Investigations in Work-Related Upper Limb Disorder Claims: Part 3 – Stenosing Tenosynovitis and De Quervain’s Disease Claims

INTRODUCTION

In last week’s edition of BC Disease News (here), we presented the second segment of our 5th feature investigations conducted in the course of WRULD claims. This week, we produce the final segment on investigations conducted in the course of stenosing tenosynovitis and De Quervain’s disease claims.

A BACKGROUND TO STENOSING TENOSYNOVITIS

Stenosing tenosynovitis is a form of tenosynovitis, an inflammation of the sheath that surrounds a tendon.  The sheaths are found in tendons that pass under ligaments or through anatomical tunnels, and their function is to reduce friction between the tendon and the surrounding tissues.  In the hands and wrists, both extensor and flexor tendons may be affected by tenosynovitis.

In stenosing tenosynovitis (also known as ‘trigger finger’ or ‘trigger thumb’), the tendons affected are the superficial and deep flexor tendons typically of the middle finger, ring finger or thumb. Problems with the tendon or sheath can impede the movement of the tendon though the tunnel, which leads to a nodule forming at the base of the finger.  It is possible for several fingers on one or both hands to be affected at once. 

The lifetime risk of developing stenosing tenosynovitis has been reported to be 2-3 %.[i] The condition most commonly affects women, and those aged between 40 to 50 years.

Causes

The main risk factor, which is common across all variants of tenosynovitis, is believed to be prolonged repetitive movements.  The risk is greater when a movement that has not been done repeatedly in the past is suddenly started, such as taking up a new recreational activity or work task, or returning to work after time off.

Other risk factors include:

  • Diabetes;
  • Rheumatoid arthritis;
  • Carpal tunnel syndrome;
  • Carpometacarpal osteoarthritis; and
  • Injury to the base of the finger or palm.

Symptoms

The symptoms of stenosing tenosynovitis include:

  • Pain in the affected finger when it moves or is touched;
  • Stiffness in the affected finger;
  • Lump at the base of the affected finger;
  • Clicking of the affected finger; and
  • Difficulty straightening the affected finger.

Treatment, Duration, Prognosis, Effect on Work

Some cases can heal without treatment, by avoiding aggravating activities and use of painkillers or non-steroidal anti-inflammatories.

Some types of treatment include:

  • Splinting can reduce symptoms by stopping movement of the affected tendon. Splinting can be helpful for some people, but can be less effective in the long term than corticosteroid injections or surgery.
  • Corticosteroids can be injected into the tendon sheath, and are believed to work by reduction of swelling of the tendon. The effects may be apparent after a few days or a few weeks.  Corticosteroids are effective for 50-80 % of people, and are most effective in those with underlying health conditions such as diabetes or rheumatoid arthritis.  In some people, the benefits of injection are permanent, and in others, re-injection is possible if necessary.

Because the pathology of this condition is inflammation, it takes a minimum of 6 weeks before a conservative treatment plan is effective. Cases treated with conservative treatment may recur if a particular activity causes the disorder, and that activity is not stopped. In severe cases that do not respond to conservative treatment, surgery may be recommended. Surgical treatment usually involves surgical release of the roof of the appropriate tendon tunnel. The roof of the tunnel is split with an incision, which allows the tunnel to open up and create more space for the tendons. The tunnel will heal closed, and will be larger than it was previously.

There are several different methods of surgery for trigger finger, including open surgery, where an incision is made through the palm of the hand, and percutaneous surgery, where a needle is used to cut the sheath.

Recovery from surgery for trigger finger involves the following:

  • The finger should be able to move straightaway;
  • The dressings may be removed after a few days;
  • Full movement should return within one or two weeks;
  • Discomfort from open surgery should pass within two weeks;
  • The patient can drive as soon as they feel it is safe, which is usually after 3 to 5 days;
  • The patient may be able to write and use a computer immediately;
  • They can play sports after around 2 to 3 weeks, once the wound is healed and they can grip again;
  • Those with desk jobs or light manual jobs may not need any time off work.  Those whose job involves heavy manual labour may need around 4 weeks off; and
  • Recovery period may be longer if surgery was performed on more than one finger.

Medical Causation in Stenosing Tenosynovitis Claims

The IIAC is an independent statutory body that advises the Secretary of State for Work and Pensions in Great Britain and the Department for Social Development in Northern Ireland on matters relating to the Industrial Injuries Scheme. The Scheme, Industrial Injuries Disablement Benefit (IIDB), provides compensation that can be paid to an employed earner because of the effects of an industrial accident or prescribed disease.

In order for a disease to become a prescribed disease the Social Security Contributions and Benefits Act 1992 states that the Secretary of State must be satisfied that the disease:

  • Ought to be treated, having regard to its causes and incidence and any other relevant considerations, as a risk of the occupation and not as a risk common to all persons; and
  • Is such that, in the absence of special circumstances, the attribution of particular cases to the nature of the employment can be established or presumed with reasonable certainty.

So, a disease may only be prescribed if there is a recognised risk to workers in an occupation, and the link between disease and occupation can be established or reasonably presumed in individual cases.

The Council applies a doubling of the risk test to determine whether a disease can be attributed to occupation on the balance of probabilities.

Tenosynovitis appears on the list of prescribed IIDB diseases.  Its listing is shown below:

4.png

In its 2006 Command Paper, Work-related Upper Limb Disorder (Cm 6868) the IIAC found that prescription for tenosynovitis was appropriate but pointed out that ‘the [research] evidence base is limited and existing terms of prescription may owe more to clinical accounts and older reports in which the onset of classical tenosynovitis is well documented following exceptional hand-wrist work. Thus many cases occurred in the 1940s when people were required to undertake unaccustomed work in factories and in agriculture as part of the war effort. Attribution to work was favoured by the clinical time course: typically symptoms appeared following return to work after a long layoff, or following a change to unfamiliar work requiring new, rapid movements. Classically, cases would develop shortly after such exposures and resolve within a few weeks’. The paper suggested that ideally, the time course of exposure and symptoms should be defined, but the evidence to make such a definition was lacking.

Considering the above, claims for stenosing tenosynovitis are more difficult to defend on causation than other WRULDs but still can be defended if claimants are accustomed to work carried out or there is evidence of other risk factors at play, which suggest the condition may be constitutional or caused by other means.

A BACKGROUND TO DE QUERVAIN’S DISEASE

Introduction

De Quervain’s disease is a form of tenosynovitis, an inflammation of the sheath that surrounds a tendon. The sheaths are found in tendons that pass under ligaments or through anatomical tunnels, and their function is to reduce friction between the tendon and the surrounding tissues.  In the hands and wrists, both extensor and flexor tendons may be affected by tenosynovitis. In De Quervain’s Disease (also known as ‘Blackberry thumb’, ‘gamer’s thumb’, ‘washerwoman’s sprain’ and radial styloid tenosynovitis), the tendons affected are those at the base of the thumb and side of the hand.  Repetitive trauma can cause thickening of the tendons, which can restrict their movement through their compartment.  Movements of the thumb and wrist then cause pain and inflammation.

De Quervain’s disease is the most common form of tenosynovitis, with reported incidences of 2.8 cases per 1000 people per year in women and 0.6 per 1000 people per year in men.[ii] The condition most commonly occurs in those aged 40 to 60 years, and advanced age has been reported to increase incidence.

Causes

The main risk factor, which is common to all forms of tenosynovitis, is believed to be prolonged repetitive movements. The risk is greater when a movement that has not been done repeatedly in the past is suddenly started, such as taking up a new recreational activity or work task, or returning to work after time off.  There have been several reports of de Quervain’s disease when sending large numbers of text messages from mobile phones.[iii]

Other risk factors include:

  • Advanced age;
  • Recent motherhood;
  • Suffering a direct blow to the thumb;
  • Inflammatory conditions (i.e. Rheumatoid Arthritis);
  • Diabetes; and
  • Carpal tunnel syndrome.

Symptoms

The symptoms of De Quervain’s disease include:

  • Pain in the wrist at the base of the thumb, or along the back of the thumb;
  • Pain moving the thumb, especially grasping, pinching or twisting;
  • Swelling and restricted movement at the base of the thumb;
  • Pain when pressure is applied to the area; and
  • Cracking sound when moving tendon or wrist move.

Treatment, Duration, Prognosis and Effect on Work

Some cases can heal without treatment, by avoiding aggravating activities and use of painkillers or non-steroidal anti-inflammatories.

Forms of treatment include:

  • Splinting can reduce symptoms by stopping movement of the affected tendon. Splinting can be helpful for some people, but can be less effective in the long term than corticosteroid injections or surgery.  Chronic De Quervain’s may require a 3 to 4 week period in a wrist/thumb splint, and use of a thumb splint may continue for at least 3 months, before gradual weaning off; and
  • Corticosteroids can be injected into the tendon sheath, and are believed to work by reduction of swelling of the tendon. The effects may be apparent after a few days or a few weeks.  Corticosteroids are effective for 50-80 % of people, and are most effective in those with underlying health conditions such as diabetes or rheumatoid arthritis.  In some people, the benefits of injection are permanent, and in others, re-injection is possible if necessary.

Because the pathology of this condition is inflammation, it takes a minimum of 6 weeks before a conservative treatment plan is effective.  Cases treated conservatively may recur if a particular activity causes the disorder, and that activity is not stopped. In severe cases that do not respond to conservative treatment, surgery may be recommended. Surgical treatment usually involves surgical release of the roof of the appropriate tendon tunnel. The roof of the tunnel is split with an incision, which allows the tunnel to open up and create more space for the tendons. The tunnel will heal closed, and will be larger than it was previously. 

Recovery from surgery for de Quervain’s involves the following:

  • There will be a bandage on the hand, which will be reduced in size after 2 to 5 days;
  • Patients are encouraged to use the hand gently within the limits of the bandage, but avoid heavy lifting;
  • The patient will not be able to use the thumb for gripping for 2 to 4 weeks;
  • Strenuous activities, such as gardening or DIY should be avoided for 2 weeks;
  • The patient should be able to drive after 3 to 5 days, though patients are advised not to drive with dressings in place;
  • Most people return to light work 2 to 4 weeks following surgery, and consultants and therapists can advise about return to heavier duties; and
  • Physiotherapy or hand therapy may be helpful to restore movement and strength, but this is not always required;
  • The success rate of surgery is good, and recurrence is rare.

Medical Causation in De Quervain’s Claims

The IIAC is an independent statutory body that advises the Secretary of State for Work and Pensions in Great Britain and the Department for Social Development in Northern Ireland on matters relating to the Industrial Injuries Scheme. The Scheme, Industrial Injuries Disablement Benefit (IIDB), provides compensation that can be paid to an employed earner because of the effects of an industrial accident or prescribed disease.

In order for a disease to become a prescribed disease the Social Security Contributions and Benefits Act 1992 states that the Secretary of State must be satisfied that the disease:

  • Ought to be treated, having regard to its causes and incidence and any other relevant considerations, as a risk of the occupation and not as a risk common to all persons; and
  • Is such that, in the absence of special circumstances, the attribution of particular cases to the nature of the employment can be established or presumed with reasonable certainty.

So, a disease may only be prescribed if there is a recognised risk to workers in an occupation, and the link between disease and occupation can be established or reasonably presumed in individual cases.

The Council applies a doubling of the risk test to determine whether a disease can be attributed to occupation on the balance of probabilities.

Tenosynovitis appears on the list of prescribed IIDB diseases.  Its listing is shown below:

4.png

In its 2006 Command Paper, Work-related Upper Limb Disorder (Cm 6868) the IIAC found that prescription for tenosynovitis was appropriate but pointed out that ‘the [research] evidence base is limited and existing terms of prescription may owe more to clinical accounts and older reports in which the onset of classical tenosynovitis is well documented following exceptional hand-wrist work. Thus many cases occurred in the 1940s when people were required to undertake unaccustomed work in factories and in agriculture as part of the war effort. Attribution to work was favoured by the clinical time course: typically symptoms appeared following return to work after a long layoff, or following a change to unfamiliar work requiring new, rapid movements. Classically, cases would develop shortly after such exposures and resolve within a few weeks’. The paper suggested that ideally, the time course of exposure and symptoms should be defined, but the evidence to make such a definition was lacking.

More recently several US reviews and studies have found that there is no evidence to confirm a causal relationship between De Quervain’s tenosynovitis and occupational risk factors, including heavy manual labour.[iv]

TEMPLATE SCHEDULE OF INVESTIGATIONS IN A WRULD CLAIM

Detail any preliminary enquiries made with the insured, setting out what information the insured has provided to date. Then concisely summarise what else needs to be investigated / clarified by identifying the main issues in dispute which require further investigation. For example:  

Lay Evidence

The Claimant

  • What was / is the claimant’s ( C ) job role and periods of employments?
  • What site(s), departments, lines, operations & processes does / did the C work at with relevant dates for the same?
  • What was C’s days and hours of work, including any regular overtime?
  • What were his / her rest breaks-formal and informal-including frequency and duration of the same?
  • Obtain a broad timeline of what happened. When did C first:
  • Start the work complained of?
  • Raise any problems concerns regarding his work?
  • Develop symptoms?
  • Go absent from work?

[Further details on complaints and absences etc. requested below]

  • Did C have any particular requirements at material time-e.g. new or expectant mother, disability and / or health problems, migrant worker with poor communication skills in English? Any physical or learning disability?

Manual Handling Operations

  • Is it accepted that the work carried out by C involved manual handling?
  • Is it accepted that this was manual handling work to which the Manual Handling Operations Regulations 1992 as amended (MHOR) would apply?

[Note: The MHOR apply to ‘manual handling operations’ which include transporting or supporting of a load (such as lifting, putting down, pushing, pulling, carrying or moving) by hand or by bodily force. A ‘load’ includes any discrete moveable object including any person or animal. They do not apply where the load is a tool used for its intended purpose.

Under MHOR there is a hierarchy of duties requiring employers to do the following:

  1. Avoid the need for hazardous manual handling operations, so far as is reasonably practicable;
  2. Assess the risk of injury from any hazardous manual handling operations that can’t be avoided; and
  3. Reduce the risk of injury from hazardous manual handling operations, so far as is reasonably practicable].

Avoiding the Manual Handling Operations, As Far As Reasonably Practicable

  • Have the insured considered avoidance of the manual handling operations, such as through automation or use of mechanical handling aids such as a conveyor, pallet truck, electric hoist, lift truck etc.?
  • If so when and how was this considered and by whom?
  • What was the conclusion reached and why?
  • Why was it not reasonably practicable to avoid the operations?

Risk Assessment

  • Have the insured carried out risk assessments regarding the operations / process and in particular the manual handling operations?
  • If so when and how were these risk assessments carried out and by whom?
  • Where the risk assessments suitable and sufficient? Did they consider the factors listed in Schedule 1 to the Manual Handling Operations Regulations (i.e. the task itself, the loads, the work environment, individual capability and physical suitability of the employee, and other factors such as whether movement or posture is hindered by personal  protective equipment or clothing).
  • Have the insured followed the manual handling risk assessment flow chart in the HSE Guidance to the MOHR? Have the insured used the HSE’s risk assessment filter for manual handling and/or the risk assessment filter for upper limb disorders in the workplace. Have the insured incorporated the Manual Handling Assessment Charts (MAC tool) and/or the Risk Assessment for Pushing and Pulling (RAPP tool) and/or Assessment of Repetitive Tasks (ART tool) as part of their assessments? Obtain full details.
  • If the risk assessments were not suitable explore reasons / why not?
  • How often were risk assessments reviewed and why?
  • Details of insured’s general Health and Safety structure and policies and procedures.

Control Measures

  • What control measures were identified by the risk assessments to reduce the risk of injury?
  • Have these been implemented? If not, why not?
  • If they have been implemented when were they implemented, how and by whom?
  • Obtain details of the existing control measures currently in place and throughout the C’s employment and reasons for any changes such as availability of mechanical lifting aids, any system of rotation (e.g. whether written or verbal, how it is implemented, the frequency/duration of tasks in the work schedule, and the extent of opportunity for rest/recovery in addition to formal rest breaks) or training programme for manual handling and/or WRULDs.

The Work

[Note: Some of these questions may overlap with the above.]

  • Please take a video of the work carried out by C-ideally of someone the same height, weight and gender. Obtain relevant measurements and photographs.
  • Obtain full details of the nature and extent of the manual handling and/or repetitive work as follows:

The Load / The Task

  • What are the loads?
  • The weight of the loads?
  • The size and shape of the loads?
  • Are the loads an awkward shape or bulky making them difficult to handle?
  • Are the contents of the load able to move or move unpredictably (like animals) and make it difficult to handle?
  • Are the loads easy to grip? Do they have handles or handholds? Do they have loose parts enabling comfortable grip?
  • Hot or cold or sharp?
  • How many people handle the load? (See also below)
  • Does the task require and large vertical movements?
  • Does the task require unusual capability-above average strength or agility?
  • Is the task complex?
  • Does the task require special information or training for its safe performance?

For Lifting Operations

  • What height is the load lifted from and to (e.g. from knuckle to elbow height)?
  • What is the proximity of the load to the body (e.g. held close to the body or with arms outstretched)?
  • Is the handler’s body position stable?
  • Is any lifting carried out whilst seated?
  • What is the hand distance from the lower back-see image below[42]?

13.png(Source: HSE)

  • What are the hand positions during course of lift-see image below? Obtain details.

14.png(Source: HSE)

  • Is there are twisting of the torso or sideways bending-see image below? Obtain details;

15.png(Source: HSE)

For Carrying Operations

  • What height is the load carried at / where are the hands located (e.g. hands held at elbow height)?
  • What is the proximity of the load to the body (e.g. held close to the body or with arms outstretched)?
  • What is the distance over which the load is carried?
  • Is the handler able to walk normally?
  • Does the load obstruct the handler’s view?
  • Is the load supported on the shoulder?
  • Is there any twisting of the torso during carrying?
  • What is the horizontal distance between the hands and the lower back? See image below?

16.png(Source: HSE)

  • What is the carrying position adopted? Are the load and hands symmetrical in front of the body? Or are they asymmetrical? Or is there one handed carrying to the side? See image below.

17.png(Source: HSE)

  • Are there any obstacles on route? Is there any need to go up a steep slope or steps or closed doors or around / over any tripping hazards or up ladders etc.? Obtain full details.

For Team Handling Operations

  • What is the horizontal distance between each person’s hands and lower back? See image below.

18.png(Source: HSE)

  • What is the position of the hands during the course of the lift? See image below.

19.png(Source: HSE)

  • What is the distance over which the load is carried?
  • Is there any twisting of the torso during lifting / carrying?
  • Are operatives able to communicate effectively to handle the load?

For Pushing/Pulling Operations

  • How is the force applied to the load (e.g. with the hands or shoulder)?
  • Is the torso largely upright or inclined and the level of the incline?
  • Is the torso bent or twisted and the level of this?
  • If the hands are used where are the hands held to support the load (e.g. between hip and shoulder level)?
  • What distance is the load pushed or pulled?
  • Are there any obstacles on route? Is there any need to go up a steep slope or steps or closed doors or around / over any tripping hazards or up ladders etc.? Obtain full details.
  • How is the load moved e.g. rolled, churned, dragged/slid?
  • What equipment is used to carry out the pushing/pulling? Is it suitable and well maintained?
  • How do the hands grip the load? See table below:

20.png(Source: HSE)

Handling Aids and Equipment

  • Are any handling aids used? What are these and when implemented?
  • Are these aids correct for the task?
  • Are the wheels on the aid suited to the floor surface?
  • Do the wheels run freely?
  • Are there any brakes? Do they work?
  • Are the aids properly maintained and serviced?
  • Any reported problems with aids?
  • Are the aids freely available or difficulties in obtaining these?

Signs and Symptoms of ULDs

  • Are there any medically diagnosed cases of ULDs from the work?
  • Are there any complaints of aches and pains?
  • Are there any Improvised changes to work equipment or tools?
  • Are workers reluctant to do the job complained of?
  • Have workers requested to be redeployed or taken off the job complained of?
  • Is there any evidence of workers carrying out the job complained of wearing splits or bandages?
  • Is there any evidence of employees carrying out the job complained of using painkillers or other pain relief medication?

Repetition

With reference to each individual task performed:

  • Are arm movements intermittent, regular or almost continuous?
  • Is a similar motion pattern for the arm and hand completed 10 times per minute or less, 11-20 times per minute or more than 20 times per minute?

Force

With reference to each individual task performed:

  • What level of force is required to carry out the task – see table below

21.png(Source: HSE)

  • What percentage of time is the level of force identified required to be used to carry out the task? – see table below.

22.png(Source: HSE)

Posture

With reference to each individual task performed:

  • Is the head or neck bent or twisted and what percentage of the time is the head bent or twisted – see image below?

23.png(Source: HSE)

  • Is there any grasping/gripping for more than 2 hours total per shift?
  • Is the back twisted or bent 20 degrees or more and how often is it like this – see image below?

24.png(Source: HSE)

  • Is either elbow raised around chest height and unsupported and how often is it like this – see image below?

25.png(Source: HSE)

  • Is either wrist bent or deviated and how often is it held like this – see image below?

26.png(Source: HSE)

  • How do the fingers or hands hold objects – see image below?

27.png(Source: HSE)

Duration and Frequency

  • How frequently are breaks taken from manual handling and/or repetitive work?
  • Are there natural breaks in the work and the extent of the natural breaks (e.g. 10 seconds every few minutes)?
  • The frequency of the handling and/or repetitive work carried out per minute / hour / over the course of a working day;
  • The duration of each individual task;
  • The cumulative duration of manual handling and/or repetitive work in a working day;
  • An estimate of manual handling work and/or repetitive work as a proportion of a working day;
  • How many days per week the manual handling work and/or repetitive work is carried out-daily and regular task / weekly and irregular etc?
  • Details of any formal job rotation between different tasks and a description of what the other tasks in the work schedule involved (including the extent of any manual handling and/or repetitive work) and the frequency/duration of each task in the rotation schedule;
  • Details of any natural variation of duties within the work and the frequency/duration of the variation;
  • Is the work rate imposed by a process and / or targets?
  • Is the work difficult to keep up with?
  • Is there sufficient rest or recovery time between handling and/or repetitive work?
  • Any seasonal variations in work-full details;

Environment and Other Factors

  • Can manual handling and/or repetitive work be carried out without hindrance? Are there any space restrictions? Do these cause restricted postures to be adopted?
  • What is the floor surface? Is it dry and clean and in good condition? Is it worn or uneven? Is it wet or slippery or unstable? Is it flat or sloping? Are there variations in floor levels, steps, closed doors or ladders to negotiate?
  • Are there any extremes of temperature (hot or cold)?
  • Do gusts of wind or strong air movements hinder handling and/or repetitive work?
  • Is handling and/or repetitive work carried out in extreme lighting conditions (dark, bright or poor contrast)?
  • Any tools or PPE used and any whether this has any impact on the work;
  • Are any tools used in either hand to strike an object and the frequency of this?
  • Is either hand used as a tool to strike something and the frequency of this?
  • Does the work involve any compression of the skin?
  • Does the work involve exposure to vibration?
  • Does the work involve any precise or fine movements of the hands or fingers?

Training

  • Please detail the training provided to the C in relation to the work generally and the tasks carried out in department;
  • Details of any induction and/or refresher training provided to the claimant in relation to the risks of manual handling and/or repetitive work. What exactly did the training cover, for example:
    • Weight of loads handled;
    • Presence of risk factors;
    • How injuries can occur;
    • How to avoid injuries;
    • How to carry out safe manual handling and/or repetitive work;
    • How to use aids safely and correctly; and
    • When and how to report any accidents and health problems and seek medical advice & assistance?
  • When, how and who carried out the manual handling and/or repetitive work training and what qualifications/experience did they have?

Complaints / Occupational Health

  • Obtain details of the insured’s system relation to injury complaints;
  • Identify whether C made any complaints about the nature of the work and/or his injury to managers/supervisors/ other employees;
  • If complaints made then when and to whom and nature/gist of the same?
  • How were C’s complaints dealt with-when and by whom-and what was the outcome? Did C carrying on with work complained of?
  • Details of the insured’s occupational health arrangements / policy;
  • Was C referred to Occupational Health-if so how, when and by whom?
  • What was done following the referral including the occupational health advisor’s recommendations and whether these were followed);
  • Were there any previous complaints about work or accidents / injuries from or others? If so when, from whom, to whom, nature / gist and what happened as a result / what action taken?

Absences and Returns to Work

  • Dates of absences from work and reasons?
  • Any assessment of capability for work on return?
  • Graduated return to work / any restrictions imposed / different work carried out?
  • Did C return to same work-if so when?
  • Were there any subsequent complaints by C after the injury / absence? If so when and to whom and nature / gist of the same? How was this dealt with and what was the outcome?
  • Identify in retrospect whether anything could have been done differently.
  • Was C’s employment terminated? If so when and for what reason(s)?
  • Was C placed on different work which effected income? Obtain full details.

Documents

This Checklist is intended only to be a guide and it is not exhaustive.

NB: IN CASES WHERE SUCH DOCUMENTS ARE NOT AVAILABLE IT IS VITAL TO CLARIFY WHETHER (I) THEY NEVER EXISTED, OR (II) IF THEY DID WHAT BECAME OF THEM AND WHEN?

The Injury

  1. Accident Book entry for the claimant’s injury and any other relevant incidents.
  2. Form F2508/ F2508A (submitted to the Health & Safety Executive). Any other documents completed for the purposes of RIDDOR 2013.
  3. Any HSE investigations or correspondence in relation to the claim, any other similar incidents or the system of work in general.
  4. Any other investigation reports or forms, including any statements taken or memos sent.
  5. First Aid/Treatment Book entry.
  6. Sick Notes submitted by the Claimant.
  7. Documents relating to any other similar claims or Accident Book entries etc.

Manual Handling/ Repetitive Work

  1. In relation to the period about which the claimant is complaining, documentation to show:
    1. The claimant’s Day Work Sheets (including details of basic hours worked and any overtime);
    2. A breakdown of the claimant’s daily activities and frequency rate of manual Handling and/or repetitive work (e.g. diaries, calendars, rosters);
    3. The claimant’s performance targets and actual achievement/production levels;
    4. Average speed of the process (e.g. in terms of units per minute, per hour or per shift). If excessive keyboard work is alleged documents to show the keystroke rate;
    5. If the Claimant was above or below average, documents to show this (e.g. statistics or a comparator employee’s Day Work Sheets etc.);
    6. The weight, size and shape of the loads;
    7. Duration and frequency of manual handling and/or repetitive work;
    8. The relevant software that was used and the workstation equipment.

Risk Assessments and Health & Safety Records

  1. Health & Safety Committee Meeting Minutes which refer in any way to the subject matter of this claim.
  2. The Company’s Health & Safety Policy.
  3. Any other relevant internal health and safety documents, including memos and e-mails, relating to manual handling and/or repetitive work.
  4. Maintenance, inspection and/or repair records for all relevant equipment, plant or tools used by the Claimant.
  5. Risk Assessments — for the period of the Claimant’s employment and also one year before and to date, in relation to:
    1. Manual Handling Operations Regulations;
    2. Management of Health & Safety at Work Regulations;
    3. Provision and Use of Work Equipment Regulations;
    4. Workplace (Health, Safety and Welfare) Regulations;
    5. Personal Protective Equipment regulations;
    6. Health and Safety (Display Screen Equipment) Regulations;
    7. Any re-assessments following changes (e.g. to the work station, to the system of work or following any accidents or health surveillance);
    8. Any other relevant risk assessments undertaken.
  6. Documents showing any other sources of information obtained, such as:
    1. Any independent health & safety reports commissioned;
    2. Time-in-motion studies; work surveys; ergonomic assessments;
    3. Documents obtained from HSE, trade associations, health & safety industry journals.

Control Measures

  1. Documents showing what steps have been taken, if any, to reduce, eliminate or avoid risk of injury. In particular:
    1. Rotation;
    2. Rest Breaks;
    3. Tools and equipment;
    4. PPE;
    5. Ergonomic layout of the workstation/work area;
    6. Provision of training where appropriate;
    7. Complaints systems;
    8. Referrals to occupational health;
    9. Any documents showing systems of review, maintenance or testing regarding the above;
    10. Any documents which explore the possibility of the above or other control measures.
  2. Documents showing what mechanical assistance was available to the claimant, in particular:
    1. Manufacturers’ specifications (e.g. catalogues, marketing information);
    2. Any manuals in respect of the use of the equipment;
    3. Maintenance and repair records.

Training and Enforcement

  1. Health & Safety Handbook/Manual — preferably the copy signed and dated by claimant to acknowledge receipt.
  2. Documents showing all training, instructions and warnings (e.g. training certificates, course notes, course registers, internal memos, publicly displayed warning notices, handbooks/booklets, notes of guidance and any other literature etc.) given to the Claimant in respect of relevant matters such as:
    1. Safe manual handling techniques;
    2. The hazards of repetitive work;
    3. Other risk control measures;
    4. Recognition of symptoms;
    5. The need to report symptoms and seek medical assistance;
    6. How to perform workstation assessments;
    7. Understanding the correct ergonomic arrangement of the workstation and how to minimise risks by adopting the correct working posture.
  3. The Claimant’s Training Records for all aspects of the work and, in particular, for manual handling and/or WRULDs.
  4. Information provided to the claimant regarding the weight of the loads.
  5. Documents relating to enforcement procedures, including warnings given and disciplinary procedures taken against employees (particularly the claimant) for failure to follow manual handling procedures and health and safety policies generally.

Health Surveillance

  1. Documents detailing any system of health surveillance (e.g. undertaken by who, when, how often and in respect of what). Complaints or comments and action taken
  2. Documents relating to any written or oral complaints or comments by the claimant or any other employees about symptoms or the system(s) of work.
  3. Documentation detailing the Company’s response to any such complaints or comments and what action was taken, if any.
  4. All correspondence passing between the Company and the Health & Safety Executive regarding this incident or any other similar matters.

Wages, Benefits and Absences

  1. Details of the claimant’s net weekly pre-absence earnings for a period of 13 weeks.
  2. Details of all payments made to the claimant during any periods of absence (from work due to the alleged injury-SSP/CSP/Holiday and bonus payments /PHI if PHI scheme fully funded by insured).
  3. The Claimant’s Absence Record (including all absences due to sickness, holidays, training etc.).
  4. If the claimant was moved to alternative work:
    1. Details of the pay in the new job compared with the old job (including differences in shift allowances and bonuses).
  5. If the Claimant’s employment was terminated:
    1. The date on which the employment ceased;
    2. All letters and documentation relating to the termination.
  6. If the Claimant was made redundant:
    1. All documents relating to the redundancy, including the selection procedure, details of payments made etc.
  7. Pension details, if applicable:
    1. Pension handbook;
    2. Pension statements;
    3. Copy correspondence confirming details of how the pension would be affected (if the Claimant’s employment was terminated or made redundant).

Confidential Records

[Forms of authority from C required]

  1. Works’ Medical Records/Occupational Health Records.
  2. Full Personnel File (including Contract of Employment and job description).

 

[i] A. H. Makkouk, M. E. Oetgen, C. R. Swigart & S. D. Dodds, ‘Trigger finger: etiology, evaluation, and treatment’, Current Reviews in Musculoskeletal Medicine, 1 (2007), pp. 92–96.

[ii] J. M. Wolf, R. X. Sturdivant & B. D. Owens, ‘Incidence of de Quervain’s Tenosynovitis in a Young, Active Population’, The Journal of Hand Surgery, 34 (2009), pp. 112–115.

[iii] M. Ali et al, ‘Frequency of De Quervain’s tenosynovitis and its association with SMS texting’, Muscles, Ligaments and Tendons Journal, 4 (2014), pp. 74–78.

[iv] S. Stahl et al, ‘Systematic review and meta-analysis on the work-related cause of de Quervainʼs tenosynovitis: a critical appraisal of its recognition as an occupational disease’, Plastic and Reconstructive Surgery, 1 (2013); Stahl et al, ‘Work related etiology of de Quervain’s tenosynovitis: a case-control study with prospectively collected data’, BMC Musculoskeletal Disorders, 16 (2015), p. 126.