What does work-related injury’ mean to employers?
By Lilly Ramphal-Naley, MD, MPH
Medical Director
WorkMed, the occupational health program of Wilson N. Jones Hospital
Sherman, TX
Employees and employers often confuse the true meaning of "work-related" illness or injury, but the importance of applying the terms accurately to a medical diagnosis becomes clear when medical costs and compensation issues are considered. It is important to educate your clients about the importance of properly classifying injuries and illnesses as work-related.
In an environment of managed care and medical cost containment, it becomes even more important to accurately define work-related illnesses because the employer becomes responsible for coverage of medical costs if a condition is deemed to be work-related.
From the employee’s point of view, anything that happens at work is considered work-related. However, this is not always a proper use of the term. For example, the diabetic whose blood sugar is aggravated by the doughnuts eaten at work is a good case in point. The worker’s diabetic condition was not caused or aggravated by the nature of his or her job tasks. The worker’s dietary indiscretion would have occurred at home just as easily as at work. However, a brittle diabetic who has difficulty controlling blood sugar despite dietary compliance may have additional aggravation of serum glucose due to diurnal variation in work schedules. This latter instance has the potential for becoming aggravated by the nature of the worker’s shift schedule.
The employer often assumes the other perspective, that employees have lives outside of work that often cause or contribute to the occurrence of the illness. This is especially true for workers who engage in vigorous after-hours sports activities and are therefore more susceptible to sports-related injuries. Employers often take an overly restrictive approach, concluding that a condition is work-related only if causative factors are strictly associated with an employee’s job responsibilities.
But how does OSHA define it?
The Occupational Safety and Health Administration’s definition of a work-related condition is "any illness or injury that arises (or is aggravated) as a result of work duties." It is the breadth of this definition that is the cause of much of the confusion. Yet the definition is purposely broad-based and is historically based in the latency period inherent in some occupational lung diseases. The inherent latency of some occupational pneumoconioses causes the delay in recognizing the causal relationship between work exposures and manifestation of disease later in life.
A sound definition for a work-related condition then rests on the following facts obtainable from the patient’s history:
1. Is the illness or injury caused or aggravated by work activities?
2. Does the illness or injury improve with time away from work or with restricted duty?
3. Are the symptoms aggravated by home activities or hobbies?
4. Are there any other illnesses or factors that contribute to appearance or persistence of symptoms?
5. Can the job tasks or workplace be modified to correct the development of symptoms?
For a true definition of a work-related illness or injury, the answer should be yes to at least three of the five questions. Question three, concerning home activities or hobbies that may aggravate the injury, also should receive a yes response to contribute to defining a work-related illness or injury. If the employee has carpal tunnel syndrome primarily caused by work activities, for example, the seriousness of the problem can be gauged in part by how much the symptoms continue outside the workplace. So a yes answer to question three, when combined with two other yes answers, helps define a work-related illness or injury.
How do the factors add up?
Consider this example:
An employee with a known history of seizures has a seizure at work while holding a flask of hot water. The hot water spills during the seizure, and the worker receives serious burns. There is no reason to believe the seizure was brought on by any work conditions.
Is this a work-related injury? Using the questions above, this situation would yield yes answers to three of the five questions, meaning the injury is indeed work-related. Holding the flask of hot water was part of the employee’s normal job tasks and not a break- or lunch-related activity. The worker’s injury, therefore, was caused by work activities despite the fact that the seizure itself was not. This injury would not have occurred if the employee had restrictions that included no handling of caustic or injurious liquids.
This point system is a good reference when deciding whether an illness or injury sustained in the workplace is, in fact, work-related.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content