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Who Wins and When? “Win” does the case end? • Physician: Case ends when all is done that can be; patient lost to follow-up; patient is on autopilot to a determined outcome • Worker: When wholeness is achieved both economically and physically. • Missouri: 2 years after last visit to w/c provider • Employer: When productivity, moral, and workforce is restored • Insurers: Motivated to get off books; limit long term liability; case closure; do the right thing; “Pay what we owe.” • Attorney: ? • System: W/C Case ends at point after which minimal change over course of the following year is expected “Win” does the case end? • Physician: Case ends when all is done that can be; patient lost to follow-up; patient is on autopilot to a determined outcome • Worker: When wholeness is achieved both economically and physically. • Missouri: 2 years after last visit to w/c provider • Employer: When productivity, moral, and workforce is restored • Insurers: Motivated to get off books; limit long term liability; case closure; do the right thing; “Pay what we owe.” • Attorney: $ • System: W/C Case ends at point after which minimal change over course of the following year is expected “Win” does the case end? • Physician: Case ends when all is done that can be; patient lost to follow-up; patient is on autopilot to a determined outcome • Worker: When wholeness is achieved both economically and physically. • Missouri: 2 years after last visit to w/c provider • Employer: When productivity, moral, and workforce is restored • Insurers: Motivated to get off books; limit long term liability; case closure; do the right thing; “Pay what we owe.” • Attorney: ? • System: W/C Case ends at point after which minimal change over course of the following year is expected Case closure begins… • Application for employment • Hire strong young men? • Hire healthy workers – Smokers – Obesity – Chronic disease Case closure begins… • Application for employment • Hire strong young men? • Hire healthy workers – Smokers – Obesity – Chronic disease Sex Differences in Work-related Injury Rates among Electric Utility Workers Michael A. Kelsh and Jack D. Sahl TABLE 3. Injury rate ratios and 95% confidence intervals (Cl) by part of body classification among Southern Califomia Edison electric utility workers, adjusted for occupation, age, and Job experience, 1980-1992 Injury Ratio of rate ratio Female Number Of Lost Injuries Number of Days Lost (females/ Days Part of Body Males Females Males Females males) 95% Cl to Male All head and neck 5,604 684 15,607 4,146 1.3 1.16-1.39 2.18 Neck 840 186 8,399 2,862 1.8 1.53-2.22 1.54 All upper extremities 7,178 1,205 12,943 7,493 1.5 1.38-1.59 3.45 Hand/wrist 2,220 448 4,643 5,551 1.7 1.49-1.89 5.92 Shoulder 889 133 7,706 1,033 1.2 1.00-1.50 0.90 Back 4,665 731 59,705 9,751 1.1 1.01-1.20 1.04 All lower extremities 6,342 1,396 34,247 9,669 2.1 1.97-2.25 1.28 Hip 304 89 3,348 454 2.6 1.88-3.58 0.46 Knee 1,908 382 22,200 5,333 1.7 1.48-1.93 1.20 Ankle 1,186 295 5,135 1,198 2.4 2.03-2.73 0.94 Body systems 756 175 9,081 2,679 1.3 1.06-1.53 1.27 All Injuries 31,892 5724 183,014 50,169 1.7 1.53 Sex Differences in Work-related Injury Rates among Electric Utility Workers Michael A. Kelsh and Jack D. Sahl TABLE 4. Injury rate ratios and 95% confidence Intervals (Cl) by selected type of Injury among Southern California Edison electric utility workers, adjusted for occupation, age, and Job experience, Ratio of 1980-1992 Female Type of Injury Fractures Number of Injuries Number of Lost Days Injury Males Males Ratio F/M 96% Cl to Male Females Females Lost Days 718 78 13,943 1,638 1.2 0.9-1.5 1.08 8,586 1,676 12,536 3,127 1.8 1.7-1.9 1.28 974 92 7,948 560 1.2 0.9-1.5 0.75 Object in orifice 2,483 172 312 30 0.9 0.8-1.1 1.39 Sprains/strains 10,467 1,805 98,928 22,148 1.4 1.3-1.5 1.30 139 96 1,951 4,417 3.6 2.4-5.3 3.28 78 48 2,410 1,971 2.9 2.0-4.3 1.33 251 92 634 56 1.5 1.1-2.0 0.24 Surface wounds Bums Cumulative trauma Mental stress Poisoning Case closure begins… • Application for employment • Hire strong young men? • Hire healthy workers – Smokers – Obesity – Chronic disease Case closure begins… • Pre-placement – Job matching – Strength testing – Culture of collaboration • Pre-placement and post accident drug testing • Accepting that complaint is legitimate then verify! • Transparency in seeking the underlying problem Case closure begins… • Pre-placement – Job matching – Strength testing – Relationship building • Pre-placement and post accident drug testing • Accepting that complaint is legitimate then verify! • Transparency in seeking the underlying problem Case closure begins… • Pre-placement – Job matching – Strength testing – Relationship building • Pre-placement and post accident drug testing • Accepting that complaint is legitimate then verify! • Transparency in seeking the underlying problem Case closure begins… • Pre-placement – Job matching – Strength testing – Relationship building • Pre-placement and post accident drug testing • Accepting that complaint is legitimate then verify! • Transparency in seeking the underlying problem Reasons for hiring attorney • Employee does not know what to expect • Fearful for themselves and families • Controversy develops between employee/employer or employee/adjuster Keys to Closure • Case management intervention before expectations and patterns have developed • Early diagnosis/aggressive diagnostics including MRI (careful!) Keys to Closure • Maintain communication with employee even if off work • Identify and alleviate employee’s concerns • Move quickly towards normalcy by closing case, settling, and moving on. Avoid These Mistakes! • • • • • Provide immediate care Late reporting Ignoring the employee Under reporting compensation Not complying with restrictions Summary • • • • Hire right demographics Hire healthy workers Pre placement drug testing Pre placement job matching and strength testing • Post accident drug testing • Early diagnosis; set expectations • Early closure and move on!