Tara Reck, Managing L&I Attorney at Reck Law PLLC - Workers' Compensation Attorneys

Category: Medical Conditions (Page 19 of 19)

Complex Regional Pain Syndrome (CRPS) in L&I Workers’ Compensation Claims

In workers’ compensation we see all kinds of work injuries and occupational diseases resulting in various medical diagnoses. These things are never easy, no matter what the diagnosis. However, some conditions seem to have a straighter claim path than others. Complex Regional Pain Syndrome (CRPS), for one, is a diagnosis that often leads to an irregular and challenging claim path.

 

L&I treatment guideline for CRPS

It seems that CRPS is a somewhat controversial diagnosis. The medical community is still working to better understand the condition. However, L&I does recognize CRPS as a medical diagnosis and has a treatment guideline for it. According to L&I, there are two sub-types of CRPS. Type I is what used to be called RSD, while type II used to be called Causalgia. The central difference between CRPS type I and type II is that type II occurs following a known peripheral nerve injury. On the other hand, type I occurs in the absence of any known nerve injury.

 

CRPS is a relatively uncommon condition. Also, it is not necessarily the right diagnosis for individuals with widespread pain in an extremity. Typically, true CRPS develops within 2 months of an injury in a single extremity. Symptoms include burning pain and severe pain caused by something that is typically not painful (such as a breeze or very light touch). Other symptoms are swelling, irregular or asymmetrical temperature and color of the limb, irregular or asymmetrical sweating of the limb, and skin, nail and hair changes in the impacted limb. While not required, a three-phase bone scan with a characteristic pattern of abnormality can help confirm the diagnosis.

 

Challenges with Complex Regional Pain Syndrome

One of the reasons I think CRPS becomes so challenging in workers’ compensation is because it is best treated early. Unfortunately, there are often many administrative claim related hurdles to be crossed before the condition is accepted. Consequently, early detection and treatment might not occur. CRPS is difficult because it produces extreme pain.

 

It makes it difficult for those who suffered a work injury to use the impacted limb. However, inactivity only worsens the condition. Therefore, studies have shown that early mobilization of a limb following an injury or surgery can help prevent CRPS. Yet, if symptoms do occur, the most effective treatment is early pain control and mobilization or restoring physical function. According to L&I, individuals with CRPS “must commit themselves to physical restoration on a 24-hour per day basis”. This is not an easy feat to accomplish.

 

L&I has divided treatment into six-week phases and will authorize a maximum of three phases. The first phase should include up to 5 sympathetic blocks to help control pain. The second phase should include up to 3 sympathetic blocks to help control pain. An additional 3 blocks may be authorized in the third phase as well. In addition to pain control through sympathetic blocks, the treatment phases should also include therapy and other pain control. The goal of therapy is physical restoration of function. The pain control is so that the injured worker can participate in therapy more fully.

 

Conclusions

In my experience the Department prefers for CRPS treatment phases to be carried out through a SIMP program (i.e., Structured Intensive Multidisciplinary Program). However, there are a limited number of SIMP programs throughout the State. It is not always practical for an injured worker to travel to a SIMP program for up to 18 weeks of treatment. In these cases, it can be quite difficult to coordinate treatment recommendations and authorizations efficiently.

 

I believe that L&I is actively trying to improve this process. I can attest firsthand to the fact that the Medical Director’s office often becomes very involved in CRPS. The goal seems to be to help treatment providers stay on track in moving these claims forward and reducing the long term disabling effects of the condition. However, the fact remains that claims involving CRPS are often irregular and challenging. More information about CRPS and the L&I Medical Treatment Guidelines can be found on the L&I website.

Work Injuries in the Hospitality Industry

Nearly one million people are employed as maids and housekeepers at hotels, motor hotels, resort hotels and motels, according to the National Institute for Occupational Safety and Health (NIOSH) and the Bureau of Labor Statistics (BLS). Approximately 89% of housekeepers are female and self-identify with an ethnic minority group. About 44% are Hispanic or Latina and 22% are another minority.

 

Context and background

As part of their daily work routines, these individuals make beds, restock linens, dust, vacuum and perform a multitude of other cleaning activities in guest rooms and throughout the facility. Very high proportions (77-91%) of housekeepers self-report experiencing pain in areas including the low back, upper back, and shoulders, which they attribute to work activities. In fact, in 2010, housekeepers had the highest reporting rate of all workers for overall injuries resulting in significant annual claims costs.

 

Medical conditions

According to the National Occupational Research Agenda (NORA) workplace hazards for maids and housekeepers may include: musculoskeletal disorders from bending, pushing carts and making beds; traumatic injuries from slips, trips and falls; respiratory illnesses from cleaning products that contain substances such as irritants and bleaches; skin reactions from detergents and latex; and infectious diseases from agents such as biological wasted and bloodborne pathogens found on broken glass and uncapped needles.

 

On its Hotel-Motel Industry Safety & Health – Custodial Housekeeping and Janitorial Cleaning page, the Washington State Department of Labor and Industries (L&I) recognizes similar hazard exposures including: awkward postures and lifting, chemicals, slops and trips, and sprains and strains. L&I also has several informational videos regarding the known dangers and hazards in the housekeeping industry. This includes a training video that addresses a number of topics such as safety and cleaning procedures, back injury prevention and chemical safety.

 

Summary

Workers in this injury laden industry are often minorities (as noted above) and are often paid minimum wages. It is also a difficult job to modify to light duty and many of the workers in this profession don’t possess education or skills for other less strenuous work. Therefore, when disabling injuries occur, these workers often face devastating circumstances due to their inability to work. Likely due to the industry wide costs associated with administering these claims, workers in this industry (especially those working for larger chains) also tend to face aggressive claim management from third party administrators. As a result, it is not uncommon for workers in this industry to seek legal guidance and representation, even when they realistically cannot afford the associated attorneys’ fees.

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