Tools & Tips to Manage Chronic Pain in Work Comp Claims

Dealing with claims involving chronic pain is a real pain in the butt – literally. These claims require members of the claim management team to be proactive and coordinate efforts and energy with outside service providers and defense counsel. Now is the time to evaluate your files for claims involving chronic pain and develop a strategy to resolve these matters.

What is Chronic Pain?

Chronic pain is generally defined as pain that lasts longer than the normal healing period or occurs alongside a chronic health condition. It can be sharp or dull and felt in one area or all over the body. Chronic pain may be “on” and “off” or continuous. It can affect people to the point that they cannot work, eat properly, participate in physical activity, or enjoy life. The problem with chronic pain in workers’ compensation claims is that it can occur in any claim. Now is the time to be proactive and address the issue.

Early Identification is Crucial

The claim handler who successfully identifies these issues handles every claim with best practices from the beginning. This requires the team and handler to provide the necessary tools to employer representatives to report a claim immediately. This all starts with a partnership and the ability to communicate from the onset effectively:

• Witness Identification: This can include an interview or recorded employee statement. Identifying lay witnesses and potential expert witnesses is vital. Defense counsel can also be used to take the employee’s sworn testimony. The use of deposition testimony is governed by statute or administrative rule.

• Document Investigation: There are countless documents needed in any claim investigation. It also starts with obtaining complete medical records, including those before the injury. Never forget to inquire about security video that may be available. The list here is endless.

• Surveillance Techniques: It is paramount to consider the use of surveillance when dealing with chronic pain claims. All surveillance must be conducted ethically and consistently with applicable state and federal privacy laws. It also needs to occur over a period of several days.

Conducting a diligent investigation must be a part of every program. While it may seem expensive, one should always consider the alternatives.

Utilize Other Tools to Better Manage Claims

Members of the claim management team have other useful tools at their disposal that can assist in better-managing claims involving chronic pain.

• Team Roundtable: The team roundtable is helpful as it allows a claim handler to receive input from other team members. Roundtables are also a valuable tool for less experienced team members to better understand the file management process.

• Medical Director: Using a team medical director is a valuable tool in handling claims where chronic pain is an issue. These directors are usually medical doctors no longer in active practice and can bring insight into issues.

• Pharmacogenetic Testing: Consider using genetic testing at the onset of a claim where red flags are identified, such as opioid drug usage and claims involving multiple injured body parts. While one cannot force an injured employee to undergo this testing, it can be suggested persuasively by outlining the benefits.

There is also an opportunity to use an independent medical examination when the treatment appears excessive. Issues concerning chronic pain can also be addressed at file reviews. Remember to use the file review process as an opportunity to learn and become better – never place blame.

Conclusions

Chronic pain is a common challenge in workers’ compensation claims – a real pain in the butt. Now is the time for interested stakeholders to be proactive on these issues. This should include aggressive file management that emphasizes safety and work injury prevention and should be coupled with best-in-class claim reporting practices. It can also include using outside tools and assistance from other experts. These steps are a great way to manage workers’ compensation claims better and reduce program costs.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%. He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors. IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.