Dr. Alchemy and Cory discuss what it’s like being a workers’ comp doctor navigating the largely uncharted terrain of rating COVID-19 workers’ comp claims. It’s not an easy job, especially in a notoriously difficult field. Fortunately, RateFast Express offers COVID-19 specific impairment ratings, staying up do date with all the new information regarding the virus.
If you’re a workers’ compensation provider, adjuster, or case manager check out RateFast Express: the service that writes your impairment reports for you!
RateFast Podcast: Getting Those COVID-19 Impairment Ratings Done with RateFast Express
Cory Oleson (Host): Welcome back to the California Work Comp report podcast. Today is Sunday, May 2 2021. This is your host Cory Oleson here with Dr. John Alchemy, discussing RateFast Express COVID-19 impairment ratings. If you’re a worker’s comp professional right now, you might want to listen to this one.
And how are you doing today, Dr. John Alchemy?
Dr. John Alchemy: Hey, Cory, I’m doing great. How are you over there?
Cory: I’m doing well, doing well. Our topic today is on a retrospective of kind of the last year of the pandemic. And I say retrospective, but that certainly doesn’t mean that it’s over. Because we still have not only new COVID-19 worker’s comp impairment claims that are coming in. But we also have the workers compensation claims from the pandemic that were never closed, and the ones that are still open and the ones that have yet to be open, as well as all of the complications that that come from that and a kind of unusual case of something happening where there’s a completely new, you know, pandemic worthy disease that we’re still figuring out kind of the long term effects of and everything like that, and then tying all of that into the notoriously complicated world of worker’s compensation. So once again, I say that I say retrospective, but really, it’s an ongoing, but we have a year to look back on.
So our first question for you, John is at you know, after about a year plus what has been your experience as a worker’s compensation doctor during the Coronavirus pandemic?
Dr. John Alchemy: Well, I think, you know, early on in the pandemic, we’d really didn’t see a lot of claims. In then I think people, the testing ramped up, we came more aware of them, I think, industry, you know, became more standardized with testing. People started to get diagnosed more timely. And then I think what happened is that it again, this is my experience, there’s a little bit of a lull, and it wasn’t until maybe about four to six months ago that the case is really started rolling in with regards to work comp.
And so these were people who, you know, were working in industry, maybe working in, you know, areas like food production, essential workers and, and things of that nature. And, and my suspicion is that a lot of cases just didn’t get reported. People either didn’t want to tell the employer that, you know, they were positive, maybe they got tested in the community and found out, you know, maybe they felt some pressure, like they had to go to work. And then, you know, it started to spread in that fashion. I think, I think to a lot of these people who are first line workers and essential workers, a lot of them have second, and even third jobs sometimes and it becomes confusing as to where did they really get it? Did they get it at home? Did they get it at, you know, the second job, and they’re trying to claim it came in from their first job, and there’s a lot of confusion around it.
So, you know, in my personal practice, you know, it was really about four months ago, when we saw the first wave of, of COVID cases, filed for work comp, hit. And in some of the cases, it’s pretty clear, they had one job, no one in the family was sick until they were diagnosed, and, you know, coworkers were sick, and so forth. I also think that we have been getting better at, you know, providing personal protective equipment protocols, I think people are getting, you know, a lot more compliant with social distancing, and things of that nature.
So, I don’t want to say that we’ve, we’ve turned the corner, although I think we can see the corner. But you know, this is this is like, you know, version one of the COVID. And there’s going to be, you know, some some post exposure syndromes, I’m sure, that are going to be claimed. And I think that there’s going to be a second wave of work comp claims where people were diagnosed, seemingly recovered, did fine, and then turn up later to have some unexplained illness that, you know, may or may not be, you know, scientifically supported, but we have to remember this is all happening real time. So we’re trying to learn about this as it’s unfolding in front of our eyes. So I don’t think a lot of this will play out for yet a couple of years to come.
Cory: Yeah, yeah. Absolutely. And to kind of back your point about you know, how we still have to see a lot of the claims and not only that is a lot of the claims, especially now that I’m thinking about it, the ones from early on in the pandemic, at RateFast, we talk a lot about the fact that claims will pile up, right. And then so you’ll have, if you’re if you’re a worker’s comp doctor who’s sort of inundated with all these claims that are COVID-19 related on top of all of your usual duties, you might have some claims from early on, where you didn’t really know how to rate it or something. And then just like a lot of the other papers, you know, the ubiquitous papers on every desk of every doctor, every person that works with papers ever, you know, that’s it might get lost in the shuffle.
And, and to kind of, to kind of look at some statistics about COVID-19, and kind of hold those up to the light of of workers compensation claims, and sort of how those get held up in general. Um, we’re, we have to revisit the statistic that we talked about, I think, if not in the last episode than the last episode before that, it’s that in December of 2020, over 50% of work comp claims were COVID-19 related. And, you know, it’s you can definitely attribute a lot of that to the fact that it seems like there was a bigger proportion of those claims being COVID-19 related, because so many people are working from home, but you still got to think that there were a lot of people that weren’t, and that there were, it’s just a staggering number of 50% of any number of work comp claims be anything related.
And since then, apparently, over the past couple of months, the work comp claims have gone down. There are some conflicting reports. But again, that doesn’t mean that one, like you said the claims won’t have lasting after effects. And again, that the claims that have come in from during the past year have all been resolved since then, just like every other kind of case with work comp claims in California, statistically speaking, you know, and we have some numbers from 2018, that about a fifth of work comp cases were disputed. And this is before the Coronavirus pandemic, before we’re dealing with something that a lot of doctors and just people in general weren’t prepared for.
So you can only imagine that it’s only going to kind of cause more complications in getting work comp claims passed and approved and everything so, but I want to ask, from your experience, John, what are some of the challenges for diagnosing it? And the challenges, you know, at work for the workers and that causes complications for physicians and such?
Dr. John Alchemy: Well, you know, I think, if you look at it from the standpoint of, you know, the symptoms, the most common symptoms that are gonna show up are the respiratory symptoms, of course, we all know that, you know, cough and fever and shortness of breath, and so forth. But what I think a lot of people in clinicians, at least early on in the in the pandemic didn’t understand is that, you know, COVID could also present as issue issues such as, with gastritis, bloating, diarrhea, constipation, those kinds of things.
And then this very large presentation and skin, you know, and people didn’t really understand that, you know, these, these depositions of immune complexes out in the feet and hands and these rashes that people were showing up with, were really related to COVID. So, I think it took on a very broad presentation, and it wasn’t, the majority of them were probably respiratory, but there were a lot of other things too, that people had, you know, insomnia problems with their vision, their hearing, you know, so there were a lot of body systems involved in it added to a lot of complexity and confusion for people and it really made it hard to to triage and figure out who needed to be tested and who didn’t just because the presenting symptoms can be so variable, I mean, you can feel well and have one or all of the symptoms or no symptoms at all, you know, it just really threw a whole wrench into the whole diagnostic filing and everything else that that went along with it.
So it was a big it was a big challenge. I think, also to what to do with these people once they you know, showed up with a claim and how to handle them, how frequently to see them, what tests do you order because there weren’t any, you know, just wasn’t any good guidance on how to do it and how to work these people up. And even now, we’re just kind of learning the risk factors of, you know, like, if you have an underlying immune problem, you know, you’re probably going to do worse with COVID, or asthma or obesity. You know, all of these things, you know, will change it. And then of course, in work comp, all of those things that are preexisting need to be considered for apportionment.
Cory: Yeah, yeah, absolutely. Yeah. Such a nasty illness. You know, it just seems that the more that comes out about it’s just this sort of all purpose, ruin your life, you know, kind of thing. But, uh, yeah, yeah. So, I mean, I want to take, I want to take a quick aside and say, you know, thankfully, people are, are getting vaccinated for this now, you know, it was just cataclysmic about, you know, it’s, I mean, it leading up until it’s still, you know, but so, I have a kind of a more specific worker’s comp question. \
What happens when somebody files a COVID-19 claim, but doesn’t follow up on it?
Dr. John Alchemy: Yeah, and we’ve had that, in my own practice, where we have people who, essentially present with some symptoms, and then we just don’t hear from again, they don’t answer calls, they don’t come to a follow up. And, you know, just to be clear, that happens in any work comp claim sometimes where people don’t show up. And then, you know, we simply do something called an administrative close. So we do, like a snapshot of what their signs and symptoms and physical exam was at the last visit. And then we create the impairment rating based on that.
And, you know, we call that an administrative impairment rating, but, you know, cases need to be closed in, I think, a lot of work comp doctors and clinics, that are these higher volume, urgent cares, and so forth. They, they don’t really understand the significance or the necessity of having to close these claims, because, you know, it technically it cannot be closed until they’ve had that primary treating physicians permanent and stationary report. And, you know, when you’re writing someone up and say, oh, they just didn’t come back, and they must not have any signs or symptoms they’re 0 is is not the correct way. To close these claims, you really have to go on the last available information, and it’s anyone’s conjecture on, you know, what happened to them or how well they did in their full recovery.
Cory: Yeah, I was gonna say, I mean, considering worst case scenario, without beating around the bush, you know, if they died, it would be a lot different for the claim, then if they got better and went back to work.
Dr. John Alchemy: Yeah. In that extreme hypothetical. Yeah. Yeah, absolutely.
Cory: Yeah. What’s the word for that? When there’s apportionment, which is sort of our workers compensation term for an injury or an illness that it’s kind of partially because of a work comp claim. But then also, is it? Is it called contradictions? Is that what I’m thinking of when when they say like, your COVID after effects or making your asthma worse, for example, or something like that?
Dr. John Alchemy: Well, it can be an exacerbation, or yeah, it’s an exacerbation of the condition. And then once it becomes a permanent, aggravating, you know, factor, it’s just a prolonged contribution to it. So it does. It does affect, you know, the outcome and, you know, the rating elements and how the apportionment it’s done does is, you know, the same as any other claim. But the difficult part is understanding on how you want to bound these underlying non industrial conditions to most accurately reflect how much they are contributing to the permanent disability that the person is walking away with in their claim, and that’s the real trick.
Cory: Yeah, absolutely. And speaking of these complications and secondary symptoms and stuff, that means that there will inevitably be a second wave of COVID-19 claims that that followed the onset of secondary symptoms. And, you know, new claims need to be open for that. And it might cause some sort of effect on claims that are already existing. Could you tell me, you know, kind of what you want anticipate happening for this second second wave COVID-19 claims or if you have any predictions or thoughts on that?
Dr. John Alchemy: Well, I think a lot is going to depend on what we decide the science says is, you know, documented and supported, from a statistical standpoint about these post infectious conditions and syndromes. Will it be that we decide that there’s a chronic fatigue that can come from this? Or is it going to be that people are at higher risk of depression, as an exposure? Will it be that a certain amount will be at increased risk for heart failure later on, as they go through time. And that really right now, I think, is still an unanswered question. Again, one of the things we have to understand is that this is happening in real time. So, where we’re seeing patients respond and react and recover, partially recover from the COVID infection, yet, we’re still trying to learn what is emerging, as, you know, science saying, Yeah, this is, you know, a significant finding, and this is not, and that’s really hard. It’s really hard to do when they happen simultaneously.
Cory: Yeah, absolutely. So just because it’s a very new development, the Coronavirus, and how to handle that, and everything there, there’s still sections of the AMA Guides, the book that is used to formulate impairment ratings, and to do worker’s comp calculations for final impairment ratings and such that are pertinent to the illnesses that are similar to COVID-19. Could you tell us a little bit about what parts of the AMA Guides are pertinent to, or close enough related to COVID-19?
Dr. John Alchemy: Sure, at at the top, we were kind of discussing well, what are some of the body systems, you know, the respiratory is by far and away the most common presenting. I mentioned that there can be some gastric or GI issues, skin, and central nervous things, such as dizziness, vision, hearing, loss of smell, and taste, a lot of people are familiar that that’s a pretty specific symptom of COVID. And you know, all those things are rate-able.
So when these people come in, it’s very important that the clinician have some type of standardized approach to taking an inventory on these major body systems, because they’re all potentially rate-able for permanent impairment and subsequent permanent disability. So you know, respiratory, for sure, and when we do the ratings, for ourselves, and also for our clients, one of the most important things for respiratory impairment rating is to get a good history and exercise tolerance. So you know, really, how far can you walk, when do you get short of breath and it goes all the way from I feel fine, with no symptoms at all, all the way to, you know, I’m so breathless, that I really can’t leave the house or have difficulty doing very basic activities, like getting dressed, or cooking a meal, something like that.
And one of the things I’ve seen, that’s come across, in my experience is a lot of these adjusters insurance adjusters, you know, pulmonary ratings have always been present. But, you know, with COVID, that’s gone up by multiples, and the adjusters just are not used to seeing impairment ratings for pulmonary loss. And so they get a lot of sticker shock when they look at these impairment ratings, because, this isn’t, a shoulder injury with an upper bound of, you know, 54% whole person impairment, these, these go all the way up to 100%. So you can have, you know, some different variants of symptoms, and the ratings will come back 15, 20, 25% or higher, and the adjusters just aren’t sure how to respond because you have to remember an earlier podcast, we’ve talked about this that, you know, for the most part, people have a hard time understanding the intricacies of impairment rating and so, the only other way they know how to respond to an impairment rating is by the value that’s given in the report and, you know, reacting based on a value is obviously incorrect or is reacting based on the data and understanding how the data is rated is a much more, you know, appropriate understanding of impairment rating.
But that being said, you know, people are very emotional and when they see numbers on something that they’re not used to seeing on other bikes parts, it raises a lot of questions and causes a lot of confusion for everybody.
Cory: Yeah, yeah, we were talking in our last episode about how the all the stakeholders, you know, for all intents and purposes, more or less kind of speak different languages about the same umbrella topic, which is worker’s compensation. And so not only do you have sort of internal, these variations and internal jargon, or you know, sharp talk regarding digital, just the general mill, you have workers compensation, but then you throw this whole new thing in there, this whole new kind of concept in there. And then you have to expect people to make it run at least as good as it was before this concept was introduced. And suddenly, that thing is, at least for a certain point in time 50% of what people are talking in different languages about. So yeah, that is a definitely a complication.
Dr. John Alchemy: A lot gets lost in the translation for sure.
Cory: Mm hmm. So that brings us to what we at RateFast can provide to workers compensation professionals, which is our RateFast COVID-19, specific impairment rating, sorry, the RateFast Express COVID-19, specific impairment rating. And we currently have a blog post on this, and the blog post came after we had already been doing it for quite some time. So, since we’ve been talking about the fact that a lot of what we’ve discovered and learned and have applied from things that we already know, from workers compensation is largely experiential. We have a lot of experience under our belt regarding doing COVID-19 specific impairment ratings.
And, John, could you tell us a little bit about what the RateFast Express COVID-19 impairment rating is what the what the physician will see on their end? And also what they’ll see when they get back? And what happens in between? That we do?
Dr. John Alchemy: Yeah, it’s a great question. So you know, at RateFast Express, we really wanted to simplify the workload and the complexity for the doctor and the patient, by just, you know, answering a few crucial and critical questions. So for years and years, we’ve done all these ratings, they’re just retooled now, in a certain constellation for COVID-19. Like I said, particularly things like the respiratory rating, and, if you’re going to do a classic respiratory and rating it respiratory impairment rating, you’re going to need a full pulmonary function test. And maybe even with a, with a with a CO, a diffusion test. And these just are not reasonable to be doing on people. Although sometimes we’ll do them on on the more severe cases, or maybe people that were, hospitalized in the unit, or have ongoing oxygen requirements. But there are other ways around rating when you don’t have that level of detail.
And RateFast Express helps you figure that out. So we’ll ask questions, again, some very basic questions that you can ask, you know, how well are you doing when you walk? You know, how well are you doing with your activities of daily living, and the patient and the provider can simply go through this checklist doesn’t take more than five minutes, the physical exam, another 10 to 15 minutes, if that, and you send it in and you get a great report totally formatted, all weight averaged coming back. Future care if you need it, the functional limitations, you know, depending on what the doctor wants, and, it just really, really simplifies it. So everyone knows that it at least they got a halfway decent impairment result for settling. And that’s really, always been our mission at at RateFast is to try to get the right rating the right, you know, and the first time the right rating. And we know that if we do that the stakeholders are going to get along a lot better than someone saying it’s zero and someone else saying it’s 100, that just doesn’t work. So, you know, the questionnaire is, is the tool that we have that helps everyone kind of come together and agree on what the findings are and what the outcome is.
Cory: And meanwhile, it takes a lot of the stress off of everybody. I mean, it’s sort of like we have somebody in the chain who understands kind of this the language is of all of all the stakeholders and not only that, but communicates with all of them. And that is highly recommended that you know physicians who are working with workers compensation and workers compensation claims. Check us out and see if I see if RateFast Express’s is good for you and your COVID-19 specific workers compensation claims.
Dr. John Alchemy: Absolutely.
Cory: So for the workers compensation professionals listening in right now, give us a give us a visit to our website at rate-fast.com. Or you can go to ratefastexpress.com. And we have a new website up with a new aesthetic and everything. So even if you’re a returning visitor to our site, you might be pleasantly surprised by what you see.
So thank you. Thank you again for the show, John. And we will talk to you next month and hopefully, hopefully we’ll have some steadily better news about the current situation. For more about COVID-19, worker’s comp impairment ratings and the RateFast Express COVID-19 impairment rating service, visit our blog at blog.rate-fast.com and give rate fast express a try and rate-fast.com.