Heat-related worker injury claims can range from quickly resolved dehydration cases to catastrophic injuries requiring emergency care, organ damage and potential long-term disability, according to workers compensation experts.
That makes early recognition and rapid response critical, particularly as employers face increased scrutiny over heat exposure and as claims teams prepare for more questions about how heat illnesses are reported, treated and managed, they said.
Heat claims vary widely depending on the severity of the exposure and the worker’s medical response, said Jim Kenney, Sunrise, Florida-based senior vice president of medical services at Broadspire.
A lot of these may end up as a catastrophic injury, depending on what happens with the heat claim,” he said.
If a worker has a severe reaction while trimming trees, paving streets or performing other high-heat work, inadequate hydration can lead to longer-term complications, including kidney problems, Mr. Kenney said.
“There are some mild versions where somebody’s dehydrated, you get them out of the sun, you get them hydrated, and they go on to recover without an issue,” he said. “There are some longstanding issues that could occur with kidney function … especially if there’s a bad case of dehydration along with heat.”
Experts say the first step in managing a heat claim is immediate clinical assessment. Mild heat illness may involve heavy sweating, weakness, nausea, irritability, headache or lightheadedness. In those cases, workers may need to be removed from heat, cooled, given fluids and monitored to ensure symptoms improve.
Heat claims often surface first through nurse triage, where early assessment helps determine whether a worker needs emergency care, clinic treatment or self-care, said Tammy Bradley, Birmingham, Alabama-based vice president of clinical strategies and market insights at Enlyte.
“It’s not just about the exposure to the heat or the cold. It’s about the other things that happen,” she said. “Do they need care? When do they need care? What level of care do they need? That’s really kind of your number one strategy when it occurs — to make sure that it is addressed immediately.”
Enlyte sees an uptick in heat-related triage activity during the summer, particularly among seasonal workers, Ms. Bradley said. Many cases are not severe enough to require long-term case management but prompt clinical guidance is critical, she said.
“From a triage nurse perspective, we certainly do” see those claims, she said. “The employer is doing the right thing, because they are getting them to a medical professional as quickly as possible after the exposure.”
Many heat-related illnesses, if caught early, can be resolved quickly, said Jean Feldman, Tampa, Florida-based director of managed care at Sentry Insurance.
More severe heat claims are a different matter. Heat stroke can escalate rapidly and may involve confusion, fainting, seizures, organ damage or loss of consciousness.
In severe cases, Broadspire’s catastrophe program may send a nurse to the hospital to help the worker, family, and employer understand the diagnosis, treatment plan and discharge instructions, said Angie Goins, Sunrise, Florida-based catastrophe product manager and prosthetic liaison at Broadspire.
“What we see is a person in the emergency room who has IVs running to try to rehydrate them,” Ms. Goins said. “They may be confused. Their family is afraid because nobody really knows what’s going on with them.”
Severe dehydration and heat stroke can lead to kidney problems, respiratory issues, neurological complications and, in some cases, temporary dialysis before discharge, she said.
Heat stroke is a life-threatening emergency generally marked by a core body temperature of at least 104 degrees Fahrenheit and central nervous system symptoms such as confusion, slurred speech, seizures or loss of consciousness, said Lynsey Stefanko, Milwaukee-based director of clinical programs at Sedgwick.
In those cases, employers should call 911, ensure airway, breathing and circulation, and begin rapid cooling, she said. Most heat stroke patients will be treated in an intensive care unit with monitoring, IV fluids and electrolyte management. Prognosis depends heavily on how quickly symptoms are recognized and cooling begins.
Claims managers also watch for rhabdomyolysis, or muscle breakdown, which can occur during extreme heat and exertion and can lead to acute kidney failure. Firefighters and other workers exposed to heat while performing strenuous physical tasks are particularly vulnerable, Ms. Stefanko said.
In some cases, disputes may arise over whether a worker has recovered sufficiently to return to work, Mr. Kenney said. That can require second opinions, peer review or additional medical record review to determine whether ongoing disability is related to the workplace heat event.
The worst thing employers can do is fail to educate themselves and their workers, said Laura Oslund, Seattle-based senior risk services consultant at Sedgwick. Heat illness should be part of basic first aid and CPR training, and workers should understand symptoms before an emergency occurs, she said.
Employers should have heat plans that include monitoring, education and effective controls, she said. That includes understanding indoor and outdoor heat exposure, humidity, access to cooling and how workers should respond when symptoms develop.
The goal, claims and safety professionals said, is to identify heat illness early enough to prevent a medical-only claim from becoming a catastrophic one.
This article was first published in Business Insurance
