On-the-Job Injuries Involving Motor Vehicle Collisions: Neurorehabilitation

Some, but certainly not all, workers’ compensation claims arise from motor vehicle collisions resulting in trauma, brain injury and a variety of other catastrophic injuries.

As a threshold matter, a determination must be made whether or not the claim is work related. If it is, workers’ compensation may be implicated. If it is not, the occurrence is personal to the employee and, therefore, other considerations come into play, including issues involving the injured individual’s insurance, that of the other party involved in the collision and the relative degrees of fault of each party. This is true even if traumatic brain injuries (TBI), spinal cord injuries (SCI) or other catastrophic injuries are involved and the stakes are high. This threshold determination is a legal issue to be determined by the workers’ compensation statutory law and interpretative case law of the governing state and is, also, fact driven.

An example of a situation in which a motor vehicle collision may implicate workers’ compensation is when an employee is making a delivery for the employer and, thus, acting within the course and scope of his or her employment. In contrast, in most states, an employee driving to work or driving home from work is not acting within the course and scope of his or her employment. Complications may arise when the employee delivers an item for the employer on his or her way to or from work and the motor vehicle collision resulting in a traumatic injury occurs then. Again, though, that is a legal issue driven by the facts and by the governing law of the jurisdiction.

Whether or not workers’ compensation governs a motor vehicle accident is important for a variety of reasons, including:

• If the occurrence does implicate workers’ compensation coverage, the workers’ compensation insurer (or, if the employer is self-insured, the employer) is “primary” for the payment of statutory benefits. The statutory benefits typically include medical expenses and at least a portion of lost wages. “Primary” means that even if the individual has private automobile insurance, the workers’ compensation insurer is obliged to pay first, according to the governing statutory scheme.

• As discussed in a prior blog, it is imperative that the employee reports the injury to the employer, and that the employer reports the occurrence to the workers’ compensation insurer in a timely manner. If the employer is self-insured, the report would normally be made to a risk manager, a third-party administrator or some other entity that administers the workers’ compensation plan of the employer.

• If the occurrence is job related, a workers’ compensation adjuster will be assigned by the insurer or other entity handling the administration of the employer’s workers’ compensation program. Also, as discussed in a prior blog, the adjuster will, in conjunction with the injured individual’s medical provider(s) and a nurse case manager, establish a plan of care. At NeuLife, a customized Client Goal Plan is developed to identify appropriate, clinically relevant services including rehabilitation, specialized rehabilitation and neurorehabilitative services. The goal to achieve the best possible outcome to help the individual return to independence, to the fullest extent possible, even in the face of the most difficult and challenging diagnoses.

Assuming the threshold is met and it is determined that the motor vehicle collision occurred within the course and scope of the individual’s employment, we need to examine the nature of the traumatic injury, which might well be a traumatic brain injury. Such an injury could occur in the following ways:

• By definition, a traumatic brain injury is usually one that results from an external blow to the head that causes damage to the brain.

• In the context of an motor vehicle collision, a traumatic brain injury can result from hitting one’s head on the steering wheel. Alternatively, it can be in the nature of a “whiplash” injury wherein the brain is shaken inside the skull. Depending upon the degree of force, contusions can be caused on the brain. Neurons, which constitute the “wiring” of the brain, can also be injured, and axons—long nerves—can be twisted and stretched; if this occurs, neurons cannot function properly.

Neurorehabilitation is a medical process intended to help recovery from a nervous system injury and to minimize or to compensate for functional alterations resulting from a catastrophic injury. Neurorehabilitation endeavors to use the skills and attitudes of the individual and his or her family and friends in doing so. It promotes the individual’s remaining skills, and attempts to create additional ones, to allow the individual to work at the highest level of independence possible. It also encourages the individual to rebuild self-esteem and a positive mood. Thus, it helps him or her to adapt to the new situation and to become empowered for successful and committed community reintegration.

In contrast, workers’ compensation is a statutory construct that limits the remedies of the employee in return for not having to prove negligence or “fault” by the employer; it has clearly defined parameters. Part of the workers’ compensation construct is that the workers’ compensation insurer (or the employer or its third-party administrator, if self-insured), together with the adjuster and the workers’ compensation nurse case manager are the initial arbiters of the health care provided, including neurorehabilitative services. The care provided may seem to be more medical than behavioral, in part, because neurobehavioral care is less “tangible.” The workers’ compensation insurer may be concerned that since neurobehavioral care and outcomes are less “tangible” than the medical part that the injured employee may be exaggerating his or her true condition (malingering) and, therefore, the “softer” side of the care that is required for complete recovery and movement toward independence may be overlooked. Therefore, the parties involved in obtaining and paying for the rehabilitation, specialized rehabilitation and other elements of post-acute care may disagree with the catastrophically injured individual or his or her representative as to the proper course of care. Although there are specialized workers’ compensation courts to hear and decide these matters, the processes take time to resolve, yet neurorehabilitative and other post-acute services are best administered as soon as possible so as to achieve the best possible outcome for the individual who sustained a traumatic amputation.

The professionals at NeuLife, including its team of neurologists, RNs and therapists are expert in the provision of innovative, clinically relevant services, including the development of a Client Goal Plan, and delivery of neurobehavioral and neurorehabilitative services. NeuLife’s goal is to provide post-acute rehabilitation to its clients to achieve the best possible outcome for those who have even the most difficult and challenging diagnoses.

NeuLife’s philosophy is that healing, wellness and personal fulfillment are best accomplished in a positive and uplifting therapeutic environment where caring staff encourage, assist and support each client so he or she may achieve specific goals. NeuLife believes personal fulfillment is equally as important as goals to increase function and independence. NeuLife seeks to achieve maximized, sustained outcomes that exceed the expectations of all persons served.

NeuLife, in Mount Dora, Florida, is a fully accessible residential post-acute program providing specialized rehabilitation to individuals diagnosed with traumatic brain injury, spinal cord injury, traumatic amputations and other catastrophic injuries.

2725 Robie Avenue

Mount Dora, Florida 32757