Handling Cumulative Trauma Claims with Care

While many workers’ compensation claims involve a specific injury or event, cumulative trauma (CT) claims can include injuries that occur over a more extended period. This timeline creates both challenges and opportunities to achieve a better claims outcome.

“A large percentage of CT claims include complex injuries, including soft tissue damage and mental health conditions,” said Lisa Strader, Senior Medical Manager at Safety National. “Comorbidities, like obesity, high blood pressure, diabetes, depression, and PTSD, can further extend the exposures and can be ongoing for the life of a claim. Stakeholders must lean on their clinical provider network to identify these risks and provide evidence-based treatment options.”

Handling CT claims requires careful consideration and consistency in decision-making to ensure the best outcome for the injured worker.

Early Investigation and Reporting

Investigation of a CT claim can be challenging since it may be difficult to establish a connection between the job and the reported injury. In CT claims, the date of injury is typically classified as the first day a worker suffered the disability and knew that their job was the source of the injury. However, the time to file the claim carries several exceptions and can further complicate the timeline of the injury.

The investigation process is most efficient when third-party administrators identify and report on all accidents or injuries, including those that may have occurred at other employers. In this instance, other employers may be responsible for sharing the costs associated with a claim. All stakeholders should work together to create a claim value, decide on their abilities to progress the claim, and determine what can be controlled if it has the potential to advance to litigation.

Potential Challenges

Many factors can complicate an injured worker’s condition and prevent an optimal outcome. Here are a few that need to be investigated when handling a CT claim.

• Age – The aging workforce has caused critical issues in CT claims, particularly concerning the length of the claim closure. Proactively speaking, risk engineering and ergonomic solutions are crucial to assist their needs.
• Injury Severity – Pain tolerance can vary by individual, and some workers who experience a CT injury may continue to work through it without understanding the extent of their injury. When the disability is finally recognized, it may involve multiple injuries involving lengthy treatments.
• Comorbidities – Diabetes, obesity, heart disease, and psychiatric conditions can cause complications in the treatment of CT injuries and prolong the injury and recovery time. Each condition must be reviewed and documented to understand the potential impact on recovery.
• Occupation – Work positioning, repetition, and force all impact the type and severity of a CT claim. Assembly line employees, nurses, hospitality workers, and teachers are all vulnerable to CT injuries due to the consistency of motions in their field of work.

Advocacy Model

True advocacy is about providing support and leadership to someone in need to resolve their claim and return their life to a sense of normalcy. The goal should always be to guide the injured worker using the team resources assigned to the claim. A supportive model will check on the injured worker’s pain, engage them consistently, help with appointments, and connect them to providers. It will also include a psychosocial evaluation for a more holistic view of their recovery. This approach reduces indemnity and recovery costs in addition to the potential for litigation.