Examining On-the-job Injuries
April 30, 2008
By Dr. Frank Izuta
Dr. Frank Izuta
Director of Occupational Medicine at Rehabilitation Hospital of the Pacific
How long have you been practicing?
I’ve been practicing for 22 years. I moved back to Hawaii in 1997 and was doing the same thing in Denver prior to that time.
What is occupational medicine?
Occupational medicine includes the medical services provided to the working population in the industrial setting.
What is a typical workday like for you?
An average day would basically be seeing employees who have been injured on the job - treatment of patients injured on the job and the performance of medical-related employment activities, including physical examinations and drug screens.
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Can you elaborate on some of the more-common injuries you see?
The blue-collar workers are the ones who have the most injuries, because they are the ones doing the physical labor and they are generally the ones working with heavy machinery. No. 1 is back injuries, but also common are knee, shoulder, neck and upper extremity (repetitive motion) conditions.
Do you primarily handle workers compensation cases?
In terms of medical care of patients, it’s 100 percent workers compensation.
So your job is to determine whether a person can return to work and to how to treat them?
My job is to function as the primary care physician for an employee’s injury. If specialty care is required, I’m responsible for finding a consultant who will see the patient. I’m also responsible for determining when an employee may return to work, either on a restricted basis or at full duty. Knowledge about the working environment, an understanding of the physical demands of a job, knowledge about local and federal laws impacting injured workers, and established lines of communication with the employer and the insurer position the occupational medicine physician to be the ideal person to medically manage and treat an injured worker.
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What is the process of workers compensation, from when the injury occurs up to when the patient leaves your care?
When a worker is injured, he can go to any provider he chooses. Many go to their family doctors, some go to the emergency room or an urgent-care center, and some go directly to a specialist. The employee must report the injury to his employer so an initial report of injury can be generated. The initial report of injury is used to inform the Department of Labor and the insurance company that injury has occurred. Following the initial visit, a physician generates a treatment plan outlining and requesting anticipated treatment, a WC-2 form summarizing the pertinent aspects of the claim and a work-status form informing the employer of the patient’s functional status are generated. An updated treatment plan is required every 120 days or sooner if the treatment plan changes. A WC-2 form is required once a month, and a work-status form is required after every visit.
I generally follow the patient from the time they are referred until the conclusion of the case. Initial efforts are directed toward evaluating and treating the injury. At some point, when it is apparent that medical treatment will not improve the patient’s condition, he is deemed to be a MMI (maximum medical improvement). If he has not been able to return to full-duty work at a functional capacity, an evaluation is performed to assess functional level for purposes of return to permanent light duty. Vocational rehabilitation may be initiated, if necessary. A patient who cannot return to work and is not appropriate for vocational rehabilitation can be deemed permanently and totally disabled.
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How do you decide to whom or where to refer a patient for treatment?
The decision on whom or where to refer patients for treatment depends on the nature of the injury. Most musculoskeletal injuries will respond to physical rehabilitation. More severe injuries requiring specialty evaluation will be sent to consultants. Unfortunately, many specialists do not accept workers compensation injuries. It is extremely difficult to find an ENT, dermatologist, general surgeon, plastic surgeon or ophthalmologist who will see an injured worker. I believe the paperwork and process for obtaining approval for treatment or diagnostic testing puts off many physicians.
What is most challenging about what you do?
The most-challenging aspect of workers compensation is managing the concerns of all parties involved with a claim, including the patient, employer and insurer. Though the common goal is to return the employee to work, it is often difficult for everyone to agree on how to reach that goal.
As the physician tasked with the responsibility for managing the claim, addressing return to work is always the most difficult.
An employee who is unwilling to return to light-duty work is often perceived as someone who is taking advantage of the system. On the other hand, there are employers who disregard light-duty restrictions and return an employee to work he cannot safely perform.
Determining the reasons an employee will not return to work while trying to ensure his safety at the workplace is a time-consuming and labor-intensive task for the physician, and one that most physicians unfamiliar with occupational medicine hesitate to address. Consequently, many patients are placed off from work for extended periods of time.