BIOMECHANICS & the RISK MANAGER: DEFENDING FLEETS, PREMISES, PRODUCTS & WC CLAIMS by Tom Jennings Do the Alleged Injuri

BIOMECHANICS & THE RISK MANAGER: DEFENDING FLEETS, PREMISES, PRODUCTS & WC CLAIMS By Tom Jennings

Do the alleged injuries fit the Medical Doctor Unlikely dynamics of the accident? Was there Diagnose and treat the injury. – Carpal Tunnel Syndrome an injury mechanism present in this – Osteophytes incident that could have caused this Biomechanical Engineer – Disc Herniation injury? Risk managers and safety, Causation—was there an injury – Degenerative Joint Disease claims and loss prevention mechanism that could have caused the – TMJ professionals deal with bodily injury claimed injuries? Biomechanics: Medicine + Engineering claims every day resulting from Biomechanics: Medicine + Engineering vehicle collisions, slips and falls, Slips, Trips & Falls: Which One Was It? product use and industrial accidents. Injuries Event Injuries Event It matters because it can determine Injury Mechanisms Kinematics In some cases, the description of loss Injury Mechanisms Kinematics does not account for the claimed whether there was an injury mechanism for this particular injury. A slip causes injuries. You may ask yourself, “How Do kinematics create different injury mechanisms than a trip. injuryDo kinematics mechanisms? create could those injuries result from the injury mechanisms? described accident?” Slips might result in lower back, wrist and head injuries. Trips could involve By conducting a biomechanical rotator cuff, wrist, knee injuries, etc. analysis of the events and injuries, Analyzing and comparing the injuries to biomechanical engineers explore the description of the loss event and whether an injury mechanism was other available factors enables the present in the event that could have biomechanic to reconstruct the event caused the claimed injuries. and to reasonably determine whether the

claimed accident matches the claimed Biomechanics injuries. If it does not, then it is likely

“The study of the mechanics of a that these injuries occurred elsewhere. living body, especially of the forces exerted by muscles and gravity on the Slips skeletal structure.”1 By education, a Possible mechanical engineer (usually) with – Sprains & Strains advanced degree(s) in human – Meniscal anatomy, physiology, tolerance of – Fractures biological tissue, neuroscience, – Disc Herniation kinematics and dynamics to name a Unlikely few. – TMJ – Degenerative Joint Disease Mechanism of Injury – Osteophytes Forces applied to the human body in a – Disc Herniation specific direction and magnitude (circumstances dictate) required to cause injury. – Carpal Tunnel Syndrome Trips Possible – Fractures

Case Study: Slip, Trip or Fall insurers and third-party administrators claimants with real back, shoulder, Claimant descending stairs at a (TPAs) because they have no viable wrist and knee injuries, but the marina, slips, falls to her left on the alternative to refute the claimed vehicle contact forces in this incident landing and suffers a serious fracture injuries. However, the science of the did not approach the level required to of the lateral ankle (lateral malleolus). events is often overlooked or simply 1) produce an injury consistent with She alleges unsafe, slippery, wet not explored because adjusters, safety the claimed injuries and 2) produce surface causing her to “slip.” experts and risk managers may be forces high enough to receive any Adjuster’s investigation reveals unaware of available legal defenses. injury at all. In other words, using a claimant was wearing very thick flip- biomechanical-oriented Accident flops. The biomechanical analysis Reconstruction and Injury Mechanism indicates that this type of injury Analysis can often produce a strong would be caused by the ankle defense against these claimed injuries. “rolling-over” to the side (i.e., falling By examining accident reports, off her flip-flop) causing the lateral medical files, damage appraisals and malleolus bone to fracture. Surface photos, an ARCCA Biomechanic will analysis (using the Brungraber Mark- formulate an opinion/report as to II to measure slip resistance) whether the magnitude and direction conclusively showed that, even wet, of force existed to produce an injury. the surface coating was well within acceptable safety parameters. Elements of a LSI Analysis Photographs: Ideally, of all vehicles to show the areas of contact. Take both digital and 35 mm photos. If possible, “walk the clock.” While circling the vehicle, take photographs from all sides, not just the impact area. Photograph the bumper shock isolators, if so equipped. Photograph the interior, airbags, the dashboard The “damage” vehicles and steering wheel. Several years later at trial, there may be claims of secondary impacts. Take the photos now to refute such future claims. Conclusion Low-Speed Impact: Generally Medical Reports: Claimant’s (and The injury was caused by a misstep considered to be less than 5-8 MPH. other occupants if possible) from rolling off the flip-flop, not the Damage/Repair Appraisals: For each client/insured’s surface condition. Employing the laws of physics and vehicle involved. human tolerance, biomechanics Depositions: Make sure the right Verdict: Favorable to defense. analyze the forces of the impact and questions are included. whether a mechanism of injury Police Reports: If any Vehicular Low-Speed Impact (LSI): existed during the impact. Witness Accounts: If any Frontal, Rear-End & Side-Swipe Occupants: Other Occupants? Vehicle damage? Does the force of Biomechanics may not necessarily Injuries? Seating Location(s) the crash equate to the probability of question the presence of the injury. Supplemental Restraint (Airbag) injury? The vehicle helps you However, they will evaluate whether Diagnostic Module Data (Black Box): determine the force of the crash and forces and an “injury mechanism” If available. the likelihood of injury in many were present in this collision ways. sufficient to produce the alleged What Can We Hope to Achieve? injury. Determine the range of speed at Every fleet, safety and risk manager impact. Calculate the “g” or has been exposed to claims involving Biomechanical analysis can often acceleration forces imparted to the questionable injuries from low speed reveal many claimed injuries to be vehicle and occupants. Compare the impacts with their commercial quite unlikely given the forces alleged injuries to the forces (based vehicles. Oftentimes, these “nuisance involved in the subject incident. Some on the laws of physics) present in this claims” are settled by insurers, self- low-speed claims may involve

collision. Scientifically determine the plaintiff’s vehicle often reveals seatback. Any minimal rebound whether there was sufficient force to only minor cosmetic damage and no energy is well within the range of cause the alleged injuries. structural damage. Inspection of the protection of the available seat belt. bumper shock isolators can reveal Typical Information to be Analyzed impact forces. With the above facts in hand, the Incident Description: What biomechanic will review the claimed happened? injuries one by one to address whether or – Typical Reports Reviewed: not sufficient forces were present in this (when available) event, which could have produced an – Police accident report injury mechanism to have caused each of – Insurer’s investigation report the alleged injuries. – Medical records – Deposition transcripts Conclusions – Plaintiff’s answers to The biomechanic’s final opinions are defendant’s interrogatories based on an objective scientific – Color photographs of incident Figure 1: Subject Vehicle analysis of the subject incident. scene, including both vehicles Accepted scientific principles are – Auto body shop repair used to determine the crash severity estimates and occupant kinematics, thus – Auto repair report enabling an evaluation of injury – Insurance invoices mechanisms, if any. Subjective findings, such as verbal medical Data history, may be useful in injury – Expert AutoStats and diagnosis, but they cannot be solely VINDeCoder data sheets for relied upon in causally relating a involved vehicles reported injury to a specific event. – Insurance Institute for This is the biomechanic’s job. Highway Safety, Damage Figure 2: Bumper shock isolator of Repair Costs in Low-Speed subject vehicle Every case and every injury is Crash Tests at 5 MPH different. However, the laws of physics are constant and apply Kinematic Analysis identically to every collision. With a Typically Claimed Injuries Using the claimant’s age, height, sufficient amount of the information weight, seat belt usage and the laws – Carpal Tunnel outlined above, an accident of physics, the biomechanical – Herniated discs reconstruction can be completed, and engineer determines relative motion – Cervical spine strain and sprain an objective biomechanical analysis of the claimant and the vehicle at the – Compression fractures can determine whether an injury time of impact. – Thoracic spine strain and mechanism was present to cause the

sprain claimed injuries and to support those According to the laws of physics, – Lumbar spine strain and sprain findings in a court of law. when a vehicle is contacted in the – TMJ – Rotator cuff rear, it will move forward, if there is Workers’ Compensation (WC) enough energy. If forward motion of – ACL tear Keeping in mind the same principles the vehicle occurs, the occupants will – Whiplash and methodology outlined above, tend to move rearward into the – Headaches biomechanics can analyze the injuries seatback, relative to the interior of the – Spasms sustained in an alleged WC accident vehicle. This would cause all – Tingling to determine whether there was an occupants’ bodies to load into the – Vision and hearing loss injury mechanism present to have seats and seatback structures, thus – Migraines caused the alleged injuries. We coupling their motion to the now – Loss of balance and orientation recognize the difficulties in accelerating vehicle. Occupants are Vehicle Damage & Crash Severity overcoming the inherent obstacles in not thrown forward within the refuting WC claims. However, The vehicle photographs are relevant vehicle. The low accelerations biomechanics can be used to mitigate in the consideration and analysis of resulting from these impacts would the severity. the physical forces in the subject cause little or no rebound of incident. Examining photographs of occupants’ bodies forward from the

Case Study Settlement Case Study: Construction Site Accident This claim involves a WC Case settled for a small fraction of the Case Study: Construction Site Accident subrogation/plaintiff defense but claimed amount. Client stated that the Worker lifting 200Worker pound lifting pipe demonstrates the possibilities in using biomechanic’s report was the key with200 coworker pound pipe with coworker biomechanics to ascertain the cause of factor in obtaining a favorable Cries out in painCries and out drops in pipepain and drops injury. Two construction workers settlement. pipe Complains of severeComplains lower of were lifting a large section of pipe at backsevere pain lower back pain Rests, self a construction site when one worker In summary, biomechanics can medicates,Rests, self thenthenmedicates, returns toto then thenworkwork returns experienced a sharp pain in his lower determine whether there was toto workwork back. At that time, he left the area to sufficient force in an accident/event to rest and medicate. create the injury mechanism necessary to cause the alleged Feeling better later that day, he injuries. These examples offer a Case Study: Construction Site Accident returned to the site where he was glimpse of what biomechanics can Case Study: Construction Site Accident

working on an elevated scaffold hope to achieve when working with Worker stepsWorker from outside a window opening. While risk managers, their adjusters and suspendedsteps from scaffoldsuspended into buildingscaffold into stepping through the window attorneys to rebut or at least mitigate building Scaffold shifts, workerScaffold trips shifts, opening, he alleges that the scaffold some of these alleged injuries/claims. andworker falls intotrips buildingand falls into building shifted, causing him to trip and fall Complains of wrist,Complains knee, of andwrist, severe knee, forward onto his knees and hands. Tom Jennings is Vice President of lowerlowerand backbacksevere painpain ARCCA, Inc. in Boston, MA. lowerlower backback painpain The Injury: Herniated disc. ARCCA is a national forensic engineering, insurance/reinsurance The Claim and litigation consulting firm that As an employee, the claimant was specializes in the analysis and Case Study: Construction Site Accident entitled to a WC claim for a herniated communication of complex issues. Case Study: Construction Site Accident Understand injury – identify injury mechanism Understand injury – identify injury mechanism disc. However, he claimed that the Herniated disc caused by combination of compressive Herniated disc caused by combination of compressive force and bending injury was sustained from the trip ARCCA Biomechanics and Engineers force and bending through the window opening, thereby will conduct 2 presentations at the involving our client, the scaffold ASSE 2007 PDC in Orlando: # 644 contractor, as a third-party litigant. “Biomechanics For Risk Managers— Therefore, apart from the WC claim, Slip, Trip and Fall Injuries” and #519 suit was filed against our client for “When Driver Safety Fails—Then $1 million. What? Vehicular Accident Analysis: The Big Picture.” A biomechanical analysis confirmed that the claimant had a herniated disc Visit ARCCA at Booth # 517. Case Study: Construction Site Accident Case Study: Construction Site Accident caused by compressive force and Which of the two events creates the injury mechanism? bending. Lifting the pipe would create Which of the two events creates the injury mechanism? ARCCA Offices an injury mechanism for such injury—tripping and falling forward Boston: 866.617.7690 would not. Chicago: 888.579.2714

A biomechanical analysis concluded Trip and forward fall Lifting a heavy object Philadelphia: 800.700.4944 Trip and forward fall Lifting a heavy object that the injury was sustained when the worker lifted the pipe. No injury Pittsburgh: 866.502.7222 mechanism for the back injury was present in the subsequent trip and fall Seattle: 877-942-7222 event.