The News You Need for Feb. 17

Dread. A question about CRPS. And Utah UR.

Dread: Navigating the Heavy Weight of Fearful Apprehension in Recovery?

Dr. Claire C. Muselman

Dread is a deeply unsettling emotion often lingering during recovery, casting a shadow over the process. Unlike worry or anxiety, dread is marked by a pervasive and usually undefined sense of foreboding—a heavy feeling that something bad is inevitable. This emotion can be paralyzing, making it difficult to focus on progress or find hope. However, by understanding the roots of dread and learning strategies to address it, individuals can lighten its burden and move forward with resilience.?

Defining Dread?

Dread is an emotional state characterized by a profound fear or apprehension about future events, often without a specific or immediate trigger. It feels heavy and pervasive, affecting both the mind and body. During recovery, dread can manifest as an overarching fear of setbacks, pain, or long-term limitations. While dread is a natural response to uncertainty, it becomes problematic when it consumes one's thoughts and impedes engagement with the present. Recognizing and addressing dread is essential for fostering a more balanced and hopeful perspective.?

Physiological Foundations of Dread?

Dread is deeply intertwined with the brain's instinct to predict and prepare for threats. Still, this protective mechanism can become overwhelming when overactivated. The amygdala, responsible for processing fear, engages excessively during prolonged dread, leading to heightened stress responses. This state triggers a cascade of physical and emotional effects that can feel all-encompassing. Understanding these physiological patterns, individuals can better recognize how dread manifests and explore strategies to manage its impact. These physiological responses highlight how deeply dread can impact both emotional and physical well-being:??

Chronic Stress Hormone Activation. Prolonged release of cortisol and adrenaline heightens the body’s stress response, leading to fatigue, irritability, and reduced immune function. Over time, this constant state of alert can also increase vulnerability to illness and slow physical recovery.?

Physical Symptoms. Dread often manifests physically as tension, headaches, digestive issues, or changes in appetite, reflecting the body's heightened state of alert. These symptoms can create a feedback loop where physical discomfort intensifies emotional distress.?

Reduced Cognitive Function. The brain’s focus on perceived threats can impair decision-making, concentration, and memory, making it harder to manage recovery effectively. This diminished capacity for clear thinking often leads to additional frustration and a sense of helplessness.?

How Dread Happens?

Dread often emerges when individuals feel trapped between uncertainty and a lack of control, creating an emotional environment ripe for fear and pessimism. This emotion thrives on ambiguity, amplifying perceived threats and overshadowing potential positives. Past experiences, current stressors, and future uncertainties intertwine, making breaking free from the weight of dread challenging. Recognizing how these elements interact can provide a foundation for addressing and mitigating dread effectively. Common triggers include:?

Fear of Pain. Anticipating future pain or discomfort can create a constant undercurrent of dread. This anticipation often leads to heightened sensitivity, where individuals may misinterpret minor sensations as signs of worsening conditions.?

Uncertainty About Recovery. Lack of clarity about timelines or outcomes can intensify feelings of foreboding. This uncertainty often prevents individuals from fully engaging with the present, as their thoughts are consumed by what might go wrong.?

Isolation. Feeling disconnected from others during recovery can amplify the weight of dread, as individuals may lack the reassurance and support they need. This emotional and social distance often exacerbates feelings of vulnerability and loneliness.?

Previous Traumatic Experiences. Past injuries or setbacks can resurface, fueling a sense of inevitability about adverse outcomes. These memories can create a distorted view of the present, where past challenges feel like predictors of future failure.?

Example in Action?

Samantha, a nurse recovering from a severe wrist injury, feels a constant sense of dread about returning to work. She worries about whether she can perform her duties, fearing that the injury has permanently impacted her skills. This dread often leaves her unable to enjoy small milestones in her recovery. With guidance from a counselor and colleague support, Samantha reframes her fears, focusing on incremental progress and celebrating her resilience. Over time, she finds ways to manage her dread and regain confidence in her abilities.?

What to Do When Dread Happens to You?

Navigating dread requires intentional strategies to break its hold and foster a more balanced outlook. Here are steps to address this emotion during recovery:?

1. Identify the Source. Reflect on what is fueling your sense of dread. Naming the underlying fears or uncertainties can make them feel more manageable.?

2. Challenge Catastrophic Thinking. Examine whether your fears are based on evidence or assumptions. Reframing negative thoughts can reduce their emotional impact.?

3. Focus on the Present. Engage in mindfulness practices to bring your attention to the here and now. Grounding yourself in the present can help disrupt cycles of foreboding.?

4. Break Down Goals. Divide recovery into small, achievable steps. Celebrating progress, no matter how minor, can create a sense of momentum and counteract dread.?

5. Seek Reassurance. Share your feelings with trusted friends, family, or professionals. External perspectives can provide comfort and challenge unhelpful thought patterns.?

6. Engage in Relaxation Techniques. Practices such as deep breathing, meditation, or yoga can help calm the body’s stress response, reducing the intensity of dread.?

How to Support Someone Experiencing Dread?

Supporting someone dealing with dread requires empathy, patience, and active engagement. Consider these approaches:?

1. Listen Without Judgment. Allow them to share their fears and feelings openly. Validating their experience helps build trust and connection.?

2. Provide Encouragement. Highlight the injured human's progress and remind them of their strengths. Positive reinforcement can help counter the heaviness of dread.?

3. Offer Practical Support: Assist with overwhelming tasks or decisions. Tangible help can ease their mental and emotional load.?

4. Encourage Professional Help. Suggest speaking with a counselor or therapist, particularly if dread becomes paralyzing. Professional guidance can offer tailored strategies for managing this emotion.?

5. Be Patient. Understand that overcoming dread is a process that takes time. Consistent support and reassurance can make a meaningful difference.?

6. Foster Connection. Encourage activities that build connections, such as group therapy, social outings, or shared hobbies. Feeling less isolated can reduce the intensity of dread.?

Looking Ahead to Lightness?

Dread, while heavy and pervasive, is not insurmountable. By identifying its sources and implementing strategies to address it, individuals can reclaim a sense of hope and progress in their recovery journey. For caregivers and supporters, offering empathy and practical assistance can help lighten the burden of dread, creating space for resilience and growth.?

In the following article, we will conclude our focus on the immediate emotional responses to injury, reflecting on the insights gained about fear, shock, confusion, surprise, vulnerability, overwhelm, stress, worry, anxiety, and dread. This final piece will tie together the themes explored in this segment and guide moving forward with strength and resilience. By shining a light on the emotional landscape of recovery, we create a space where everyone feels seen, heard, and supported. That is the type of workers' compensation landscape I am here to support, educate, and encourage. Join me!?

Was Nurse’s Injury After Patient Fell on her a Load of CRPS?

Chris Parker

What Do You Think?

An employee who makes herself look more injured than she is may find herself without benefits in New York. A case involving a worker for a dialysis center highlights what types of behavior might bar compensation benefits based on fraud or misrepresentation.

In 2014, claimant, a registered nurse, was injured at work when a patient fell on her. She obtained workers' compensation benefits for complex regional pain syndrome (CRPS) involving her right foot, left leg, and both upper extremities.

In separate visits, two doctors judged her to be extremely limited in terms of her ability to function physically, because of the condition. The claimant reported that her ability to work, sit, or stand for extended periods, grasp objects or lift overhead, walk or run or engage in recreational activities, were all significantly affected and diminished by her CRPS in the upper and lower extremities and neck.

After they saw surveillance video of the claimant engaging in regular activities, such as holding a bag of recyclables at shoulder hight and walking without an expression of pain or discomfort, they believed claimant had misrepresented or exaggerated her disability and limitations when she was examined. She did not look like the same patient in the videos.

In New York, claimant who, for the purpose of obtaining workers' compensation benefits or influencing any determination relative thereto, knowingly makes a false statement or representation as to a material fact shall be disqualified from receiving any compensation directly attributable to such false statement or representation. Workers' Compensation Law § 114-a(1).

Did the claimant’s actions fall under § 114-a(1)?

A. Yes. The contrast between her appearance at doctor’s visits and her appearance in the videos indicated she misrepresented her condition to the doctors to obtain benefits.

B. No. She could have been just having a good day physically when the videos were taken.

If you selected A, you agreed with the court in Carpenter v. Albany Dialysis Center, No. CV-23-1587 (N.Y. Sup. Ct. App. 02/06/25), which held that the employee was not entitled to benefits for her CRPS.

The court noted that the two doctors changed their minds after reviewing the videos and concluded that the claimant had exaggerated her symptoms and limitations and during her appointments. That made sense, given that the videos purportedly showed the claimant engaging in everyday activities, such as lifting a bag of recyclables and holding it at shoulder level, without any apparent difficulty.

“[C]laimant is seen walking without any evidence of pain or discomfort exhibited in her face, able to walk for extended periods of time in sneakers without assistive devices or any altered gait,” the court wrote.

The Board was free to reject the claimant’s “self-serving explanations,” the court wrote. The evidence showed that she was less than forthcoming to the doctors about her condition and abilities. The court affirmed the Board’s determination that she misrepresented her condition for the purpose of obtaining benefits.

The court also upheld the board’s penalty against the claimant of permanent disqualification from future wage replacement.

Utah Utilization Review Rules

Frank Ferreri Do You Know the Rule?

If you were in Utah, and needed to know what that state had to say about utilization review, where would you turn? You could turn to Simply Research, but we have some highlights here too.

A. Purpose of Utilization Review and Definitions

1. "Utilization Review" is used to manage medical costs, improve patient care and enhance decision-making. Utilization review includes, but is not limited to, the review of requests for authorization and the review of medical bills to determine whether the medical services were or are necessary to treat a workplace injury. Utilization review does not include:

a. bill review for the purpose of determining whether the medical services rendered were accurately billed, or

b. any system, program, or activity used to determine whether an individual has sustained a workplace injury.

2. Any utilization review system shall incorporate a two-level review process that meets the criteria set forth in subsections B and C.

3. Definitions.

a. "Request for Authorization" means any request by a physician for assurance that appropriate payment will be made for a course of proposed medical treatment.

b. "Reasonable Attempt" requires at least two phone calls and a fax, two phone calls and an e-mail, or three phone calls, within five business days from date of the payor's receipt of the physician's request for review.

B. Level I - Initial Request and Review

1. A health care provider may use Form 223 to request authorization and payment for proposed medical treatment. The provider shall attach all documentation necessary for the payor to make a decision regarding the proposed treatment.

a. Requests for approval of restorative services are governed by the provisions of Section R612-300.5. C. 7. which requires submission of the appropriate RSA form and documentation.

2. Upon receipt of the provider's request for authorization, the payor may use medical or non-medical personnel to apply medically-based criteria to determine whether to approve the request. The payor must:

a. Within 5 business days after receiving the request and documentation, transmit Form 223 back to the physician, in a verifiable manner, advising of the payor's approval or denial of the proposed treatment.

i. If approval is denied, the payor must include with its denial a statement of the criteria it used to make its determination. A copy of the denial must also be mailed to the injured worker.

C. Level II - Review

1. A health care provider who has been denied authorization or has received no timely response may request a physician's review by completing and sending the applicable portion of Commission Form 223 to the payor.

a. The provider must include the times and days that she is available to discuss the case with the reviewing physician and must be reasonably available during normal business hours.

b. This request for review may be used by a health care provider who has been denied authorization for restorative services pursuant to Subsection R612-300-5.C.7.

2. The payor's physician representative must complete the review within five business days of the treating physician's request for review. Additional time may be requested from the Commission to accommodate highly unusual circumstances or particularly difficult cases.

a. The insurer's physician representative must make a reasonable effort to contact the requesting provider to discuss the request for treatment. The payor shall notify the Commission if an additional five days is needed in order to contact the treating physician or to review the case.

b. If the payor again denies approval of the recommended treatment, the payor must complete the appropriate portion of Commission Form 223, and shall include:

i. the criteria used by the payor in making the decision to deny authorization; and

ii. the name and specialty of the payor's reviewing physician;

iii. appeals information.

c. The denial to authorize payment for treatment must then be sent to the physician, the injured worker and the Commission.

3. The payor's failure to respond to the review request within five business days, by a method which provides certification of transmission, shall constitute authorization for payment of the treatment.

D. Mediation and Adjudication. Upon receipt of denial of authorization for payment for medical treatment at Level II, the Commission will facilitate, upon the request of the injured worker, the final disposition of the case.

1. If the parties agree, the medical dispute will be referred to Commission staff for mediation.

2. If the parties do not agree to mediation, the matter will be referred to the Division of Adjudication for hearing and decision.

E. Reduction of Fee for Failure to Follow Utilization Review Standards

1. In cases in which a health care provider has received notice of this rule but proceeds with non-emergency medical treatment without obtaining payor authorization, the following shall apply:

a. If the medical treatment is ultimately determined to be necessary to treat a workplace injury, the fee otherwise due the health care provider shall be reduced by 25%.

b. If the medical treatment is ultimately determined to be unnecessary to treat a workplace injury, the payor is not liable for payment for such treatment. The injured worker may be liable for the cost of treatment.

2. The penalty provision in D. 1. shall not apply if the medical treatment in question has been preauthorized by some other non-worker's compensation insurance company or other payor.