Yesterday we covered how the patient’s work history is important to know who to bill for the surgery when the underlying condition is not caused by a single event. Of course who to bill is preceded by the issue of causation and what caused the your medical condition to be aggravated, lit-up or accelerated in cases of cumulative trauma.

Doctor you are killing my workers compensation claim, February 2013

To put the point I made yesterday in perspective you need to consider how slow developing conditions the lawyers refer to as cumulative traumas, can be related to what you do at work. To do that everyone needs to know more about the physical activity you do for work. That’s important because the cumulative trauma is one that happens slowly over time where the body wears down, breaks down till finally the medical condition manifests itself. Cumulative conditions are things like carpal tunnel syndrome, arthritic hips, knees and shoulders, rotator cuff tears and of course spinal stenosis. Single event injuries are along the line of falling down and breaking your leg or when lifting an 80# sack of salt a disc suddently ruptures and pain shoots down your leg making further work that day impracticable. Those cases are the easy ones, cumulative trauma cases, not so much. So today I’ll tell you the things to do to protect your income when you have a condition suspected to be caused by cumulative trauma and you are heading off to see the doctor.

First, when the doctor takes your medical history listen to the questions as you answer them and ask yourself if the doctor is asking enough questions about whether or not the condition may be related to your work. Do the questions indicate the doctor is considering work relatedness? Keep in mind we are not here to blame the doctor only to work with them. Doctors and lawyers are busy just trying to get through the day assisting as many people as they can. 

Second do the questions indicate consideration of aggravation, acceleration and the condition being lit-up by the work?

Third, are there questions being asked about how hard the work is and if it’s repetitive, for the joint or body part that is breaking down? Certainly if it’s a spinal condition we want to know about lifting, how many times a day, how many shifts, how heavy the objects and for how many years you have been doing this repetitive heavy lifting.

Fourth, there should be some questions focusing on whether there have been significant single event accidents involving the anatomy where you’re having the problems.

Fifth, if these questions have not been asked by the nurse, the doctor or your family doctor it’s time for you to start asking them questions. Don’t be afraid to ask if they have considered the work connection between your need for medical care and work you do. Don’t be bashful about speaking up because sooner or later you are going to need an answer to that question.

You can’t rely on the insurance companies to do the ground work that ferrets out who should be paying and whether or not a cumulative trauma condition is work related. The medical profession has a somewhat different focus than does insurance and the legal system when asking questions having to do with “causation”. If you read the Mayo Clinic definition of “spinal stenosis” from the Mayo site you will see to what I’m referring. See the following definition that relates aging as the cause. While that is true it says nothing about wear and tear brought on by repetitive work. [See the underlined phrase below.]

Spinal stenosis is a narrowing of the open spaces within your spine, which can put pressure on your spinal cord and the nerves that travel through the spine. Spinal stenosis occurs most often in the neck and lower back.

While some people have no signs or symptoms, spinal stenosis can cause pain, numbness, muscle weakness, and problems with bladder or bowel function.

Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to aging. In severe cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves.

And lastly, if they aren’t asking and you can’t for whatever reason, don’t hesitate to find a lawyer with a significant workers’ compensation practice who can assist with writing letters asking the right questions before surgery takes place. This is one of the things we do. We work with doctors, nurses and insurance adjusters to iron out issues of causation before they become a problem. 

Today's image: Gregory Paul, playing songs from his CD, Little Black Train. Greg can be heard outside of City Market in Seattle, Washington. The day I ran into him he was outside of the original Starbucks in Seattle strumming his guitar for the pleasure of entertaining people as he fine tuned his talent. You can also hear him on YouTube. Support live music!

Steve Lombardi
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Iowa personal injury, workers' compensation, motorcycle, quadriplegic, paraplegic, brain injury, death
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