Concussions increasingly make today’s news headlines, especially in athletes playing contact sports like football. But concussions don’t only happen on the field — they are being reported more often in the workplace, too. And they can be complex and costly to treat.

What is a concussion?

A concussion is a traumatic brain injury caused by a blow to the head or whiplash that results in the head and brain moving rapidly back and forth.

“This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells,” according to the Centers for Disease Control and Prevention .

How serious are concussions when compared with other work-related injuries?

In 2016, 78 percent of SFM’s concussion claims involved lost time from work, compared with 15 percent for non-concussion claims.

Because the duration, symptoms, diagnostic testing and treatment in each case are so varied, concussions can be very complex and costly to treat.

Are there more concussion injuries now than in the past?

In Minnesota, the number of lost-time claims with concussions increased to its highest level in 2018, according to the Minnesota Department of Labor and Industry’s COMPACT newsletter . The number of workers with concussions who receive wage loss benefits due to time off work is now 10 times higher than the number in 2006, according to the newsletter. The increase could be due to heightened awareness of concussions among employers and employees.

What are the symptoms of a concussion?

Physical symptoms of concussions may include:

• Headaches
• Nausea
• Vomiting
• Balance and visual problems
• Dizziness
• Fatigue
• Sensitivity to noise and light
• Tingling and numbness
• Ringing in the ears

Workers may report:

• Feeling mentally foggy or slowed down
• Having difficulty concentrating
• Being forgetful or confused

Those suffering from concussions might answer questions slowly or repeat questions. They may be irritable, sad, nervous or more emotional than normal. They may be drowsy, sleep more or less than usual, or have trouble falling asleep.

How long does it take to recover from a concussion?

Most cognitive issues related to mild concussions resolve within 7-10 days and go away completely after three months. However, 10-15 percent of sufferers experience longer-lasting symptoms, often referred to as post-concussion syndrome.

How do I accommodate an employee who has had a concussion?

Since a concussion isn’t a visible injury, employees might seem ready to return to regular work when they really aren’t. It’s important to respect any work restrictions. This could mean offering a shortened work day, breaks or fewer tasks and responsibilities.

The injured employee may be encouraged to rest and may initially need to reduce physical and cognitive exertion. In some cases, reducing work during the initial stages of healing may help the employee’s recovery.

After the employee returns to work, the doctor may recommend the employee avoid driving, heavy lifting, working with machinery or working from heights for a period of time. It’s helpful if you can provide a calm, quiet work area where the lighting can be lowered if needed. It can also be helpful to provide them with a place to rest.

Keep in mind that rehabilitation therapy is key during recovery and may include speech therapy, occupational therapy, physical therapy, or a combination of the three, from one to four days per week.

Realize that their thinking, speech and reaction times might be slowed, and they may be less able to concentrate. They probably won’t be as productive as usual at first, and their job tasks may need to be altered. But incrementally over time, the employee should be able to return to normal work.

It’s important to take the condition seriously, but it’s also important to be positive and reassuring with the employee about their recovery. The injured employee may be in a vulnerable state — scared and upset by their symptoms and worried they might worsen in the future. The anxiety just makes their situation worse.

Thankfully, most cognitive symptoms clear within two weeks and most patients recover fully within three months.   

What are the common causes of concussions at work?

Concussions are often related to slips, trips and falls, strikes to the head, or motor vehicle accidents. Inanimate objects, such as falling boxes, might cause a strike to the head. In other cases students, patients or co-workers might strike an employee.

How can I prevent concussions among employees?

To prevent concussions in the workplace, encourage employees to take the following precautions:

• Remove tripping hazards. Make sure walkways and workspaces are free of clutter, cords, puddles of water or anything else that could cause a slip, trip or fall.
• Use proper signage to alert employees of wet surfaces.
• Use handrails when taking the stairs.
• Avoid standing on chairs, desks or tables. Use a step stool instead.
• Use caution when working from heights. Never stand on the top two steps of a ladder.
• If a job requires wearing a helmet, make sure it’s properly fitted and in good condition.

What should I do if an employee suffers a head injury?

If a head injury does occur, and you’re an SFM policyholder, report the injury immediately and make sure the injured employee gets the proper care.

It’s crucial to get a thorough evaluation by a doctor who is trained to assess and treat concussions. Do not try to diagnose a concussion yourself.

For the best outcome, the employee should receive treatment from a provider who has experience with post-concussion syndrome.

If the employee is off work due to the injury, check in frequently to let them know you care about them and hope they feel better soon. Be kind and empathetic. 

You can also provide reassurance, as the employee might be suffering from any number of very concerning symptoms, and anxious that they’ll never be the same again. You can reassure the employee that typically most symptoms resolve in a couple of weeks, and go away completely within three months. 

Try to bring the employee back to work as soon as possible after the employee’s doctor will allow it. This might mean providing a transitional job, reduced hours or other accommodations. 

What are the challenges of managing a concussion claim?

Due to the wide range of symptoms, treating concussions can be complex. It can involve multiple specialists in the areas of neurology, orthopedics and psychiatry.

When a workers’ compensation claim involving a concussion becomes litigated, things get more complicated and costly. The cost of independent medical examinations alone can easily top $20,000, due to all of the different medical specialists needed. And because many symptoms of concussions are subjective, it can be challenging to independently verify the extent of the injury.

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

Injured workers who are off work due to an injury may also struggle with another health issue – depression.

A study by the Institute for Work and Health of workers who missed at least five days of work due to work-related musculoskeletal injuries showed that half frequently felt symptoms of depression in the year following their injuries.

Of employees who were off work for at least five days, almost 10 percent were diagnosed with depression at some point during the 12 months following the injury.

The workers’ ability to return to work in a reasonable timeframe factored into their mental health.

“Frequent symptoms of depression were more common among participants who were having trouble returning to work,” according to study author Nancy Carnide.

Reasons why employees may become depressed

For many employees, work is more than just a paycheck. It’s a place where they are socially connected and a source of identity.

Take that away, and it’s easy to get to an emotionally dark place, especially when they’re facing struggles in other areas of their lives as well.

Employees who are off work due to injuries may struggle with:

• Social isolation
• Challenges performing everyday tasks like bathing or lifting things
• Relationship stress
• Missing out on gatherings with family or friends
• Guilt or shame over others having to take on more work during their recovery
• Anxiety over losing their job or future earning potential
• Financial stress
• Pre-existing mental health issues
• Chronic pain

Being off work can actually make things worse because they may have fewer distractions and more time to ruminate on these struggles.

5 steps to reduce the risk of post-injury depression

Depression after workplace injury can prolong a workers’ comp claim and delay return-to-work. In some cases, post-injury depression may even be compensable as part of the workers’ compensation claim, but it depends a lot on the specific facts of each case.

Post-injury depression isn’t always preventable, but employers can take steps to lower the risk:

1. Have a strong return-to-work program
   Bringing employees back to work not only reassures them that their future employment is secure, but also gives them a way to feel productive.

   The company can provide a positive, supportive environment upon employees’ return, even if they have significant work restrictions. It’s important to manage the expectations of supervisors and coworkers so the injured employees aren’t made to feel guilty that they can’t yet work at full capacity.

2. Consider your employees’ mental health
   Offer an employee assistance program and make sure employees know it’s there to help them if they’re having struggles in their personal lives. Oftentimes, employees who experience consequential depression had pre-existing depression that was either undiagnosed or diagnosed but untreated.

   Encouraging employees to address any mental health conditions before an injury occurs is not only the right thing to do, but can also stave off lengthy and costly complications in the event of an injury.

3. Encourage good relationships between supervisors and employees
   When employees are injured at work, knowing their employer cares about them and wants them to return can go a long way in preventing anxiety. That said, employees might be suspect of their supervisors’ sincerity if the leaders never seemed to care about their well-being in the past.
4. Stay in contact with employees
   If employees are off work due to an injury, be sure to stay in contact with them to reassure them that you care about them and that there will be a job for them when they’re medically able.
5. Foster a positive work environment
   Make sure employees feel appreciated. Hold all-employee parties or find other ways to have fun and show employees you appreciate their work. Employees who like their jobs will be much more motivated to return to work as soon as they are able.

Recovering from a work injury is difficult enough without the added pain of depression. Do everything you can as an employer to reduce the risk and help injured employees return to health and productivity.

We asked our claims representatives what questions they typically hear from employers who are managing employees with workers’ compensation claims. Here are a few common questions, and the answers:

How do we manage performance issues when an employee has an active workers’ compensation claim?

When an injured employee isn’t performing the duties of their job up to your standards, the first thing you need to ask yourself is whether the substandard performance is related to the work injury.

If it is related, you may need to review the tasks assigned and confirm they fall within the employee’s medical restrictions. Your claims representative and rehab professional (if one is working with the employee) can assist with this process.

If it is unrelated to the injury, the next thing you need to ask yourself is how other employees are treated when similar performance issues arise. All employees should be treated the same, including the injured employee.

After you’ve decided what you’re going to do, act promptly because your silence implies approval and condones the performance. If the performance concerns are not addressed right away, but you later bring up the issue as a reason for discipline or termination, the employee could claim the issue is simply a “pretext” and that the real reason for the discipline is the work injury. Employees cannot be disciplined for suffering a work injury.

Lastly, be sure that you thoroughly document any performance concerns and disciplinary action. If you do feel you need to terminate an employee who has suffered a work injury, we’d recommend discussing it with your claims representative and your employment law attorney. They can walk you through the potential workers’ compensation implications of terminating, and whether there may be a basis for an employment law claim.

How do we handle the employee’s health insurance premiums while they are off work due to a work injury?

This differs by state. For example, in Minnesota, the law prohibits terminating group insurance for an employee who is absent due to becoming totally disabled.

Talk with your employment law attorney to make sure you’re aware of any relevant laws and rules. Workers’ compensation wage loss benefits do not include health insurance premium withholding.

How do we maintain a good relationship with an employee who is off work due to a work injury?

The most important thing you can do after an injury is to stay in regular contact with the injured employee. Call or text the employee right away, and keep in touch.

First and foremost, let the employee know you care about them and want to see them recover. Send a card or small “get well” gift if appropriate.

Another thing you can do is to make sure the employee knows that you will provide any needed accommodations so that they can return to work as soon as they’ve healed enough to come back. Injured employees who are off work often worry that they won’t have a job to return to, and this will help alleviate those concerns.

If you ever have a question about managing a claim, don’t hesitate to reach out to your SFM claims representative for help.

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

Sometimes during the course of treatment for a work injury, a claims representative will decide to request an independent opinion from another physician.

This can help in making determinations such as whether:

• The injury is work-related
• The employee could go back to work without or with fewer medical restrictions
• The employee is getting the right medical treatment
• The employee needs surgery

For example, an employee has already undergone two unsuccessful back surgeries and requests a third one, or an employee with arthritis claims that work aggravated the condition, causing the need for a total knee replacement.

In cases like these, a workers’ compensation insurer might pay an independent doctor to review the employee’s medical history, conduct a physical exam and give an opinion that can be used in a hearing. These are referred to as “independent medical examinations” in most states. There are states that don’t have independent exams, however, such as Iowa where employers choose the treating doctor.

Here are a few things you should know about independent medical examinations:

• Timing is everything
  If we arrange for the examination too soon, the doctor might conclude that more time is needed to determine whether the present course of treatment is working. This typically isn’t a desired outcome, since usually one goal of requesting the independent examination is to gain support for a change in the course of treatment.
• They’re expensive
  One examination can cost from $2,000-$12,000. For some injuries, examinations by multiple specialists might be necessary. For example, a head injury might require examinations from a neurologist, ophthalmologist, psychiatrist and other specialists.
• The conclusion isn’t always favorable
  Of course, when requesting an independent medical examination, the claims representative is hoping it supports the employer’s case, but it’s not uncommon for the results to come back otherwise. Even though the insurance company is paying for the examination, it’s understood that the doctor is to give an honest opinion.
• They’re not final
  Even if the doctor’s opinion seems favorable, it’s only one factor that will be considered by the judge in a litigated workers’ compensation claim. The judge will also consider the treating doctor’s opinion, any other medical opinions the employee has sought out, and the employee’s own statements.
• Choice of doctor is critical
  A judge can decide to throw out the results of an independent medical examination entirely if he or she believes an opposing opinion, such as that of the treating doctor, is more credible. Because of this, it’s important to choose a high-quality doctor who will provide a credible opinion backed up by the facts of the claim.
• They’re perceived as adversarial by employees
  If an employee hasn’t yet retained an attorney, a request for an independent medical examination may compel the employee to do so. If the independent examination recommendations are counter to how the employee has been comfortable being treated, the likelihood of getting an attorney involved increases.
• They’re not the only option
  There are other ways to learn more about an employee’s medical condition, such as writing a letter to the treating doctor, or asking that the employee get a second opinion from a doctor of his or her choice. Another option in some states, including Minnesota, is to get a neutral evaluation in which the judge chooses a doctor to do the examination.

There is a lot to consider when requesting an independent medical examination, and SFM has doctors and attorneys on staff who provide advice when claims reach this point. Independent medical examinations typically aren’t necessary, but they can be useful tools.

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

“Who are all these people, and why do they all want to talk about my workers’ compensation claim?”

After filing a workers’ compensation claim, a injured employees typically aren’t surprised to hear from a claims representative at the insurance company.

What they might not expect is hearing from others too, such as medical, rehabilitation or legal professionals.

Depending on the particulars of the claim, an employee may interact with any number of the following:

• telephonic medical case managers
• vocational rehabilitation consultants
• disability case managers
• field nurse case managers
• attorneys

For someone unfamiliar with the workers’ compensation system, this can seem like an overwhelming amount of attention.

It’s important to know that everyone involved adds a significant and unique value to the process. Whatever differences exist between their job titles and training, each of them has the same goal: to make the process of returning to a normal life as quick and easy as possible.

What happens after a workers’ comp claim is filed

After a claim is filed, the employee’s first point of contact will be SFM’s claims representative, and in some cases it’s the only direct contact the employee will have with SFM.

The claims representative begins the process by learning as much as possible about the claim. This involves not only learning the details about how the injury occurred, but gaining a complete understanding of the employee’s health before and after the incident.

In addition to gathering information from the employee, the claims representative establishes a role as the employee’s primary resource for information about the claim.

Regardless of who else gets involved, this relationship continues throughout the handling of the claim. SFM’s claims representatives are always available to assist the employee, which often involves introducing other professionals into the process to provide additional expertise.

Introducing the medical case manager

When an injured worker requires medical attention, SFM frequently assigns a member of its telephonic medical case manager team to a claim to make sure that the employee has consistent access to optimal medical care throughout the recovery process.

SFM’s in-house medical case management staff consists of highly trained medical experts who evaluate and adjust the course of treatment to make sure that it’s focused on getting the employee healthy and back to work as quickly and safely as possible. This may include anything from educating the employee about procedures available to scheduling an appointment with the right specialist. Once connected with a claim, the case manager is always available to make sure that there are no unanswered questions about an employee’s recovery program.

The role of vocational rehabilitation

For claims involving more severe injuries or complications, an additional kind of professional may be brought in to facilitate the return to work. A service known as “vocational rehabilitation” comes in the form of a neutral consultant who will work as an intermediary with the employee, employer, insurer and health care system to identify and eliminate problems that may be preventing a return to full health and productivity.

A vocational rehabilitation consultant may meet with the employee in person to facilitate recovery. A vocational rehabilitation professional may go by any of a number of titles, often known as a qualified rehabilitation consultant (QRC), disability case manager (DCM) or field nurse case manager (NCM).

The specific responsibilities of the vocational rehabilitation consultant differ by job designation, and can vary greatly from state to state. For example, Minnesota statute requires that the insurer assign a QRC to any employee whose disability is expected to extend beyond 13 weeks. Once assigned to a claim, a QRC develops, administers and implements a rehabilitation plan to guide the employee back to pre-injury health and productivity. These activities are closely regulated by the state and the employee is required by statute to cooperate with the plan developed by the QRC.

A less formal option available within the realm of vocational rehabilitation comes from a DCM or NCM. Similar in training and expertise to QRCs, case managers are not regulated by any state agency. They can be called upon by either the insurer or the employer to coordinate care and pursue a safe and timely return to work.

Attorney involvement in a claim

Hearing that attorneys are involved in a claim may conjure up images of a courtroom drama involving a dispute between an injured employee and the insurance company, but that’s not usually how it plays out in reality. If a claim involves input from attorneys at all, it’s often in the form of providing legal expertise to others involved in handling the case.

Through its in-house law firm, SFM maintains a base of specialized support for all matters related to workers’ compensation law. The attorneys are not only available to represent and defend SFM policyholders in the event of litigation, but to provide legal advice to employers whenever it’s needed.

Making it all work together

By getting the right experts involved at the right time, SFM strives to make sure that employees always have access to the resources that can help them the most. Every time that telephone rings, it means the claim handling team is working hard to get the employee healthy and back to work.

Back in 2015, before opioids were regu­larly making news headlines, SFM began a concerted effort to help injured workers reduce or quit use of the addictive pain­killers.

Since then numerous individuals have thanked our claims team for helping them “get their lives back,” sometimes after years of disability. And with drug overdose deaths at an all-time high in the U.S. due primarily to the opioid epidemic, these efforts can be life-saving, too.

We’re continuing to help injured workers get off these drugs, and we’re now focus­ing more on preventing long-term use in the first place.

Long-term opioid use reduced significantly

In 2015, we hired a prescription drug e to identify high-risk cases and work with injured workers and their doctors to prevent opioid addiction.

Since then we’ve seen a reduction of 77 percent in the number of injured workers taking a higher dosage of opioid painkillers than is recommended for long-term use, according to SFM research.

Among a group of injured workers who were taking opioids in 2015, 87 percent have been weaned off completely, or are taking lower doses.

SFM sends letters to treating doctors of injured workers taking high doses of the drugs, and then works with injured workers and their doctors to provide weaning schedules that help them reduce or quit using the drugs over time.

While we’re happy with the success of these efforts, we’re not backing down. Rather, we’re now focused on making sure short-term use doesn’t evolve into long-term dependence on the drugs.

Focus shifts to early intervention

Opioids are generally recommended for short-term pain relief due to an injury or surgery.

They’re much more likely to become problematic when they are used for longer periods of time. When used long term, they can increase a patient’s sensitivity to pain, requiring higher doses for the same level of pain relief. This pattern can con­tribute to dependence.

The best chance of success is early inter­vention — not letting them get to 90 days of use.

To do this, our medical professionals monitor injured workers who are undergoing surgery. If three weeks after surgery they’re still taking opioid painkillers, she will send a letter to the treating doctor.

Doctors have been very receptive and cooperative in helping get injured workers off opioid painkillers before an addiction can develop.

Injured workers also receive copies of the letters we send to their doctors. This often­times spurs them to request that their doc­tors take them off these prescriptions.

A combination of public awareness, stiffer regulations and deliberate effort has helped us improve and perhaps even save lives. We take our responsibility to injured workers seriously, and will continue to work at preventing dependence and addic­tion.

Claims representatives spend their days helping injured workers recover and return to work.

We asked a few claims representatives to talk more about their jobs for a recent recruiting video, and they shared how rewarding and, at times, challenging their jobs can be.

They said working closely with team members and other experts, such as in-house doctors, nurses and attorneys, helps them do their best to serve injured workers and employers.

Watch the video below to learn more about how SFM’s claim representatives view their jobs.

One of the best ways you can keep your workers’ compensation costs under control is by bringing injured employees back to work as soon as they are medically able.

Even if the employee can’t return to his or her regular job due to medical restrictions, you can bring the employee back to work in a light-duty, modified-duty or transitional role.

Because work injuries are unexpected, you might have trouble thinking of light-duty jobs for your employee to perform. That’s why SFM created a free listing of ideas — broken down by industry — of potential light-duty jobs.

Here are links to the transitional work ideas by industry:

• Bus driving/transportation industry
• Construction industry
• Grocery stores/convenience stores
• Health care
• Manufacturing
• Service industry

Transitional jobs listed include:

• Answering phones
• Completing equipment inspection logs
• Data entry
• Greeting customers
• Filing
• Shredding documents

Even if the jobs listed don’t quite fit your organization, they might help you think of other ideas.

Research shows that timely return-to-work helps speed recovery and increase the likelihood that injured workers will ultimately work again. That makes it worth the effort to bring employees back, even if at a reduced capacity.

Read more on how return-to-work helps control workers’ compensation costs in our post, why early return-to-work benefits your employees and bottom line.

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

By Brian Bent, CPCU, ARM

With an increasingly globalized economy, more and more people are traveling overseas for their jobs. But how does overseas travel affect workers’ compensation coverage?

Employees who are working overseas temporarily are generally covered by their employers’ domestic workers’ compensation policies.

The issue is that “temporarily” is not clearly defined in the policy language or by state statute. Because of this, viewpoints differ on what constitutes a temporary work assignment. This is why it’s important to make sure your insurer knows about any foreign business travel your employees are doing.

Additional coverage might still be needed

Even if your employees are covered by your domestic policy, the countries to which they’re traveling might have additional requirements. Depending on where employees are traveling, you may also want to look at additional coverage options such as kidnap and ransom coverage or foreign voluntary workers’ compensation to cover any loss potential that might not be covered fully by your domestic policy.

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

Opioid painkiller misuse is now a public health emergency in the United States.

Taking opioid painkillers long term, or in high doses can have a major impact on an injured worker’s recovery and return to work. Even individuals without a history of drug use can fall into this addition, experts say.

Opioid painkiller use tied to delayed return-to-work

Studies have shown that injured workers given high doses of opioid painkillers end up spending significantly more time off work due to their injuries than those who use other types of painkillers or lower dosages.

A 2008 California Workers’ Compensation Institute study cited by The New York Times showed that injured workers receiving high doses of opioid painkillers stayed off work three times longer than those with similar injuries taking lower doses.

When someone becomes addicted to opioids, they develop a tolerance. This means they need higher and higher doses of the drug to get the same effect. As they take more of the drug, they become more sedated and less able to work.

How opioid painkiller use affects workers’ compensation claim costs

In part because of more lost wages due to delayed return to work, studies have shown that claim costs for injured workers using opioid painkillers are significantly higher, on average, than those with similar injuries who aren’t using the drugs.

A Johns Hopkins University study cited by Claims Management magazine showed a nine-fold increase in average claim costs associated with long-acting opioids.

Additional claim costs could also include drug addiction and dependency treatment.

Opioid painkiller use could cause workplace safety risks

Opioids can make you less alert and slower to react.

This means employees using opioid painkillers could pose risk to themselves and coworkers if they work in safety-sensitive situations, such as operating heavy machinery, working at height or driving. This could lead to another workers’ compensation claim if an injury occurs.

For more information on opioid painkillers, see our post, Opioids and workers’ compensation: Why employers should care.

For educational and prevention-related resources on prescription drug addiction visit drugabuse.gov .

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.