Category: Medical Conditions (Page 17 of 19)

As an L&I attorney representing injured workers, I see all kinds of work injuries and specific problems that arise. That includes L&I claims for head injury and L&I claim issues for traumatic brain injuries (TBI). Workers compensation clients suffering from head injury or brain injury can be very difficult to work with. But often, they are also the ones that need my help the most.

 

What is a traumatic brain injury?

The CDC defines TBI as “a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury“. The CDC reports that everyone is at risk for TBI. However, children and the elderly are particularly vulnerable. TBI is considered a serious public health concern resulting in death and disability for thousands yearly. Not all bumps, blows, or jolts to the head result in a TBI. However, if a TBI does occur it can vary in severity from mild to severe.

 

Mild TBI cases, often referred to as a simple concussion, usually resolve fairly quickly. More severe cases may involve extended periods of unconsciousness or amnesia following the injury. According to the CDC, TBI symptoms may affect a person’s ability to think, ability to remember, and their physical well-being. Furthermore, it can also affect one’s emotions, mood and sleep. Some symptoms may appear quickly. Others may take days or even months to appear.

 

L&I claim for head injuries or brain injury

An L&I claim for TBI or head injury can be a very challenging case. In fact, as an L&I attorney, these cases are probably the most challenging ones I handle. This is due to a variety of things:

(1) The symptoms are largely subjective – There isn’t much objective medical evidence available to support the extent of the injury.

(2) Head injuries are often accompanied by physical injuries impacting other parts of the body. Those other injuries often take priority, and the head injury is overlooked.

(3) Significant efforts are being made to research and understand head injuries, especially related to professional athletes. However, in L&I claims and workers’ compensation setting there seem to be significant medical delays in TBI diagnosis and treatment.

(4) Fourth, it seems to me that there is an institutional resistance within the L&I claim administration system to accepting and authorizing necessary and proper treatment for TBI.

(5) Finally, due to the nature of the injury itself, clients who have suffered TBI are often difficult to work with.

 

Subjectivity in L&I claims for head or brain injury

In the L&I workers’ compensation system, if the work injury claimant makes statements or complaints to a medical provider, then those statements are considered subjective. On the other hand, objective findings of disability are those that a medical provider can see, feel or measure. It is widely acknowledged that mental health conditions such as depression and anxiety lack objectivity. Most other injuries in the L&I claim system require objective evidence to substantiate the extent of disability. Head injuries and TBI are complicated because it is a physical injury, but the extent can’t be seen, felt, or measured.

 

Usually, a TBI diagnosis is based on the worker’s description of how the injury occurred and their subjective symptom complaints. Common symptom complaints that I see all the time include difficulty thinking clearly, headaches, blurred vision, irritability, and sadness. Other symptoms include excessive sleeping, difficulty sleeping, noise sensitivity, concentration problems, problems remembering, lack of energy, nervousness, anxiety, and dizziness. Doctors simply cannot objectively verify these symptom complaints. Especially when the onset may be days or months following the injury.

 

Lack of Priority for L&I claims for TBI

TBI generally occurs from a blow to the head, or a jolt or a bump. Consequently, it is not uncommon for other physical injuries to occur in addition to the head injury. For example, someone may have fallen from a ladder breaking their arm and hitting their head. In most cases, the initial medical treatment is so focused on the arm injury that the head injury is ignored or overlooked. If the worker was working alone, they may not recall whether they lost consciousness. In fact, they may have significant difficulty recalling the details of the injury entirely.

 

According to the CDC, TBI symptoms are challenging to sort out. It is not uncommon for symptoms to be overlooked by the person injured, their family, friends, and even doctors. I have seen many severe TBI diagnosis made long after the original work injury. In my experience, this creates difficulty for getting the condition accepted under the claim.

 

L&I claim for head injury often result in medical delays

From my experience as an L&I attorney, it seems that many of the providers within the Department’s Medical Provider Network (MPN) overlook the importance of making an early and accurate TBI diagnosis. There seems to be a lack of urgency in making appropriate referrals for TBI diagnosis and treatment.

 

For example, I have seen cases where a blow to the head has been reported as the primary injury and wasn’t referred for MRI for more than a year. I’ve also seen work injury victims discharged from medical care and released to return to work without restriction, based on resolution of their other physical injuries, despite having numerous ongoing symptoms consistent with TBI. Unsurprisingly, the lack of attentive medical care leaves work injury claimants, who are already struggling with the symptoms of their TBI, feeling scared, hopeless, and angry.

 

Institutional Resistance within the Department of Labor and Industries (L&I)

From my perspective, L&I claim administrators tend to view the conditions causally related to an injury very narrowly. Generally, the administrator accepts the initial diagnosis on the accident report. It can be very difficult to add another condition to the claim later.

 

In some head injury and TBI cases, the initial diagnosis may include “concussion”. However, it is not uncommon for the head injury not to be reported at all on the initial paperwork. If the person suffering a work injury develops symptoms, or if the TBI diagnoses appears sometime later, then adding the condition to the L&I claim is often met with administrative resistance.

 

L&I attorney dealing with TBI work injury clients

As I’ve already noted, there are many symptoms for TBI. Side effects such as difficulty thinking clearly, irritability, sadness, and concentration problems, can be very challenging. Other issues such as problems remembering, nervousness, and anxiety, don’t make things easier. Add these kinds of symptoms to the normal stress of a workplace injury including financial instability and recovery uncertainty – clients who have suffered a TBI are often challenging to represent.

 

In my experience, they have good days and bad days. They aren’t always good at recalling past conversations, keeping appointments, or following through with requests. But I am always reminded that these are the people that need me the most. And I never discount this fact. On the positive side, our office has vast experience representing injured workers who have suffered a TBI. Because we understand the symptoms and their impact on our clients, we always do our best to help those clients understand the current status, difficulties, and needs of their claim.

 

L&I attorney and TBI workers compensation claims – additional resources

Remember, just because TBI claims are difficult does not mean they are impossible. The good news is that TBI is a condition that’s undergoing significant research by the medical community, professional athletic organizations, and the CDC. Every year it seems that new developments are made, to better understand the diagnosis and treatment. In fact, the CDC has several resources available related to TBI. One of those resources is the “Acute Concussion Evaluation” or ACE forms available for medical providers. The CDC also has a program called “HEADS UP” designed to help parents, sports and school coaches, as well as health care providers minimize and respond to the risk of TBI.

 

If you suspect that you, a friend, or family member sustained a TBI in a workplace injury, I would encourage you to review the helpful Brain Injury Basics information on the CDC website. If a TBI is complicating your workers’ compensation claim, don’t delay in consulting with an experienced L&I attorney who can help you understand your rights and determine if you need representation. You must ensure you receive appropriate benefits in such a challenging claim and difficult times.

Back or spinal injuries and illnesses are probably the most common conditions I see as an L&I attorney representing workers. There are many L&I claim occurrences for back injury. I thought it’ll be helpful to share some basic information about the topic. However, I am not a doctor and nothing in this post is a medical advice. Simply put, my goal is to help work injury claimants understand some of the terms and issues that may arise.

 

Back injury in workers’ compensation claims

The spine has roughly three regions:
(1) The cervical or neck region, which includes the cervical vertebra C1-C7;
(2) Thoracic or mid-back region where the T1-T12 vertebra are located;
(3) The lumbar area (L1-L5) and sacral back area (S1 through S5), which we also call the low back region.
In my experience, the most common region where work injuries and illnesses occur is the low back. The second most common is the neck. Mid-back injuries and illnesses do occur, but they are much less frequent.

There are two types of L&I claims when it comes to a back injury. One is an Industrial Injury Claim and the other is Occupational Disease Claim. An industrial injury is a sudden and tangible event. Often, back injuries at work involve lifting. Or, a combination or lifting and twisting with the sudden onset of pain or other symptoms. In contrast, occupational diseases are illnesses that develop as a result of the “distinctive conditions of employment”. Usually, they develop over time and it can be difficult to determine if work activities are a contributing cause.

 

Back injury treatment under an L&I claim

People who injure their backs at work usually receive conservative treatment in the beginning. This means resting while taking over-the-counter medication to control pain and inflammation. Normally, that’s all that is needed to recover from a basic sprain or strain, or soft-tissue type of injury. In these cases, symptoms can improve within days or weeks after the injury. If symptoms don’t improve, there may be a need for additional treatment. That includes diagnostic imaging such as X-ray, cat scan (CT), or MRI. In some cases, physical therapy and massage therapy can help as well.

 

 

More severe injuries involving acute spinal fractures, injuries to spinal discs, and injuries impacting nerves require more invasive treatment. Our office represents many injured workers with significant back injury or illness diagnoses. Among others, we regularly see conditions such as spondylosis, spondylolisthesis, radiculopathy, and nerve impingement. We sometimes also encounter instability, disc bulge, disc herniation, stenosis, degenerative disc disease, and even thoracic outlet syndrome. The most common treatments for many of these severe cases are back injection and surgery.

 

Proving causation in L&I claim for back injury

From a legal standpoint, our experience shows that the more severe the back injury, the more challenging causation becomes. In fact, proving causation can be very difficult. That’s because all of us experience “degenerative” changes in our back and spine as we age. Some people call it arthritis and others call it degenerative changes. Furthermore, not all people experience the same symptoms from spine injuries, arthritis, or degeneration.

To complicate things even further, there is also a pretty lengthy medical study of spine disease with the title “Twin Spine Study”. The study concludes that genetics is the most significant factor impacting back or spine health. Because of this, more severe aspects of back injuries or illnesses in workers’ compensation are often attributed to genetics or aging and not the injury or work exposure.

 

Conclusion

So, what’s the takeaway? Many people are working a physical job that impacts the back or the spine. If you are one, then take a few extra steps of caution. Try to minimize the likelihood of back injury. Wear protective gear when you can and if applicable. See a chiropractor on a regular basis to help with spine movement. Exercise your core and back muscles regularly to help ease the impact on your spine. And, if you are hurt on the job, go see a doctor immediately. Have them file an L&I claim for back injury. But most importantly – be safe out there!

If you recall, back in May I posted about an ongoing workers’ compensation case at the Washington State Supreme Court. Namely, Weaver vs City of Everett. The case is about a firefighter that has Melanoma. On October 17, the Court issued its decision affirming the Court of Appeals. In short, the Court declined to apply the common law principles of res judicata and collateral estoppel to preclude Mr. Weaver from seeking permanent totally disability benefits when he previously filed a claim seeking temporary total disability benefits. However, L&I rejected that previous claim.

 

Supreme Court upholds the rights of injured workers in Washington State

Clearly, the Supreme Court has the commitment to uphold the intent and purpose behind of Industrial Insurance Act. That is, to protect and provide benefits for injured workers. Often referred to as “boilerplate” language, in its decision the Court referenced case law I reference all the time. “[T]he guiding principle in construing provisions of the Industrial Insurance Act is that the Act is… to be liberally construed… with doubts resolved in favor of the worker.” Dennis v. Dep’t of Labor & Indus., 109 Wn.2d 467, 470, 745 P.2d 1295 (1987). LET THAT SINK IN. In fact, the Court referenced it TWICE in the Weaver decision, at page 6 and again at page 13!

 

RCW 51.32.185(10(a)(3) states that for firefighters, there is a presumption that certain conditions are occupational diseases. Melanoma is one of those firefighter conditions. Mr. Weaver was a firefighter. He has melanoma. Mr. Weaver’s melanoma is a death sentence. As near as I can tell, there’s no dispute that his melanoma is a result of his fire fighting occupation. Therefore, the Court declined to apply collateral estoppel. Doing so to preclude Mr. Weaver’s claim would serve an injustice and would be contrary to public policy.

 

Firefighter’s melanoma – Legal arguments, common law and implications

The Court also declined to apply res judicata. That’s because Mr. Weaver couldn’t have made a claim for permanent total disability in the prior litigation. In essence, the Court acknowledged the Department of Labor and Industries (L&I) and Employer’s argument that the “threshold question of whether he had an occupational disease” was part of the decision for purposes of that claim. They argued that the prior claim rejection also precludes future claims flowing from the same ailment (melanoma).

 

Also, the Court made another interesting statement. While it might be true in theory, the Industrial Insurance Act does not use the term “claim allowance”. The Court concluded that the subject matters of Weaver’s two claims are distinct. His “permanent disability claim did not exist and could not have been brought at the time of his temporary disability claim”. Hence, his prior claim and current claim do not share the identical subject matter. Consequently, the Court held that res judicata does not apply.

 

Firefighter and melanoma – The court’s decision

I’ve read this new decision multiple times since last week. Every time I read it I notice something new. Interestingly, it is a nuanced and complex decision. On top, I suspect it is going to take some time for the workers’ compensation legal community to figure out it’s full impact. However, one thing is certain: It is a victory for Mr. Weaver and his family. The Washington State Supreme Court adopted language from the Appellate Court decision in ruling that Mr. Weaver’s claim would not be precluded by collateral estoppel or res judicata, because

 

“Applying either doctrine here would be an apples-to-oranges application of common law principles to statutory claims, which would result in a “distasteful fruit salad of injustice.”.