Is employee being less than truthful?
Story may contradict the facts
You probably get the feeling, more often than you'd like, that there is more to the story than what a worker is telling you about an injury. There are several possible reasons for the facts not adding up.
"We are trying to make everyone more mindful of the mechanism of injury," reports Laurie Heagy, RN, COHN-S, president of the Berks County Pennsylvania Association of Occupational Health Nurses. "We are trying to look more critically at that issue right up front when seeing a new injury."
An employee once told Heagy that he had injured his hand at work. When the X-ray revealed a boxer's fracture, it did not fit the "mechanism of injury" that he had reported. "After digging some more and talking to the employee, he finally admitted that he had punched his locker and that was how he was hurt," says Heagy.
Another employee presented with a bump on his leg, and immediately went to the hospital. He was diagnosed with a cellulitis and infection, and was admitted to the hospital within only a few hours of the injury. "The mechanism did not fit that scenario in the time frame he reported," says Heagy.
Studies ordered for employees may reveal inconsistencies. If the results show that there is a full thickness rotator cuff tear, for example, you need to determine if that result fits the reported body movement that was the mechanism of injury, says Heagy.
It may be that the employee has a triangular fibrocartilage complex tear in one hand and is treated for hand pain with no acute injury. This may be a degenerative tear, and may call for studies to be done on the other hand to see if the tears are bilateral, says Heagy. "The employee may have been in a motor vehicle accident in the past, and braced themselves on the dashboard. That may have been the cause," she says.
Go look at the job
Workers may not want to admit that they got hurt by doing something unsafe. One left-handed worker claimed that he lacerated his right forearm by cutting strapping from a stack of boxes. "He was, in fact, cutting. However, he was reaching way over his head with a box cutter in his hand, which is unsafe practice, " says Susan L. Zarzycki, RN,COHN,CM, an occupational health manager at Finch Paper LLC in Glens Falls, NY.
How did Zarzycki find out the truth in this situation? By going to the job site and asking the same questions over and over.
"I don't understand, so can you show me? How did it happen? Can you please show me what you were doing so I can understand the injury?" are some of things she asked.
If an employee presents with repetitive strains or sprains, Zarzycki always looks at their job and asks what they do outside of work for recreation. "People may bowl, fish, or hunt. They sometimes don't realize that what they do for fun might have an impact on their body," she says.
If the injury doesn't match the job, then Zarzycki documents "The employee states that the incident occurred ...."
To catch inconsistencies, however, you need to have a solid understanding of the job someone does. "I work in a paper mill and I don't have to know how to make paper, but I do need to know if the injury matches the job they are doing," says Zarzycki. "If someone is complaining of right shoulder pain and their job does not involve the upper body, this is important to note."
A right-handed employee may tell you that he has carpal tunnel in both wrists, with the right wrist being much worse. He then goes on to say that he bowls three nights a week. Do you have an obligation to tell the employer?
When it comes to a work-related injury, the employer has a right to information about what happened, says Zarzycki. "If the stories don't match up, eventually somebody has to question the employee a bit further" she says. (See related story, p. 137, on how to handle various scenarios.)
At times, the inconsistency in the employee's story may result in denial of workers' compensation or disciplinary action. "They may not be happy with the outcome, and may be angry at you," says Zarzycki. "They will, most times, understand, if it is explained that the facts need to be documented and consistent."
Zarzycki tells workers, "You stated ..., I will be documenting.... Others can learn from this incident. We may be able to prevent a more serious injury by understanding exactly what happened."
The bottom line, though, she says, is that people are working adults responsible for their actions. In order to gather all of the information about an incident, sometimes hard questions have to be asked.
"Demonstrate that you are fair and consistent by asking the same questions after any injury occurs. Everyone appreciates this," says Zarzycki.
For more information on understanding how an employee's injury occurred, contact:
Laurie Heagy, RN, COHN-S, President, Berks County Pennsylvania Association of Occupational Health Nurses. E-mail: firstname.lastname@example.org
Susan L. Zarzycki, RN,COHN,CM, Occupational Health Manager, Finch Paper, Glens Falls, NY. Phone: (518) 793-2541 ext. 5389. Fax: (518) 793-1872. E-mail: email@example.com.