Indiana Worker's Compensation Institute

This article is from an advertisement from the arthrocare.com website.  It is a new procedure that is being introduced to the Indianapolis area by Dr. Scott Taylor and Integra Health Care.

There are some seminars scheduled on this topic in the near future.   Most of us have probably not heard of this before, if you are like me.   Stay tuned for more information.

Plasma Disc Decompression is an option for those people who have failed conservative care, and in many cases provides an alternative to more invasive open surgery. It is a minimally invasive procedure that allows you to go home on the same day of the procedure.

The procedure is performed under x-ray guidance to accurately place a surgical port (passage way) into the disc. Using this minimally invasive approach, a small pathway is made into the disc and a precisely engineered device, known as a SpineWand® surgical device, is then inserted through the surgical port into the center of the disc. The device utilizes Coblation technology to dissolve tissue while preserving nearby healthy tissue.

The removal of nucleus tissue relieves pressure on the protective ring around the disc or annulus, typically allowing the bulge to recede, so that the disc no longer irritates the nearby nerve root. Normally, the entire procedure takes less than an hour, and the patient can leave the medical facility one to two hours later, with no overnight hospital stay required.

Plasma Disc Decompression is recognized by the National Institute for Clinical Excellence (NICE) and the SpineWand devices used in the procedure have been cleared by the FDA for ablation, coagulation and decompression of disc material to treat symptomatic patients with contained herniated discs. The plasma technology used in the Plasma Disc Decompression procedure (known as Coblation), was developed by ArthroCare and has been used successfully for more than 10 years in over 4.5 million procedures, including knee, shoulder, and ear nose and throat surgery. The difference between Plasma Disc Decompression and other methods of disc decompression is found in ArthroCare’s unique Coblation® technology which enables tissue to be removed quickly and efficiently, without damaging nearby healthy tissue.

Why choose Plasma Disc Decompression

Plasma Disc Decompression allows for controlled tissue removal. This minimizes the possibility of removing too much tissue or tissue beyond the targeted area which can lead to disc degeneration. The procedure does not rely on heat for tissue removal, and does not introduce excessive heat that may cause tissue damage. A minimally invasive approach using only a small needle (1mm or 1/20th inch) to access the disc is used, which minimizes scarring or annular disc damage that may be caused by larger or more aggressive devices.

Plasma Disc Decompression has successfully become a leading method for performing minimally invasive disc decompression and is a leading choice for physicians around the world.

Procedure Day

Here’s what to expect on the day of your procedure:*

• You will be directed to an exam or changing room.
• An IV may be started to administer medications.
• Prescriptions, MRI’s, and X-rays and reports will be reviewed with you along with the steps of the procedure.
• You will lie down on a procedure table as directed by your health care personnel.
• The procedure will be performed under anesthesia or sedation medications as directed by your physician.
• You will be lead to a recovery area after the procedure.
• Prescriptions for post-procedure therapy, medications, and follow-up instructions will be reviewed with you by a member of the health care staff or your physician. After the procedure you will remain in the recovery area for observation typically for one to two hours.
• Generally patients are released to rest for one to three days with limited sitting or walking.
• After about one week, patients participate in physical therapy to assist with full recovery.
• Patients are typically allowed to engage in some physical activity and return to work.

* Steps may vary depending on physician and location.

On 12/29/2007, President Bush signed the “Medicare, Medicaid, and SCHIP Extension Act of 2007”.  The bill was sponsored by Senator Chuck Grassley (D-IA) and was passed in the House (12/19) and Senate (12/18) before the signing by the President.  The bill passed unanimously in the Senate and 411-3 in the House.  Grassley has long been an advocate for increased Medicare Secondary Payer enforcement and the passage of this bill into law has ramifications for Liability Insurance, Self Insurance, No Fault Insurance, and Workers’ Compensation Insurance programs nationwide.

Of  major importance to liability, self, no fault, and workers’ compensation insurers is Section 111 (“Medicare Secondary Payor”), paragraph 8 (“Required Submission of Information by or on behalf of Liability Insurance (including Self-Insurance), No Fault Insurance, and Workers’ Compensation Laws and Plans”), items (A)-(H).  Here are a couple key sections of the law:

(A) REQUIREMENT – On or after the first day of the first calendar quarter beginning after the date that is 18 months after the date of the enactment of this paragraph (the law was passed on 12/29/07, making the following requirements begin July 1st, 2009), an applicable plan shall-

(i) determine whether a claimant (including an individual whose claim is unresolved) is entitled to benefits under the program under this title on any basis; and

(ii) if the claimant is determined to be so entitled, submit information described in subparagraph (B) with respect to the claimant to the Secretary in a form and manner (including frequency) specified by the Secretary.

(B) Required Information – The information described in this subparagraph is –

(i) the identity of the claimant for which the determination under subparagraph (A) was made: and

(ii) such other information as the Secretary shall specify in order to enable the Secretary to make appropriate determination concerning coordination of benefits, including any applicable recovery of claim.

(C) TIMING – Information shall be submitted under subparagraph (A)(ii) within a time specified by the Secretary after the claim is resolved through a settlement, judgment, award, or other payment (regardless of whether or not there is a determination or admission of liability).

(E) ENFORCEMENT

(i) In General – An applicable plan that fails to comply with the requirements under subparagraph (A) with respect to any claimant shall be subject to a civil money penalty of $1000 for each day of noncompliance with respect to each claimant (in addition to any other penalties prescribed by law and in addition to any other Medicare secondary payer claim under this title with respect to an individual).

What does it all mean?

Beginning on 7/1/2009; Liability Insurers, Self-Insurers, No Fault Insurers, and Workers’ Compensation Insurers must determine Medicare beneficiary status on all claims and report those claims involving a Medicare beneficiary to the Secretary at the time of settlement, judgment, or award.  If the reporting is not done in a timely manner, the Secretary may enforce a civil money penalty of $1000 per day per claim.  Beyond the reporting requirements and financial penalties, this now provides Medicare huge amounts of previously difficult to collect primary payer data on liability, self-insured, no-fault, and WC claims which can be utilized to enforce their Secondary Payer rights.  It will be very easy for Medicare to review settlements, judgments, and awards to determine if their interests were adequately considered in the settlement.  Workers’ Compensation has faced a similar situation (on a smaller scale) since 2002 with Medicare Set-Aside Arrangements.  The scope of this law is much broader than MSAs though and adds liability and no-fault settlements into the process, with stiff financial penalties for non-compliance.

What can be expected?

The Secretary has two issues to address in this law, (1) what data to collect and (2) what timeframe to receive the information post-settlement, judgment, or award.  The timing of the collection of data (post-settlement, judgment, or award) suggests that a copy of the  the settlement agreement, judgment or award will be required submission to the Secretary.  Since the intent is to enforce Medicare’s Secondary Payer rights, it is reasonable to assume injury information, diagnosis codes, and primary payer data will be required .  The language is broad enough to allow for the collection of medical information to determine if the settlement adequately protected Medicare’s interest.  It is likely that the timeframe will be shortly after the date of settlement, judgment, or award, but may be more frequent.

What can an insurer do?

In that the cost for non-compliance is great, insurers need to formulate a plan for compliance well in advance.  Imagine that a case settled on 7/2/2009 and involved a Medicare beneficiary; if this case was not  identified and reported to Medicare until 7/2/2011, the civil money penalty could be $730,000.00 (depending on the Secretary’s definition of timing and data).  And rest assured, Medicare has a number of resources available to help them discover noncompliant cases long after they have settled.  But the risk goes beyond just reporting correctly.  By giving the data to Medicare, the conditional payments related to the injury and adequacy of the settlement will be easy to review.   The resolution of conditional payments and the sufficiency of consideration to Medicare’s interests must be addressed before settling and reporting data to the Secretary to avoid having Medicare seek additional monies post-settlement.

A partner that can identify Medicare status quickly, assist with addressing conditional payments, and demonstrate adequate consideration of Medicare’s interests in the settlement will be a valuable asset over the next 18 months and in the years to follow.

Author unknown.  This article was published by NAMSAP (National Association of Medicare Set-aside Professionals)

*Stay tuned for more information on changes in Medicare statutes  at the upcoming IWCI  Seminar in August 2008!

Two recent cases help to explain the way civil courts are looking at the existence (or non­existence) of employment relationships when work place accidents occur. Unfortunately, the holdings of these cases put in doubt the predictability of the law in this area.

1.     Temporary Employees – Who is their Employer?

Since the amendments to the Act in 2001, there has been statutory language in the Workers’ Compensation Act which defines the relationship between an employee working for a temporary agency while assigned to the workplace of a company. That language is present in the definition of Employer found in Indiana Code §22-3-6-1 (a) as follows:

(a) “Employer” includes. . . Both the lessor and a lessee of employees shall each be considered joint employers of the employees provided by the lessor to the lessee for purposed of IC 22-3-2-6’ and IC 22-3-3-31.

Despite this statutory language, the court in Wishard v. Kerr 846 N.E.2d 1083 (Ind.Ct.App. 2006) seemed to analyze the case solely on the criteria by which an individual is determined to be an employee of one or the other company.

Ms. Kerr was a registered nurse assigned to work at Wishard through a temporary staffing agreement with CareStaff, Inc. She slipped and fell on a slick floor in the hospital as she departed at the end of her shift. She collected workers’ compensation benefits as against the staffing agency and then sued Wishard civilly. A motion to dismiss the suit based on the worker’s compensation bar was denied, and the denial was upheld by the court on appeal. Evidently there was nothing in the contract between the two companies that stated Ms. Kerr would be a “dual employee” and there was not sufficient other information presented to support such a finding. However, it would seem under the language of the WCA noted above, such a “weighing of the evidence” was unnecessary, and the bar to civil liability should have been upheld.

11C 22-3-2-6 limits an employee’s remedy for any personal injury or death by accident to the provisions of the Workers’ Compensation Act.

21C 22-3-3-31 states that when an employee works for two employers at the same time, the employers are liable for benefits in proportion to their liability for wages;

however, the employers are allowed to make any alternative arrangement between themselves a long as it is reasonable.

2.     Independent Contractors – Who is their Employer?

While it may seem counter intuitive to talk about the “employer” of an “independent contractor,” that sort of question often plagues litigants before the Board. Since the Workers’ Compensation system was designed to attempt to establish a remedy covering a minimum amount of benefits in all cases of work related injuries (i.e. lost wages, medical expenses, and PPI), the Hearing Members are reluctant to deny compensation to any worker without clear statutory authority to do so.

In like manner, civil courts are likely to look closely at the relationship of the individuals involved in a workplace accident to determine if in fact an employment relationship exists limiting the injured worker to benefits under the Workers’ Compensation Act. One such example is the case of Nickels v. Bryant, 839 N.E.2d 1211 (Ind.Ct.App. 2006). In that case, the infonnal arrangement between two truck drivers to work as a team was found to establish an employer-employee relationship between them.

Bryant worked as an independent contractor for New Prime, Inc. (NPI) and Nickels was an employee of NPI. Bryant agreed to take Nickels as a 2’”’ seat driver to train her on his runs. Though Nickels was an employee of NPI, the Court found that she was also an employee of Bryant for the purpose of the exclusivity doctrine of the Workers’ Compensation Act. Therefore, when Bryant ran over Nickels’ foot causing her injury, Nickels’ civil suit for damages against Bryant was dismissed and she was directed that her only remedy was workers’ compensation benefits. The court used the following seven factors to determine if an employment relationship existed between the two drivers:

1. The right to discharge
2. The mode of payment
3. Who supplies the tools or equipment
4. Whether the parties believe there is an employer-employee relationship
5. The control over the means used and the results reached
6. The length of employment, and
7. The establishment of work boundaries.

Clearly this sort of “weighing of the evidence” is appropriate in a situation such as this when there is no statutory basis to establish whether an employment relationship exists. The problem faced by litigants, however, is the difficulty in predicting the outcome of such a “weighing of the evidence” review by the courts. Furthermore, it would seem important in almost every instance for potential “employers” to seek the counsel of those well versed in workers’ compensation law as well as employment law in order to educate the court as to the ramifications of any potential decision that is rendered while there is still time to have an impact on that decision.

Pain is an unfortunate reality in all of its forms, especially in our aging and tireless workforce.  Work-related musculoskeletal disorders (WMSD’s) affect 7% or our populations in and result in 14% of visits to physicians.  One third of these WMSD’s can be attributed to overexertion or repetitive motion injuries. Many of these injuries respond with focused RICE regimen (rest, ice, compression, and elevation of the affected injured extremity).  However, if pain persists despite conservative measures, you should not delay a more detailed examination by your physician.  Recalcitrant pain can be a sign of an underlying worse pathology such as muscle, tendon, or ligament rupture.   Sometimes work habits, techniques, tools, and/or work environments may need to be modified to prevent further injury and facilitate your recovery.

Diagnostic workup would begin with a thorough physical exam and understanding of the individual’s mechanism of injury and normal work routine.   Frequently, this exam and a plain film x-ray is all that is necessary to determine the extent of the injury.  Fortunately, MRI is readily available when x-rays are not definitive and can even guide the length and type of treatment.  Treatment for most WMSD’s begin with a short course of anti-inflammatory medication, RICE regimen, modification of work habits/environment and possibly physical therapy.   Ignoring your joint pain that doesn’t respond to normal pain relief methods can lead to a more difficult to treat injury.  Moreover, you may be overlooking simple changes to your work routine or workplace that can be made to prevent re-injury.  Prevention and early treatment remain the mainstay for successful management of WMSD’s.

Patients considering lumbar spine surgery should be informed that the likelihood of having another spine operation later is substantial.  In a new study, Darryl T. Gray, MD, ScD, of the Agency for Healthcare Research and Quality, and colleagues from the University of Washington in Seattle found that one in five patients who had lumbar spine surgery for degenerative spine disorders underwent another back surgery procedure within the next 11 years.  This is higher than commonly reported rates for hip and knee replacement, where 10 percent of patients have a second operation within 10 years.

Not all reoperations are actually repeat procedures performed at the same operative site.  However, those that are imply persistent symptoms, progression of degenerative changes, or treatment complications, explains Dr. Gray.  To address this issue the researchers examined data from Washington’s State hospital discharge data, which are contributed to AHRQ’s State Inpatient Databases.  They identified 24,882 adults who underwent inpatient lumbar surgery for degenerative spine disorders from 1990 to 1993.  They had either lumbar decompression surgery or lumbar fusion surgery.  A total of 19 percent of patients had another lumbar spine surgery during the subsequent 11 years.  Patients with spondylolisthesis had a lower cumulative incidence of reoperation after fusion surgery than after decompression alone (17.1 vs. 28 percent).  However, for patients with other diagnoses, the cumulative incidence of reoperation was higher following fusion than following decompression alone (21.5 vs. 18.8 percent).

After fusion surgery, 62.5 percent of reoperations were associated with device complications or unsuccessful fusion rather than with new levels of disease or disease progression.  Spinal fusion is sometimes viewed as a definitive procedure that may reduce the need for subsequent surgery.  However, this study suggests that, except when performed for spondylolisthesis, fusion procedures for degenerative spine disorders were associated with a higher rate of reoperation beyond 1 year than were decompression procedures alone.  Patients and their physicians should consider this when weighing options for treating degenerative diseases of the lumbar spine.

Immigration is among the most controversial of current political topics.  It is a subject that impacts our society at many points, including worker’s compensation.  Employers, carriers and administrators are handling increasing claims involving undocumented workers.  The issue most often presented is what benefits, if any, an undocumented worker is entitled to under the Indiana Worker’s Compensation Act.  The underlying premise of this issue is that undocumented workers, who are often illegal immigrants, have entered into an employment contract under false pretenses thereby negating the employment relationship and making them ineligible for worker’s compensation benefits.  There are, however, many facets to this issue and at present no specific guidance from the present Worker’s Compensation Board as to how such claims should be handled.  It appears that a consensus among the Board may be developing but there has yet to be any specific pronouncement by the present Board or any reported appellate court decision regarding an undocumented worker’s entitlement to worker’s compensation benefits.

The Garcia Decision

There is general widespread knowledge of an unreported decision of the Indiana Court of Appeals that unfortunately is often used as guidance for these sorts of claims.  In the case of Garcia v. Owens-Corning, the Court sustained a decision of the Worker’s Compensation Board that awarded medical services and permanent partial impairment benefits to an undocumented worker, but denied temporary total disability (“TTD”) benefits on the grounds that the lack of a legal employment relationship made Plaintiff ineligible for income replacement benefits.  Because the Garcia case is an unreported decision of the Indiana Court of Appeals, the decision pertains only to that case and is not to be used as guiding precedent in the administration of future claims.  The Rules of Appellate Procedure (Rule 65 D) specifically prohibits such use.

Undocumented Workers

Recently, the Worker’s Compensation Board staff has returned Agreements to Compensation providing for payment of disability benefits in cases where the Board was unable to obtain the proper social security number or other identification number clarifying the employee’s work status.  The author has insufficient knowledge of whether this is still a consistent practice by the Board, but is aware that the issue has arisen in a number of cases requiring some resolution by the appropriate Board Member.  In one instance, an injured employee’s undocumented status was discovered when the Board staff sought to obtain a social security/identification number while processing an Agreement to Compensation for permanent partial impairment (“PPI”) benefits.  The undocumented status of the injured employee first became known to the adjuster handling the claim at the time of the Board’s rejection of the PPI agreement.  The adjuster thereafter sought to claim credit for TTD benefits paid against the PPI settlement consistent with the Garcia case reasoning.  The attorney for the injured employee argued that his client was entitled to the permanent partial impairment benefits regardless of any error in payment of disability benefits and that the claimed credit was inappropriate.  The appropriate Board Member informally resolved the dispute in favor of the injured worker.

The emerging consensus of the Board seems to be maintenance of the Garcia reasoning; however, there are some indications that the Board may examine eligibility for benefits under a presumption that the employment relationship is legitimate and defer issues regarding documentation of the employment relationship to other authorities.

In addition, there may be some thought given to the statutory basis for the Garcia decision.  In that case, the defendant-employer argued that plaintiff’s entitlement to disability benefits was precluded under Indiana Code §22-3-3-7 which provides that TTD benefits may be terminated when an employee is unavailable for work due to reasons unrelated to the work injury.  While this is a sound basis for precluding eligibility for disability benefits, the specific language for the statutory provision that was used addresses termination of disability benefits after payment of such benefits has begun; not preclusion.  The criticism then is that Indiana Code §22-3-3-7 addresses termination of disability benefits rather than eligibility for disability benefits.  How the Board and the courts may view such argument if presented in another case is unknown; however, it is reasonable to anticipate that this argument will be advanced in any future case that may result in a reported decision by the courts.

Collateral Issues

A point regularly made in the immigration debate is that the employer-based enforcement mechanisms have not worked for any number of reasons.  Employers may be given false documentation; but some also suspect there could be lax enforcement of applicable law, or violation of the law.  This dynamic requires the Worker’s Compensation Board to examine the employment relationship under laws that may be outside of its jurisdiction, hence the seeming reluctance of the Board to decide issues better left to other authorities.

A possible conflict of laws arises when an employer/carrier/administrator seeks to keep an undocumented worker inside the United States, most probably inside the State of Indiana, in order to exercise direction of medical care.  Taking such action as allowed by applicable Indiana worker’s compensation law, may be in violation of federal laws making it a crime to harbor an illegal alien.

Another facet to this dynamic is the cost of worker’s compensation insurance.  The premium charge to an employer (or the securities required by the Worker’s Compensation Board for self insuring employers) is based upon experience and estimated exposure.  Those costs are paid but then a reduction of liability estimates results from an injured worker’s ineligibility for disability benefits under the circumstances described above.  Again, the practice within the industry on this matter is unknown to the author but some have raised the question of whether premiums or self insurance security requirements should be altered by what is effectively a reduced exposure resulting from payment of fewer TTD benefits to fewer claimants.

Legal Framework

Given the lack of clarity in addressing claims involving undocumented workers, these matters could be evaluated and administered using four broad legal concepts:

Employment

First, there should be a determination of employment status; i.e. does the worker meet the definition of employee set forth in Indiana Code § 22-3-6-1 (b) and the associated case law.  The parties could also look to the provisions of an insurance policy or the terms of an approved self insurance program to determine status in such cases.  All further analysis will hinge upon the fundamental determination of whether there is an employment relationship that invokes application of the Indiana worker’s compensation law.

Benefits

Secondly, there should be a determination of the benefits due to the worker.  The traditional worker’s compensation benefit construct is medical services, disability and impairment compensation.  If medical services are provided, consideration must be given to where such services are provided and by whom.  While employer direction of medical care is appropriate under the Indiana Act, the Worker’s Compensation Board may assess the reasonability of direction of care under the extraordinary circumstances created by claims of this nature.

Experience indicates that medical services and PPI compensation will likely be awarded in these cases.  However, there may be circumstances in which other forms of benefits may be owed to the undocumented worker.

Claims Handling

Third, attention should be given to claims handling.  In many cases involving undocumented workers there is a language barrier.  Appropriate administration of a claim by employer representatives, adjusters and attorneys may require increased attention to language translation issues during claim administration, discovery, depositions and adjudication.  The Board is likely to expect employers/carriers/administrators to make extra efforts to ensure proper claim administration and disfavor any impact caused by language barriers.

Subcontractors

The last area of consideration dovetails with the first.  In examining the employment relationship, the parties should also look to whether there are any secondary liabilities created by a contractor/subcontractor relationship.  Indiana Code § 22-3-2-14 sets forth requirements and liabilities for such relationships.  It is important for an employer and their carriers/administrators in these situations to have some understanding of the risk beforehand.  It is not practically feasible for contractors to always know the employees of a subcontractor.  Consequently, the statutory requirement that contractors obtain a certificate of compliance from subcontractors verifying proper worker’s compensation coverage has increased importance in this area.

Conclusion

As practitioners of Indiana worker’s compensation law wait for more definitive guidance in cases involving undocumented workers, it appears that the proper claim administration is to assess each claim individually.  Board direction is readily available when appropriate in awarding benefits to undocumented workers.

The ASTYMTM System is a relatively new therapy approach of treating soft tissue injuries that are causing pain, restricting movement, and limiting function. Treatment can be effective for nagging overuse injuries as well as for new injuries and post-operative scarring. The ASTYM System was developed and researched under the direction of Thomas Sevier, MD, of Performance Dynamics Inc. within the past 10 years.

Using the ASTYM System, trained and certified rehabilitation professionals use non-invasive hand-held instruments on the skin to locate and treat dysfunctional areas within the soft tissue that are causing pain and limitations to movement and use. The treatment process assists in “jump-starting” the body’s natural healing process during which abnormal, scarred soft tissue is broken down and reabsorbed into the body.

Adhesions and fibrosis or scarring can result within the soft tissue following an injury or trauma, chronic irritation, tendonitis, or surgery. It is these adhesions and fibrotic scars that interfere with movement and function and cause pain. During treatment, the patient and therapist feel the abnormal “bumpy” or “rough” tissue as the instruments glide over the skin. Over the course of treatment, as the abnormal tissue is eliminated, the gliding of the instruments is noticed to become “smoother.”

This controlled “microtrauma” of the ASTYM treatment stimulates normal healing and repair of the affected soft tissue. Optimal healing can be achieved as the therapist develops and prescribes an individualized exercise program tailored to the patient’s problem. The stretching, strengthening, and functional progression of the exercise program help to rebuild healthier and stronger tissue more suited for the activities, work, or sports the patient performs.

“This treatment technique is based on the normal healing principles of the body, and it is supported by research and outcomes data,” says Belinda Hays, PT of Progressive Physical Therapy in south-central Indiana. “This approach provides an effective alternative treatment to persistent, chronic problems. But it can also be successfully used with newer injuries and post-surgical adhesions as well.”

Some of the clinical diagnoses and conditions that have responded well to this treatment approach are:

• Post-injury scar tissue
• Post-surgical scar tissue
• Trigger finger
• Carpal tunnel syndrome
• Lateral epicondylitis (tennis elbow)
• Medial epicondylitis (golfer’s elbow)
• Plantar fasciitis and heel pain
• Achilles tendonitis
• Chronic ankle sprains
• Shoulder pain
• IT band syndrome
• Anterior knee pain
• Hip pain and trochanteric bursitis
• SI and low back pain
• Muscle strains

To locate a certified ASTYM provider in your area, contact Performance Dynamics Inc. at 1-800-333-0244 or look on the web at www.astym.com. Progressive Physical Therapy provides the ASTYM System at four locations in south-central Indiana in Columbus, Seymour, Greensburg, and Scottsburg.

Back pain leads to a significant amount of time off work for employees at a substantial cost to employers and the society at large. The main goal in treating patients suffering from this pervasive health issue is to facilitate their return to work in a safe and expeditious manner.

The first and most critical step in treating patients complaining of back pain is to make an accurate diagnosis and identify the source of their pain. There are many possible pain generators — the patient’s symptoms may emanate from their intervertebral disc, facet joint, fracture of the vertebral body, muscle, or even the sacroiliac joint. In over 90% of patients, we are able to make the diagnosis based on the patient’s history and a thorough physical exam. X-rays are then used to confirm this diagnosis. In most cases, an MRI is not necessary and tends to be overutilized.

The next step after making a comprehensive and accurate diagnosis is to institute a targeted treatment plan to address the pain generator. For the majority of patients, a treatment plan involving modified work duty, anti-inflammatory medications, and physical therapy is sufficient, and no further treatment is necessary.

Facet injections and radiofrequency ablations are occasionally beneficial, but tend to offer short-term relief. However, in some cases these can be very useful in determining the pain generator, thereby facilitating physical therapy. A common misconception is that epidural injections are effective in the treatment of low back pain. In reality, there is no data to support the use of epidural injections for the treatment of low back pain.

Surgical intervention is recommended in only a small proportion of patients, and should be considered only after a long course of non-operative treatment. Good surgical outcomes for patients with low back pain are strongly correlated with careful patient selection, excellent surgical technique, and early and aggressive postoperative rehabilitation. While micro-discectomy’s typically provide predictable outcomes, spinal fusions have yielded less than perfect results. However, fusion operations do work in properly selected patients. Some of the newer, minimally-invasive spine fusion techniques are an advance from a post-operative morbidity standpoint, but have not demonstrated a significant improvement in clinical outcomes. The newer motion-sparing, artificial disc replacement options are also exciting, but clinical data does not suggest that they offer any improvement over fusion. The future seems bright for significant advancement in these areas.

Early and aggressive postoperative rehabilitation is critical to ensuring successful surgical outcomes. We recommend rehab starting at 2-weeks post-op, followed by work conditioning for 3-weeks, if needed, starting at 3 to 4 months post-op. By doing so, our patients are typically able to return to work full-duty within 5 to 6 months. Depending on light-duty availability, many patients are able to return to work much sooner.

A comprehensive spine-care system is critical to delivering optimal care for patients with low back pain. The treating team must be proficient in making an accurate diagnosis and must also be knowledgeable about entire spectrum of spine-care options to recommend an appropriate treatment modality for each patient.

Dr. Nitin Khanna is a Board certified and Fellowship trained Spine surgeon. Dr. Khanna completed his Spine Fellowship from the prestigious RUSH Presbyterian Hospital in Chicago. He completed his Orthopaedic and Spine training at the world renowned Washington University in St. Louis. He can be reached at Spine Care Specialists at 219-924-3300.

1 in 6 Americans say they’ve had financial information stolen.  Half of all identity thefts are carried out by friends or family.  Identity theft can be devastating. Here’s how to restore your name.

Signing autographs and posing for pictures were all part of the job for Dan Benish. As a defensive lineman for the Washington Redskins in the early 1990s, Benish often made public appearances where he did grip-and-grin meetings with fans. Yet one woman did more with his signature and photos than Benish banked on. She started posing as his wife. Armed with the NFL player’s signature and a wallet full of doctored photos that made it seem as if they were married, the faux fan purchased cars, secured a mortgage, opened credit accounts and more—all in the guise of Mrs. Dan Benish. The identity thief eventually got caught and went to jail. And Benish, who was compelled by the experience to become a consultant and identity theft expert, spent years trying to reclaim his identity. “I was like a lot of victims—I didn’t think it could happen to me,” says Benish, who now lives in Atlanta, Ga. “But what I’ve learned is it can happen to anyone at any time. Rich, poor, young or old.” Indeed, while few Americans sign autographs and pose with strangers,         Benish’s experience exemplifies the many ways that thieves swipe millions of identities each month. The crooks go on lavish spending sprees, tap medical benefits, create fake employment histories, and even commit crimes in the name of someone else. Maybe you. While thieves are stealing identities at a record clip (32 million in the first six months of 2006 alone), consumers, financial institutions and insurers are fighting back with new safeguards and increased awareness that have reduced the severity of losses. And state-of-the-art identity recovery services help victims piece their credit—and lives—back together.

Who’s a Target?  

Consumers can take action to protect their identities from would-be-thieves. The first step is to clearly understand that—regardless of financial standing— anyone can be a lucrative target for identity thieves seeking anything from medical benefits to a pseudoidentity that offers cover for a crime spree. “I have so many people who tell me, ‘I don’t buy things online or I don’t have a mortgage, so I’m not at risk,’” says Michael McCoy, an identity fraud consultant and co-author of Who is You? The coming epidemic of identity theft (The Consortium Books, 2006). “I ask them have you ever been married? Have you ever gone to the doctor? Have you gone to college? Have you applied for a credit card? If the answer is yes to any of those, there’s a possibility your data is at risk. And if you’re not one of those, then maybe people are going through your garbage or clearing out your mailbox.” Experts recommend shredding all mail and documents that contain personal information. Don’t carry Social Security cards or other sensitive documents in a wallet or purse, and use a secure postal box instead of putting bill payments into a roadside mailbox. “It’s amazing how many people still carry all their personal information in their wallet,” McCoy says. “I had a young man just call me who had lost his wallet. In it he had his driver’s license, Social Security card, medical insurance card and student ID. Someone on the street could easily sell that package for $3,000.”

Not if, When

McCoy claims the problem has escalated to the point that it is not a matter of if your identity is stolen, it is when. Even the most conscientious consumer can be hit. Witness the 26.5 million veteran and active duty military personnel whose names and personal information fell into the hands of thieves last June. The  criminals stole a laptop computer and external hard drive from the U. S. Veterans Administration. Realization that identity thieves will always exist has led to increased emphasis on raising awareness, reducing losses, and establishing identity recovery services that help victims navigate the twisted path to restoring their name and credit. Some insurance carriers have recognized the potential risk to customers and have responded.

Lifting the Burden

Indeed, the theft itself is just the beginning for those whose identities have been stolen. It can take months or years to fix the problem for those who attempt to clear their name on their own. Over time, victims can invest more than 60 hours and hundreds or thousands of dollars into the restoration effort. The process is a tangled maze for consumers. Police are sometimes hesitant to file a report on the theft, which can delay the recovery process. Companies may not follow laws concerning consumer disputes and customer rights. And, on occasion, creditors re-report identity theft after a problem has already been resolved, creating confusion and putting red flags on credit reports.

Working as a team

It is best to have a good system in place for storing documents and sensitive data before an identity theft occurs.   The bulk of the restoration process typically takes three to six months.  A thorough credit and identity check is then performed 120 days later to make certain there hasn’t been anymore suspicious activity. If no problems are detected, the case is considered closed. If there are more red flags, the entire process begins again. “Generally speaking, the situation gets under control,” Cernak said.  Unfortunately, once your identity is out there, you’re never quite sure where it has traveled on the dark recesses of the globe. It’s a matter of being cognizant and vigilant about what is going on with your credit and personal information on a regular basis.”

‘I got my life ’ back

Mari Jo* of Fairfax, Va., experienced the benefit of  identity recovery services like those provided by  ERIE. The 34-year-old waitress was paid by direct deposit one Friday afternoon last year. On the following Tuesday, she called to check her account balance only to learn the account had been emptied out. Over the next few days, thieves wrote 13 checks on her account, totaling an additional $3,500. “I tried to handle the situation myself for the first few days,” she said. “I didn’t get very far.” Mari Jo soon connected with a licensed investigator who started unraveling how her identity had been stolen. He quickly determined that the thief had duplicated her checking account and then printed counterfeit checks using her account number, routing number, name and address. Two months later, the thieves struck again, using her identity to obtain a credit card and run up a $5,000 debt.

Peace of mind

Getting people’s lives back is what  identity recovery coverage is all about. And it offers something else as well—peace of mind. Former footballer Dan Benish wishes he would have had the benefit of identity recovery  services when he was piecing his identity back together several years ago. He took on the time-consuming  task of contacting all the agencies and clearing up his credit reports. “When I went through this I had no guidance at all,” Benish says. “It was a very uneasy feeling. People need to know that even if you do all the right things, you can’t be 100 percent sure that your identity won’t be stolen. You have to monitor your credit and make sure you have some type of managed identity recovery coverage.” •

Phil Friday’s Identity Theft Prevention Tips

Phil Friday, ERIE’s feisty fraud-fighter, usually spends his days cracking capers involving crooks. But when Phil isn’t working the fraud beat, he’s trying to get the word out about how to avoid getting scammed. One of your most precious assets is your good name. Here are tips on how to keep it and prevent others from traveling to Tahiti on your dime.

• Protect your Social Security number.
• Don’t carry your Social Security card or anything bearing the number with you. Store it in a safe place. If a business asks to use it for something, request that they use another number instead.
• Protect your mail.
• Outgoing bills should be mailed from post office collection boxes, not your home mailbox. A locking mailbox or a P.O. box will help protect incoming mail.
• Protect your PINs.
• Choose your PINs carefully—no birth dates, names of pets, or consecutive numbers. Do not use any part of your Social Security number or anything that could be easily guessed. Memorize your PINs.
• Destroy sensitive documents.
• Never just throw sensitive material into the trash. Shred everything that contains personal information. This includes ATM receipts, insurance forms, credit card bills, bank statements and pre-screened credit offers.
• Shop online with caution.
• Use a credit card, not your debit card, when shopping online. Set aside a special card with a low limit to use just for online shopping. The lock symbols at the bottom of your browser window will tell you if a site is secure.
• Beware of solicitations.
• Unless you are the one who initiates the contact, do not give out any personal information over the phone, online, or through the mail. Thieves may pose as banks, credit card companies or anything else.
• Check your credit. You now have the right to three free credit reports per year, one from each credit bureau. You can access your credit report through www.annualcreditreport.com. Check your credit regularly and be on the lookout for any suspicious activity. Investigate anything that appears suspicious on your credit report.

Scott Westcott is the editor of In Sync magazine and a professional writer. His work has appeared in many national magazines including Inc., Outdoor Life, Woman’s Day, Psychology Today, Cooking Light and Family Circle. Illustrator James Shepherd lives with his wife, two boys in the town of Muskego, WI. His work is generally found on packaging for high energy toys for kids, or high energy snacks for kids.

A new report from Harvard Medical School refutes the common assumption that computer use causes carpal tunnel syndrome.

Instead, says this report edited by Harvard-based hand experts, carpal tunnel syndrome is caused by the compression of the median nerve in the wrist. This compression may occur because of heredity, body weight, fracture, or even pregnancy, but not computer use.

This 40-page report, “Hands: Strategies for strong, pain-free hands”, also explains the many causes of hand pain, and describes the exercises, therapies, and medications used to treat them.

Carpal tunnel syndrome, a condition that affects between 2 percent and 3 percent of the population, occurs when one of the three major nerves that travel from the spinal cord down to the hand becomes “pinched”. It affects nearly twice as many women as men. A procedure to ease this nerve disorder is one of the most common surgeries done in the United States, with more than 20,000 performed each year.

Recent research has found that heavy computer use-up to seven hours a day-does not increase risk for carpal tunnel syndrome. However, improper computer use and other workplace conditions can contribute to a type of disorder known as repetitive stress injury.

Carpal tunnel syndrome is in fact not a repetitive stress injury, though it is often incorrectly described as one, says the Harvard report.

http://www.insurancehournal.com/news/nationsl/2005/12/15