Injuries involving amputation comprise about 0.5% of on-the-job accidents and are among the most devastating and costly workers’ compensation claims. These claims generally require prosthetic devices, 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 workers’ compensation, prosthetics are often categorized as durable medical equipment (DME), like a wheelchair or crutches. However, this is not in the best interest of either the injured worker or their employer.
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. When tissue dies due to lack of blood flow, it must be removed. In contrast, most work-related amputations are of upper extremities due to handling heavy objects and operating dangerous machinery.
A certified upper extremity specialist is best suited to help an injured worker get the right device(s), 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, the better their chances of a positive claim outcome.
More is not always better
Some prosthetists may see these claims as opportunities 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 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?
Without timely support and proper 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. 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
Employers 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, an experienced team of prosthetic specialists work to ensure the employee receives just the right device(s), knows how to use the equipment, and has the tools they need to return to work and productive living.
A well-established prosthetics program gives injured workers access to a nationwide network of clinicians experienced in working with amputees, with strong relationships with the companies that manufacture and service prosthetic devices. Program coordinators 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, along with other clinical care. Having prosthetic experts involved in the claims process ensures the appropriateness of costs for devices and care, as well as projected costs based on the employee’s anticipated needs.
Utilizing a prosthetics program is the right thing to do for 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, fair price, skilled care and the empathy they need to resume living a full life.