New Jersey blood clot case raises questions for comp community

Should a worker with multiple health risks who died of a blood clot after sitting for many hours be awarded workers' comp benefits? Yes, according to a court in New Jersey.

The case is garnering attention from many factions in the workers' comp system. Some are wondering about the impact of comorbidities while others suggest employers take steps to prevent such injuries -- among on-site employees as well as telecommuters.

The case. In James P. Renner v. AT&T, Renner said the pulmonary embolism his wife suffered was due to work-related extensive sitting, not the fact that she was morbidly obese and had recently begun taking birth control pills. The courts agreed and awarded him workers' comp death benefits.

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Cathleen Renner was a salaried manager for AT&T who worked three of five days each week from her home in Edison, N.J. In 2007, she died from a blood clot in her lung after working much of the night while sitting at her computer.

While AT&T argued it was a combination of risk factors that led to the pulmonary embolism, the court said otherwise.

"Cathleen led a sedentary life in and out of work; however, credible evidence exists in the record to support the [workers' comp] judge's finding that her work inactivity was greater than her non-work inactivity," the court said.

Renner's medical expert testified that "sitting for prolonged periods of time precipitates stasis of blood flow and that blood flow led to her developing clots." He also presented evidence from the autopsy showing the blood clot was unorganized "and therefore developed within the time period she was working."

With so many workers spending long hours sitting at their desks, the case provokes questions about the risks of prolonged sitting. "It's a big question out there -- how long is too long in your chair?" said Dr. Christopher Clare, an Atlanta-based physician and medical director for Best Doctors, a global health company that helps people "get the right diagnosis and right treatment," according to company officials.

Clare said while there are indications that blood clots can develop in people who sit on airplanes for extended periods, there is no evidence-based medicine to suggest the length of sitting time related to increased clotting risk.

"Clearly, the longer you sit immobile, the more likely you are to have stasis," Clare said. "But nobody has said, 'OK, you have X percentage of risk for sitting for so many hours.'"

Clare suggests periodic breaks for those who sit for extended periods. "It cuts down on back strain and cuts down on eye fatigue. There are a whole host of reasons it's good to get up and walk around every hour," he said.

Protecting employees. Many workers' comp experts say the case points up the need for employers to get employees moving. One way is through wellness programs.

"Employers have a vested interest in the health of their employees," said Sherri Hickey, director of medical management for St. Louis-based Safety National. "From a comp perspective, healthy employees have fewer accidents, and if they do, there are fewer complicating factors."

Employers can take actions that are not cost prohibitive. "One of the things I did here was I suggested they relocate the printers so everybody has to get up and walk to them," said Mark Noonan, managing principal for casualty at Integro Insurance Brokers and program cochair for the National Workers' Compensation and Disability Conference® & Expo. "There are no more individual printers anymore. You have to walk 10 to 15 yards each way to get to them. So that's something that I encourage."

Noonan said many companies have set up walking clubs. Some are subsidizing gym memberships or creating on-site workout facilities.

"I probably get an inquiry a month about the risks of putting a gym on-site," Noonan said. "There are some risks, but if you give employees the ability to do that on their own time, it's a benefit to employers."

Noonan also suggests employers consider the following options:

Replace soda and other vending machine items with healthy alternatives.
Set up and/or sponsor smoking cessation programs.
Redesign office space to encourage more walking and standing.
Develop on-site weight-loss programs.
Set up standing workstations.

Noonan also suggests updating safety programs to ensure the safety functions are correct. Also, make sure new employees can handle the job.

"Don't hire your comp claim," Noonan said. "If you've got someone who can't walk 100 yards and the job requires them to walk 200, that's the wrong job for the person."

Read more at the WorkersComp Forum homepage.

August 1, 2011

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