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Massage Today
June, 2003, Vol. 03, Issue 06

The World of the Injured Worker

By Vivian Madison-Mahoney, LMT

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Author's note: This revised article was originally prepared by myself and Sherry Smith, LMT; it was presented to a three-member panel of the Florida Workers' Compensation Division, which included Insurance Commissioner, Bill Nelson.

The panel was in the process of revising its 1997 "Florida Workers' Compensation Health Care Provider Fee For Service Reimbursement Manual" during a time when the workers' compensation system was trying to eliminate massage therapists from the original draft for changes in the system; needless to say, workers' compensation carriers in Florida are still reimbursing us. It pays to fight for your rights!

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This article is directed toward those interested in working with injured workers. If you have not considered working with these types of patients, this article may help you understand why accepting some insurance for reimbursement is necessary.

I originally wrote this article with the Florida worker in mind, so some references may not fit the circumstances in every state; still, it is generally the same everywhere. Keep in mind that not all cases or conditions are the same, and this article focuses on cases involving the more serious or catastrophically injured worker. Health-care providers who specialize in work injury cases generally agree that the following summarizes the experiences of a typical injured worker.

The Typical Injured Worker Scenario

1. An employee who sustains a work-related injury counts on receiving medical care.
2. The world of the injured employee begins to change. The injury is more than a mere inconvenience; it can be painful and, in some cases, a real tragedy.
3. The injured employee is sent to see a physician of the employer's (or insurer's) choice.
4. The relationship between the employer and the employee becomes adversarial; the employee feels alienated from the workplace; the longer the employee is out of work, the worse the situation becomes.
5. The physician prescribes tests and a course of treatment for the employee.
6. The employee must wait for the insurance carrier to authorize treatment. The insurance carrier often takes excessive time to respond or authorize treatment; sometimes treatment is refused.
7. The employee continues to experience pain while waiting for treatment authorization.
8. The employee experiences the additional emotional stress of being caught up in the politics among the insurance carrier, employer and physician(s), each of whom have different purposes.
9. The physician wants the proper treatment for the injured worker, but is often unable to administer treatment because of the mandates set forth by unlicensed adjusters or others making medical decisions for a patient they have never seen.
10. The employee begins to feel like a victim all over again, tossed among the authorities involved.
11. The employee is seen by an independent medical examiner (IME) chosen by the insurance carrier. The IME often reports that nothing is wrong with the patient. The carrier may require the employee to visit one provider after another, searching for one who will agree that the patient does not need the medical treatment prescribed or provided by the original authorized physician.

The Employee's Continuing Nightmare

At this point, the employee can experience any of the following:

• A system encouraging helplessness: The employee is no longer self-reliant, and instead, must rely on others for decisions related to treatment.
• Financial pressure: Bills pile up when income is limited or nonexistent due to injury.
• Changing family relationships: The employee can feel physically and emotionally unstable and insecure.
• Deteriorating self-esteem: The employee feels defeated and unable to perform and contribute as before.
• Anxiety about the future: The employee may wonder how long it will take to feel good enough to return to work or feel better in general.
• Continued alienation with employer and the likely possibility of losing the job.
• Disintegration of social networks: Friends and former co-workers are alienated from the employee.
• Side-effects of prescriptions and over-the-counter medications, which only treat the symptoms, rather than the source of the injury.
• General feelings of depression, hopelessness and despondency.
• Increased pain.
• Remarks by outsiders who claim the injury and side-effects are "all in your head."
• Remarks by outsiders that the employee is "taking advantage of the system" because the employee is relegated to sitting at home.
• Fear that increasing activities may result in accusations that the employee is "on the dole."

Surveillance of Injured Workers

The insurance carrier's surveillance officer begins to film the employee engaging in activities such as attending a child's baseball game; walking with a cane through a fairground; or swimming.

Consider the following examples:

• An employee is accused of having a maintenance job because he was seen carrying a three-pound, hand-held vacuum cleaner into his family's office;
• An employee is told he is able to work as a "courier" because he was filmed carrying a few documents into a Social Security disability physician's office, even though his injury occurred while working as a funeral director - his profession for 35 years.

Injured employees may experience fear knowing that their every move may be filmed. They can't tell whether they are being stalked; are about to be robbed or beaten; if their children are in danger; or if it is just the carrier's surveillance crew filming their activities. This causes undue stress and fear for innocent employees who, through no fault of their own, were injured.

These stories go on and on. Surveillance films (paid for by the carrier) often present a distorted or incomplete report of the employee's activities, or are not even of the patient.

Searching for Normalcy

The employee will try to find some semblance of normalcy by trying to engage in daily activities as best as possible, even though these minor activities can cause undue pain. Unfortunately, the surveillance crew is not present to film this pain or disability. The employee's injury may allow him or her to engage in certain activities for short intervals when there is time available to recuperate. These activities may not allow for repetitive motion but may be necessary to begin the improvement process; however, the employee may not be able to perform on the job without ample rest time between activities. Once again, the insurance carrier's spot surveillance is taken out of context, and the employee is punished for trying to rise above his or her injury by beginning to participate in short and varied activities.

The Employee's Changed World

By now, the employee's world has changed - maybe forever - because of this injury. The employee's disability income does not meet financial obligations; disability checks that were initially on time become delinquent or are cut out completely at the whim of the insurance carrier or adjuster.

The employee's once-good credit rating is lost as bills are turned over for collection. Collectors call the home daily. The employee's spouse works, but can no longer carry the financial or emotional load alone. Family emotions and financial pressures continue to escalate. The employee receives the disability check late, or it is reduced or stopped completely. The utilities are shut off. The adjuster refuses the prescribed treatment plan, including medications, and the employee cannot purchase the prescribed medicines. The employee's spouse is leaving him or her, or contemplating doing so. The employee has no choice except to seek legal counsel. The children suffer from experiencing the discouragement, depression and other sorrows created by the situation.

Employee Seeks Self-Medication

To obtain some relief, the employee begins self-medicating with prescribed medications (if he or she can get them through workers' compensation coverage); over-the-counter medications, alcohol; or all of the above, to cope with the physical and emotional pain. Some employees become addicts.

To keep sane, the employee seeks the help of a mental-health counselor or is referred to one by the attending physician. The employee feels emotionally strung out, despondent, and sometimes suicidal. The system has created the need for these additional services.

And They Wonder Why?

Many months (frequently, more than a year) have elapsed since the employee's injury, and the employee feels as if the world is crashing down. Despite many forms of treatment, the employee's condition has not improved and has often intensified. The employee has begged for something to help him or her deal with the pain and get back to a life that includes work and normalcy. Despite what the employer or insurance carrier may think, the majority of employees do not like watching soap operas, feeling incompetent, and being out of the work atmosphere: It has been forced upon them by the system.

It is my belief that the majority of injured employees would rather work than be supported or made to feel the effects of despair, inadequacy, and self-doubt created by the system and this situation. And they wonder why they can't get an injured worker off of temporary or permanent disability to return to work.

No two cases are alike: Not all carriers defer treatment, and not all employees are completely honest; but there are a few exceptions, and it is those exceptions that get the most publicity. It is my opinion, from my years of observation, that employers and insurance carriers pay a much greater price to avoid paying for the catastrophic legitimate cases, than they lose on those who try to elude the system now and then.

I will be attending the annual Workers' Compensation Educational Conference again for the 19th year. (Incidentally, there are more surveillance exhibits there than other types of services.)

The Employee Finally Receives a Prescription for Massage Therapy

Watch for the continuation of this article in the August issue.

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Click here for previous articles by Vivian Madison-Mahoney, LMT.

 

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