Compensation Authority Research Articles

Shoulder biomechanics and the success of translational research

In 2009, the International Shoulder Group (ISG) had the opportunity to propose to the readers of Medical and Biological Engineering and Computing a Special Issue on shoulder biomechanics. At that time, we pointed out that the field was evolving to include more applied research. After 4years, we can confirm that impression: 10 out of 12 papers included in this second Special Issue deal with clinical related questions, through theoretical and experimental methodologies. This demonstrates that the translational research at the base of ISG foundation in 1989 is effective. We think that the papers of this issue will have an impact on clinics in general and on the treatment of work-related injuries and diseases in particular. Based on the statistics of the Italian Workers' Compensation Authority (INAIL), injuries at the shoulder are first in terms of average duration of "temporary total disability to work". Moreover, occupational diseases at the shoulder in the industrial and services sector represented 16% of all occupational diseases in 2012, i.e., 46% of those related to the upper limb. These data stress the need for specific interventions, with the contribution of both researchers and policy makers. Starting from the papers included here, we would encourage additional efforts on: (1) quantitative analysis of shoulder loading during tasks associated with musculoskeletal injuries, and ways to reduce that loading, (2) simple and effective tools to improve the diagnosis and outcome assessment of motion-related shoulder diseases, and (3) the development of rehabilitation treatments focused on occupational tasks, taking advantage of state-of-the-art biofeedback technologies, and exploiting the power of biomechanical models for muscle force prediction.

A model of workplace safety incorporating worker interactions and simple interventions

Although there was substantial research into the occupational health and safety sector over the past forty years, this generally focused on statistical analyses of data related to costs and/or fatalities and injuries. There is a lack of mathematical modelling of the interactions between workers and the resulting safety dynamics of the workplace. There is also little work investigating the potential impact of different safety intervention programs prior to their implementation. In this article, we present a fundamental, differential equation-based model of workplace safety that treats worker safety habits similarly to an infectious disease in an epidemic model. Analytical results for the model, derived via phase plane and stability analysis, are discussed. The model is coupled with a model of a generic safety strategy aimed at minimising unsafe work habits, to produce an optimal control problem. The optimal control model is solved using the forward-backward sweep numerical scheme implemented in Matlab. References Australian Bureau of Statistics. Forms of employment. Commonwealth of Australia, 2010. http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/6359.0November%202010?OpenDocument Bahn, S. Power and Influence: Examining the Communication Pathways that Impact on Safety in the Workplace. J. Occup. Health Safety–-Aust. N.Z., 25(3):213–222, 2009. Bird, P. Reducing Manual Handling Workers Compensation Claims in a Public Health Facility. J. Occup. Health Safety–-Aust. N.Z., 25(6):451–459, 2009. Breslin, P. Improving ohs Standards in the Building and Construction Industry through safe design. J. Occup. Health Safety–-Aust. N.Z., 23(4):89–99, 2007. Breslin, P. National Harmonisation: Designers' Duties of Care in the Australian Building and Construction Industry. J. Occup. Health Safety–-Aust. N.Z., 25(6):495–504, 2009 . Driscoll, T., Mitchell, T., Mandryk, J., Healey, S., Hendrie, L. and Hull, B. Trends in Work-Related Fatalities in Australia, 1982 to 1992. J. Occup. Health Safety–-Aust. N.Z., 18(1):21–33, 2002. Driscoll, T. Fatal Injury of young workers in Australia. J. Occup. Health Safety–-Aust. N.Z., 22(2):151–161, 2006. Foley, G., Gale, J. and Gavenlock, L. The Cost of Work-Related Injury and Disease. J. Occup. Health Safety–-Aust. N.Z., 11(2):171–194, 1995. Glendon, I. and Waring, A. Risk management as a framework for occupational health and safety. J. Occup. Health Safety–-Aust. N.Z., 13(6):525–532, 1997. Gunningham, N. and Healy, P. Agricultural ohs Policy: Towards Systemic Reform. J. Occup. Health Safety–-Aust. N.Z., 20(4):311–318, 2004. Hawkins, A., Eather, J. and Fragar, L. Improving Health and Safety in the Farm Workshop. J. Occup. Health Safety–-Aust. N.Z., 24(2):155–160, 2008. Heads of Workers' Compensation Authorities. 2008/09 Australia and New Zealand Return to Work Monitor. http://www.hwca.org.au/documents/Australia%20and%20New%20Zealand%20Return%20to%20Work%20Monitor%202008-2009.pdf Kermack, W. O. and McKendrick, A. G. A Contribution to the Mathematical Theory of Epidemics. Proc. R. Soc. Lond. A., 115(772):700–721, 1927. doi:10.1098/rspa.1927.0118 Lenhart, S. and Workman, J. T. Optimal control applied to biological models. Chapman and Hall CRC Mathematical and Computational Biology Series, 2007. Mallet, D. G., Bagher-Oskouei, M., Farr, A. C., Simpson, D. P. and Sutton, K-J. A mathematical model of Chlamydial infection incorporating movement of Chlamydial particles. B. Math. Biol., 75(11):2257–2270, 2013. doi:10.1007/s11538-013-9891-9 Murray, J. D. Mathematical Biology, I: An Introduction. Springer, 2002. Raggett, G. F. Modelling the Eyam plague. B. I. Math. Appl., 18:221–226, 1982. Safe Work Australia. The cost of work-related injury and illness for australian employers, workers and the community:2008-2009. Commonwealth of Australia, 2012. http://www.safeworkaustralia.gov.au/sites/SWA/about/Publications/Documents/660/Cost%20of%20Work-related%20injury%20and%20disease.pdf Shulgin, B., Stone, L. and Agur, Z. Pulse vaccination strategy in the sir Epidemic Model. B. Math. Biol., 60(6):1123–1148, 1998. doi:10.1006/S0092-8240(98)90005-2 Vanderkruk, R. Workplace health and safety officers: a Queensland success story. J. Occup. Health Safety–-Aust. N.Z., 15(6):557–563, 1999. Winder, C. The development of ohs legislation in Australia. J. Occup. Health Safety–-Aust. N.Z., 25(4):277–287, 2009.

Assessment of work‐related exposure to polycyclic aromatic hydrocarbons in Italy

Polycyclic aromatic hydrocarbons (PAHs) are generally present in the workplace environment as complex mixtures and often difficult to identify a priori. The aim of this study is to evaluate the level and coverage of occupational exposure to PAHs in Italy. Data were collected from exposure registries of companies with mandatory reporting to the National Workers' Compensation Authority. Statistical analyses were carried out on the retrieved information and the number of workers potentially exposed was estimated for some industrial sectors. Overall 12,849 measurements of exposure levels to individual PAHs were selected from the database of registries in the period 1996-2010. Most exposures occurred in the manufacture of chemicals (N = 5,383, 51%), and the occupational group most frequently measured was chemical-processing-plant operator (N = 3,930, 31%). Measurements were associated to various PAHs, including benzo[a]pyrene, benzo[a]anthracene, benzo[b]fluoranthene, benzo[k]fluoranthene, dibenz[a,h]anthracene, and benzo[j]fluoranthene. Overall, 39,230 workers were estimated as potentially at risk of exposure to PAHs in the selected industrial sectors. This study summarized data recorded in the Italian occupational exposure database and identified specific exposure patterns to PAHs. The systematic recording of occupational exposures is a source of data that allows the recognition, control, and prevention of high-risk situations for workers' health.

Hexavalent Chromium Compounds in the Workplace: Assessing the Extent and Magnitude of Occupational Exposure in Italy

Hexavalent chromium (Cr(VI)) compounds have been classified as carcinogenic to humans. This study evaluates the extent and magnitude of occupational exposures to Cr(VI) in Italy. Data were collected from exposure registries of companies compulsorily notified by the National Workers’ Compensation Authority. Each measurement was characterized by economic activity sector, work force size, worker personal data, job description, year of measurement, and level of exposure. Descriptive statistical analysis was carried out on the retrieved information. The number of workers potentially exposed was estimated for some industrial sectors. A mixed-effects model was adopted to evaluate the association between exposure variables and exposure concentrations. Over 8400 measurements of Cr(VI) exposures were selected from the database of registries for 1996–2009. Most exposures occurred in the manufacture of fabricated metal products (>50%), and the occupational group most frequently measured was metal finishing-, plating- and coating-machine operators (>52%). Measurements were associated with various Cr(VI) compounds, including chromium trioxide, potassium dichromate, sodium dichromate, strontium chromate, and zinc chromate. Cr(VI) exposure has decreased in more recent years, and the fixed-effects (Cr(VI) compound, activity sector, size and location of the facility, job category, and year of measurement of the final statistical model explained more than 70% of the variance in the observed exposure data. This study summarized data recorded in the Italian occupational exposure database and identified specific exposure patterns to Cr(VI). The mean level of exposure to Cr(VI) was 30.41 μg/m3, and 50,118 workers were estimated at exposure risk in the selected industrial sectors. Systematic recording of occupational exposures is a source of data that allows recognition of high risk situations and improvements in exposure assessment for epidemiologic studies.

Mesothelioma incidence surveillance systems and claims for workers’ compensation. Epidemiological evidence and prospects for an integrated framework

BackgroundMalignant mesothelioma is an aggressive and lethal tumour strongly associated with exposure to asbestos (mainly occupational). In Italy a large proportion of workers are protected from occupational diseases by public insurance and an epidemiological surveillance system for incident mesothelioma cases.MethodsWe set up an individual linkage between the Italian national mesothelioma register (ReNaM) and the Italian workers’ compensation authority (INAIL) archives. Logistic regression models were used to identify and test explanatory variables.ResultsWe extracted 3270 mesothelioma cases with occupational origins from the ReNaM, matching them with 1625 subjects in INAIL (49.7%); 91.2% (1,482) of the claims received compensation. The risk of not seeking compensation is significantly higher for women and the elderly. Claims have increased significantly in recent years and there is a clear geographical gradient (northern and more developed regions having higher claims rates). The highest rates of compensation claims were after work known to involve asbestos.ConclusionsOur data illustrate the importance of documentation and dissemination of all asbestos exposure modalities. Strategies focused on structural and systematic interaction between epidemiological surveillance and insurance systems are needed.

The criminal injuries compensation scheme

PurposeThis paper seeks to provide an analysis of historic and current criminal injuries compensation schemes in Great Britain.Design/methodology/approachThe paper aims to explain the nature of the Criminal Injuries Compensation Authority (CICA) that administers the present scheme and to identify the qualifying criteria to establish eligibility for awards of compensation and obstacles to success. It deals with the nature and amounts of the awards available, the evidence gathering process, causes of delay and impediments to the achievement of fair outcomes. In the context of cases of serious injury, including acquired brain injury, it examines specific problems that are likely to be encountered and a perceived inadequacy of the compensation available to victims of such injury. The paper considers the involvement of the National Health Service in cases where applications for compensation are made and the possibility that medical professionals might inadvertently hinder the chances of a fair award. The position of local authorities and social services departments is also addressed, as is the danger that proper claims for injured victims might not be identified.FindingsFrom the point of view of the victim of crime who is faced with making an application to CICA, the problems that they face lie with the process, the possibility of being refused on technical grounds, limits on compensation, gaps in the scheme – which might leave victims or their relatives going uncompensated or under‐compensated, and finally the lack of financial support with the cost of representation where it is needed. Of equal concern is the fact that the description of the circumstances of the assault and the injuries suffered can be crucial to ensure that full, proper, and relevant evidence gathering is undertaken. Without suitable skills, it is very easy for the lay applicant inadvertently to mislead, or to give the CICA the opportunity to reject or under‐compensate.Originality/valueThis paper provides a detailed analysis of CICA and reflects upon what the future might hold for injured victims of crime.

Health care utilisation following hospitalisation for transport-related injury

BackgroundTransport injuries are a substantial cause of disability and death internationally. There is little published information regarding patterns of healthcare utilisation following transport injury. AimsTo investigate patterns of in-hospital and post-discharge healthcare use following transport injury. MethodsAnalysis of all accepted adult claims from the database of the transport accident compensation regulator in Victoria, Australia between 1995 and 2008. The analyses focused on injuries resulting in hospitalisation. Indicators of in-hospital and post-discharge healthcare utilisation (e.g. number of services per practitioner group) within the first 12-months were summarised. ResultsMore than a third (33.6%, n=68,639) of all accepted compensable transport injuries resulted in admission to an acute care facility within 28 days of injury. In this group, the compensation authority paid for a total of 4.5 million healthcare services in the 12 months post-discharge (median of 19 services per claim). Services provided by medical practitioners were accessed by nearly all claimants (95.7%) at a median of 11 (5–26) per claimant. Less than half of claimants (46.7%) accessed paramedical or allied health services but the median number of services accessed was higher at 29 (9–82) per claimant. ConclusionTransport-related injury cases require a substantial interaction with multiple components of the healthcare system in the year following hospital discharge. Compensation system datamay provide adetailed understanding of healthcare utilisation, a key element of injury burden.

Understanding changes over time in workers' compensation claim rates using time series analytical techniques

ObjectiveThe objective of this study is to better understand the inter-temporal variation in workers' compensation claim rates using time series analytical techniques not commonly used in the occupational health and...

Occupational cancer in Italy: Evaluating the extent of compensated cases in the period 1994–2006

The aim of this study is to analyze occupational cancer claims compensated in the industrial sector in Italy between 1994 and 2006. A descriptive analysis of compensated occupational cancers based on the Italian Workers' Compensation Authority (INAIL) data was performed. Summary statistics were compiled by sex and age of worker, cancer type, workplace agent and economic sector. The temporal trend in the period 1994-2006 was investigated for the most frequently compensated cancers (mesothelioma and lung cancer from asbestos; nasal cavities cancer from wood and leather dust). Between 1994 and 2006, 6,243 cancer claims were compensated by INAIL due to occupational exposure in the industrial sector. Most (5,288, or 85%) of these compensated claims occurred in the period 2000-2006, when the annual mean of the most compensated cancers increased approximately four times compared to the period 1994-1999. There is an increasing trend in compensation for work-related cancers in Italy in recent years, even if occupational cancers are still widely underreported.

Estimating the prevalence of clinical manganism using a cascaded screening process in a South African manganese smelter

Objectives A diagnostic algorithm for clinical manganism was developed to screen all employees at a South African manganese smelter. Methods The study design was for all 754 smelter employees in 2006/7 to be screened by an occupational health nurse using nine questions and nine brief neurological examination procedures. More than one symptom, any neurological sign, or blood manganese exceeding 40 μg/l triggered referral for neurological examination by an Occupational Medical Practioner (OMP). Abnormal findings by the OMP triggered referral to a movement disorders specialist neurologist and to a neuropsychologist. Features of parkinsonism and a clinical picture consistent with the scientific literature were used to diagnose manganism. Results Total manganese dust was mostly within (<5 mg/m 3) or near (<9 mg/m 3) the South African Occupational Exposure Limit, with one outlier near 20 mg/m 3. Occupational Health Service problems and uncertainty about the nature of manganism before the full diagnostic algorithm was developed, resulted in 10 referrals who were certified as manganism cases by the state compensation authorities. They were only assessed in the early stages of this screening programme, and never examined by the above specialists. Of 744 employees screened with the full diagnostic algorithm, the nurse referred 152 (20.3%) and the OMP 27 (3.5%) of all those screened respectively. No definite manganism cases were diagnosed, while one (0.13%) employee was found to have possible manganism and another had an indeterminate neurological diagnosis. A sensitivity analysis assuming that all 10 compensated cases were either normal, or alternatively had definite manganism, yielded a prevalence range for definite manganism from 0% to 1.3%. Conclusion Acknowledging possible downward bias when excluding the 10 employees who did not receive the full workup, the true prevalence of definite manganism was likely to be either zero or close to zero.

Workers compensation and occupational health and safety in the Australian agricultural industry

The objective of this paper is to review the available workers compensation and occupational health and safety data and the legal framework in relation to the agricultural industry to explore whether any factors highlight the need to pay special attention to the particular circumstances of those engaged in the industry. This paper explores some of the special features of the agricultural industry, looking first at agricultural worker fatalities and injuries as a matter of ongoing concern for all participants in this industry, government, as well as occupational health and workers compensation authorities. The paper analyses how occupational health and workers compensation laws may have special application to this industry. Finally, the paper considers some workers compensation provisions that have particular application to the agricultural industry. Our survey of the available data and literature leads to the conclusion that the dangerous nature of agricultural work and the special legal and economic framework in which that work is undertaken identify the agricultural industry as presenting Australian Governments and specialist authorities with particular challenges in relation to improving workplace safety and reducing workplace injury.

ISO 15189 accreditation in medical laboratories: An institutional experience from Turkey

Objectives: The Italian Workers’ Compensation Authority (INAIL) carried out a national survey to investigate the employer’s perception and awareness about Occupational Health and Safety (OHS) implementation. The aim of this study is to point out if there is any difference in employer’s perceptions on OHS management with respect to different firms sizes. Methods: The study has been conducted on a sample of 1010 employers. All measures were self-reported through a computer-assisted-telephone-interview (CATI). Results: Employers of microenterprises resulted less persuaded of the usefulness of occupational risk assessment and management activities. Employers of microenterprises more often perceived OHS as a law duty than an added value if compared with large ones (OR = 7.09, CI 95%: 1.80–27.95). About 56% of employers in our sample found the levels of OHS increased after the enforcement of Legislative Decree n. 81/2008, even if micro and small businesses more frequently than others reported it to be unchanged (OR = 2.07, CI95%: 1.19–3.58). Conclusions: These findings may drive policy implementation at national level in order to improve OSH in SMEs, taking into account their structural, economic and productive characteristics.

The Impact of Workers’ Compensation Experience-Rating on Discriminatory Hiring Practices

The widespread adoption of experience-rating has been a major trend in workers’ compensation systems for over a decade (O’Grady 1999). Under this approach, a firm’s insurance premium rate for its industry or class is adjusted upwards or downwards to reflect the costs of the insuranc e claims made by that firm’s workers. Firms that have higher-than-normal claims levels are punished with a penalty, paid on top of their base premium. In contrast, firms that have lower-than-normal claims levels are rewarded with a partial rebate (discount) of their base premium. Many workers’ compensation authorities across the United States, Canada, Australia, and New Zealand adopted experience-rating as a pricing mechanism to encourage employer investment in hazard prevention measures. Although earlier research (e.g., Chelius and Smith 1983) indicated that experience-rating was not associated with improved health and safety performance in the United States, the evidence from more recent studies suggests that experience-rating reduces fatalities in Canada (Bruce and Atkins 1993), lowers the reported accident rate in Canada (Thomason and Pozzebon 2002) and the United States (Worrall and Butler 1988), shortens claim duration in the United States (Krueger 1990), and encourages better safety practices in Canada (Kralj 1994). However, most researchers have been cautious about crediting experience-rating for lowering overall actual injury rates, because experience-rating provides incentives for injury under-reporting (McClintock 1994; Samaras 2001) and undesirable employer activities, such as the contracting out of hazardous activities and excessive claims management (Kralj 1994). Before experience-rating becomes further entrenched in the workers’ compensation system, understanding any other unintended, negative side effects remains important.

Victims of violence told to call police immediately after incident

Nurses who are attacked at work have been warned to go straight to the police, as any delay could jeopardise their claim for compensation from the Criminal Injuries Compensation Authority (CICA).

Job stress in the Australian and international health and community services sector: A review of the literature.

We reviewed 25 international and 10 Australian studies published between 1999 and 2004 for evidence of individual and organizational impacts of stress in the health and community services (HCS) sector. Several HCS occupations showed high levels of distress compared to Australian population data. Results were consistent with the Job Demands-Resources model: High demands (e.g., workload, emotional) combined with low resources (e.g., control, rewards, support) were associated with adverse health (e.g., psychological, physical) and organizational impacts (e.g., reduced job satisfaction, sickness absence). Australian-specific issues included rural and remote work and the complex role of Aboriginal Health Workers. Strong associations between modifiable work factors and adverse outcomes provide a rationale for primary preventive policy development by occupational health and safety regulators and workers' compensation authorities.

Risk of repeat accidents by economic activity in Italy

Rationale The phenomenon of repeat work-related accidents has not been sufficiently studied. Objectives To evaluate the role of work-related factors in the occurrence of repeat accidents in Italy, using economic activity and the size of the enterprise as proxies and basing the analysis on available administrative data. Methods The data, provided by the Italian Workers’ Compensation Authority (INAIL), refer to accidents in the industry and artisan sectors and in the service industry between 1994 and 1999. We selected the data on accidents among 633,735 persons 25–55 years of age with a first accident in 1996–1997, and we determined the occurrence of further accidents within two years in the same economic activity, taking into account job mobility and factors associated with underreporting (geographic area, age, and size of the enterprise). The gender-specific relative risk was computed for each economic activity, given by the ratio between the risk of repeat accidents in a given economic activity and the risk in all of the other activities. Results Individuals with a single accident differed from those with a repeat accident in terms of the distribution by gender, age-class, and severity of injury. The economic activities with the highest relative risk were generally those known to represent a risk of accidents in general: metal ore and coal mining, shipbuilding, the manufacturing of railroad equipment, building construction, road and railway construction, the primary iron and steel industry, foundry work, logging/wood manufacturing, slaughtering, and agriculture. However, certain activities not generally considered as hazardous showed a high risk of repeat accidents (e.g., public hygiene, and the manufacturing of bricks, pottery, and glass). Conclusions The epidemiological pattern of repeat accidents by economic activity reflects that of accidents in general, though with exceptions. Results suggest that factors associated with specific technical aspects and production processes are important determinants of safety. The differences between single accidents and repeat accidents by gender, age class, and severity of injury suggest that studying repeat accidents separately from first accidents is quite useful.

Supporting a Person with Learning Disabilities for Criminal Injuries Compensation

Despite growing awareness of abuse of people with learning disabilities and prospective legal improvements, it is still uncommon for people with learning disabilities to obtain justice for experiences of abuse. It has been recognised that recent legislation pertaining to the Sexual Offences Act, as well as the Mental Health Act, has been little used and has not provided effective protection for people with learning disabilities, especially if abuse is perpetrated by another person with learning disabilities. This can leave the abused person feeling, among other things, disempowered and silenced, which can be compounded if they are believed by professionals and others and still no justice is evident. This paper is an account of supporting a man with learning disabilities, both therapeutically and legally, to obtain recognition of his experience of sexual abuse by using the Criminal Injuries Compensation Authority (CICA) as an alternative to the criminal justice system.

Criminal injuries compensation for abused children.

An introduction to the topic of compensation for children who have been physically or psychologically abused Discretionary schemes to compensate the victims of violent crime have been in place in Great Britain since 1964. The original framework provided that compensation would be awarded on a “common law basis” whereby awards were assessed in exactly the same way as if being made by a court—that is, adhering to principles of restitution, seeking to put the victim back, so far as possible, into the same position that they would have enjoyed had the crime and the injury not occurred. Apart from compensation for the actual injuries, awards would therefore also include full and future care costs, provision of therapies, equipment, transport needs, special accommodation, loss of earnings, and future earnings. There was no limit on an award and each case would be assessed on its individual merits. In 1996, a statutory scheme (the Criminal Injuries Compensation Scheme 1996) was introduced under the provisions of the Criminal Injuries Compensation Act 1995 to replace the earlier discretionary ones, with awards for pain and suffering to be made on a tariff basis with a limit of £250 000 for catastrophic injury and an overall limit of £500 000 in total, inclusive of care needs, loss of earnings, etc. The scheme was revised slightly in 2001, and is now administered by the Criminal Injuries Compensation Authority (CICA). Compensation may be paid to an applicant who has sustained a criminal injury after 1 August 1964. If the victim has since died, payment can be made to a qualifying dependant claimant. A criminal injury is defined as a personal injury directly attributable to a crime of violence. Personal injury includes physical (incorporating fatal) injury, mental injury (being a temporary mental anxiety, medically verified, or a disabling mental illness …

Predictors and severity of injury in assaults with barglasses and bottles

Background: Although glasses and bottles are frequently used as weapons in assaults, there is little knowledge on which prevention strategies can be based. Design: Scrutiny of a random sample of...

Injury in the workplace: Criminal Injury Compensation Authority.

Bob was a staff nurse in the accident and emergency department and was used to dealing with drunk people at weekends. One Friday night, however, he was caring for a patient who had been knocked down by a car. The man's friends were extremely drunk and attempted to interfere with their friend's treatment. Bob asked them to leave, but they refused. He warned them that he would be calling the police but one of them lunged at Bob, who fell backwards against a trolley causing a severe back injury. He was off work for several weeks and was warned that he might never fully recover. How can he obtain compensation?