Getting workers� compensation for a back/spinal injury can be a daunting and overwhelming task. There are plenty of questions, and we have answers from both medical and legal professionals. Anyone can be affected by back pain at work.
Work-related back injuries can be prevented by paying attention to posture, taking standing/moving breaks, stretching out, and lifting properly. However, if back pain at work stems from a work injury individuals could be entitled to workers� compensation benefits.
Workers’ compensation is an insurance program that helps with and provides benefits and medical care for workers that have been injured or fallen ill resulting directly from their job. This means if an individual is injured at work, employers have negotiated to free themselves of a majority of the liability by paying for the treatment and recovery. Companies that employ five-hundred or more are able to manage their own workers� compensation program. However, most workers� compensation programs are managed by state governments. Every state has its own workers� compensation program that employers pay into. The federal government handles the federal workers� compensation program for federal employees. The program is funded by the employer with the cost not affecting an individual’s paycheck.
Workers� Compensation Coverage
Compensation programs are different throughout the country. Typically workers� compensation pays for:
Initial emergency department
Urgent care visit
Diagnostic testing recommended by the emergency department
Under workers� comp back injury treatment/s are completely covered, meaning an individual does not have to meet a deductible or pay premiums, copayments, or coinsurance. Individuals continue to receive regular health insurance benefits from the employer. This could require a deductible, premiums, copays, and coinsurance. This is for the treatment of other health issues while receiving workers� compensation care. If an individual is unable to work because of a workers’ comp back injury, a worker can expect to be paid a base salary after taxes while being treated. Those whose salary is dependent on overtime creates a disadvantage. Workers� compensation can mean a pay cut for these individuals. Workers� comp pay depends on the state. Usually, there is a wage rate set by the state.
High Risk for Back Injury on the Job
Employees that are involved in physical labor like construction, factory work, and healthcare work have a higher risk of getting a back injury on the job. These injuries are often the result of:
Improper lifting techniques
Twisting while lifting
Holding something heavy
Lifting heavy objects above the head
Using the back muscles instead of the hips and legs when lifting bending of the knees and bringing heavy objects close to the core
Truck drivers also have a higher risk of back injuries. Sitting for long periods and reduced physical activity contributes to the back muscles losing their strength, endurance, and cardiovascular ability. Then when unloading the cargo the stress on the spine is doubled.
A back injury should be reported to the supervisor or the company�s human resources department. Depending on the state, there is a statute of limitations to file an injury claim. For example, an individual has one year from the date of injury to file a workers� compensation claim with the supervisor or human resources department. However, it is best to report the injury and seek medical attention as soon as possible after being injured at work. The longer the wait, the more the employer could dispute the legal validity of a workers� compensation claim.
If injured at work, assume the injury will be covered by workers� compensation. However, it is not always completely clear. An individual could be injured at a work-related cookout or working from home and trip down the stairs. These are gray areas and are very new as more people working from home. These kinds of workers� comp claims are now starting to be seen. Whatever the event, report injury/s to the employer. If the situation is untraditional, there could be some back and forth with the employer.
Spine Specialist Referal
To receive work comp treatment patients with back injuries will be referred to an occupational therapy clinic. An occupational therapist or clinic will set up the treatment. This could include:
For many that could be enough to get them back to work. If the initial treatments fail an individual could be referred to a spine specialist to set up an optimal treatment plan. A spine specialist could recommend additional therapy, medication, diagnostic imaging, spinal injections, or surgery. Occupational therapy usually goes on for four to six weeks before the individual is referred to a spine specialist. This all depends on the situation. Individuals can be referred immediately for specific spinal treatment or be told to wait for a specific time. It all depends on the medical situation.
Employer and the Spine Specialist
In most states, employers will request a copy of the treatment plan and spine surgeon�s clinical notes written about the case during office or telemedicine appointments. Doctors have to provide clinic notes and treatment plans to the human resources departments along with the workers� compensation insurance carrier. Consistent, active communication goes on between the primary doctor, the company�s human resources department, and the insurance carrier. Note that workers� compensation is exempt from HIPAA privacy regulations. Employers and the workers� compensation insurance carrier have access to medical records related to the back injury. But medical information unrelated to the injury is restricted.
Obtaining Workers� Compensation From a Doctor
Generally, no. Obtaining Workers� comp is between the individual and their employer, not the doctor. Sometimes doctors are asked to determine if an individual’s injury/s are work-related. This involves going through medical records but these requests are rare.
It depends on the case and where an individual lives. Every state is its own system. In some states, treatment can be ongoing for as long as treatment is needed and is consistent. What is highly recommended is meeting with a workers� compensation attorney in your state when beginning the process to learn your rights and the process. This can help in preventing issues from popping up like an employer pressuring a worker to come back before a doctor has cleared them to return.
Making Most of Workers� Comp
Keep appointments and be compliant with the doctor’s treatment plan and recommendations. Be transparent with the doctor. Not telling them exactly what is happening will not help in their recovery. If there is an improvement from the treatment/s fantastic, but if there are minimal to no improvements be as descriptive as possible about what is happening and what does work. The goal is to work with a clinical team that can get an individual better back to work and normal activities.
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