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New Jersey, Workers' Compensation

Tomorrow Is Official Launch Day!

Well, here it is. After more than a year of building, Workers Compensation Psychological Network Launches tomorrow.

In what seems to come right out of Star Wars’s opening line – Long ago in a galaxy far away – Richard Filippone and Mary Ann Kezmarsky had a vision, a dream of doing something never before done anywhere in America. They realized that the workers’ compensation system in New Jersey for dealing with mental and behavioral health issues was an afterthought, at best, resulting in high costs for employers, frustration for insurers and angst for injured workers. Claims adjusters did not want to “buy a psych claim,” because of the fear that doing so sent the claim into a psychological black hole and created a lifetime annuity for some PhD.

Richard and Mary Ann, PhDs of the first order, themselves, knew there had to be a better way.

And thus was born a dream that becomes reality tomorrow.

At Workers Compensation Psychological Network you’ll find a network of Psychologists and Neuropsychologists, as well as Cognitive Behavioral Health and Biofeedback experts. The network covers all of New Jersey’s 21 counties, from Sussex in the north to Cape May in the south. All members of the network have been highly trained in New Jersey’s workers’ compensation system. They have learned what employers go through every time a worker is injured and misses time away from work. They’ve learned about experience modification and modified duty and how premiums are built. They know how important is the concept of MMI, Maximum Medical Improvement. And they’ve learned all this without checking their expertise and compassion at the door.

But that’s not all. In addition to building this unique network, Richard and Mary Ann have built the nation’s first totally electronic claimant referral portal and electronic health record system. Richard had another vision – no paper. This means that a referral can happen in a matter of minutes, saving claims adjusters hours, even days of time in finding the proper person to see a claimant.

So, tomorrow, at the New Jersey Self-Insurers Association annual conference, we launch. We couldn’t be happier

 

New Jersey, Upcoming Events

The John Geaney Seminar

John Geaney is a renowned New Jersey attorney focusing on workers’ compensation. He heads the workers’ compensation practice for Capehart Scatchard, and is a good friend of Workers Compensation Psychological Network.

John is the author of “Geaney’s New Jersey Workers’ Compensation Manual for Practitioners, Adjusters, and Employers,” and updates it annually. If you have anything to do with workers’ compensation in New Jersey, you need to have John Geaney’s Manual.

In addition to representing a great number of New Jersey’s foremost employers, writing a Lexis Nexis Top Blog and creating the aforementioned Manual, John, teaming with Millennium Seminars, puts on three seminars each year for New Jersey professionals specializing in workers’ compensation. The seminars are always full. Attendees keep coming back, which is a testament to the high regard employers and insurers have for John.

As I write this, Workers Compensation Psychological Network founders Mary Ann Kezmarsky and Richard Filippone are attending and exhibiting at one of John’s seminars in Mount Laurel, New Jersey.  There are more than 100 work comp pros here.

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They’ll also be exhibiting at the upcoming Annual Conference of the New Jersey Self-Insurers Association in Atlantic City at the end of the month where attendees will number nearly 300.

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Workers Compensation Psychological Network, with trained and certified workers’ compensation psychology professionals throughout New Jersey,  as well as an online claimant referral portal and electronic health record system, is gathering steam. We’ve been Beta Testing for a couple of months. Our official company launch is only two weeks away. To say we are excited doesn’t begin to describe it.

Upcoming Events, Workers' Compensation

Upcoming Events

Workers Compensation Psychological Network is making steady progress toward our official launch when we throw open the doors for business. We’re just finishing Beta testing, and if you’ve ever launched a new enterprise, then you know what that’s like. We expect to launch just in time for the New Jersey Self Insurers’ Association’s Annual Conference at Harrah’s Resort and Casino in Atlantic City on April 28 and 29. If you’re there, please stop by and say hello. You’ll find us at Table 42. We look forward to chatting.

The theme for this year’s Conference is “Drafting the Right Workers’ Compensation Team.” We’re hoping you’ll give us a chance to add a lot of value to your team!

Meanwhile, we’ll be exhibiting at Millenium Seminars’ One Day New Jersey Workers’ Compensation Seminar on April 14 at Doubletree Suites by Hilton in Mount Laurel, New Jersey. Please say “Hello” if you’re there. And it’s not too late to register for this highly worthwhile conference organized by our good friend John Geaney of the excellent Capehart Scatchard law firm.

We’d love to speak with you at either of these great events. Workers Compensation Psychological Network is the only state-wide network of clinicians who are highly trained and certified in dealing with those hard to handle workers’ compensation claims fraught with biopsychosocial issues. We aim for Recovery: Sooner, Faster, Smarter.

Best Practices, Research

Early Intervention: Good For The Injured Worker, And It Saves Money, Too

It’s long been known that workers’ comp claims in which behavioral health issues are present cost more than those without such issues. Often a lot more. This month’s issue of Health Affairs reports on a Canadian Study that found that the average cost for a “mental health high-cost patient” was roughly 33 percent greater than the average cost for other high-cost patients. The authors suggest that intervening early when behavioral health issues are first detected can mitigate these higher costs.

Also, the Robert Wood Johnson Foundation’s Health Policy Snapshot, published in March 2013, examined the prevalence of mental disease in the U.S., and described how early treatment and intervention can improve lives and ultimately lower related health care costs.

Patients and payers are best served when screening occurs during the first month of any workers’ comp claim involving head injury or when the claimant is depressed, overly anxious or fearful. These can delay return to work and increase the cost of the claim. Intervening early leads to Recovery: Sooner, Faster, Smarter.

Financial, Return To Work, Workers' Compensation

Workers’ Comp State Laws Can Lead To Depression For Injured Workers

According to the Bureau of Labor Statistics’ (BLS) Consumer Price Index calculator, what you bought for $100 in 1973 would today cost $533.82. Despite this, during that same period wage growth for the median hourly worker grew by less that 4%. 

That’s how yesterday’s Workers’ Comp Insider’s blog post begins. Fifty States, Fifty Different Laws underscores the sobering reality that many hourly workers in America live perilously close the edge of the financial cliff, one crisis away from homelessness.

The Insider’s post analyzes “The Uncompensated Worker,” a Special Report from WorkCompCentral’s Peter Rousmaniere. The highly readable, but detailed, report illustrates how workers in every state take a pay cut when injured and out of work. Because all state laws are different, the pay cut can be minimal in a few states and catastrophic in many others.

At Workers Compensation Psychological Network, we see workers who, in addition to struggling to recover from a work injury, are also walking on the edge of an economic razor blade. These workers are deeply fearful that their injuries might lead to their families being forced to bunk under a bridge. Mr. Rousmaniere’s report shows that even short-term injuries can lead to deprivation. For instance, a 50-state chart at the end of the report shows that if an injured worker incurs only a brief disability – say, three, six or ten days – some of the provisions of New Jersey’s workers’ comp law (the calendar days waiting period before indemnity can begin, for example), will force a pay cut of 28% for that period.

As psychologists and neuropsychologists, we are mindful that helping these vulnerable people return to work as quickly as medically possible could spell the difference between financial stability and financial disaster. The mental health benefits of such an outcome are, quite frankly, immeasurable.

That’s why our overarching goal is now and always will be Recovery: Sooner, Faster, Smarter. 

Testing, Workers' Compensation

There Is A Need For Better Psychosocial Intervention In Workers’ Compensation

This morning, Workers Comp Insider, the Grand Daddy of workers’ compensation blogs, published an illuminating post focusing on why workers’ comp claims professionals wait far too long to engage qualified psychologists.  This, from the opening of Are We Only Paying Lip Service To Psychosocial Issues In Workers’ Compensation?:

It is a cliché in the workers’ comp industry that claims adjusters never want “to buy a psych claim.” Perhaps that’s why they rarely resort to psychologists until the horse is out of the barn and grazing four pastures over. By then it’s a last resort kind of thing.

The Insider goes on to say that claims payers and psychologists just don’t understand each other. It chides those claims adjusters who settle for asking only the basic questions suggesting that “digging deep” and

peeling the injured person’s personality onion to discover what really matters will allow for early detection of those relatively rare cases where speedy referral to a qualified psychologist might make all the difference.

We couldn’t agree more, yet lest we with the PH. D.s after our names begin to feel too comfortable, we come in for some sharp criticism, too. Most of us “know not even the first thing about workers’ compensation and give every indication of being proud of it.” Ouch.

The blog post suggests that we and the payers need to come together to build a system that works for everyone and that if claims adjusters are attuned to the subtle nuance inherent in a good conversation with an injured person, then perhaps certain signs will become apparent that indicate early psychological intervention is warranted.

Part of that coming together requires trust on both sides. The Insider suggests that a sign of trust on the side of the payers would be to adopt a  policy that “entrance into a payer network should not be determined solely by a license to practice and the forced acceptance of a ridiculously low fee. Quality and results matter.”

Finally, the post tells payers that they have a whole lot of educating to do, education that should start today. Why?

Because identifying early and resolving quickly the factors that have the potential to turn physical injuries into mental health problems will save employers, the folks who pay the bills, a significant amount of money and adjusters, whose goal it is to put the toothpaste back in the tube, considerable otherwise wasted time.

That, in a nutshell, is why we created Workers Compensation Psychological Network. To partner with payers for the betterment of injured workers to build a better system – Sooner, Faster, Smarter.

Brain Injury, Testing, Trauma

A Good History: The Devil Is in the Details

It has been my experience that taking an extensive history from an injured client about a head injury has to be more than just “what happened, where did you hit your head and what do you remember?”

One has to determine whether loss of consciousness occurred and, if so, for how long. If loss of consciousness was prolonged, has the injured worker experienced Post Traumatic Amnesia? Post Traumatic Amnesia refers to the time the head injury happened until when the patient is laying down consistent, recoverable memories. While head-injured workers may have islands of memory during this period, they often do not retain their memories consistently. Understanding and evaluating this is vital to providing the injured worker the appropriate services and treatment.

A real-life example will help to understand what I mean.

A patient recently was referred to me secondary to depression from a work­related accident. The history provided to me was that the worker had  slipped and fallen at work. When she was delayed in returning to work, a neurological evaluation concluded that her overall presentation was more impaired than would be expected for the type of injury she had suffered – a simple slip and fall. The suggestion then was that her problem was more psychological than neuropsychological or phsyical.

In our initial session, I took a very extensive and detailed history of the actual events . The accident report said she slipped on water and fell in the hallway and had been out of work since then. The history was woefully incomplete. It did not tell me anything about what kind of fall, what was going on surrounding the event and what happened after the event. From talking with her, this is what I learned and what should have been in the history I’d been given: She was a kindergarten teacher. She was walking 20+ kindergarteners in a line down a hallway. This was the first week of school and the children did not know what to do, so she had to help them stay together in a line in order to follow her . This was when she slipped on a puddle of water from a nearby water fountain, fell on the floor, hit her head and lost consciousness. I asked her what she remembered when she awakened into consciousness. She told me there was someone standing over her asking her something.

She was cloudy about the event.   I asked if there was anyone in the hall? “No.”  Any children? “No.” Any other teachers? “No.” Any nurse? “No.”

So, I learned that when she regained consciousness, the hallway was cleared of everyone with the exception of the person who was standing over her trying to talk to her.

If you extrapolate from that to try to determine the duration of her loss of consciousness, you would conclude that from the time she slipped, fell and lost consciousness, the following would most likely have occurred : The kindergarteners would have been upset, anxious and crying. Another teacher would have had to notice that, gather the children and take them into another room. This would have taken at least a few minutes. Meanwhile, a colleague would presumably try to get the nurse. And, finally, while all of this was going on, someone would stay with her. This would be the person who was standing over her trying to talk to her when she awakened from her loss of consciousness.

This history now suggested that at the very least, she had  lost consciousness for around 10-15 minutes and awakened to a vague sense of someone asking if she were all right. She told me she does not remember what she replied. She thinks she said she was okay. She was confused, dazed and disoriented.

There was no ambulance called, and she was sent home.  She slept the rest of the weekend. While she had ‘islands of memory” over the next couple of weeks, she was not laying down consistent memories , suggesting a protracted Post Traumatic Amnesia.

Clinically, all of this presented a very different picture from the one I had been given initially. From a simple slip and fall with a neuropsychological testing that looked too impaired for someone who just had a slip and fall, this woman clearly had a head injury.  She had a positive loss of consciousness of 10-15 minutes, islands of memory and Post Traumatic Amnesia for a couple of weeks.

My report to the case manager was that this was a  woman who had suffered a very serious injury. By the time she got to me, she had been struggling for weeks with no services for the head injury. Her deficits included neurocognitive dysfunction, post-traumatic vestibular dysfunction and post-traumatic visual dysfunction.       Much of the delay in treatment had to do with an initial assessment in which the history was incomplete and the conclusions less than accurate. If a complete history had been taken at the beginning, she could have been helped with these issues and would have improved more rapidly. The accident analysis and narrative failed this woman and she paid the price.

The bottom line to this is that we at WCPN know the importance of taking a very detailed history. Of course, this is important for any accident, but even more so for accidents involving head injuries, which by their very nature are psychologically problematic. For us, getting the history right is the first essential step in treating our patients sooner, faster,smarter.

Brain Injury, Trauma

Retrograde Amnesia: Why Doesn’t The Injured Worker Remember The Accident?

After the recent and horrid AMTRAK crash just outside Philadeiphia authorities determined the train was traveling more than twice as fast as the speed limit allowed. Media then focused on the engineer’s claim that he had “no recollection of the crash.” This phenomenon of not being able to remember an accident is not uncommon in  the field of neuropsychology.

In my years of practice working with head injured workers, I have noted that with an altered state of consciousness or a positive loss of consciousness, inevitably, the injured party has no recollection of the actual incident. This phenomenon is called Retrograde Amnesia. It is classified under Post Traumatic Amnesia ( PTA), which I  will discuss in a future post. Retrograde Amnesia is a partial or total loss of the ability to recall events that have occurred during the period immediately preceding the brain’s injury. Retrograde Amnesia targets the most recent memories. Ribot ‘s Law  suggests that  there is a pattern of destroying new memories before older ones because  the neural pathways of the new  memories are  not as strong as the older ones,  which  have been strengthened by years of retrieval. Basically, what happens is that the injured worker loses the memory of and access to the events that occurred immediately before the injury.

Neuropsychologically, here’s how memory storage works, in part. The hippocampus, which deals with memory consolidation (particularly episodic or event memory) is responsible for  transferring information from short-term to long-term storage. It quickly stores new information that it will then transfer to the neocortex for long-term storage. When an event such as a blow to the head results in an altered state of consciousness and/or loss of consciousness, the information about events that have just happened is not immediately transferable – and it may never be. It is as if those events never happened.

Retrograde amnesia usually involves minutes,  sometimes hours,

A study by Cartlidge and Shaw in 1981 showed that the duration of Retrograde Amnesia usually progressively decreases. It is particularly distressing for the injured worker because of the disquieting sense of not knowing exactly what happened. In my clinical experience it is highly unusual that the particular event memories are ever regained totally.

So, what can we take away from this? Well, in retrospect, the media should have cut Brandon Bostian, the train’s engineer, a little slack when he “claimed” to not remember the crash or the events leading up to it. He might or might not have been at fault, we won’t know until the investigation is complete, but he nearly certainly wasn’t lying about his loss of memory. And, by the way, he’s probably not the only person who lived through the crash and has lost memory of it. Second, workers’ compensation claim adjusters should, as part of their training, learn about Retrograde Amnesia. Why? Because, as I’ll describe in a future post, considering this psychological phenomenon early on in a head injury case can significantly shorten the disability and lower its cost.

That’s the sooner, faster, smarter way.

Brain Injury, Testing

Neuropsychological Testing reports – What they should be saying about injured workers!

As a neuropsychologist with over 37 years of neuropsychological testing experience I have a keen appreciation for the time and cost of neuropsychological testing. A key question to me is what value does this expensive assessment have to the injured worker or to his payor of medical services?

In answering this question I am reminded of a case several years ago as Clinical Director of Cambridge Rehabilitation Services. Called on to consult by a private disability insurance carrier, this man had been a top salesman in New Jersey for a national company for many years. Unfortunately he suffered a brain injury from which he physically recovered but left him with mild cognitive impairments. The referral included his medical reports and a Neuropsychological Test report. This report was not from a local neuropsychologist but by a leading expert from New York. The expert, well published and a professor, made many correct observations and conclusions about my patient.   However, it was my belief that the report missed the mark on informing his disability insurance carrier about his rehabilitation potential in terms of return to work.

I went over the test data and concluded that the expert, retained by claimant’s attorney on behalf in his disability claim, presented a very static view of his capabilities.   As with many Neuropsychological Test reports I have reviewed over the years, several critical work related questions went unaddressed. The expert simply opined the claimant had suffered cognitive impairments and that returning to his job “as is” was not possible. With the simple “yes he is disabled” conclusion, a disability “payout” was inevitable with this report in hand.

After an interview with the claimant, I imagined a very different outcome for him, one that he was eventually very pleased with in the long term.

My report to his insurance carrier pointed out several missing factors left unaddressed in the prior report.

  • Job related cognitive limitations – The specific cognitive changes causing his loss of work functions
  • Potential benefits of rehabilitation efforts– the specific interventions and their projected benefits to improving his work product
  • Emotional and motivational factors– the personality factors which could be tapped into and leveraged to assist him in perservering with a rehabilitation program that would assist him in accepting personal changes
  • A specific time line for return to work and projected costs– a detailed outline of the time and cost of the rehabilitative efforts.

His insurance carrier offered him our cognitive rehabilitation program in lieu of a full and permanent disability payout, with the option of the payout if the program failed. He chose the rehab offer.

Our team of a neuropsychologist, speech pathologist and cognitive therapist went to work on an intensive basis with interventions in his work environment itself. Remediation efforts attacked his critical cognitive weaknesses that blocked him from success and within 3 months he returned to work. While his work output was still diminished (after all he had been national top salesman for several years, allowing quite a bit of leeway), he was happy he could see himself successful earning a living, competing in the workplace as he always had.

The full cost of our cognitive rehab program was less than 4 months of the disability payments that would have been paid to him had our interventions not been successful! A net win-win for all.

 

 

Pain

Pain Pathways and Treatment Options

In our last blog post (link to post), we focused on chronic pain and suggested that New Jersey’s workers’ comp claim system did a poor job of helping injured workers who are chronic pain sufferers to recover.

But there are two kinds of pain injured workers face: Chronic and Acute. The first step in pain management is knowing which is afflicting the patient. Seems simple? It’s not. Make a mistake here, and you can harm the patient.

WCPN Psychologists first perform a comprehensive evaluation to determine the level and type of pain. Then, working in active a steady communication with the patient’s physical health provider, they begin a targeted treatment plan to help restore the patient to high functionality.
But what’s in that “comprehensive evaluation?” How do they assess the current mental well-being of the patient, so the best treatment plan can emerge?

Well, first of all, there’s no black box. No Wizard behind the curtain.

Together, we and our patient begin the assessment journey. First, we need a good history. This includes an individual and family medical history, as well as the patient’s educational history. The fancy name for this is a “Biopsychosocial Assessment (BA).” Here are some of the things that go into conducting the BA:

  1. We need to identify and gauge the role of pre-existing conditions.
  2. We discover the patient’s levels of anxiety and depression.
  3. We consider the patient’s personality factors that might be affecting his or her perception of pain in daily life.
  4. We review prescription medication use or abuse.
  5. By listening closely, we cull out the patient’s pain history.
  6. We identify specific functional behaviors the patient’s pain is affecting.
  7. Through all of this we introduce appropriate coping skills and the concept of medication reduction. Here, the patient begins to learn about the Mind-Body relationship, after which, as part of treatment, we can begin Awareness Training.

Through a good Biopsychosocial Assessment and follow-on treatment, our constant goal is helping our injured worker patient walk down Recovery Road and return to work as soon as health allows. WCPN Psychologists aim for Recovery: Sooner, Faster, Smarter.