Returning from injury: Genetics, hard work, or performance enhancement?

Baltimore Ravens linebacker Ray Lewis speaks during an NFL Super Bowl XLVII football news conference on Wednesday, Jan. 30, 2013, in New Orleans. Lewis denied a report linking him to a company that purports to make performance-enhancers. The Ravens face the San Francisco 49ers in the Super Bowl on Sunday. We all marvel in the extraordinary recovery of athletes following injury. Ray Lewis returned to play less than 3 months following tricep repair surgery. Adrian Peterson nearly broke the single season NFL rushing record less than a year after ACL reconstruction. Kyle Lowry played point guard for Villanova less than 4 months following his own ACL reconstruction. How is this possible? Do these gifted athletes just work harder during rehab? Do their bodies heal faster than the rest of us? Or could it be the fear of most sports fans in the 21st century? Could these be using performance enhancing agents to speed up their recovery? Let’s discuss the factors and controversies that contribute to a speedy recovery in more detail. Ray Lewis and his tricep. Ray injured his tricep on October 14th, 2012. He had surgery three days later and played in his first game on January 6th, 2013. That’s less than 3 months after injury—an unheard of turnaround time. There are many factors contributing to his extraordinary recovery. First and foremost, Ray took a great risk at returning that soon. His chance of re-tear was very high as the surgical repair takes at least 3-4 months to be even close to being strong enough to withstand the forces involved in football. I’m sure that his rehab was rigorous in regaining the strength needed to block and tackle in the NFL. One would think his age would be a detriment to a speedy recovery, but it doesn’t seem to have been a factor. The big question: did the deer antler spray help? There is little scientific evidence that IGF-1 (insulin-like growth factor) has any performance enhancing or injury recovery benefit. And IGF-1 is not affected when delivered through a spray. In Ray Lewis’ case, he probably beat the odds of re-injury by playing as early as he did vs. having an amazing recovery aided by performance enhancing supplements. Adrian Peterson. He is still the talk of the town when it comes to returning from ACL surgery. In his first season back, he nearly sets the NFL rushing record. Adrian’s first game back was 9 months after his ACL surgery. Although his level of play was astonishing— many players never quite get back to their pre-injury level—the time frame that he returned to play in is within the normal range of 9-12 months. Was there anything more than hard work and determination that contributed to his recovery? A good surgeon and rehab staff helps. But probably more than anything is what makes him such an amazing athlete is the same thing that gave him such a remarkable recovery… great DNA. There are no rumors or whispers about deer spray or any other performance enhancing substances with Peterson, just old fashioned hard work. When we look for an unbelievably quick recovery from ACL rehabilitation, we don’t need to look any further than the Main Line and former Villanova basketball star Kyle Lowry. Kyle tore his ACL the summer before his freshman year at Villanova. He had surgery on September 17th and played in his first collegiate game on December 31st. That’s just 3 ½ months after ACL reconstruction! Not only did he return to play so quickly, but he had a great season and was named to the Big East All-Rookie team as well as being tabbed Philadelphia Big Five Rookie of the Year. Kyle has gone on to have a successful NBA career without any inkling of a previous ACL injury. In Lowry’s case, his recovery can be based almost exclusively on his genetics as even performance enhancing substances couldn’t have produced such as a rapid return to basketball. Genetics, hard work, or performance enhancement? How do these athletes return so quickly? Even though in Ray Lewis’ case there are questions regarding hormone usage, all the deer antler spray in the world won’t get players back on the court and field as quickly as these players returned. These players get back to sports on the accelerated track due to their genetic makeup, excellent surgeons and rehab staff, hard work, and willingness to play in a time frame that puts them at higher risk for re-injury.

Delaware panel seeks change in workers' compensation oversight

A task force charged with formulating plans to limit future increases in Delaware workers’ compensation insurance rates has recommended freezing some fees that insurers can charge for injured worker care and more closely scrutinizing requests for rate hikes made by insurance companies. Lt. Gov. Matt Denn, who chaired the panel, released the recommendations Monday. The General Assembly acted to form the group in January, a month after state insurance regulators approved a 15 percent increase in the workers’ compensation rates paid by businesses. According to the task force, the rates have risen by 34 percent in the last two years. “We have asked for and reviewed hundreds of pages of medical cost information from the insurance industry,” Denn said. “We think there is still work to do, and one of our recommendations is that our task force keep on meeting.” The report includes 18 ideas to improve the system in Delaware, many of which build on measures enacted in 2006 and 2007, when Denn was insurance commissioner. Half of the recommendations relate to the fees that insurers can charge for medical services provided to injured workers, including a plan for a two-year freeze on increases in hospital reimbursement payments based on inflation. Proposals also call for revised fee schedules for lab tests, price controls for prescription drugs and caps on the number of drug tests conducted on patients. Five recommendations would make vetting of rate increase requests more rigorous. Denn said the task force found about half of last year’s approved rate increase was attributable to rising medical costs. The rest, he said, was for insurance companies to replenish reserves. The task force suggests the Department of Insurance hire an attorney to serve as a ratepayer advocate. It also wants the insurance office’s existing review committees to more closely monitor medical costs. Senate President Pro Tem Patricia Blevins, D-Elsmere, said the recommendations would be molded into legislation that she hoped to pass by the close of this year’s legislative session on June 30. “The recommendations are very specific, they’re not vague, and they’ll actually have an impact,” Blevins said. Business groups praised the task force report. However, the response was mixed from the Delaware Compensation Rating Bureau, which sets workers’ compensation rates on behalf of the state’s insurance companies. In a dissenting document, the DCRB warned of additional costs to implement the proposed changes and expressed concern about handing greater oversight to committees within the insurance department. The DCRB said empowering a ratepayer advocate with the ability to solicit facts and data from it would be “an unlawful delegation of authority.”

Delaware task force issues report on addressing workers compensation costs

A state panel examining soaring workers compensation rates in Delaware is recommending that the state implement a two-year inflation freeze on medical providers’ fee schedules. The recommendation is included in a report released Monday by the workers compensation task force. The panel also recommends a permanent reduction in the inflation rate allowed for hospital treatment, and reductions in allowed reimbursements in several medical categories. The task force also says insurance carriers’ requests for rate increases should receive careful scrutiny, and that officials must require insurers to enforce Delaware’s medical cost controls. The panel was established to address a 34 percent increase in average workers compensation rates over the past two years. Officials say those increases make it harder for Delaware businesses to compete for bids with businesses from neighboring states.

Kasich proposes $1 billion rebate of workers' compensation premiums

Gov. John Kasich apparently isn't letting a huge defeat in court suffered by the Ohio Bureau of Workers' Compensation stop him from proposing a $1 billion rebate of workers' comp premiums to public and private employers that pay into the system. Under Gov. Kasich's proposal, about 210,000 employers would receive rebate checks. The governor's office said the rebates would be equal to about 56% of employers' most recent annual premiums. The governor also has proposed that the Legislature change the billing method for workers' comp premiums so that employers pay in advance of a coverage period rather than after the coverage period has concluded, as is the case now. In order to help employers make the transition to the new billing method, the proposal calls for the workers' comp bureau to issue a credit to employers equal to the full amount of their previous six-month premium. The credit is estimated at $900 million in total. The governor's office said the change in billing would result in modest premium rate reductions — 2% for private employers and 4% for public employers — in part because it would increase the bureau's ability to detect employer non-compliance and fraud. The governor put forth the rebate proposal despite a March 20 ruling by Cuyahoga County Common Pleas Judge Richard McMonagle that a group of more than 270,000 Ohio employers that are part of a class-action lawsuit are entitled to $859 million in premium overpayments from the workers' comp bureau. The suing employers had claimed that steep discounts were offered to employers who could join groups administered by third parties at the expense of employers who did not qualify for group membership, like the plaintiffs in this case. In a statement issued at the time of the ruling, the workers' comp bureau said it was disappointed with the judge's finding. “We maintain our actions were lawful and restitution is not warranted in this case,” the statement read. Potential job-creating benefits extolled Today's announcement by the governor made no mention of the court action. Rather, it focused on the job-creating potential of the rebates. “Returning these funds to public and private employers, strengthening worker safety efforts and modernizing operations are the kinds of reforms that help create jobs and they're the kinds of reforms that my administration will keep pursuing,” Gov. Kasich said in a news release. Besides the big rebate and the proposed change in billing, the governor has proposed tripling Ohio's Safety and Wellness Grant program to $15 million. The announcement from the governor's office said all the elements of the proposal would be financed from the bureau's net assets, which have grown to $8.3 billion “and are far in excess of the target funding ratio of assets to liabilities established by the BWC board in 2008.” The Ohio Chamber of Commerce called Gov. Kasich's three-part plan “great news for Ohio employers.” “We applaud the governor's fight to make Ohio's business climate more competitive and believe the workers' compensation plan announced today is another step in the right direction,” said Andrew E. Doehrel, president and CEO of the state chamber.

NFL Workers Comp

Reading through opinions from the Maryland Court of Appeals, one does not often find the justices grappling with quandaries such as “whether injuries occurring while playing and practicing professional football are accidental injuries’ and thus compensable under the Maryland Workers' Compensation Act.” That phrase comes from a decision handed down this week in a case pitting former Redskins punter Thomas J. Tupa Jr. — you probably remember him as Tom Tupa — versus his former employers, the Washington Redskins, whom you might not recognize in legal papers as “Pro-Football, Inc., t/a the Washington Redskins.” The central drama of the case surrounds what happened to Tupa seven years ago, on Aug. 19, 2005, at FedEx Field in Landover. The decision says that “during his pre-game warm-up for a preseason game, Tupa landed awkwardly after a punt and felt a sharp pain in his lower back. He described the pain as a ‘jarring’ sensation, sought immediate medical attention, and received medication.” Tupa never got better. He eventually left the NFL, and he filed for workers’ comp. In the interest of saving digital space, let us just say that legal challenges to Tupa’s claims went into overtime and eventually made their way to Maryland’s highest court, which considered two issues. One: Could Tupa could file in Maryland even though the team’s headquarters was in Virginia? Two: Are football injuries “accidental injuries” or not? In the first, the court ruled that the punter could file in Maryland, citing a litany of case law. In the second — the more interesting point of contention — the team and its insurers argued that Tupa’s injury was not accidental. Football is a dangerous sport, etc. The state high court, in its decision, took a narrow reading of Maryland’s workers’ comp law, ruling that “Tupa’s injury occurred ‘out of and in the course of [his] employment.’” It added: “He was warming up for a game when he landed awkwardly and thereafter sought immediate medical treatment. Ample evidence was presented to show that Tupa suffered a compensable accidental injury during the course of his employment.” Tupa gets his workers’ comp. “For Tupa, it means lifetime medical care,” Benjamin T. Boscolo, Tupa’s attorney, told the Baltimore Sun. "It means surgery if and when he gets to a place where he can't function in his state of health.” You can read the entire 16-page decision here. In a separate but similar case on Thursday, the court handed down another decision in support of a former Redskins player seeking workers’ comp in the state. The court said Darnerien McCants, a former wide receiver, could in fact seek workers’ comp in Maryland even though the team argued that the bulk of his employment was in Virginia, where the team practices, hold meetings and watches film. Also, several of his injuries occured out of state.

Calif. approves alternative security program for self-insured workers comp employers

SACRAMENTO—A California state agency has approved a $6.17 billion alternative security program to guarantee the 2012 and 2013 workers compensation risk for participating self-insured California employers. The California Department of Industrial Relations on Monday approved the alternative security program, which provides collateral for eligible self-insured employers in lieu of each employer securing its own financing to meet California’s collateral requirements for self-insured workers comp liabilities. For more information please visit Workers-comp-claim.com

Workers compensation law would restrict public access to information

Lawmakers have passed a bill aimed at cracking down on employers that put workers at risk by not holding legally required workers' compensation insurance. But one provision of HB237, added at the last minute, may restrict public access to the information that first brought the problem to light.
An investigation by The News & Observer in April revealed that tens of thousands of North Carolina employers had no workers' compensation insurance and that few faced repercussions, in large part because the state often learns about noncompliant companies when a worker is hurt and appealing for help.
The Rate Bureau, a group of insurance companies that among other things sets the rate for workers' compensation insurance, informs the state-led Industrial Commission of companies that are noncompliant; the Industrial Commission does not collect the information on its own.
Under the bill passed by the General Assembly on Thursday, though, the information used for the investigation would have been shielded from public view.
Rep. Dale Folwell, a Forsyth Republican and one of the bill's primary sponsors, said in an interview the goal is to protect confidentiality of companies providing information to the Rate Bureau. The confidentiality law would be the same as that governing the Department of Labor, he said.
"What I desire is that once we figure out someone has really dropped their coverage, once a case is open, it's all open records," Folwell said.
Gov. Bev Perdue is still reviewing the bill, according to spokesman Mark Johnson.