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Chronic Pain: The New Workers' Comp


By: 
Date: December 8 2003

The number one issue affecting persons who live with chronic, debilitating pain is lack of validation, from family, friends, healthcare providers, insurers, case workers, and employers. Although we´ve all seen the undercover videos about people who claim that, due to a painful condition, they are unable to perform the necessary requirements of their job and therefore must receive workers´ compensation, when in fact they are caught on hidden cameras lifting, carrying and moving large, heavy objects. In some cases, they are even caught engaging in strenuous physical activities like running, wrestling and golfing. These people are abusing the only system in America that exists to provide and care for those injured on the job, reaping the benefits of a system meant to provide for seriously hurt people and their loved ones.

Unfortunately, these people have given a bad name to those who truly do suffer from serious painful conditions that prevent full- or part-time work. Many people suffering from serious injuries must depend on workers´ compensation for their fixed income. These people not only suffer from reduced wages and income, but also from depression, anxiety and a feeling of worthlessness because they are unable to provide for their families and loved ones as they did before their injury.

The effects of workers´ compensation take a debilitating toll on the pain sufferer, their families and their loved ones and on the economy. These effects become even more difficult to overcome when the initial injury suffered on the job results in some sort of chronic pain condition. Chronic pain is defined as pain lasting more than six months and not relieved by medical and/or surgical care.

Shockingly, The National Pain Foundation estimates that chronic pain results in more than 50 million lost workdays, equating to more than $3 billion in lost wages and more than $100 billion in lost productivity. In addition, results from Research America show only 16 percent of chronic pain sufferers feel their boss is sympathetic to their condition. These results suggest that most corporations don´t recognize or realize the severity or pervasiveness of this painful, often debilitating and long-lasting disease.

As a result, many employers and companies are trying to fight workers´ compensation for chronic pain because, unlike broken bones and diseases like cancer, chronic pain is often hard to detect and even harder to diagnose. Since people cannot physically see chronic pain, employers are extremely hesitant to offer workers´ compensation, suspicious the employee is either making up the illness to avoid work and reap benefits or that the pain is in fact "all in their head." This is a difficult obstacle for chronic pain sufferers to overcome - it is important they know how to combat this problem.

Should the employer or insurance carrier have a reason to believe the injury or illness is not work related or is "all in their head," they have the right to deny all benefits. However, workers´ compensation is the only way people injured on the job can receive money to cover their medical expenses and lost income.

Workers´ compensation laws provide medical benefits and temporary total disability, temporary partial disability, permanent partial disability or permanent total disability. Each state varies in the maximum and minimum amounts required for weekly temporary disability benefits, as well as in how any permanent partial disability is determined. Early workers´ compensation laws were established as a "no fault" system for injuries occurring in the workplace. This "no fault" system enabled injured workers to receive medical care and income replacement until they were healthy enough to return to work. Workers´ compensation then became the exclusive remedy for workers to recover any losses resulting from an on-the-job injury. Workers´ compensation is still the only way to be compensated for medical care and lost income in most states, but the system has become increasingly difficult, especially for those who suffer from chronic pain.

In many states, the employer has the right to select the treating physician. If there is a question of a pre-existing condition that resulted in the chronic pain condition, they may accept part and deny part. In most cases, it is obvious when an injury or illness is work related, but in those instances in which there is doubt, such as injuries that result in chronic pain, the treating physician, who has taken a good accident/medical history, is in the best position to state whether it is work related. In most states, if there is controversy as to whether an illness or injury is work related, either party has the right to request an independent medical evaluation by another physician. State laws vary with regard to the rules of procedure an employee must follow in obtaining an independent medical evaluation. With so many variables, workers´ compensation can lead to controversy and disputes. Some jurisdictions handle disputes through a court system, some through an administrative system and some through a combination of both.

Initially, many people with a chronic pain disorder find they have few or no problems with workers´ compensation, but after a couple of years of being funded by it, the trouble begins-and only gets worse. It becomes a battle to keep workers´ compensation, and many people who do suffer from hard-to-diagnose chronic pain illnesses may need to find a lawyer experienced in workers´ compensation laws and chronic conditions to help them in their battle. Sometimes, workers´ compensation insurance agencies mandate that sufferers be retrained in another profession. Many times they are retrained and interviewed, but potential employers still deny them positions due to restrictions such as the inability to lift heavy objects or sit or stand for long periods of time.

As part of some state´s workers´ compensation systems, chronic pain sufferers must visit multiple independent medical examiners (IMEs)-independent physicians hired by the workers´ compensation insurance company to examine patients with injuries resulting from work-related accidents. The IME then presents his or her findings to a judge during a hearing. The patient may present the findings of his or her doctor during the same hearing. In the case of chronic pain sufferers, it is hard for independent IMEs with no experience in chronic pain diagnosis to determine their painful conditions and present their findings to the judge. This results in even more problems for those seeking workers´ compensation. Many chronic pain sufferers are fed up with the fact that workers´ compensation insurance companies categorize people with chronic pain as suffering from an "invisible" disease.

So, what is a chronic pain sufferer to do? For those people suffering from chronic pain who rely on workers´ compensation as a means of living, there are necessary steps they need to take to receive and maintain full rights under workers´ compensation laws. First, they should be encouraged to educate themselves about their pain condition and the system. The Internet has information for researching facts that substantiate claims about specific physical conditions. Also, it is advisable that the person participates in support groups to find how others with chronic pain won their workers´ compensation battles. Most importantly, some people may need to hire a lawyer to protect themselves, and not just any lawyer, but a lawyer who understands chronic pain conditions and who has fought for these cases before.

People can effect positive changes in the system by becoming involved. The government is slowly becoming aware of the problems facing chronic pain sufferers. The more people who call and write their legislators about the problems in the workers´ compensation system, the more likely changes will be made.

What can human resource employees to do if they are caught in a workers´ compensation dilemma? The most important thing is to validate the person´s report of pain. Just because you cannot see the pain does not mean it doesn´t exist. By simply validating the person, you have already opened the door to more effective handling of the situation. Be understanding and thorough in gathering your information. Remember, you may be the most important contact for the person during this process, and how you handle the situation can make a significant difference in the outcome.

The National Pain Awareness (NPA) campaign is seeking to raise awareness among employers, insurance companies, healthcare institutions and the U.S. public that chronic pain is a pervasive health issue that drains lives, resources, money and productivity. Due to the pervasiveness of this disease, Congress declared the 10-year period of 2000-2010 as the "Decade of Pain Control Research." In addition, the National Pain Care Policy Act of 2003 was submitted to the House of Representatives in April for consideration. If passed, this legislation will have a significant positive impact on the training, education and research of effective ways to confront the problem of chronic pain.


For more information on chronic pain and available treatment options, visit www.painconnection.org. For a searchable database of physicians in your area, visit www.painmed.org.



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