Author: WorkCompAcademy

Traditionally, claim administrators project the cost of a lifetime award using statistical actuarial tables that predict life expectancy based upon historical data. The settlement value of a workers compensation claim also considers the expected lifetime cost of the claim. But now, researchers say it may be possible to slow and even reverse aging by keeping DNA more stably packed together in our cells. Perhaps evaluating the cost of settlement value of a claim is getting far more complicated than just using an actuarial table.

In a breakthrough discovery, scientists report that they have found the key to keeping cells young. In a study published Thursday in Science, and reported by Time Magazine, an international team, led by Juan Carlos Izpisua Belmonte at the Salk Institute, studied the gene responsible for an accelerated aging disease known as Werner syndrome, or adult progeria, in which patients show signs of osteoporosis, grey hair and heart disease in very early adulthood.

These patients are deficient in a gene responsible for copying DNA, repairing any mistakes in that replication process, and for keeping track of telomeres, the fragments of DNA at the ends of chromosomes that are like a genetic clock dictating the cell’s life span. Belmonte – together with scientists at the University Catolica San Antonio Murcia and the Institute of Biophysics at the Chinese Academy of Sciences – wanted to understand how the mutated gene triggered aging in cells. So they took embryonic stem cells, which can develop into all of the cells of the human body, and removed this gene. They then watched as the cells aged prematurely, and found that the reason they became older so quickly had to do with how their DNA was packaged.

In order to function properly, DNA is tightly twisted and wound into chromosomes that resemble a rope in the nucleus of cells. Only when the cell is ready to divide does the DNA unwrap itself, and even then, only in small segments at a time. In patients with Werner syndrome, the chromosomes are slightly messier, more loosely stuffed into the nuclei, and that leads to instability that pushes the cell to age more quickly. Belmonte discovered that the Werner gene regulates this chromosome stability. When he allowed the embryonic stem cells that were missing this gene to grow into cells that go on to become bone, muscle and more, he saw that these cells aged more quickly. “It’s clear that when you have alterations in [chromosome stability], the process of aging goes so quickly and so fast that it’s tempting to say, yes, this is the key process for driving aging,” says Belmonte.

Even more exciting, when he analyzed a population of stem cells taken from the dental pulp of both younger and older people, he found that the older individuals, aged 58 to 72 years, had fewer genetic markers for the chromosome instability while the younger people aged seven to 26 years showed higher levels of these indicators.

“What this study means is that this protein does not only work in a particular genetic disease, it works in all humans,” says Belmonte. “This mechanism is general for aging process.” Before it can be considered as the Fountain of Youth, however, Belmonte says new and better techniques need to be developed that can more specifically and safely alter the Werner gene in people, not just a culture dish of human cells. He also stresses that there may be other processes contributing to aging, and it’s not clear yet how important chromosome stability is compared to those factors. But, he says. “having technologies like this will allow us to determine how important each of these parameters are for aging.” And if the findings hold up, they could be first step toward finding a way to help cells, and eventually people, live longer.

Closer to home, Stanford University seems to agree with this science. Its website proclaims “”Now we have found a way to lengthen human telomeres by as much as 1,000 nucleotides, turning back the internal clock in these cells by the equivalent of many years of human life,” said Helen Blau, PhD, professor of microbiology and immunology at Stanford and director of the university’s Baxter Laboratory for Stem Cell Biology. “This new approach paves the way toward preventing or treating diseases of aging,” said Blau. “There are also highly debilitating genetic diseases associated with telomere shortening that could benefit from such a potential treatment.”

A recent paper, Red Herrings and Medical Overdiagnosis Drive Large-Loss Workers’ Compensation Claims published by Keith Rosenblum, senior strategist for Workers’ Compensation Risk Control in Lockton’s Kansas City operation describes what all risk and claims professionals see time and again. The common musculoskeletal injury where recovery stalls, no treatment works and the injury becomes a “creeping catastrophe.”

“Five percent of injured workers account for 80 percent of the cost and lost time in workers’ compensation systems” according to the American College of Occupational and Environmental Medicine. “The majority of these workers end up on long-term disability following injuries that would not be considered serious at their outset.” One-third of Social Security Disability’s recipients are receiving benefits because of musculoskeletal disabilities. Low-back injuries are the most costly, and the most researched, musculoskeletal conditions. Lockton’s large claims database indicates that low back injuries represent 20 percent of all loss dollars. When looking at claims over $250,000, they represent 25 percent of loss dollars.

Studies have shown that in the Medicare population, spinal imaging (especially MRI) rose by a dramatic 300 percent in the last decade reported (1994-2004). During that period, more diagnoses have been based on detected “abnormalities” with a corresponding 300 percent increase in aggressive and expensive treatment. As a consequence, costs have increased roughly tenfold. A similar expense in delivering invasive treatments solely from these imaging studies in workers’ compensation is creating more large loss claims.

These results, according to Lockton, are ‘grossly disappointing’ because outcomes for workers have not improved. In fact, the availability of more precise imaging has meant that workers are disabled longer than historical baselines. Disability rates among working age Americans are higher than at any time in our country’s history, and the problem is getting worse. According to Lockton, If images showing structural abnormalities have not improved results, it looks like patients and medical professionals are going down the wrong path.

Based on the latest science, the Lockton pager says that many of these diagnoses are red herrings. In medicine, a red herring is a diagnosis made based on poor science or inaccurate criteria. False certainty is created, and the search for the actual problem ends. In chronic pain cases, imaging findings are often red herrings. The real source of pain and distress usually lies elsewhere, being generated by soft tissue or by the brain itself, or a combination. Medical overdiagnosis occurs when a physician labels a condition more serious than it truly is, attributing a usually benign condition to causes more serious than the scientific data and situation warrant. The medical literature suggests that in more than 90 percent of common situations, an alleged diagnosis based on MRI “abnormalities” represents medical over-diagnosis.

The American College of Physicians and the American Pain Society put together an independent panel of experts to systematically review world literature concerning low-back pain. Their findings noted many asymptomatic volunteers have changes in their spines that look exactly the same on MRI as spines of people with pain. The panel recommended that many common low-back diagnoses be completely abandoned. These included lumbar disc protrusion, lumbar disc herniation, lumbar spondylosis, and others. The panel advocated that these entities be replaced by the term “nonspecific low-back pain.” This can be interpreted as an acknowledgement that most anatomically based “diagnoses” for pain confer no medical benefit to the patient..

As a solution, the authors of the Lockton paper have been actively following, assessing, and piloting the integration of one of the innovative new models in diagnostic technology that addresses potential chronic pain cases in their various stages of development. “We have been able to definitively identify which of several possible sources is creating a specific worker’s pain by integrating NeuroPAS Global’s NP3 testing methodology along with behavioral medicine assessment in some of our clients’ claims processes. The resulting clarity has enabled more workers to be referred for appropriate physical rehabilitation or cognitive behavioral therapy in lieu of surgery and chronic opioids.” Some insurance carriers and TPAs are working toward or are starting to pilot these technologies earlier in the life of a claim.

Lockton concludes “From a claims perspective, we believe that intervening early in the claim (2-4 weeks) by engaging physicians to comply with medical treatment guidelines, diagnose patients complaints based more on evidence-based medicine and less on imaging studies where not recommended, will make a substantial impact on the 5 percent of workers’ claims and their 80 percent of costs.

Tiffany Shorter, 26, and Jabe Satterfield, 77, owners of the Green Cactus Collective Medical Marijuana Dispensary in Palmdale, were arrested on multiple felony counts of insurance fraud. The owners failed to carry workers’ compensation benefits for their employees and allegedly told a security officer to lie about his employment status after he sustained severe injuries from two separate robberies at the dispensary, leaving him without benefits and responsible for expensive medical bills.

In November of 2013 Arcenio Tavares, a 34 year old security officer, was shot three times while suspects wearing bandanas and hoodies robbed the dispensary. After he spotted the three males approaching with guns in their hands he drew his handgun, but was shot multiple times by one of the suspects. Despite being hit by the bullets, Tavares returned fire and the suspects ran off on foot. Sheriff’s Capt. Don Ford said at the time that the dispensary itself was illegal because such businesses are not permitted in unincorporated Los Angeles County. Shorter and Satterfield allegedly told their employee to lie to hospital personnel by saying he was a volunteer and not an employee, which made him ineligible for workers’ compensation insurance benefits. The employee, without workers’ compensation benefits and in fear of losing his job, continued working.

In December of 2013, the dispensary was robbed again and the same employee, while still recovering from gunshot wounds from the prior attack, was beaten with a firearm and sustained further injuries. Again, the lack of coverage by his employers left him without medical benefits and liable for all medical expenses.

Shorter and Satterfield are facing up to four years in prison if convicted and were booked into the Los Angeles Sheriff’s Department Palmdale Station. The Los Angeles County District Attorney’s Office is prosecuting this case. Shorter and Satterfield are due to appear in court on May 18, 2015 at the Criminal Courts Building, Department 30.

The Green Cactus Collective was located at 36153 Sierra Highway in Palmdale. A new medical marijuana dispensary now occupies that location but the D.A.’s office said it is not known whether Shorter and Satterfield are associated with the new business.

“This case serves as a reminder that workers’ compensation fraud is a costly crime for employees who are left uncovered when their employers cheat the system,” said Insurance Commissioner Dave Jones. “The costs of these crimes are passed on to consumers through higher rates and premiums and drain the state’s economy of billions of dollars annually.”

The Division of Workers’ Compensation (DWC) has posted draft interpreter fee schedule regulations to the online forum where members of the public may review and comment on the proposals. The draft regulations include:

1) A new fee structure. The fee structure is based upon a number of factors including whether the interpreter is certified, the language to be interpreted, and the forum where the interpreting occurs. The base rate for a certified Spanish interpreter is derived from the Federal Court rate. Higher rates are paid for certified interpreters of other languages. Lower rates are paid to provisional and non-certified interpreters.
2) Establishes objective, uniform rates resulting in faster bill payment without liens and protracted litigation. Independent bill review procedure will resolve residual disputes.
3) Emphasis on a qualified interpreter. The regulations require use of certified interpreters in all forums wherever possible, with restrictions on use of provisionally certified interpreters. This is to guarantee the injured worker is provided with a qualified interpreter.
4) Detailed billing information and billing codes. The regulations require interpreters to provide detailed billing information, and set forth specific billing codes, to be compensated. The billing information and codes require the interpreter to identify the event billed, the time charged, the language, and qualifications of the interpreter, in addition to other information specific to the particular situation.
5) Selection and arrangement of interpreters. The regulations provide clarity on the selection of, and arrangement for interpreters.

The proposed regulations require that the notice of hearing, deposition, medical-legal exam, or other setting shall include a statement explaining the right to have a qualified interpreter present if the injured worker does not proficiently speak or understand the English language. Where a party is designated to serve a notice, it shall be the responsibility of that party to include this statement in the notice. It shall be the obligation of the party or individual needing interpreter services to communicate the need for an interpreter to the claims administrator as soon as the need becomes known.

The fees for Spanish language certified interpreter for hearings and depositions are $210 for each half-day of service and $388 for each full-day of service. For a certified interpreter for hearings and depositions in all languages other than Spanish the fees are $240 for each half-day of service, and $418 for each full-day of service. “Half-day” means all or any part of a morning or afternoon session, when appearing at any Workers’ Compensation Appeals Board hearing, day-time arbitration, or when appearing at a deposition, all or any part of 3.5 hours, or when appearing at an evening arbitration, all or any part of 3 hours. “Full-day” means services performed which exceed one-half day, up to 8 hours.

However, the employer may negotiate for an agreed upon rate with an interpreter since the proposed regulations provide “Nothing in this section precludes an agreement for payment of interpreter services, made between the interpreter or agency for interpreting services and the claims administrator, regardless of whether or not such payment is less than, or exceeds, the fees set forth in this section.”

All interpreters who provide interpreter services at medical-legal exams shall include with the bill, a signed statement from the examining physician verifying time spent providing interpreter services beyond two hours. All interpreters at medical treatment appointments shall include with the bill, a signed statement from the treating physician verifying time spent providing interpreter services beyond one hour. Proof of certification may be requested by the claims administrator and shall be provided by the certified interpreter for the purposes of hearings and depositions if the interpreter is not listed on the State Personnel Board webpage.Proof of certification may be requested by the claims administrator and shall be provided by the certified interpreter for the purposes of medical treatment appointments and medical-legal exams if the interpreter is not listed in the CCHI or National Board website directory.

The forum can be found online on the DWC forums web page. Comments will be accepted on the forum until 5 p.m. on Thursday, May 7, 2015.

Many workers’ compensation risk managers are using predictive analytics to guide claim management for better treatment outcomes. A new study that shows a relationship between MRI findings and the development of chronic pain may be a new tool in the predictive analytics tool chest.

While most people should expect to fully recover from whiplash injuries within the first few months, about 25 percent have long-term pain and disability that lasts many months or years. Using special MRI imaging, Northwestern Medicine scientists have identified, within the first one and two weeks of the injury, which patients will go on to develop chronic pain, disability and post- traumatic stress disorder (PTSD). This is the earliest these patients have ever been identified, according to the scientists. The ability to identify these patients so early will enable faster and more specialized treatment, which could be particularly beneficial for the PTSD.

After one to two weeks of the injury, Northwestern scientists found unusual muscular changes in the chronic pain group using a sophisticated MRI that measures the fat/water ratio in the muscles. The imaging revealed large amounts of fat infiltrating the patients’ neck muscles, indicating rapid atrophy. The presence of fat in the muscle does not appear to be related to a person’s body size or shape.

“We believe this represents an injury that is more severe than what might be expected from a typical low-speed car crash,” said lead investigator James Elliott, assistant professor of physical therapy and human movement sciences at Northwestern University Feinberg school of Medicine. The study was published March 17 in the journal Spine. “This opens up a new door for research on whiplash,” Elliott said. “For a long time whiplash has been treated as a homogenous condition. Our study has shown these patients are not all the same; they have different clinical signs and symptoms.”

Whiplash-associated disorders from motor vehicle collisions affect more than 4 million Americans annually, harming their quality of life and costing an estimated $30 billion for medical/rehabilitative care per year.

The finding builds on previous research Elliott did as a post-doctoral fellow at the University of Queensland, Brisbane, Australia. That study, which used standard MRI imaging, also found a large amount of fat in neck muscles of whiplash patients at one and three months post injury. Those patients went on to develop chronic pain and disability.

Not everyone needs a MRI scan after a whiplash injury from a motor vehicle collision. However, these findings help physicians understand water/fat MRI, in tandem with other clinical signs/symptoms can be used to identify who is likely to develop post-traumatic stress disorder. This then could be used to justify the referral of the patient to a psychiatrist or psychologist, Elliott said. PTSD is a disorder caused by experiencing or witnessing a traumatic event. “These patients have shown to not respond well to traditional rehabilitation such as physical therapy,” Elliott said. “It appears that they may require a more concerted effort for pain management from their physician and help from a psychologist.” Emerging, yet preliminary evidence suggests this to be a reasonable strategy.

The findings may indicate the importance of changing standard imaging protocols to identify these individuals early and start accelerated treatment. Routine imaging does not reveal this fat infiltration in individuals with whiplash injuries.

A small preliminary study previously done by Elliott and Northwestern colleagues shows whiplash victims with chronic pain also have a high level of muscle fat in their lower legs, indicating muscle atrophy. Elliott hypothesizes these patients may have partially damaged their spinal cord. They reported feeling fatigued and clumsy when walking and weakness in their legs, with difficulty pushing hard on the gas pedal of a car or standing on their tiptoes. “We haven’t found an effective treatment for these folks with chronic whiplash, and I think it’s because we haven’t really figured out what’s wrong with them,” Elliott said.

The finding helps to demystify the condition and let individuals know their chronic pain is not all in their heads. A basic exam will not consistently show a fracture, herniated disc or ligament tear. “If you’re a whiplash patient with ongoing chronic pain, but no objective imaging finds anything wrong, people are frequently informed that nothing is wrong with them,” Elliott said. “It’s been a huge problem. That fat appears to be a response to an injury,” Elliott said. “What has actually been injured remains for us to find out. But now we know to look more deeply into the problem.”