $1,000,000 $900,000 $800,000 $700,000 $600,000 $500,000 Series1 $400,000 $300,000 $200,000 $100,000 $- 2001-2 2002-3 2003-4 2004-5 2005-6 2006-7 2007-8 2008-9
Average Time Lost 10000 9000 8000 7000 6000 5000 Series1 4000 3000 2000 1000 0 <1week 1-2 weeks 2-4 weeks 4-26 weeks >26weeks
Injury rate/million hours worked 14 12 10 8 6 4 Series1 2 0
Type of injuries in manufacturing sector Chart Title contusion with intact skin 9% burns 3% others 8% fractures 10% strains & sprains 52% Open wound, not traumatic amputation 18%
Type of injuries in manufacturing sector 900 800 700 600 500 400 300 Series1 200 100 0
The Employer
Soft tissue injuries and age
Pre-existing condition A pre-existing condition is a condition that has developed prior to the injury. It makes the person susceptible to the injury. Pre-existing condition could be aggravated by work. Any aggravation by work is considered work-related injury and is therefore compensable. Impossible to separate pre-existing from aggravation. Arthritis is a degenerative condition that develops in the 4 th decade of life. A pre-existing condition will at some point of time become symptomatic.
What is an aggravation at work? An aggravation can be an injury at work that has caused the pre-existing condition to deteriorate. OR The strenuous or repetitive nature of the employment aggravated the condition through the course of the employment causing further deterioration of the condition. It is often determined by a legal process based on a medical opinion by a medical specialist and NTD. There is no scientific method to determine whether the pain is due to an injury or a natural ageing process. Even if it is determined that it is an ageing process, often the claim is decided because there would have been an aggravation of the process.
When is an aggravation considered NOT work-related? If it is believed that such aggravation to the pre-existing condition would have occurred at the same time regardless of the employment. When an aggravation has ceased. Again, there is no scientific method to determine whether it may have occurred at that time regardless of employment.
Age vs workplace injuries/ million hrs worked 8 7 6 5 4 Series1 3 2 1 0 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+
Age and frequency of occ. diseases/million hours worked 6 5 4 3 Series1 2 1 0 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+
Age and Av. time lost/wk 12 10 8 6 Series1 4 2 0 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+
Cost per claim average & median 25000 20000 15000 10000 Series1 Series2 5000 0 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+
Age and permanent disability 700 600 500 400 Series1 300 200 100 0 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+
Payment cost 500000 450000 400000 350000 300000 250000 200000 150000 100000 Series1 50000 0
The Injury Lawyer
Treatment obligation WorkCover will treat the aggravation to when it is considered that the aggravation has ceased clinically Problem: Age-related wear and tear is a chronic condition that PROGRESSES with time. It is not static by nature so the person will NEVER be the same again.
Problems Chronic degenerative condition progresses with time irrespective of injury. Immobility and de-conditioning causes further impairment in function and increase in pain. Stress from impairment and disability causes more pain to be experienced. Most aggravations of pre-existing injury do not recover to its pre-injury state. Not possible. Liability becomes unlimited leading to medical retirement under WorkCover. Lawyers defining medical outcome rather than doctors. Treating doctors obliged to help his/her patient, rather than the employer.
The Insurer
Solutions?
Solution 1 IW needs to be realistic of expectation. IW needs to be informed of their physical limitation with age and be aware of a realistic medical outcome when injured. Wanting to be like new again is ideal but is not medically possible whether the reduced functional capacity is clinically noticeable or not.
Solution 2 Discourage legal involvement before final certificate. Legal involvement has no role in managing a recovering injury. Obvious conflict of interest when lawyers informed IW that they will be financially compromised if they return to work.
Solution 3 Legislative changes to limit aggravation. Legal interpretation of injuries has overtaken medical opinion. Often aggravation is minor and should not be considered a substantial contributing factor. Examples: CTS, rotator cuff, tennis elbow, back pain, MRI and disc pathology
Solution 4 NSW WorkCover needs to be realistic of medical outcome similar to the IW. Are they aware of their own statistic data collected over the last decade? If they are then can they doing anything about it?
Solution 5 NSW WorkCover needs to recognise the trend and acknowledge that a large proportion of claims are not work-related. NSW WorkCover needs to index injury rate and recovery rate with age according to statistics collected. Needs to reconsider legislative changes to reasonably quantify an aggravation before considered it an injury.
Solution 6 Avoid family doctor treating their own patient. The family doctor is clinically biased. The family doctor is medico-legally unaware of the legislative definition of an injury. The family doctor s priority is not employers and insurance companies. An average GP earns 3% of income from WorkCover.
Solution 7 Proper peer review on medical opinions. Legislation should allow for the AMS to have a more authoritative power to decide whether a condition is an injury or not. AMS should have better screening process currently there is a varied standard and opinion. Legislation to push unreasonable GPs and specialist off the system. If IW not better then treating team should be dismissed.
Thank you for listening!