Catastrophic injuries are so common in the trucking industry that we rank truck driving as one of the Top 5 Most Catastrophic Occupations. Fatigue, long hours, highway conditions and difficult to maneuver vehicles combine to make truck drivers one of the most likely demographics to suffer catastrophic injury during their careers. According to the Bureau of Labor Statistics, the five most dangerous occupations as measured by missed work because of injury are mining, transportation, utility work, construction, and manufacturing.
Accidents and Catastrophic Injuries in Trucking
Trucking, part of the transportation industry, is second on that list. About 500,000 trucking accidents happen annually in the United States, according to Legal Info. Sixty-eight percent of trucking-related fatalities happen in rural areas, not in cities. Fatigue and long hours on the road are considered risk factors in trucking, according to a 1992 article in the Journal of Public Health Policy.
In the 1992 study, over one thousand long haul tractor-trailer drivers were interviewed by a research team over four months, and almost three-quarters of the respondents said they self-reported violations of Hours-of-Service rules. Two-thirds said they “routinely” drive more than legal weekly maximums. Those long hours in the driver’s seat lead to decreased attentiveness and heightened rates of fatigue, creating prime conditions for unwanted accidents and catastrophic injuries.
Of the five occupations with the most catastrophic injuries, transportation has the highest rates of multiple trauma, spinal cord injury, and traumatic brain injuries. Among truckers, common co-morbidities like obesity, sleep apnea, smoking, diabetes, and high blood pressure can make treatment options and outcomes more difficult to manage.
Trucking Safety
The American Trucking Association reported an 84 percent increase in miles traveled by large trucks, as well as a 41 percent increase in the number of registered large trucks, between 1986 and 2006. Over the same time span, the number of large trucks involved in fatal crashes declined by 5 percent, according to the same source. Legal changes and industry self-regulation may be contributing to increased safety ratings among truckers. Still, the nature of truck driving—long hours in a large, heavy vehicle carrying variable cargo—makes trucking a particularly hazardous occupation.
Catastrophic injuries are life altering and employees in these catastrophic occupations are at increased risk for major disruptions to income and well-being. When accidents happen, protect your employees and your bottom line with proven care management services from Paradigm.
Paradigm Outcomes is always ready to assist with complex medical cases. For more information on our full-service offerings or to find out more about catastrophic care management, please contact us through our website or call (888) 621-6602. We also invite you to join our social communities on LinkedIn, Twitter, YouTube and Facebook.
Vascular injury may be more common than we think in traumatic brain injury (TBI) cases. Mild cases of TBI are often evaluated in emergency room settings and discharged to home with no further care or treatment. Yet, new research by the National Institute of Neurological Disorders and Stroke shows evidence of vascular injury with potential long-term effects even in mild TBI cases. The previously held belief that patients with no observable evidence of concussion do not need treatment or follow up should be revisited.
The THINC Study
The research was headed by Dr. Gunjan Y. Parikh, a fellow at the National Institute of Neurological Disorders and Stroke. He and several associates evaluated 256 patients enrolled in a study implemented at two hospitals: Washington (D.C.) Hospital Center and Suburban Hospital in Bethesda, Md. The study, termed the Traumatic Head Injury Neuroimaging Classification (or THINC) study, evaluated 256 patients during initial emergency room visits for head injuries and in the crucial first hours of treatment. The findings were released on March 12, 2012, just before their presentation at the American Academy of Neurology Annual Meeting (March 16 to 23 in San Diego), where the research was presented for the first time.
New Imaging Protocols
The THINC study implemented imaging protocols: an MRI within 48 hours of presentation at the hospital with acute head injury, followed by visits at 4, 30, and 90 days—even if patients didn’t receive a positive diagnosis for concussion. Protocols at follow-up visits were intensive: diffusion-weighted imaging (DWI), T2-weighted MRI, fluid-attenuated inversion recovery (FLAIR), and three-dimensional tracking imaging (3-DTI).
Surprising Results
Of the 256 patients, 104 had evidence of hemorrhage in the brain. These patients received more detailed brain scans (using advanced MRI technologies) within an average of 17 hours after injury. 20 percent of those 104 patients showed imaging evidence of microbleed lesions, while 33 percent had linear lesions that suggest vascular injury. These linear lesions, new evidence of vascular injury in TBI, were associated with injury to surrounding or adjacent brain tissues. Microbleed lesions, on the other hand, were distributed throughout the brain after mild TBI.
Putting Research Into Practice
The team’s research findings have multiple implications for treatment of TBI. Dr. Parikh and his team found evidence of trauma indicative of mild TBI and long-term impacts even in patients that would have been sent home untreated using traditional diagnostic protocols.
The results also have implications for doctors who see diffuse axonal injury (DAI) on a regular basis. In cases of diffuse axonal injuries, which often happen due to the shearing forces in auto accidents or falls, trauma to the brain is widespread rather than in a narrow location as with focal brain injury due to direct impact. DAI has been thought to be one of the most common causes of coma or persistent vegetative state after TBI. However, as Dr. Parikh told Doug Brunk of ACEP News, “Not everything that we’re calling diffuse axonal injury is diffuse axonal injury.” In many cases, targeting therapies to vascular injury rather than to assumed DAI may drastically improve patient outcomes.
Dr. Parikh is quick to point out that this research is preliminary and difficult to replicate due to the exigencies of working with TBI in clinical settings. Still, the research findings are important to the successful treatment of both mild and severe TBI, so further research along these lines should be forthcoming in future years.
At Paradigm, we work to keep abreast of the latest traumatic brain injury research and other relevant medical topics. Connect with us on LinkedIn and Facebook to stay up to date on the latest workers’ compensation and complex care management news.
Traditionally, soldiers who have lost limbs are discharged from military duty and return to civilian life facing the prospects of adjusting to life using a prosthetic or other assistive devices. Recent technology, however, has led to the introduction of prosthetics that are so advanced that some soldiers are returning as active service members even after the loss of a limb. Comfortable prosthetics equipped with microprocessors provide range of motion similar to normal limbs, which has made these success stories possible.
U.S. News & World Report recently reported on 167 service members who have remained on active duty after a major limb amputation. Some have returned to battle situations, while others are now working behind the lines in “support roles.” John Fergason, chief of prosthetics at the Army Center for the Intrepid in Houston, told U.S. News: “When we have someone we know wants to return, their rehab is geared that way.”
Innovation Out of Tragedy
“Unfortunately, when you have war, you have casualties, but with that comes innovation,” Fergason said.
“The person doesn’t have to worry about the prosthetic device, they’re worrying about the task in front of them,” said Kevin Carroll, vice president of prosthetics at Hanger, a company that makes artificial limbs. “If they want to go back to be with their troops, that’s an option for many soldiers these days.”
Every military branch has separate protocols for allowing soldiers with amputations to return to work. Soldiers pass requirements specific to the tasks they perform. Soldiers returning to battle must be able to perform at least as well as their fellow soldiers, and many perform even better. Individuals who can’t perform the same tasks after their amputations as they did previously are reassigned to different duties.
Despite the advances in technology, it’s a soldier’s drive that enables him or her to return to work. Often, lower-tech options are used in battle situations to avoid the possibility of prosthetics failure at a crucial moment.
For information about how Paradigm successfully manages cases involving amputations, contact us via our website or call 888-621-6602. We also invite you to join our social communities on LinkedIn, Twitter, Facebook and YouTube.
When it comes to life, we’re taught to expect the unexpected. However, for truck driver Walter Loving, the unexpected included a near-fatal accident that crushed him from his legs to his abdomen.
When complex outlier workers compensation claims like Walter’s happen, it’s important to have an established action plan to help keep the recovery process running smoothly. Research shows that up to 6.5% of claims represent 50% or more of today’s claim and IBNR positions.
Paradigm has delivered exceptional outcomes for the most costly and complex workers’ compensation cases for more than 20 years. Learn more about containing medical costs by checking out the Paradigm webinars and articles at ParadigmCorp.com.
Work-focused psychotherapy can help employees return to work sooner, according to the American Psychological Association (APA). Cognitive-behavioral therapy, specifically designed to help employees manage work-related problems, generally sped a healthy return to work with significant improvement in mental health over the course of a year according to the APA’s Journal of Occupational Health Psychology (2012 Vol. 17, No. 2 issue). The proper kind of cognitive-behavioral therapy may even help with catastrophic case management.
Multi-Tiered Benefits of Mental Health Therapy
Mental health therapy can increase the overall health and competence of your employees. Employees with depression or anxiety, who tend to take sick days in order to address or manage their problems, seem to respond particularly well to the type of cognitive-behavioral therapy introduced in the APA study. A focus on tools and techniques to help facilitate a return to work often isn’t part of traditional therapeutic practices, but work-focused cognitive behavioral techniques significantly improved worker outcomes in this study.
Indirectly, effective mental health therapy can also reduce an employer’s workers’ compensation costs, thus improving both the health of your employees and your business.
Here are the key points to consider:
Cognitive-behavioral therapy is based on the idea that one’s thoughts, rather than external factors like people or events, determine emotion and thus behavior. Patients are usually taught particular tools or techniques to help them manage their emotion and behavior.
Employees who received work-focused, cognitive-behavioral therapy and returned to work sooner did not suffer adverse effects. Rather, these patients showed significant improvement in standard mental health evaluations over the course of a year.
Study groups that included work-focused techniques with typical cognitive-behavioral therapy treatment averaged a full return to work 65 days sooner than participants in a comparative standard therapy group – and they even started a partial return to work another 12 days earlier.
This study offers evidence that building a work-focused form of cognitive-behavioral therapy into your employee wellness program can help employees improve their health, wellness and productivity.
Through research and experience managing the care of hundreds of patients, Paradigm has built a complex care management approach that addresses the biological, psychological and social components of care. For more information on our methodology and services, please feel free to contact us online or call 800-942-1725. We also invite you to join our social communities on Facebook, Twitter, LinkedIn and YouTube.
Claims professionals understand the importance of properly reserving workers’ compensation claims. Yet, despite the attention given to complex large loss claims associated with catastrophic injuries, accurate reserving is a big challenge.
In a May 2009 industry survey by Wilson Associates titled “Catastrophic Injury Management in the Workers’ Compensation Industry,” respondents provided the following answers when asked what tools were used to estimate reserves for catastrophic cases:
Individual Judgment 48%
Internal Guidelines 19%
Third-Party Experts 11%
Predictive Model 6%
Other 12%
These results explain a great deal about why so many catastrophic cases are under-reserved.
The predominant use of individual judgment has many limitations, the most important of which tends to be the small sample sizes of comparable cases. Catastrophic injuries vary greatly from one case to the next. Differences in the patient’s age, weight and other factors make enormous differences in cost projections. It is rare to have large enough pools of comparable cases to make these distinctions and accurately predict total costs.
In addition, there are other factors that are often responsible for less-than-adequate reserve setting. These include:
Lack of access to credible data. Very few external resources exist to use in benchmarking comparable cases, and claims professionals often find it difficult to access their own data for predictive purposes due to system limitations.
More volatility than expected. The costs associated with intensive care, multiple surgeries, the involvement of multiple specialists and high medication needs can often be highly unpredictable and require probability-adjusted estimations for the complications that can occur through missed handoffs and medical treatment.
Unrealistic durations (often too short). Many project expenses for only the acute period of care and grossly underestimate the complications that can and do occur years later as the body ages and the prior trauma causes ongoing complications and spikes in medical costs.
Abundance of optimism. Often there is the hope or expectation that “this claim” will recover without complications, yet, the statistical reality is that with catastrophic injuries, the abundance of optimism principal rarely holds.
Abundance of pessimism. Conversely, one may believe that “this claim” is so severe that the patient will die and therefore not require traditional services; again, statistically, the abundance of pessimism is not borne out in medical evidence.
When you understand these five potential pitfalls and seek out professional guidance and expertise, it is possible to accurately set reserves for complex large loss cases. What resources have you found helpful when setting reserves for this type of case?
Employers large and small face the challenge of rising healthcare costs and the devastation caused by catastrophic workers’ compensation claims. For the average employer, 6.2% of the claims result in 49.9% of lifetime medical costs. The best way to address the unique issues associated with catastrophic cases is through the use of effective complex case management.
When “one of our own” has been severely injured, the employer’s focus is on trying to ensure the best recovery possible. Positive medical results are not only the best thing for the injured worker, but they also benefit the company by reducing the likelihood of costly complications and long term care. Unfortunately, what works for the majority of injuries is inadequate for catastrophic injuries, and only specialized care management will provide the desired results.
Catastrophic and complex injuries require a comprehensive care management model involving medical experts, high quality providers and an experienced clinical support infrastructure. While wrapping an expert team like this around a mildly injured person may be too much for the most frequent claims, it is necessary for these complex claims. This is where employers benefit the most from having a partner like Paradigm involved from the onset of the case.
Paradigm’s focus is on the best possible medical outcomes, which ultimately translates into substantial savings for clients. We strive for the best possible recovery, including restored function and quality of life, and a release to return to work. When you do the right thing for the injured worker, the results follow. We know that our proprietary Systematic Care ManagementSM model achieves five times better results than the industry benchmark for release to return to work, five times better for return to competitive work, and 13 times better for return to work full duty. Likewise, significant savings can be achieved in addressing unresolved legacy cases.
Whether an employer is large or small, self insured, or carrying a low or high deductible, all employers benefit from improved outcomes, better quality of life for injured workers, improved return to work rates, and lower overall costs.
For more on what employers should know in complex case management, please watch our webinar on the topic featuring leaders from Donatos Pizza and DHL.
Workers’ compensation claim offices nationwide are plagued with thousands of unresolved complex large loss claims that could benefit from complex case management. These are persisting claims with mounting expenses due to ongoing and escalating medical complications and often pharmaceutical misuse or abuse. These claims may stay open for years and if not settled, the medical costs may be open for the lifetime of the injured worker. These ongoing medical costs may even be seen as a fact of life for individuals monitoring the file and not viewed as a priority for medical management.
Fortunately, there is now a solution for cases with ongoing or escalating medical costs. A 2009 research study by Milliman, Inc., shows that proper medical management of legacy claims can lead to better clinical outcomes and a 29% average reduction in lifetime projected reserves.
Milliman is one of the world’s largest independent actuarial and consulting firms. In this study, they looked at aged large loss claims with significant incurred costs. The study included pre- and post-Paradigm management projections of long term costs as determined by Milliman. The reductions included a number of cost elements including physician services, pharmaceutical expenses, attendant care and future medical and indemnity benefits.
In cases managed by Paradigm Management Services, the study found a 49% reduction in lifetime costs for spinal cord injuries, a 14% reduction for traumatic brain injuries, and 29% reduction for other diagnoses such as severe burns and amputations. The average reduction in all cases managed by Paradigm was 29%.
Visit our website for a white paper titled “Innovations in Reducing Reserves” with additional detail on this study and our proven outcomes. You may request the complete study by writing to Robert Briscoe at Milliman Inc., RR3 3117 Park Lane, East Stroudsburg, PA, 18301, or e-mailing bob.briscoe@milliman.com.
If you would like to refer a case to Paradigm Management Services, feel free to contact us at 800-942-1725 or join our social communities.
Depending on the extent and location of an injured worker’s burn, there can be a negative impact to virtually every system in the person’s body. Possible complications after the initial injury, and the complexity of treatment, make burns very difficult and expensive to treat. A workers’ compensation-related burn injury can end up costing a payor millions of dollars. In fact, Paradigm has seen cases where the acute hospital costs approached $20 million. To achieve the best medical and financial outcomes possible, one should apply a comprehensive complex case management approach, focused on optimal clinical recovery, restoration of function and reintegration, when treating severe burn injuries.
Comprehensive Care for Burns
The successful treatment of severe burns requires a coordinated team of specialists from multiple disciplines, and specific surgical expertise on the long term management of burn wounds. The current standard of care for acute burn wound management involves daily evaluation and management by physicians and other members of the care team. Critical care services are often necessary as part of daily care for patients with extensive or complicated burn injuries.
Patients frequently require multiple surgical interventions. As part of the ongoing care, there are both active medical issues and premorbid medical diseases to manage. Those issues can range from correcting simple metabolic and electrolyte abnormalities to significant cardiovascular disease interrupting the healing process. Burn patients are at a continual risk for complications such as disfigurement, scarring, infection, chronic pain, cataracts, and psychological issues, including depression. Complications can significantly delay and prevent the desired medical and financial outcomes.
Systematic Care ManagementSM
Paradigm uses a comprehensive, expert-driven approach known as Systematic Care ManagementSM to successfully improve medical outcome levels associated with severe burn wounds. The key components of this strategy are the use of medical experts, the selection of top providers, and leveraging a custom-built catastrophic care infrastructure. This process relies on the oversight and coordination of care by a skilled burn physician and onsite nurse case manager to create a plan in advance that outlines the key aspects of care and risks that must be mitigated. Getting injured workers to a specialized burn center will help implement all aspects of care from medical to long term care to equipment and transportation.
Using data and proprietary models to identify risks and optimize care paths specific to injury components and co-morbid conditions is also critical to the medical management system. Through the use of this approach, better medical outcomes are possible.
Return to Work Outcomes
One measure of the clinical effectiveness of an acute and long-term care plan is the return to work status of a burn victim. A recent article published in the Journal of Burn Care and Research (2010; 31: 692-700) provides evidence supporting the efficacy of Systematic Care Management for burn patients. In the study, Paradigm’s burn patients were matched as closely as possible to a national register of burn patients. Despite the Paradigm set of patients having more severe burns, the Paradigm return to work rate was more than twice the industry average.
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