Repetitive stress injuries are the most common and costly occupational health problem in the United States, affecting hundreds of thousands of workers and costing more than $20 billion a year in workers' compensation costs.
Repetitive Stress Injury (RSI) is defined as an injury that occurs as a result of over or improper use. Nearly two-thirds of all occupational illnesses reported were caused by exposure to repeated trauma to a worker's upper body, namely the wrist, elbow or shoulder, according to the U.S. Bureau of Labor Statistics. These statistics are highly alarming for those in the food service industry. Repetitive motions in the kitchen such as chopping, dicing vegetables or sautéing multiple pans on the burners may cause damage to tendons. The swelling of the tendons may result in added pressure on the median nerve and produce Carpal Tunnel, a condition that can lead to muscle damage in the hand and fingers. Wait staff carrying heavy trays on a daily basis can also suffer from repetitive stress injuries, making this a risky claim situation for the employer.
Cumulative trauma injuries and occupational injuries that develop over time are eligible for workers' compensation in every state, even if the injury cannot be tied to a single event. Only five states have limitations as to when or how workers' compensation benefits can be claimed for RSI.
This widespread acceptance of RSI claims is becoming traumatic in and of itself for employers. Some state statutes, such as California Labor Code Section 5412, do not clearly define a timeframe to hold an injured worker accountable for reporting an injury. Given the difficulty involved in diagnosing and treating cumulative trauma disorders, causation plays an important factor in determining if the injury arose from the course and scope of employment. This is why AEO/COE (Arising out of Employment /Course of Employment) investigations are crucial.
CMS Requirements Increase Exposure
To make matters worse, the new Centers for Medicare & Medicaid Services (CMS) requirements designed to protect Medicare from future medical expenses for workers' compensation and general liability claims further increases an employer's exposure.
CMS has the ability to look back, identify workers' compensation-related medical care payments made by Medicare, and seek repayment from the insured or the employer. This creates a situation where the employer could pay the future medical cost twice; once to the claimant at settlement and later when Medicare seeks reimbursement for the medical care they paid on behalf of the claimant (known as the cumulative effect).
So, how can you protect your company? The “magic bullet” would be to “age” the injury and determine if it arose out of the course and scope of employment.
One of the few tools proven effective is the Electrodiagnostic Function Assessment – Soft Tissue Management Program (EFA-STM). The EFA-STM is specifically designed for an employer's current workforce as well as new hires and complies with all Americans with Disabilities Act Amendments Act (ADAAA) and Equal Employment Opportunity Commission (EEOC) regulations.
How the EFA WorksIt begins with a baseline assessment that is stored in a secure database. When a work-related injury is reported, a post-injury assessment is performed, at which time the information collected from the baseline assessment is compared to the data from the post-injury assessment. The baseline data is read only if an injury occurs and the post-loss assessment is performed. This ensures employers are protected against claims of discrimination as well as disability.
If there is no change from the baseline, then the claim does not proceed. If there is a change, then only the portion that is related to the occupational injury is accepted and treated.
By establishing an objective, baseline snapshot of an employee's condition prior to the report of an injury, an employer's true liability for a claim is established and responsibility for pre-existing conditions is eliminated.
The value proposition for the EFA-STM program is significant and will positively impact current direct and indirect costs, as well as potential future costs created by CMS Mandatory Reporting. The EFA is the only device of its kind that has stood up to court challenges.*
For more information on the EFA Soft Tissue Management (STM) program, please talk to your Risk Services consultant or visit www.emergedx.com.
Robert Fiorito, serves as Vice President, Hub International Northeast., where he specializes in providing insurance brokerage services to the restaurant industry. As a 20-year veteran and former restaurateur himself, Bob has worked with a wide array of restaurant and food service businesses, ranging from fast-food chains to upscale, “white tablecloth” dining establishments. For more information, please visit www.hubfiorito.com
Robert Fiorito, serves as Vice President, Hub International Northeast, where he specializes in providing insurance brokerage services to the restaurant industry. As a 20-year veteran and former restaurateur himself, Bob has worked with a wide array of restaurant and food service businesses, ranging from fast-food chains to upscale, “white tablecloth” dining establishments. For more information, please visit www.hubfiorito.com