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Worker Compensation in Commercial Drivers Injury Prevention and Case Management Brian Harrison, M.D. April 2014

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Worker Compensation in Commercial Drivers Injury Prevention and Case Management Brian Harrison, M.D. April 2014. Worker Comp (WC) in Commercial Drivers (CD)- Concepts. DOT Regulations reduce major WC Cases BUT: DOT Regulations may increase Lost Workdays in both major and minor cases

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Worker Compensation in Commercial Drivers

Injury Prevention and Case Management

Brian Harrison, M.D.

April 2014

worker comp wc in commercial drivers cd concepts
Worker Comp (WC) in Commercial Drivers (CD)- Concepts
  • DOT Regulations reduce major WC Cases BUT:
    • DOT Regulations may increase Lost Workdays in both major and minor cases
  • Employers can improve primary prevention of CD WC Cases through
    • Safe work practices while performing non-driving duty
    • Truck driver wellness
    • Safe use of all medications (Rx and OTC)
  • Case managers and adjusters should attend to all potential barriers to RTW in WC Cases
  • Use Worker Rehab Program more liberally
commercial driving big vehicles big costs big regulations
Commercial Driving – Big Vehicles, Big Costs, Big Regulations

Active Interstate Truck and Bus Companies (2004)


Between 2000 and 2010:

truck and bus miles increased 20%; more carriers.

Total Number of CDLs Issued

6-7 million

FMCSA certification examinations for commercial motor vehicle drivers: 3-4 million exams annually

Source: Motor Carrier Safety Progress Report (September, 2004)


they live in regulation nation
They Live inRegulation Nation!
  • 1939 – First Regs: Interstate Commerce Commission “Good physical & mental health, no addiction to narcotics, no excessive use of alcohol.”
  • 1954 - Exams first required
  • 1970 – DOT created
  • 1999 - Ill bus driver liable for 22-death crash
  • 2000 – FMCSA created
  • 2005 – SAFE TEA – LU: Chief Medical Officer, Medical Review Board, Medical Expert Panels; National Registry of Certified Medical Examiners proposed
  • 2006 – Sleep Apnea: Joint Task Force Guidelines
  • 2014 – National Registry of Certified Medical Examiners
        • Trained, Tested, Certified
medical standards regulations of the fmcsa
Medical Standards (Regulations)of the FMCSA

13 standards directly related to medical requirements

4 standards are specific

Medical examiner cannot interpret or alter

Vision, Hearing, Epilepsy, Insulin use

9 standards are general (“likely to, which interferes,” or satisfied by Skill Performance Evaluation or OK’ed by MD)

Medical examiner decides if medical condition affects driver’s ability to safely operate a CMV



Joint Task Force Guidelines

Two or more of the following:

1. Body mass index >35 kg/m2

2. Neck circumference in men >17” and in women 16”

3. Hypertension (new, uncontrolled, or unable to control with fewer than two medications)

an observational study of commercial drivers at risk of osa
An Observational Study ofCommercial Drivers at risk of OSA

And kept it off

For 1 year!!!

49 (100%)

Remained at BMI < 35

40% did,

Average of

33# !

When given option

to lose weight:

49 (56%)

Seen for re-cert (10.6 mo average f/u)

613 (67%)

No unaddressed OSA risk


Index Exams

87 (40%)

At BMI < 35 in 3-9 months

219 (92%)

To weight loss option

302 (33%)

At risk for OSA, BMI ≥ 35

239 (79%)

Available for f/u at 3-9 mo.

132 (60%)

BMI still ≥ 35 at 3-9 months

1 (0.5%)

To bariatric surgery

132 (100%)

Proceeded to PSG and treatment (if indicated)

63 (21%)

Lost to f/u

19 (7.5%)

Out of service PSG (all positive)

22nd anniversary of dot drug tests
22nd Anniversary of DOT Drug Tests

The Omnibus Transportation Employee Testing Act became law on Oct. 28, 1991

Seems like a long time ago: Packers went

4-12 in 1991 with Coach Infante and QB

Mike Tomczak

Illegal drug use among transportation workers has since dropped 50%

Fatal accidents from alcohol use by truck and bus drivers has since dropped 23%

top 10 critical reasons cr for truck crashes 2 mechanical 8 operator
Top 10 “Critical Reasons” (CR) for Truck Crashes(2 mechanical, 8 operator)

Over loaded

Making illegal maneuver

Inadequate surveillance

Traveling too fast for conditions


Following too close

Misjudgment of gap or other’s speed

Stop required before crash

External distraction

Brake problems

top 10 associated factors associated with cr ranked by frequency
Top 10 “Associated Factors” (associated with CR)- Ranked By Frequency –

And, 5th

most important by



  • Brake problems
  • Traffic flow interruption (congestion, previous crash)
  • Prescription drug use
  • Traveling too fast for conditions
  • Unfamiliarity with roadway
  • Roadway problems
  • Required to stop before crash (traffic control device,


8. Over-the-counter drug use

9. Inadequate surveillance

10. Fatigue

trucking cost conundrum
Trucking Cost Conundrum
  • Trucking Industry has improved safety, cut illegal drug use and alcohol misuse, and followed the rules
  • Costs should have gone down, but haven’t, in:
    • Health plan
    • Worker comp
    • Turnover
    • Compliance costs
    • Accident Liability
worker comp conundrum
Worker Comp Conundrum
  • Trucking companies pay higher worker comp premiums every year, even as large truck crash rates continue to drop.
  • Non-life threatening injuries suffered during non-driving duties make costs climb, despite fewer major injuries from crashes
worker s comp conundrum root causes
Worker’s Comp Conundrum – Root Causes

Ill health and health-risking behavior underlie this conundrum, not a lack of driving safety

Individuals with multiple health risks are more likely to submit claims

Workers Comp medical care and wage indemnity costs are higher in high risk claimants

Organizations with higher prevalence of health risks have higher Workers Comp costs

And – Drivers must WORK more safely, not just DRIVE more safely!

low risk will mean low cost high risk will mean high cost
Low Risk will Mean Low CostHigh Risk Will Mean High Cost

Overall Score:

LowRisk(any 2 or fewer)

Medium Risk(any 3 or 4)

HighRisk(any 5 or more)

obesity and all medical costs
Obesity and All Medical Costs

77% higher average medical costs (obese vs. ideal)

Treatment of obesity-related diseases accounted for 27% of the rise in inflation-adjusted per capita medical spending between 1987-2001

Thorp et al, “The impact of obesity on rising medical spending” Health Affairs 2004 supplement

commercial drivers drive safely but might not work safely
Commercial Drivers Drive Safely, But Might Not Work Safely
  • Commercial driver safety improvements have cut large truck crashes to half of what they were 10 years ago, per million miles driven.
  • High rates of strains, sprains, bruises, and other conditions classified as musculoskeletal disorders (MSDS).
  • While lumping freight, climbing in and out of the cab, and managing the trailer.
get in and out safely
Get In And Out Safely!
  • Classic “3 points of contact” method.
  • When a 220 pound trucker jumps from the height of the cab to the ground, they drive 1,637 pounds of force throughout their body.
  • From the lowest step, a mere 16 inches from the ground, more than 300 pounds of force drives upward into the body.
  • Mechanical lifts such as powered lift gates pay for themselves.
  • Never climb onto cab tires to clear snow from windshields.
  • Flashlights to inspect the ground outside their cab door.
get ergonomic equipment
Get Ergonomic Equipment
  • Cranking landing gear of the trailer pulling the fifth-wheel “kingpin”.
  • Air-ride seats and lumbar support.
  • Correctly use multi-position seats
  • Position the steering wheel directly in front of the driver’s seat.
motor carriers should also help drivers to handle freight safely
Motor Carriers Should Also Help Drivers to Handle Freight Safely
  • Drainage holes in the floors of refrigerated trailers.
  • Install handles at the rear of trailers that retract into the floor.
  • Position folding steps at the back of the trailer.
  • Retrofit power lift gates if needed.
  • Straps to dangle from the bottom of rollup trailer doors.
  • Help to handle unexpectedly heavy deliveries.
combat the sitting disease
Combat the Sitting Disease!
  • Weight goes up and fitness goes down
  • Diabetes and heart disease
  • Injuries happen more commonly
  • Prolonged sitting punctuated by short bursts of strenuous activity
off your seat on your feet
Off your seat & on your feet!
  • Get drivers to walk whenever they can
  • Take laps around the truck plaza after fueling
  • Walking 36 laps around a big rig equals

1 mile.

  • Walking 10 minutes 3 times a day briskly will help fitness just as much as walking once for 30 minutes does.
stop the shake rattle and roll
Stop The Shake, Rattle, And Roll!

Age-related degenerative lumbar disk disease develops simply as a part of life. It makes some less able to tolerate the whole body vibration they absorb from work vehicles.

Get Vibration-Canceling Equipment.

Prolonged Driving is Associated with Common Backache and Cervicalgia:

But studies specific to Disc Degeneration (LSP and CSP DDD) do not show this correlation

lsp ddd has not shown association with driving in more recent studies
LSP DDD Has Not Shown Association With Driving In More Recent Studies
  • Twin study which used MRI (Videman, Lancet 2002 Nov 2; 360(9343):1369-74) found no effect of prolonged driving or occupational driving histories upon LSP DDD.
    • Some association was found with non-specific LBP, but not with LSP DDD. “Although driving may exacerbate symptoms of back problems, it does not damage the disc. Our inability to identify structural damage should be encouraging to those employed in occupations involving motorized vehicles and operation of heavy equipment.”
    • Earlier, the same author showed that MRI findings in professional racecar drivers are no different from controls (Videman, Clin Biomec 2000 Feb;15(2):83-6)
case manager botlo
Case Manager BOTLO:
  • Claimant says “I can't work d/t WC injury” (but then renews Fed Med card anyway!)
  • Wants to RTW but has non-WR obstacle that disqualifies Fed Med; hides in WC instead of treating own health (or retiring)!
  • Always ask to see Fed Med card; who signed it?
  • Resolve all RTW obstacles early in WC case, even if non-WR disqualifiers
  • Untreated OSA plus benzos or opiates can kill!
  • Employer might not realize the trucker can't drive if any restrictions (let them ride-along as trainer, or send to Worker Rehab Program)
traumatic msk injuries common to commercial drivers
Traumatic MSK Injuries Common to Commercial Drivers
  • Superior Labrum Ant-Post Tear (slipping and hanging from cab or trailer door)
  • Crushed hand - wind slamming trailer door
  • Contused lower leg - stepping between trailer threshold and dock plate
common to cd
Common to CD
  • Vertebral compression fx – stepping backward off trailer, hitting ground in sitting position (then concussion from hitting back of the head)
  • Trimalleolar ankle fx, tibial plateau fx – jumping off flatbed trailer
  • RC Tear – landing gear crank kicks back
non work related look alikes
Non-Work Related Look Alikes
  • Wrist pain when steering – DJD, old scapholunate dissociation.
    • Carpal tunnel syndrome risk is NOT increased by the frequency of vibration which comes from the steering wheel
  • Neck pain while riding – age related spondylosis
  • Back pain with prolonged sitting – lumbar degenerative disc disease