Tuesday, November 10, 2015

Any Childhood Experience

Ask Bowzer about his childhood...
Adverse Childhood Experience - ACE.

This is the new buzz phrase to describe early childhood psychological issues underlying complaints of pain that can't be explained by objective physical measurements. The theory: something bad happened early in life that manifests in generalized complaints of pain as an adult.

ACE was also a topic explored at the 17th Annual AAOS Workers' Compensation and Musculoskeletal Injuries course in Boston, MA this past weekend.

Case studies were presented to orthopedists in the audience to show how this phenomenon materializes.

The remedy, at least from the orthopedic standpoint, was less clear.

ACE can have a profound effect not only on the "experience" of incurring a work injury (or any injury for that matter) but also the duration and extent of disability - perhaps even more so.

Yet, ACE is something that is more universally applicable to claims than we likely appreciate.

That childhood experiences affect adult behavior has long been settled in the psychological world.

And while ACE certainly impacts the injured worker's claim experience, I suspect it affect how a claim is handled as well - i.e. ACE in reverse.

Underlying psychological trauma is, for a lot of people, difficult to accept, and is part of the reason that in workers' compensation there is a very low threshold of "causation," because the process is supposed to be administrative and essentially self-executing.

The theory is that while there will be some claims for which someone's co-morbidities are being paid for through the work comp system, those are exceptions and just a cost of the system, whether it is psychology, obesity, cardiac, etc.

That theory was temporarily lost on a Pennsylvania claims adjuster that was probably frustrated and having a bad day when she told a claimant with a known history of childhood sexual abuse that the carrier was "tired of paying for something that happened to you as a child," in a settlement conversation.

The claims adjuster later retracted that statement and apologized, but the damage was done and she, and the carrier, were sued in civil court by the claimant for psychological harm.

The carrier, PMA Insurance Group and the claims representative, Mylene Zimmerman, raised the defense of exclusive remedy.

The Pennsylvania Superior Court last week said there is no such protection and that the claimant, Matthew Charlton was not barred from seeking a tort recovery from them.

Since Charlton's claim was premised on the idea that Zimmerman intentionally caused him injury by referencing a non-work-related psychological injury, which exacerbated the harm caused by the non-work-related psychological injury, the court said his claim was not based upon a work-related injury.

What we experience as children shapes us as adults. These could be adverse, or positive - in either situation an employer, and ultimately the claims payer, must take the worker as he or she is at the moment, including any baggage that may come along (which is why I propose that the phrase be renamed, "Any Childhood Experience," to reflect this reality).

Workers' compensation laws have been dissected over time, and exceptions to liability for the Whole Person in a claim have been carved out, largely because there are folks who are, "tired of paying for something that happened to you as a child."

Ultimately, though, that emotion may cost more than simply treating the Whole Person, as we see in Charlton vs. PMA/Zimmerman.


  1. Read the study from the CDC. It was published in 2009

  2. Another study was done by Kaiser out of their San Diego facility

  3. intervention with the right kind of counselling support is usually very successful with helping the injured worker get back on his feet