Transcript Headline

Worker Compensation in
Commercial Drivers
Injury Prevention and Case
Management
Brian Harrison, M.D.
April 2014
Worker Comp (WC) in
Commercial Drivers (CD)- Concepts
• DOT Regulations reduce major WC Cases BUT:
– DOT Regulations may increase Lost Workdays in
both major and minor cases
• Employers can improve primary prevention of CD WC
Cases through
– Safe work practices while performing non-driving duty
– Truck driver wellness
– Safe use of all medications (Rx and OTC)
• Case managers and adjusters should attend to all
potential barriers to RTW in WC Cases
• Use Worker Rehab Program more liberally
Commercial Driving –
Big Vehicles, Big Costs, Big Regulations
• Active Interstate Truck and
Bus Companies (2004)
 662,392
– Between 2000 and 2010:
• truck and bus miles
increased 20%; more
carriers.
• Total Number of CDLs
Issued
 6-7 million
• FMCSA certification
examinations for commercial
motor vehicle drivers: 3-4
million exams annually
Source: Motor Carrier Safety Progress Report
(September, 2004)
3
Professionals Drive More Safely Than We Do
Vehicles Involved in non-Fatal injury per 100 Million
Vehicle Miles Traveled by Vehicle Type
They Live in Regulation Nation!
• 1939 – First Regs: Interstate Commerce Commission
“Good physical & mental health, no addiction to narcotics,
no excessive use of alcohol.”
• 1954 - Exams first required
• 1970 – DOT created
• 1999 - Ill bus driver liable for 22-death crash
• 2000 – FMCSA created
• 2005 – SAFE TEA – LU: Chief Medical Officer, Medical
Review Board, Medical Expert Panels; National Registry of
Certified Medical Examiners proposed
• 2006 – Sleep Apnea: Joint Task Force Guidelines
• 2014 – National Registry of Certified Medical Examiners
– Trained, Tested, Certified
Medical Standards (Regulations)
of the FMCSA
• 13 standards directly related to medical requirements
4 standards are specific
• Medical examiner cannot interpret or alter
• Vision, Hearing, Epilepsy, Insulin use
9 standards are general (“likely to, which
interferes,” or satisfied by Skill Performance
Evaluation or OK’ed by MD)
• Medical examiner decides if medical condition
affects driver’s ability to safely operate a CMV
6
Joint Task Force Guidelines
Joint Task Force Guidelines
Two or more of the following:
1. Body mass index >35 kg/m2
2. Neck circumference in men >17” and in
women 16”
3. Hypertension (new, uncontrolled, or
unable to control with fewer than two
medications)
An Observational Study of
Commercial Drivers at risk of OSA
613 (67%)
When given option
to lose weight:
And kept it off
For 1 year!!!
Remained at
BMI < 35
49 (56%)
Seen for recert (10.6 mo
average f/u)
No
unaddressed
OSA risk
915
Index
Exams
49 (100%)
40% did,
Average of
33# !
87 (40%)
219 (92%)
To weight loss
option
302 (33%)
239 (79%)
At risk for OSA,
BMI ≥ 35
Available for
f/u at 3-9 mo.
132 (60%)
1 (0.5%)
To bariatric
surgery
63 (21%)
Lost to f/u
19 (7.5%)
Out of service
PSG (all
positive)
At BMI < 35 in
3-9 months
BMI still ≥ 35
at 3-9 months
132 (100%)
Proceeded to PSG
and treatment (if
indicated)
22nd Anniversary of DOT Drug Tests
• The Omnibus Transportation Employee
Testing Act became law on Oct. 28, 1991
– Seems like a long time ago: Packers went
4-12 in 1991 with Coach Infante and QB
Mike Tomczak
• Illegal drug use among transportation
workers has since dropped 50%
• Fatal accidents from alcohol use by truck
and bus drivers has since dropped 23%
Large Truck Crash Causation Study
FMCSA 2007
CRASHOLOGY - THE SCIENCE
OF DRIVING SAFELY
Top 10 “Critical Reasons” (CR)
for Truck Crashes
(2 mechanical, 8 operator)
–
–
–
–
–
–
–
–
–
–
Over loaded
Making illegal maneuver
Inadequate surveillance
Traveling too fast for conditions
Inattention
Following too close
Misjudgment of gap or other’s speed
Stop required before crash
External distraction
Brake problems
Top 10 “Associated Factors” (associated with CR)
- Ranked By Frequency –
1.
2.
3.
4.
5.
6.
7.
Brake problems
Traffic flow interruption (congestion, previous crash)
Prescription drug use
Traveling too fast for conditions
Unfamiliarity with roadway
Roadway problems
Required to stop before crash (traffic control device,
And, 5th
crosswalk)
most important by
8. Over-the-counter drug use
Preventable
9. Inadequate surveillance
Fraction
10. Fatigue
Trucking Cost Conundrum
• Trucking Industry has improved safety, cut illegal drug
use and alcohol misuse, and followed the rules
• Costs should have gone down, but haven’t, in:
–
–
–
–
–
Health plan
Worker comp
Turnover
Compliance costs
Accident Liability
Worker Comp Conundrum
• Trucking companies pay higher worker
comp premiums every year, even as large
truck crash rates continue to drop.
• Non-life threatening injuries suffered
during non-driving duties make costs
climb, despite fewer major injuries from
crashes
Transportation: Highest rates of Lost Time
(258, up from 251 in 2011)
258, up from
251 in 2011
Worker Comp Medical $ Climb
As Has the Cost of All Benefits
Worker’s Comp Conundrum – Root Causes
• Ill health and health-risking behavior underlie
this conundrum, not a lack of driving safety
– Individuals with multiple health risks are more likely to
submit claims
– Workers Comp medical care and wage indemnity
costs are higher in high risk claimants
– Organizations with higher prevalence of health risks
have higher Workers Comp costs
• And – Drivers must WORK more safely, not just
DRIVE more safely!
The burden of chronic illness in
an aging workforce is a culprit
you can seize!
Low Risk will Mean Low Cost
High Risk Will Mean High Cost
Elevated Body Mass Index
Recreational Drug Use
Lack of physical Activity
Perceived ill-health
High Stress
Dissatisfaction with life
High Cholesterol
Dissatisfaction with work
High Blood Pressure
Depressed mood
Smoking
Excessive Alcohol
Imperfect Safety Belt Use
Established Chronic
Disease
Overall Score:
Low Risk (any 2 or fewer)
Medium Risk (any 3 or 4)
High Risk (any 5 or more)
Low Risk Will Mean Low Cost
78%
79%
77%
72%
67%
62%
63%
65%
56%
2013
2012
2011
2010
2009
2008
2007
2006
2005
38%
30%
29%
23%
2004
2003
2002
2001
0%
10%
20%
19%
18%
19%
25%
26%
25%
25%
25%
27%
48%
55%
54%
58%
30%
Low (0-2 Risks)
40%
50%
Medium (3-4 Risks)
60%
70%
High (5+ Risks)
80%
3%
3%
4%
3%
6%
13%
12%
10%
17%
17%
15%
17%
18%
90%
100%
Obesity and All Medical Costs
• 77% higher average medical costs (obese vs. ideal)
• Treatment of obesity-related diseases
accounted for 27% of the rise in inflationadjusted per capita medical spending
between 1987-2001
– Thorp et al, “The impact of obesity on rising medical spending”
Health Affairs 2004 supplement
Personalized Care
Drive Down Trucker Trauma by
Reducing
Injuries Away From the Wheel
Commercial Drivers Drive Safely,
But Might Not Work Safely
• Commercial driver safety improvements
have cut large truck crashes to half of
what they were 10 years ago, per million
miles driven.
• High rates of strains, sprains, bruises, and
other conditions classified as
musculoskeletal disorders (MSDS).
• While lumping freight, climbing in and out
of the cab, and managing the trailer.
Get In And Out Safely!
• Classic “3 points of contact” method.
• When a 220 pound trucker jumps from the height of the
cab to the ground, they drive 1,637 pounds of force
throughout their body.
• From the lowest step, a mere 16 inches from the ground,
more than 300 pounds of force drives upward into the
body.
• Mechanical lifts such as powered lift gates pay for
themselves.
• Never climb onto cab tires to clear snow from
windshields.
• Flashlights to inspect the ground outside their cab door.
Get Ergonomic Equipment
• Cranking landing gear of the trailer pulling
the fifth-wheel “kingpin”.
• Air-ride seats and lumbar support.
• Correctly use multi-position seats
• Position the steering wheel directly in front
of the driver’s seat.
Motor Carriers Should Also Help
Drivers to Handle Freight Safely
• Drainage holes in the floors of refrigerated
trailers.
• Install handles at the rear of trailers that retract
into the floor.
• Position folding steps at the back of the trailer.
• Retrofit power lift gates if needed.
• Straps to dangle from the bottom of rollup trailer
doors.
• Help to handle unexpectedly heavy deliveries.
Combat the Sitting Disease!
•
•
•
•
Weight goes up and fitness goes down
Diabetes and heart disease
Injuries happen more commonly
Prolonged sitting punctuated by short
bursts of strenuous activity
Off your seat & on your feet!
• Get drivers to walk whenever they can
• Take laps around the truck plaza after
fueling
• Walking 36 laps around a big rig equals
1 mile.
• Walking 10 minutes 3 times a day briskly
will help fitness just as much as walking
once for 30 minutes does.
Stop The Shake, Rattle, And Roll!
Age-related degenerative lumbar disk
disease develops simply as a part of life.
It makes some less able to tolerate the
whole body vibration they absorb from
work vehicles.
Get Vibration-Canceling Equipment.
Prolonged Driving is Associated with
Common Backache and Cervicalgia:
But studies specific to Disc Degeneration
(LSP and CSP DDD) do not show this
correlation
LSP DDD Has Not Shown Association With
Driving In More Recent Studies
• Twin study which used MRI (Videman, Lancet
2002 Nov 2; 360(9343):1369-74) found no effect
of prolonged driving or occupational driving
histories upon LSP DDD.
– Some association was found with non-specific LBP,
but not with LSP DDD. “Although driving may
exacerbate symptoms of back problems, it does
not damage the disc. Our inability to identify
structural damage should be encouraging to those
employed in occupations involving motorized
vehicles and operation of heavy equipment.”
– Earlier, the same author showed that MRI findings in
professional racecar drivers are no different from
controls (Videman, Clin Biomec 2000 Feb;15(2):83-6)
Case Manager BOTLO:
• Claimant says “I can't work d/t WC injury” (but
then renews Fed Med card anyway!)
• Wants to RTW but has non-WR obstacle that
disqualifies Fed Med; hides in WC instead of
treating own health (or retiring)!
• Always ask to see Fed Med card; who signed it?
• Resolve all RTW obstacles early in WC case,
even if non-WR disqualifiers
• Untreated OSA plus benzos or opiates can kill!
• Employer might not realize the trucker can't
drive if any restrictions (let them ride-along as
trainer, or send to Worker Rehab Program)
Worker
Rehab
Program
Traumatic MSK Injuries
Common to Commercial Drivers
• Superior Labrum Ant-Post Tear (slipping
and hanging from cab or trailer door)
• Crushed hand - wind slamming trailer door
• Contused lower leg - stepping between
trailer threshold and dock plate
Common to CD
• Vertebral compression fx – stepping
backward off trailer, hitting ground in
sitting position (then concussion from
hitting back of the head)
• Trimalleolar ankle fx, tibial plateau fx –
jumping off flatbed trailer
• RC Tear – landing gear crank kicks back
Non-Work Related Look Alikes
• Wrist pain when steering – DJD, old
scapholunate dissociation.
– Carpal tunnel syndrome risk is NOT increased
by the frequency of vibration which comes
from the steering wheel
• Neck pain while riding – age related
spondylosis
• Back pain with prolonged sitting – lumbar
degenerative disc disease