One of the most common, and often hard to evaluate, injuries for contractors is one on the back. A person can injure her back in many ways, such as trauma, excessive use, prolonged wear and tear, and degeneration due to disease or age. Pinpointing exactly what causes a specific back injury is often a difficult, costly diagnosis process. Usually, people feel they can go about their daily lives and avoid seeking medical attention until the pain starts to make regular activities difficult. The delay in having injuries assessed when they first started impacts the difficulty of determining an accurate diagnosis. Part of the task is figuring out what caused the injury, and the second is ascertaining how much of the condition is due to aggravation to the primary injury. Due to the difficulties in determining the exact cause of back injuries, it makes liability adjusters’ jobs even harder when it comes to confirming whether an injury is a result of a workplace accident or a preexisting condition.
The Anatomy of Back Pain
The back is made up of vertebrae that run through the spinal cord. From the top of the neck, there are 7 cervical vertebrae, called C-level; then 12 dorsal or thoracic vertebrae, called T-level; then 5 lumbar vertebrae in the lower back, called L-level; then 5 fused vertebrae that make up the sacrum, called S-level; and lastly the coccyx at the bottom, which consists of 4 fused vertebrae. The spinal cord starts up in the central canal of the brain, and extends through the vertebrae down to the first or second lumbar vertebrae, at which point it tapers off as nerve roots. Throughout the rest of the vertebrae in the spine, there are nerves that work with the different body muscles.
Between each of the vertebrae, there are intervertebral discs, which are made of a nucleus pulposus surrounded by the annulus fibrosis. Think of these discs as tires that have had their middles filled in with a jelly-like substance. The outer annulus fibrosis is a rubbery, protective substance, and the nucleus pulposus is gelatinous. If these discs rupture, the jelly-like material can protrude through the exterior material, causing pressure on the spinal column. This is called a bulging or ruptured disc, which is known to be extremely painful, and can cause numbness or even paralysis.
How a Back Injury is Diagnosed
Pain is something that is very subjective, and is hard to gauge from person-to-person. When it comes to workplace injuries, oftentimes people may exaggerate the pain that they’re experiencing. Back pain is one of the most common complaints from people with legitimate injuries. Taking both of these points into consideration, it’s really hard to distinguish fraudulent back pain complaints from the genuine ones. The human back bears the weight of most of the body, and due to its flexibility and the many maneuvers we make daily that involve our backs, it is extremely susceptible to injuries that can lead to serious disability. Estimates have claimed that as many as 50-70% of Americans may have back pain of one form or another.
A physical examination is the first step in diagnosing a back injury. During the exam, a physician can assess a patient’s range of motion, muscle strength, reflexes, and nerve response. A physical exam can be sufficient for initially confirming that there is, in fact, a back injury, and where the pain is localized. Most back pain sufferers will heal on their own within a month of being injured. In those situations, further examination is not usually pursued. However, when there are warning signs of more serious issues during primary exams, more advanced imaging technology is often the next step to determining the severity of the injury.
There are many different types of imaging examinations available, but not all of them are appropriate for assessing back injuries. X-rays, for example, are not the right tests for examining muscular injuries, so unless the back injury may involve potential fractures in the vertebrae, they are not usually helpful tests to use. Magnetic resonance imaging (MRI) is the testing method often employed when there is a difficulty finding a precise diagnosis, if the pain has lasted for a long time, or if the doctors fear the patient may be susceptible to infection. MRIs use magnets to create a picture of the patient’s body that doctors can use to assess the patient’s condition. When there’s a question about an injury to nerve roots or muscles, physicians may use an electromyogram (EMG), which reads electrical impulses emitted from the muscle through small needles placed into the muscle.
How a Back Injury is Treated
Surgery is usually a last-ditch effort when it comes to back injury treatment. Due to the flexibility of your vertebrae, most back injuries can heal on their own with rest. Pain that lasts longer than expected can often be minimalized by steroid shots injected directly into the spinal canal to soothe the spinal cord nerves. Wearing a brace and limiting your motion is generally sufficient to heal a vertebrae fracture. In severe instances, surgery may be the only way to eliminate pain or return mobility, but due to potential significant side effects of surgery, most doctors only consider surgery as a last resort option.
Workers Compensation Claims Investigations
There are a number of points that should be addressed during the investigation of any injury or accident claim in the workplace, especially when a back injury is involved, due to the gray area that surrounds them. Considering that there’s a certain level of subjectivity and questionability when it comes to back injuries, claims adjusters have to be very detailed in their investigations.
Factors that should be addressed include:
- Facts and details of when the accident took place, including any kind of trauma that occurred and the direction from which is came, and how the situation happened in the first place
- Witnesses to the accident should be questioned regarding the events that took place, to either corroborate the statements made by the claimant or to contradict the claimant’s allegations
Additionally, complete medical information is incredibly important.
These records should include:
- The claimant’s type of work and regular activities
- A description of the symptoms and their date of origin
- A record of past medical history
- The diagnosis and prognosis as given to the treating physician, and any record of hospitalization either prior to being injured or after the accident took place
- A statement of competency of the treating physician
- A comparison of the prescribed treatment measures to documented medical guidelines
- The extent to which the claimant is disables due to effects of the injury, including any loss of wage-earning capacity
It is likely that the claims adjuster will also assess the claimant’s historical information.
This will include:
- Any prior accidents
- Any family-related stressors, including marriage/divorce/job stability/dependency of parents and children
- Extended treatment beyond the norm will often require the claims adjuster to monitor the claimant’s regular neighborhood activity, to ensure that the disability is legitimate and not a fraudulent accusation.