Over the years — 23 to be exact — I have written many articles for our members on topics related to the need to seek medical treatment, the “who,” “what,” “where” and “when” of treating workplace injuries and the cost of medical care, just to name a few. I reviewed these past articles to see what has changed other than the date and the letters after my name. I was completely blown away by what I saw!

The NHADA Workers’ Compensation Trust (WCT) sees literally hundreds of claims for minor cuts, scrapes, lacerations and puncture wounds. That statistic has not changed. The cost of these claims, however, has gone up exponentially. Based on this, it is time for some new information. It’s time for a review as to why being frugal when it comes to medical care is not the path to take and also a reminder of how something small can turn into something HUGE.

In the automotive industry, it is not uncommon for someone to get minor cuts and scrapes on a day-to-day basis; most are an easy washing, antibiotic ointment and a Band-Aid and then back to work. This is the best-case scenario; unfortunately, not all simple cuts end with a Band-Aid. There is a lot to consider with work injuries, no matter how small. Remember, no matter how clean and great the shops look, the automotive industry can be a bit dirty.

When a work injury occurs, a call should be placed to us; of course, in the event of a true life-threatening injury, always call 911 first and follow up with us afterward. When it is not life-threatening, the call to us will assist the injured worker in getting the most appropriate level of medical care and, in the long run, will avoid medical complications and save money. So, a simple cut has occurred at work; what now?

• What To Consider
  • Is formal medical treatment really necessary? Calling NHADA-WCT and speaking to the nurse case manager gives the employer/employee and the nurse a chance to review the injury and determine if treatment is needed or if simple first aid at the workplace will do the trick.
  • Are sutures needed? When a cut occurs, a “timer” starts ticking. There is a window in which sutures can be placed to ensure appropriate healing. Missing this window could lead to poor healing, scarring and infection. Not sure if it’s that bad? Consider the alternative: avoiding a quick urgent care vs. multiple visits for an infected wound.
  • Is a tetanus shot needed? Most people cannot remember when they got their last tetanus shot. During annual physicals with our primary care provider, it will typically be addressed. Most adults get a tetanus shot every 5-10 years. These avoid complications from breaks to the skin that introduce bacteria and put you at risk. Not sure when you had one and have a minor cut or scrape; it’s best to be seen so a medical provider can determine if a tetanus shot is necessary.
  • Is the cut small but deep? A common misconception is a small cut or puncture wound that is deep is too small to suture, so why seek treatment? In this case, treatment is absolutely necessary. Deep cuts can damage muscle and even bone. Antibiotics most likely are needed to avoid serious infections from deep cuts.
  • Is it OK to just wait and see how it looks later? So many times, injured workers just do not want to take the time to get something that appears minor addressed. They are busy at work, they may be embarrassed to tell someone they got hurt and some feel they do not want their employer to incur costs for their treatment. Others just simply want to take the wait-and-see approach, and maybe they don’t need to go to the doctor. This is absolutely the worst route to take. The most minor cut can lead to complications that could include infection, scarring, loss of function and, in the most extreme but not completely unlikely scenario, amputation.
• What Not To Consider
  • Skipping the call to the nurse because the employee or employer thinks it is so minor that nothing can come of it … because something will come of it.

If a complication arises with a simple cut, scrape, laceration or puncture wound, it can be a medical emergency. The risk of wound infections is high. Early signs of infection can be redness and swelling around the wound. This can then greatly worsen; there can be drainage from the wound and redlines spreading away from the wound. A minor infection can be treated with oral antibiotics and wound care, whereas a more severe infection may require IV antibiotics, hospitalization and surgery. With increased care comes time lost from work. A simple cut can become a lost-time claim quickly.

The cost of medical care is skyrocketing. With personal health insurance, someone may be looking at co-pays, but with workers’ compensation, we are looking at full prices for care. NHADA-WCT has negotiated discounts with some providers, and per the Department of Labor, we pay what is reasonable. Discounts and reasonable charges can still leave us with large medical spend balances. When looking at the cost of medical care for lacerations, it is not uncommon to see a wide range of charges

• Urgent Care
  • The average cost of an urgent care visit for a simple laceration with or without sutures is approximately $300.00-$800.00 or more. Costs include but are not limited to suturing supplies, wound care supplies, tetanus shots, prescription medication, X-rays and provider fees. Some facilities will also charge a “facility” fee. The radiologist may also charge a separate fee for reading the X-rays.
• Emergency Rooms
  • The average cost of an emergency room visit for a simple laceration with or without suturing is now approximately $2,000.00-$6,000.00 or even more in some cases. The care may be the same or like that of an Urgent Care, but the cost is much higher for the visit and any procedures done. There may be more than one bill as well, similar to the urgent care but again higher because now there are emergency room provider bills, radiology bills and facility bills but, again, at a much higher rate. This doesn’t include the other expenses that are associated with emergency rooms, such as lost time from work due to long waits to be seen.
• Out Patient Follow Up Care
  • If a wound becomes infected to a point where oral antibiotics are not enough to treat the infection, IV antibiotics may be ordered. This will require the injured worker to return to the emergency room or outpatient center, sometimes daily, for IV treatment. A semi-permanent catheter may need to be placed for the infusions to occur. IV antibiotics are not the cost of a pill or capsule; they can run upwards of $5,000.00 per treatment, and again, there will be charges from the facility and provider. Some wounds will not close on their own and will require treatment at a wound center. These could be daily to weekly visits where specialists clean, debride and redress the wound to enhance healing. These visits, depending on how much treatment is needed, may run from $750.00 to thousands of dollars. Some of the equipment needed to treat wounds has to be purchased, versus rented, and a wound vacuum, which is often ordered, could be as much as $7,500.00.
• Surgery
  • Infected wounds sometimes don’t respond to treatment, or treatment was so delayed that surgery will be required. Wound infections can spread to the bone and subsequently infect the bone and bloodstream. These are very dangerous complications that can occur from a simple cut. It’s difficult to fully approximate the cost of this, but surgery would include charges from multiple providers and may include a hospital stay, medical equipment, follow-up care and lost time from work. We have seen bills for this type of scenario go upwards of approximately $20,000.00 to $60,000.00.

Now, if we look at all that has been presented here, we can take the “this will never happen to us” approach and just see how that next simple cut plays out, but unfortunately, we can report it has happened to NHADA-WCT members. We have had medical complications from infections that need oral antibiotics to the need for IV therapy to the need for surgery and the threat of loss of limb. These injuries creep … they creep up the severity scale, and they creep up the cost of care. We would much rather pay for an urgent care visit that the injured worker or employer feels is unnecessary than set someone up for pain, lost time from work, loss of their ability to enjoy hobbies and family, and not to mention the cost to the trust and the employer directly.

We prefer that with every injury at work, the employer and or injured worker give us a call. Even if it is determined treatment is not necessary, we can start the paper trail. Deciding not to file an employer’s first report of injury because it is felt to be “too minor” and then later becomes a serious medical issue puts us all behind the 8 ball.

Give me a call at (603) 224-2369, and together, we can put together a plan for the care and treatment of the work injury.