Injuries involving amputation comprise about 0.5% of on-the-job accidents and are among the most devastating and costly workers’ compensation claims. When such an incident occurs, the employer is responsible for making the employee whole again. This generally includes providing a prosthetic device, along with lifetime maintenance and medical care. Matching an injured worker with the right device and right providers for their unique needs is a complex process requiring deep knowledge and understanding of the intricacies of prosthetics.
Not one-size-fits-all
In the workers’ compensation arena, prosthetics are often categorized as durable medical equipment (DME), like a wheelchair or crutches. However, this oversimplified approach is not in the best interest of either the injured worker or their employer. Simply sending an employee to their nearest orthopedist or prosthetics clinic is not likely to yield the best outcome or most cost-effective solution.
Here’s why: In the U.S., most amputations in the general population are of lower extremities. This is due to the prevalence of cardiovascular and circulatory conditions that hinder blood flow, especially to parts of the body far from the heart. When tissue dies due to lack of blood flow, it must be removed. In contrast, most work-related amputations are of upper extremities. Because people primarily work with their hands, the upper extremities are far more susceptible to workplace injuries — especially when handling heavy objects and operating dangerous machinery is part of the job.
Due to this disparity, U.S. providers of prosthetics and medical practitioners in related fields spend much of their time and training focused on lower extremities. Many providers do not have the experience needed to properly meet the short- and long-term care needs of an upper extremity amputee. A certified upper extremity specialist is best suited to help an injured worker get the right device (or combination of devices), heal physically and emotionally, return to work safely and productively, and function independently in all aspects of their lives. The sooner an injured worker can connect to the right specialist and be fitted for a device appropriate for their needs and stage of recovery, the better their chances of a positive claim outcome.
More is not always better
Some prosthetists see dollar signs when they learn a patient is a workers’ compensation claimant. They may get excited about the opportunity to fit an injured worker with the latest cutting-edge device, knowing the cost will be covered by the employer. However, the prosthesis with the highest price tag and the most bells and whistles is not necessarily what’s best for the amputee. Do the prosthesis’s features align with the employee’s stage of recovery, lifestyle, job responsibilities and physical capabilities? Are there specialists near the employee who can train them on how to use it, provide maintenance care, and perform physical/occupational therapy appropriate for the individual and their device? Understanding these nuances requires specialized expertise, beyond what most practitioners of medicine, utilization review and medical bill review are equipped to handle.
On the flip side, it’s also not good when the employee does not receive a proper prothesis in a timely way. While not providing any device may at first glance appear to save the employer money, this can cause multiple issues. Without proper support and equipment, the employee may be inclined to simply learn how to do things without their amputated extremity; however, this can lead to serious safety concerns, especially on the job. A lack of motivation to adapt won’t yield the best outcome for the individual’s physical or emotional recovery. Further, it’s dangerous for the employee to have a weight imbalance in their upper body, as it can cause neck pain, scoliosis and other issues — and because these conditions stem from the original injury, they are covered under workers’ comp. It’s critical to get the right device on an injured employee within 90 days to keep recovery on track, promote acceptance of the prosthesis, and support a positive outcome.
Benefits of a WC prosthetics program
To protect their people and their financial interests, employers — especially those with employees at risk of catastrophic injury — have much to gain from adding a specialized prosthetics program to their managed care services for workers’ compensation. When a workplace accident involves a life-altering amputation, you want the right ancillary care experts on your side to support the employee and their family through every step on the difficult road ahead. An experienced team of prosthetic specialists works to ensure the employee receives just the right device(s) for their particular needs, knows how to use the equipment, and has the tools they need to return to work and productive living. (It’s worth noting that amputees have the highest return to work rate among employees who experience catastrophic injuries; they just need the right motivation and the right device to facilitate a smooth transition.)
A well-established prosthetics program gives injured workers access to a nationwide network of clinicians experienced in working with amputees, with the added benefit of strong relationships with the companies that manufacture and service prosthetic devices. Program coordinators help guide amputees so they know what to cover during their appointments; they also connect amputees with peer support, so injured employees can speak to others who truly relate to their circumstances.
Another significant advantage of a specialized prosthetics program is accuracy in reserve funding. Because amputation is a lifelong injury, the employer is responsible for providing lifetime medical care under workers’ comp. In addition to the high cost of the initial prosthesis, the device needs to be replaced approximately every five years. Replacements of sockets and liners, along with other clinical care, quickly add up to a lot of expenses. Having prosthetic experts involved in the claims process from the outset ensures the appropriateness of costs for devices and care, as well as projected costs based on the employee’s anticipated needs and lifespan.
Utilizing a prosthetics program is the right thing to do for the employees experiencing a traumatic injury and for the employers supporting them throughout the process. Enlisting specialized expertise in prosthetics is the best way to ensure an amputee receives the right device at a fair price, as well as the skilled care and empathy they need to resume living a full and productive life.
> Learn more — read about Sedgwick’s best-in-class prosthetics program, part of our suite of ancillary managed care services for workers’ compensation