Back Claims Research Articles

An Examination of Washington State Workers’ Compensation Claims for Home-Based Health Care Workers, 2006 to 2016: Part 2. Injury Rates and Trends

Research of home-based health care (HBHC) has shown that care providers suffer from a high rate of injuries. Analysis of workers’ compensation records, a reliable source for injury and illness data, enables the identification of trends within a specific working population. HBHC workers’ compensation compensable claims in Washington State from 2006 to 2016 were compared to clinical health care (CHC) claims. Injury event and source attributed to HBHC claims were also analyzed, with a focus on work-related musculoskeletal disorders (WMSDs). Though CHC had 5 times the number of full-time employees during the study period, HBHC grew by 61.1%, compared to 28.7% in CHC. Claim rates for all compensable claims and WMSD claims consistently decreased year-over-year for both HBHC and CHC. WMSD claims experienced a year-over-year decline of 5.3%; for all compensable claims the decline was 4.5%. Analysis of HBHC claim rates by injury event found WMSD had the highest rates, followed by falls from the same level. However, the largest annual change was for the injury event overexertion (−10.1%, 95%CI: −13.4, −6.8). HBHC injuries attributable to the health care patient were the most common. Claims with this injury source declined annually by 6.0%. Claim rates for injuries to the back region, and specifically back WMSDs, were consistently higher year-over-year compared to other body regions and WMSD types. Claims for injuries to the back declined by an annual rate of 6.6% (95% CI: −7.9, −5.3), while back WMSD claims decreased by 6.4% (94% CI: −7.8, −4.9).

Third time’s the charm? Brazil scales back efficacy claims for COVID-19 vaccine from China

Third time’s the charm? Brazil scales back efficacy claims for COVID-19 vaccine from China

Mind Versus Stomach: The Philosophical Meanings of Eating

Ray Boisvert has started with his book an ambitious project to rethink the most important disciplines of philosophy from the stomach not from the mind. The stomach comprises an intrinsic connection with nature, people, and everything else that contributes to feeling well. The book presents a sometimes joyous and mostly very serious celebration of what eating can bring us in doing philosophy. The blurb text on the back cover claims: ‘Building on the original meaning of philosophy as love of wisdom, it explains how the search for wisdom can best succeed by addressing not just the mind, but the entire human being. Eating, an activity that integrates physiological, social, religious, cultural, ethical, and aesthetic dimensions, offers an opportunity to re-think fundamental questions. The result: surprising and novel ways to approach art, religion, knowledge, ethics, and even democracy.’ Well, let’s see what it is all about with these claims. A start is made in the first chapter with a glance on the history of philosophy where a first inventory is made of philosophers that aim at detached, universal and ideal knowledge and the ones that perceive the human being as ‘convive’, as immersed in the natural and social world (p. 19). This the first of many passages where Boisvert creates new words to make his claims real, next to quoting and rephrasing passages from novels of for instance Camus, Chaucer, Fielding or Forster, proposing recipes and etymological detours. The second chapter, hospitality, starts with feeding the stranger, than goes to the question hoe wide is the circle of we?’(24) and then discusses hospitality in religion and philosophy. In this last section Boisverts develops first a sharp distinction between hospitality according the Modern paradigm, where hospitality is a kind of

Examination of the Relationship Between Theory-Driven Policies and Allowed Lost-Time Back Claims in Workers' Compensation: A System Dynamics Model

ObjectiveThe purpose of this study was to develop a model that evaluates the impact of policy changes on the number of workers' compensation lost-time back claims in Ontario, Canada, over a 30-year timeframe. The model was used to test the hypothesis that a theory- and policy-driven model would be sufficient in reproducing historical claims data in a robust manner and that policy changes would have a major impact on modeled data. MethodsThe model was developed using system dynamics methods in the Vensim simulation program. The theoretical effects of policies for compensation benefit levels and experience rating fees were modeled. The model was built and validated using historical claims data from 1980 to 2009. Sensitivity analysis was used to evaluate the modeled data at extreme end points of variable input and timeframes. The degree of predictive value of the modeled data was measured by the coefficient of determination, root mean square error, and Theil's inequality coefficients. ResultsCorrelation between modeled data and actual data was found to be meaningful (R2 = 0.934), and the modeled data were stable at extreme end points. Among the effects explored, policy changes were found to be relatively minor drivers of back claims data, accounting for a 13% improvement in error. Simulation results suggested that unemployment, number of no-lost-time claims, number of injuries per worker, and recovery rate from back injuries outside of claims management to be sensitive drivers of back claims data. ConclusionA robust systems-based model was developed and tested for use in future policy research in Ontario's workers' compensation. The study findings suggest that certain areas within and outside the workers' compensation system need to be considered when evaluating and changing policies around back claims.

The burden of chronic lower back pain with neuropathic components: a healthcare resource perspective

The burden of chronic lower back pain with neuropathic components: a healthcare resource perspective

Predictors of delayed return to work after back injury: A case–control analysis of union carpenters in Washington State

Union administrative records identified 20,642 union carpenters who worked in Washington State from 1989 to 2003. The Department of Labor and Industries provided records of workers' compensation claims and associated medical care. Work-related back claims (n = 4,241) were identified by ANSI codes (back, trunk, or neck/back) or ICD-9 codes relevant to medical care consistent with a back injury. Cases (n = 738) were defined as back injury claims with >90 days of paid lost time; controls (n = 699) resulted in return to work within 30 days. Logistic regression models estimated odds ratios and 95% confidence intervals (OR, 95% CI) of delayed return to work (DRTW). Thirty percent of case claims and 8% of control claims were identified by an ICD-9 code. DRTW after back injury was associated with being female (2.7, 95% CI: 1.3-5.5), age 30-44 (1.2, 95% CI: 0.9-1.7) and age over 45 (1.6, 95% CI: 1.1-2.3), four or more years union experience (1.4, 95% CI: 1.1-1.8), previous paid time loss back claim (1.8, 95% CI: 1.3-2.5), and >or=30-day delay to medical care (3.6, 95% CI: 2.1, 6.1). Evidence of more acute trauma was also associated with DRTW. Use of ICD-9 codes identified claims with multiple injuries that would otherwise not be captured by ANSI codes alone. Though carpenters of younger age and inexperience were at increased risk for a paid lost time back injury claim, older carpenters and more experienced workers, once injured, were more likely to have DRTW as were those who experienced acute events.

Impact of publicly sponsored interventions on musculoskeletal injury claims in nursing homes

The rate of lost-time sprains and strains in private nursing homes is over three times the national average, and for back injuries, almost four times the national average. The Ohio Bureau of Workers' Compensation (BWC) has sponsored interventions that were preferentially promoted to nursing homes in 2000-2001, including training, consultation, and grants up to $40,000 for equipment purchases. This study evaluated the impact of BWC interventions on back injury claim rates using BWC data on claims, interventions, and employer payroll for all Ohio nursing homes during 1995-2004 using Poisson regression. A subset of nursing homes was analyzed with more detailed data that allowed estimation of the impact of staffing levels and resident acuity on claim rates. Costs of interventions were compared to the associated savings in claim costs. A $500 equipment purchase per nursing home worker was associated with a 21% reduction in back injury rate. Assuming an equipment life of 10 years, this translates to an estimated $768 reduction in claim costs per worker, a present value of $495 with a 5% discount rate applied. Results for training courses were equivocal. Only those receiving below-median hours had a significant 19% reduction in claim rates. Injury rates did not generally decline with consultation independent of equipment purchases, although possible confounding, misclassification, and bias due to non-random management participation clouds interpretation. In nursing homes with available data, resident acuity was modestly associated with back injury risk, and the injury rate increased with resident-to-staff ratio (acting through three terms: RR = 1.50 for each additional resident per staff member; for the ratio alone, RR = 1.32, 95% CI = 1.18-1.48). In these NHs, an expenditure of $908 per resident care worker (equivalent to $500 per employee in the other model) was also associated with a 21% reduction in injury rate. However, with a resident-to-staff ratio greater than 2.0, the same expenditure was associated with a $1,643 reduction in back claim costs over 10 years per employee, a present value of $1,062 with 5% discount rate. Expenditures for ergonomic equipment in nursing homes by the Ohio BWC were associated with fewer worker injuries and reductions in claim costs that were similar in magnitude to expenditures. Un-estimated benefits and costs also need to be considered in assessing full health and financial impacts.

Poster 63: Work-related low back injuries: an analysis of workers’ compensation claims in Virginia

Objectives: To describe the frequency of low back injury in workers’ compensation claims in the Virginia Workers’ Compensation Commission (WCC) database; to analyze correlations of low back injuries to select demographic data and injury characteristics; and to describe the rehabilitation cost of the claims and to compare cost with other types of injury. Design: Cohort study. Setting: Database of claims submitted to the Virginia WCC. Participants: Claims involving low back sprain, strain, or contusion (N=76,025) resulting in ≥7 days of missed work or total compensation paid of at least $1000 from 1985 to 2000. Interventions: Not applicable. Main Outcome Measures: Low back injury claim frequency and rehabilitation costs. Results: The low back was the most common injury location (9.1%) in the database. The mean age of low back claimants ± SD was 37.2±10.4 years with a peak at 34 years of age. The male to female ratio of low back claimants was 2:1. Injury to the low back was associated with mechanism of injury (χ 2=42.26, P<.0001). Worker motion and exertion were the primary mechanisms of injury in 87% of low back claims versus 44% of all other injury claims, whereas motor vehicle collisions and falls were less often associated with back claims compared with other injuries. Cross-tabular analysis showed no meaningful predilection of back claims by industry, occupation, or sex compared with other injuries. Rehabilitation cost analysis showed low back claims had higher mean rehabilitation costs compared with other injuries ($388 vs $338, P<.05). Rehabilitation costs were associated with industry ( P=.0016), with the highest relative cost in construction, agriculture, forestry, and fishing. Conclusions: This data describe nonspecific low back injury claims made to the WCC in Virginia. Injury prevention strategies should target worker motion and overexertion.

Reducing Back and Shoulder Injuries in the Nursing Home Industry

Work related musculoskeletal disorders (WMSDs) such as low back pain, tendinitis, hand arm vibration syndrome and carpal tunnel syndrome, account for a major component of the cost of work-related illness and injury in the United States. The National Occupational Research Agenda (NORA) musculoskeletal team identified intervention studies of engineering and work organizational improvements as a high priority in reducing the burden of WMSDs. In Washington State, direct workers compensation costs are more than $410 million per year. Nursing homes have high claims incidence of back and shoulder WMSDs, related primarily to resident handling activities. A cooperative industrywide “zerolift” initiative has resulted in significant reductions in back and shoulder WMSD claims and costs in the Washington State nursing home industry. Rates have decreased 19% in those nursing homes receiving workers compensation premium discounts for purchasing equipment compared to 3% reduction for those nursing homes without premium discounts. Payback on investment in “zerolift” programs appears to take 6–12 months.

Impairment Ratings for Back Claims are Poor Predictors of Wage Loss

Disability impairment ratings are used in 19 states to determine the benefits for severely injured workers; hence, these impairment ratings are implicitly a prospective assessment of wage loss. We compare 810 assessments made in 1989 for low-back injuries against the actual subsequent wage loss (through 1993), and find that the impairment ratings are statistically insignificant predictors of lost wages. Because low-back permanent partial claims form the single largest class of indemnity claim in workers' compensation in terms of cost, this research throws serious doubt on the validity of pure impairment rating schemes now used in many states' workers' compensation systems.

The Costs and Outcomes of Chiropractic and Physician Care for Workers' Compensation Back Claims

INTRODUCTION Recent studies suggest that both chiropractors and physicians provide effective care for back pain, but the relative costs of chiropractic and physician care are still debated (USDHHS, 1994). Manga et al. (1993) argue that chiropractors are less costly than physicians. Carey et al. (1995) use data on charges to conclude that primary care physicians are the least-cost providers. The relative costs of health care are not, however, the appropriate comparison for work-related back pain. Workers' compensation insurers and self-insured employers pay health-care costs and disability benefits for persons with work-related injuries. From the payers' viewpoint, relatively costly modes of health care are efficient if the care produces sufficiently large savings in indemnity benefits by reducing durations of work absences. The authors use data from a workers' compensation insurer (the Zenith Insurance Co.) to compare the sum of health care and indemnity costs for non-surgical back patients treated by chiropractors or physicians. The data refer to approximately 850 closed claims for episodes of back pain that began and ended between 1991 and 1993. The comparison groups are (1) cases treated by a physician but not by a chiropractor and (2) cases treated by a chiropractor but not by a physician. The authors' measures of health-care costs are payments to providers, rather than health-care charges. Charges are deceptive because payment discounts vary among providers. The authors compare chiropractors' and physicians' pricing, service mix, and service utilization, and describe how each contributes to the differences between the average health-care costs of claimants treated by chiropractors and physicians. The measures of outcomes are the distribution of injured workers among claim types (medical only, temporary disability only, and permanent partial disability) and the durations of temporary disability claims. The authors estimate an ordered logit model to determine the relative effect of chiropractic treatment on the distribution of claim types, controlling for differences between the characteristics of chiropractic and physician patients. The authors estimate a Weibull duration model to determine the relative effect of chiropractic treatment on durations of work absence within the temporary and permanent disability groups. One limitation of the study is that severity of injury is unobserved. The problem of unobserved differences between chiropractor and physician patients is addressed by estimating a second set of models in which support points are added to control for the effects of unobserved worker heterogeneity. To the authors' knowledge, this is the first application of the method to the problem of unobserved differences that can include the severity of health conditions. The cost data are unusual because they include both payments for health care and disability benefit payments. The results show that the average total costs of back claims treated by chiropractors are lower than the average total costs of back claims treated by physicians. Part of the cost differential reflects the fact that a relatively large proportion of chiropractic patients are not paid disability benefits because they return to work within California's three-day waiting period. This result is similar to Ebrall's (1992) findings for Australian workers. The apparent superiority of chiropractic care disappears, however, when the probability of returning to work in less than four days is estimated from multivariate models that control for unobserved heterogeneity in the characteristics of individual workers. These results show no significant differences in the effectiveness of chiropractic and physician care in determining the probability of returning to work within the waiting period. The estimates of the effects of care on durations of work absence for temporary and permanent disability claims do, however, weakly support the conclusion that chiropractors are more effective than physicians in reducing durations of work absence. …

Low back pain: Predictors of absenteeism, residual symptoms, functional impairment, and medical costs in Oregon workers' compensation recipients

Background Wide variations in disability duration and magnitude have been noted among recipients of workers' compensation for low back pain. Findings from recent studies have indicated that inclusion of a broad array of variables (i.e., physical, occupation, social, economic) is needed to understand differences in workers' responses to occupational low back pain. Methods Workers' compensation and questionnaire data from 340 Oregon workers with low back claims were merged to develop multivariate models predicting: (1) absenteeism days, (2) residual symptoms, (3) functional impairment, and (4) medical costs. Results Forty-two percent of the variation in low back symptoms was explained by: discontinuing physical fitness activities post-injury (β = −.419), self-reported low energy/high fatigue (β = −.227), poorer general heath (β = 0.137), and attorney involvement in claim (β = 0.117), (adjusted R2 => 0.418, p < 0.001). Survival curves revealed significantly longer claim durations among workers who discontinued physical fitness activities post-injury, compared with workers who did not; these differences remained significant even after controlling for severity of the initial injury. Conclusion Continuation of physical fitness activities during the recovery process was found to be a significant predictor in three of four regression models, providing evidence on behalf of a relationship between fitness and positive health outcomes. However, it was not possible to clearly differentiate pre-morbid from post-injury fitness, nor to determine if this relationship was due to a therapeutic effect on the back, the general restorative benefits of remaining active, or represents a proxy variable for workers' self-care efforts during recovery. Am. J. Ind. Med. 34:559–567, 1998. © 1998 Wiley-Liss, Inc.

Increasing claims for soft tissue injuries in workers' compensation: Cost shifting and moral hazard

During the last decade, the distribution of workers' compensation claims has exhibited a marked shift towards soft tissue injuries such as sprains, strains, and low back claims. There are three possible explanations for this trend; (1) safety incentives induced by workers compensation or OSHA may have reduced other, traumatic claims; (2) the movement away from heavy manufacturing and the 1980 construction recession may have changed the underlying risk of a workplace injury; and (3) there has been moral hazard behavior on the part of workers and health care providers. Using a new data source and estimation framework, we find evidence that moral hazard response explains most of the 30% increase in the proportion of soft tissue injuries during the 1980s.

The effect of workplace based strengthening on low back injury rates: A case study in the strip mining industry

The purpose of this study was to demonstrate the effect of a once a week exercise program focused specially at lumbar extensor strengthening. This is a comparative study where workers volunteered to exercise were compared to workers who did not exercise. Low back claims for one year were noted to document efficacy of the training program. Change in strength was also noted. There was a 54% to 104% increase in strength during a 20 week program. The incidence of back injuries in the exercise group was 52 injuries per 200,000 employee hours versus the industry average of 1.09 back injuries per 200,000 employee hours. The average incidence of injury for the previous nine years at the company participating in the program was 2.94 injuries per 200,000 employee hours. The injury incidence in the workers not exercising was 2.55 injuries for 200,000 employee hours. The average workers' compensation liability dropped from $14, 430.00 per month to $380.00 per month for the study year. The significant increase in strength associated with the exercise program correlated with the greatly reduced incidence of back claims.

The cost of 1989 workers' compensation low back pain claims.

Cost data were gathered from computerized records of the Liberty Mutual Insurance Company for low back pain workers' compensation claims (N = 119,107) and for all claims (N = 731,087) initiated from 45 jurisdictions (states) during 1989. This study provided more current, accurate, and additional information to estimate the costs and incidence associated with compensable low back pain compared with all compensation claims. The first group of data included all compensable low back claims selected by specific codes: body part codes consisted of low back area, sacrum and coccyx, disc, and multiple trunk; injury codes consisted of strain, sprain, inflammation, rupture, hernia, fracture, and contusion. The second sample included all compensable claims, including both occupational injuries and illnesses. Low back pain cases represented 16% of all claims but 33% of all claims costs; 55.4% of the low back pain cases received medical payments only (i.e., did not receive indemnity payments for lost time). The mean cost per case for low back pain was $8321; median cost per case was $396. Medical costs represented 32.4% of the total costs; indemnity costs (i.e., payment for lost time) represented 65.8%. Since indemnity costs represent the greatest percentage of workers' compensation expenditure, the primary goal of low back pain management should be the prevention or reduction of prolonged disability.