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Workers' Compensation

Another Busy Year for Workers’ Compensation and Occupational Health

The new 2011 Edition of Occupational Injuries and Illnesses (LexisNexis) has shipped to customers

This was another busy year for workers' compensation and occupational health. In light of the passage of the Patient Protection and Affordable Care Act (PPACA) of 2010, many were trying to predict its impact on access to care, coordination of benefits, and relative usage of workers' compensation. Much remains to be seen, as its provisions are implemented, what the intended and unintended consequences will be, as access to health insurance coverage is potentially expanded under the new law.

Perhaps due to the massive pendulum swings in many state legislatures in the midterm elections of 2010, several workers' compensation reform bills passed around the country. In spite of much discussion, there was no attempted federalization of workers' compensation.

However, there were Congressional hearings to investigate the validity and applicability of the AMA Guides across the states and in federal cases. They were questioned by various witnesses on their fairness to workers and the depth of evidence-based studies used to develop the individual rating percentages. Nonetheless, it remains the bedrock of impairment evaluation in its various iterations as adopted across the jurisdictions, and Volume Three of Occupational Injuries and Illnesses (LexisNexis) is again updated with all the relevant cases involving use of the AMA Guides.

The United States Department of Health and Human Services added eight more substances to its Report on Carcinogens, an evidence-based document that identifies chemicals and biological agents that may put people at an increased risk for developing cancer. Formaldehyde and aristocholic acids are now listed as known human carcinogens, and six other substances-captafol, cobalt-tungsten carbide, inhalable glass wool fibers, onitrotoluene, ridelliine, and styrene-are now considered as reasonably anticipated to be human carcinogens. This brings the total to 240 identified substances in the listings demanding thoughtful approaches to minimize exposure to workers.

One of the worst public health disasters of 2011 to date was the magnitude 9.0 earthquake and subsequent tsunami that damaged the Fukushima Daiichi nuclear power plant in Japan. The events disabled the reactor cooling systems and led to nuclear radiation leaks in a 30 km evacuation zone around the reactor site. The radiation entered the water supply, has been detected in plant matter, and will surely have downstream effects for many years to come. Some response workers have already died from the radiation and many others have been exposed to varying degrees. Readers of Occupational Injuries and Illnesses (LexisNexis) can refer to Chapter 44 for recent updates on the physics of radiation contamination and possible human health effects of exposure.

One can stay up to date on federal, state and other legislative and general news items that affect the occupational health community by subscribing to the free weekly LexisNexis Workers' Compensation eNewsletter by sending your name and email address with your request to receive it to

Low back claims are among the most expensive and most contentious of all medical issues in workers' compensation and disability. Indeed it is among the most common reasons for adults to see any medical provider. There is great variation in best practices among different medical specialties, causation is difficult to establish, and no objective, quantitative diagnostic testing reliably identifies the specific pain generators. The issue is problematic for patients, providers, insurers and employers. Nonetheless, we have tried to update Chapter 15 in Occupational Injuries and Illnesses (LexisNexis) to reflect the current information on the topic in this ever-shifting landscape.

This year marked the 30-year anniversary of the identification of the human immunodeficiency virus (HIV). The infection has transcended its original death sentence upon diagnosis to a chronic disease state when adequately treated with the panoply of various treatment options these days. Once widespread fears of transmission in a host of occupational situations has thankfully now been limited to mostly preventable scenarios. Chapter 46 of Occupational Injuries and Illnesses (LexisNexis) reflects these advances.

This year, we have also updated the following chapters in Occupational Injuries and Illnesses (LexisNexis): Chapter 38 on occupational cardiovascular issues; Chapter 18 on spinal cord injury; and Chapter 3 on risk management issues.

I would like to acknowledge the tireless efforts of my editor from LexisNexis/Matthew Bender, Robin Kobayashi, and contributing author and assistant to the editor-in-chief, Thomas A. Robinson, who had the foresight to remake this publication into a more updated reference for professionals in the industry, and the determination to keep me and the contributing authors on schedule for publication. I also want to thank the various contributing authors for their zeal to improve the quality of the chapters. Most of the contributing authors I have selected not only have experience and training in occupational medicine, but also specialty board certification or career expertise in the subject matter to sort through the mountains of existing data to provide simple, informative text as a resource for you.

Brian Caveney
Brian J. Caveney, M.D., J.D., MPH
Durham, North Carolina

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