Compensation Claims Data Research Articles

Work Disability and Costs Caused by Recurrence of Low Back Pain: Longer and More Costly Than in First Episodes

Retrospective analysis of workers' compensation (WC) claims data for nonspecific low back injuries (LBI) in a single jurisdiction. To examine whether recurrences, defined as post-initial episodes of work disability or medical care, substantially contribute to total medical and indemnity costs, and total duration of work disability. Previous studies have not measured the proportion of care seeking and work disability that are associated with recurrences in claims for work-related LBI. All persons with new lost-time claims for nonspecific LBI reported in New Hampshire to a large WC provider from 1996 to 1999 were selected (N = 1867). Three years of follow-up data, starting at the beginning of the first episode, were collected. Previously validated definitions of recurrence were used identify new episodes of care and new episodes of lost work time (work disability). Total duration of work disability, total medical costs, and total indemnity costs were investigated. For individuals with recurrences, these variables were separated into first-episode and recurrent period duration and costs. The rate of recurrent work disability was 17.2%, and the rate of recurrent care seeking was 33.9%. Individuals with recurrence had significantly higher total length of work disability, and higher medical and indemnity costs. For those with recurrent work disability, 69% of total lost time from work, 71% of associated indemnity costs, and 84% of total medical costs occurred during the recurrent period. For those with recurrence of care, the respective values were 48%, 47%, and 42%. Recurrences contributed disproportionately to the total burden of work-related nonspecific LBI, through both additional care seeking and work disability. Results imply that those who have recurrences may be an especially important target for secondary prevention efforts.

Workers' compensation experience of Colorado agriculture workers, 2000–2004

Agriculture is among the most hazardous of occupations. The lack of information regarding agriculture injuries or fatalities has been recognized as an obstacle for effective injury prevention. Workers' compensation claims data for non-fatal injuries among agriculture and agri-business workers in the State of Colorado between the years of 2000 and 2004. Workers' compensation claims are utilized to estimate injury claim incidence rates, determine the distributions of sources, causes, types and body locations of injuries, and estimate the costs of these injuries. Colorado agriculture and agri-business workers (e.g., cattle dealers, cattle or livestock raisers, dairy farmers) have high rates of injury claims, especially in sectors that involve interaction with animals or livestock. Grain milling operations had a high rate of injury claims among agri-business operations. Injuries related to animals, strains, machinery, and falls or slips were the most frequent among all occupations analyzed. Understanding the occurrence of injuries among Colorado agriculture and agri-business workers is critical to implementing and evaluating effective intervention programs for specific agriculture-related occupations. The development of safety interventions that address the worker-animal interface, fall protection systems, machinery usage, and overexertion prevention strategies is recommended.

The use of state workers' compensation administrative data to identify injury scenarios and quantify costs of work-related traumatic brain injuries

Problem: Traumatic brain injury (TBI) is a public health problem but little is known about the nature of that problem in the working population. Method: The author used a national definition to identify cases in Washington State from workers' compensation (WC) hospital billing data, quantified the cost of WC insurance benefits using actuarial cost estimates, and identified high risk industries using ANSI Z16.2 typology. Results: There were 928 cases of TBI with a lifetime claim cost of $159 million from the Washington State Fund (1994-2001). Sixty percent of injuries resulted in death or disability. The highest risks of TBI are concentrated in 16 industrial insurance risk classes and the highest costs in 19 North American Industry Classification codes. Injury scenarios were identified for nine industrial insurance risk classes. Conclusions: TBI is a disabling and costly workplace injury in the state of Washington, affecting even teenagers and seniors who are not generally considered to be part of the workforce. Injury typology codes provide useful information for improving workplace safety. Impact on industry: This research provides industry with quantitative information regarding the cost of work-related traumatic brain injury and the usefulness of using workers' compensation claims data to reduce the burden of workplace injury.

Predictors of antiviral therapy in a post-transfusion cohort of hepatitis C patients.

In the past, antiviral therapy has been given to 15% to 30% of patients infected with hepatitis C virus (HCV). The efficacy of therapy has recently improved with the addition of ribavirin and pegylated interferon. The aim of the present study was to identify the clinical, socioeconomic and health-system predictors of antiviral treatment for HCV. A retrospective analysis of compensation claims data of patients who acquired HCV through blood transfusions between 1986 and 1990 was performed. The patients consisted of 2456 Canadian HCV-positive individuals. The authors reviewed narrative comments from physicians, and constructed univariate and multivariate logistic regression models, using receipt of antiviral therapy with interferon or interferon/ribavirin as the primary outcome. Of the 2456 patients, approximately 30% appeared to be eligible, but only 16% received treatment. Univariate analyses suggested that the disease severity, age, HIV status and province of residence were associated with the likelihood of receiving treatment (P<0.01). The final, multivariable model indicated that in patients with HCV: intermediate disease severity (eg, fibrosis, P<0.0001); middle age (P<0.0001); HIV-negative status (P<0.0001); and province of residence (Quebec, P<0.0001; and Saskatchewan, P<0.0001) were independent predictors of treatment. Narrative comments of physicians emphasized the importance of age, HIV status and patient preferences in clinical decision-making. Given the efficacy and cost-effectiveness of current antiviral therapy, treatment rates of HCV patients may be suboptimal. Further work is required to understand barriers to treatment related to geography, organization of medical care, age, medical provider and patient preferences.

The impact of shift work on the risk and severity of injuries for hospital employees: an analysis using Oregon workers' compensation data.

While past research on health care workers has found that shift work can lead to negative physiological and psychological consequences, few studies have assessed the extent to which it increases the risk of specific work-related injuries, nor quantified and compared associated types, severity and costs. This study aimed to derive and compare the rates, typologies, costs and disability time of injuries for various hospital worker occupations by day, evening and night shift. This study used Oregon workers' compensation claim data from 1990 to 1997 to examine the differences in hospital employee claims (n = 7717) by shift and occupation. Oregon hospital employee claim data, hospital employment data from Oregon's Labor Market Information System and shift proportion estimates derived from the Current Population Survey (CPS) were used to calculate injury rate estimates. The injury rate for day shift per 10,000 employees was estimated to be 176 (95% CI 172-180), as compared with injury rate estimates of 324 (95% CI 311-337) for evening shift and 279 (95% CI 257-302), night shift workers. The average number of days taken off for injury disability was longer for injured night shift workers (46) than for day (38) or evening (39) shift workers. Evening and night shift hospital employees were found to be at greater risk of sustaining an occupational injury than day shift workers, with those on the night shift reporting injuries of the greatest severity as measured by disability leave. Staffing levels and task differences between shifts may also affect injury risk.

Designing a Supervisory Training Program to Optimize Injury Response: A Macroergonomics Approach

The role of supervisors to aid injured workers by accessing health care and providing reasonable accommodations has been suggested as a means to prevent prolonged disability among workers experiencing musculoskeletal pain and discomfort. Based on a macroergonomic approach, a 4-hour supervisor training workshop was designed to optimize supervisors' responses to work injuries through improved communication and accommodation. Supervisors from two industries provided high ratings of the workshop, and showed post-training improvements in injury-related attitudes and perceived ability to communicate with and accommodate injured workers effectively. Workers' compensation claims data in the 7 months before and after the workshop showed a 47% reduction in new claims and an 18% reduction in active lost-time claims versus 27% and 7% respectively, in the control group. Improving the response of frontline supervisors to employees' work-related health and safety concerns may produce sustainable reduction in injury claims and disability costs.

Improving case identification in administrative databases such as workers compensation data: use of narrative text

To evaluate if case identification in administrative data can be improved using narrative text searches. We analyzed workers compensation (WC) claims data to identify both the nature and cause of injuries resulting from ladder use. As part of an ongoing study, we identified 9826 potential ladder-related injury cases using a computerized search of 535,605 worker's compensation (WC) claims from a large insurer. Cases were identified using index search terms (e.g., “ladder”, “ladd”) and by specific codes indicating ladders. Among these cases we used comparable index terms such as “frac” to identify all fracture cases, which were compared with the cases that were coded as fractures. Manual review of injury mechanism and nature of injury text was used to validate the ability of predetermined index term searches to identify cases. Index term searches alone identified 98.3% of potential ladder cases. Fracture was assigned as the nature of injury code for 589 cases, of which only 34 did not contain appropriate fracture index terms (4 were miscoded as fractures). An additional 141 potential fractures were identified by fracture index terms, of which 113 were true fractures. A similar review of dislocations found an additional 7 true fracture cases. Of the 705 true fracture cases, 120 (17%) were not coded as fractures—all but 2 of whom were identified by index term searches of free text. Of the 705 potential ladder injuries identified involving fractures, 589 (83.5%) were falls from ladders, 101 (14.3%) were other injuries involving ladders (e.g., tripped on ladder), and only 15 (2.1%) were incorrectly identified as ladder injuries. Narrative text analysis using index term searches provides a valuable adjunct to case identification in administrative databases that often have incomplete nature and cause of injury coding. These searches also provide a useful check on the validity of injury coding, with 17% of all fractures being identified only by text searches.

An assessment of the effects of increased regulatory enforcement and legislative reform on occupational hearing loss workers' compensation claims: Oregon 1984–1998

Hearing loss from occupational exposures is a serious and widespread problem. This study measured the outcomes that increased enforcement of regulations and legislative interventions had on hearing loss workers' compensation claims. Workers' compensation claim data from Oregon was analyzed for the period of 1984-1998 to examine trends and severity of hearing loss claims. In 1987 and 1990, Oregon enacted legislative reforms to improve enforcement and promulgation of safety standards in the state. This study examined hearing loss claims between the periods of pre- and post-legislative reforms. It was found that hearing loss claims decreased significantly following the legislative reforms, although the average cost per claim increased. Age and tenure effects, and evidence of moral hazard were also discovered. Increased enforcement of regulations and legislative interventions by Oregon improved working conditions leading to occupational hearing loss. Nevertheless, hearing loss remains problematic, and continued efforts are required to improve worker safety.

Do drug-free workplace programs prevent occupational injuries? Evidence from Washington State.

To evaluate the effect of a publicly sponsored drug-free workplace program on reducing the risk of occupational injuries. Workers' compensation claims data from the Washington State Department of Labor and Industries covering the period 1994 through 2000 and work-hours data reported by employers served as the data sources for the analysis. We used a pre-post design with a nonequivalent comparison group to assess the impact of the intervention on injury risk, measured in terms of differences in injury incidence rates. Two hundred and sixty-one companies that enrolled in the drug-free workplace program during the latter half of 1996 were compared with approximately 20,500 nonintervention companies. We tested autoregressive, integrated moving-average (ARIMA) models to assess the robustness of our findings. The drug-free workplace intervention was associated (p < .05) with a statistically significant decrease in injury rates for three industry groups: construction, manufacturing, and services. It was associated (p < .05) with a reduction in the incidence rate of more serious injuries involving four or more days of lost work time for two industry groups: construction and services. The ARIMA analysis supported The drug-free workplace program we studied was associated with a selective, industry-specific preventive effect. The strongest evidence of an intervention effect was for the construction industry. Estimated net cost savings for this industry were positive though small in magnitude.

Evaluation of a safety training program in three food service companies

Problem: Outcome measures for safety training effectiveness research often do not include measures such as occupational injury experience. Effectiveness mediators also receive sparse attention. Method: A new safety training curriculum was delivered to workers in a stratified random sample of food service facilities across three companies. A similar group of facilities received usual training. We collected post-test measures of demographic variables, safety knowledge, perceptions of transfer of training climate, and workers' compensation claim data for one year after the initial training activities. Results: Knowledge test scores were apparently higher in the new-training units than in the usual-training units. Some demographic variables were inconsistently associated with these differences. Evidence for reduction of the injury rate associated with the new training was observed from two companies but only approached significance for one company. A second company revealed a similar but non-significant trend. Knowledge scores were not significantly associated with lower injury rates. Discussion: We found evidence that safety training increases knowledge and reduces injuries. We found almost no evidence of effects of training effectiveness mediators, including no relationship between safety knowledge and injury experience. Methodological issues related to conducting a large study may have influenced these results. Impact on Industry: Although safety training leads to greater knowledge and, in some cases, reduced occupational injuries, the influence of mediating variables remains to be fully explained.

The Feasibility of Using Skin Protectant Products and Education to Prevent Poison Oak

Poison oak and poison ivy are common in the Pacific Northwest. Poison oak often grows in dense clusters of bushes, with vines up to 30 feet that can twine around tree trunks or other plants, making it difficult for field and woodland workers to avoid contact.1,2 The oil (urushiol) found in the leaves, roots, stalks, and berries of these plants causes an allergic reaction, with catechols as the active allergens.1–6 Exposure to the oil can occur by direct skin contact with the plants, by contact with or inhalation of soot or smoke particles from burning plants, by contact with aerosolized urushiol released during chain sawing, or by contamination or penetration of clothing, boots, work gloves, and tools.2,3 Among agricultural workers, exposure commonly occurs during brush cutting, land clearing, or burning activities. Among forestry workers, exposure commonly occurs during timber cruising and marking, tree felling, climbing and bucking, yarding and loading, tree replanting, and firefighting.3,7,8 Exposure to poison oak or poison ivy is the most common cause of allergic contact dermatitis resulting in accepted Oregon workers’ compensation claims. The Oregon Health Division’s analysis of Oregon workers’ compensation claims data showed that 106 (13%) of 800 accepted claims for dermatitis were caused by poison oak or poison ivy from October 1, 1992, to September 30, 1999. Of these 106 claims, 28 (26%) were submitted by agricultural and forestry workers. The pattern of occupational dermatitis from poison oak/ivy that we observed in Oregon is similar to that observed by the US Department of Agriculture Department of Forestry in California and Washington for forestry workers and firefighters where these plants also exist.2,6–8 Because of the impact of allergic contact dermatitis

Estimation of Wildlife-Inflicted Property Damage and Abatement Based on Compensation Program Claims Data

Wildlife imposes costs on agricultural landowners in the form of damage to crops, livestock, and other property, and some wildlife agencies maintain abatement and compensation programs. This paper incorporates endogenous claim submission by producers into a model of deer-inflicted crop damage that can be used to facilitate agency decisions regarding deer densities and distribution, abatement use, and to forecast compensation budgets. The model is applied to field-level compensation claims data from Wisconsin for 1994–1996. The results are consistent with theory, and aggregate damage estimates fall within the range of published estimates from more costly survey data.

Usefulness of North Carolina Workers' Compensation Data for Surveillance of Cumulative Trauma Disorders

Abstract North Carolina workers' compensation claims data were explored to determine the ease with which the data could be used to study cumulative trauma disorders. A descriptive survey was performed to determine the frequency and distribution of claims for carpal tunnel syndrome and upper extremity tendinitis during 1986 to 1988. Minor claims were not computerized and therefore were not available for study. Cases were not entered into the database until the claim had legally closed, resulting in a delay in claim ascertainment for more complex cases. Race of claimants was not available for study. There were 851 claims for cumulative trauma disorders in the study group. The highest rate was found in the food products industry (5.6 claims per 10,000 workers); the 6 next highest rates were found among manufacturing industries (2.5 to 4.2 claims per 10,000 workers). In the 10 industries with highest cumulative trauma disorder rates, the proportion of claims diagnosed as carpal tunnel syndrome varied from 26....

The sexual assault of women at work in Washington state: 1980 to 1989

Sexual assault in the workplace and the related factors have not been well studied. Workers' compensation claims data were used to describe work-related sexual assaults in Washington State between 1980 and 1989. Sixty-three cases of work-related rape were identified during this study period. The occupations of the rape victims were similar to occupations identified as high risk for other intentional injuries, and the rape incidents were characterized by isolation from the public and from coworkers. Estimates of industry-specific rates are presented. The identification, evaluation, and prevention of sexual assault and other workplace violence are discussed.

The sexual assault of women at work in Washington State, 1980 to 1989.

Sexual assault in the workplace and the related factors have not been well studied. Workers' compensation claims data were used to describe work-related sexual assaults in Washington State between 1980 and 1989. Sixty-three cases of work-related rape were identified during this study period. The occupations of the rape victims were similar to occupations identified as high risk for other intentional injuries, and the rape incidents were characterized by isolation from the public and from coworkers. Estimates of industry-specific rates are presented. The identification, evaluation, and prevention of sexual assault and other workplace violence are discussed.

Use of Workersʼ Compensation Claims Data for Surveillance of Cumulative Trauma Disorders

Workers' compensation claims in Ohio were evaluated as a source of surveillance data for identifying workplaces at high risk of cumulative trauma disorders (CTDs) and analyzed for their demographic and industrial characteristics. During a 5-year period (1980 to 1984), 6,849 workers' compensation claims met the case criteria for CTDs. Tenosynovitis due to continuous motion was the most frequently reported condition (58%), and the wrist was the body part most frequently affected (48%). The highest case rate was observed for female workers in the 36 to 45 age group. Incidence rates for individual companies were determined and those with the highest rates for CTDs were identified. The employer-specific rates for CTDs based on workers' compensation claims data can be used as an effective surveillance tool in locating high-risk operations where ergonomic interventions can be implemented to reduce CTD hazards.

Assessment of workers' compensation claims for back strains/sprains.

Workers' compensation claim data for 1979 obtained from the Bureau of Labor Statistics' Supplementary Data System (SDS) were utilized to examine the demographic and occupational incidence of back strains/sprains among U.S. industrial employees covered by state compensation systems. These data were combined with estimated employment figures to provide incidence ratios, which allowed better approximations of industry- and occupation-specific risk. Industries found to have the largest incidence ratios were construction (1.6 claims/100 workers) and mining (1.5 claims/100 workers). Occupations with the largest ratios were miscellaneous laborers (12.3 claims/100 workers) and garbage collectors (11.1 claims/100 workers). The 285,468 compensation claims due to back strains/sprains filed in the 26 SDS states in 1979 suggest that back injuries continue to be a large and costly problem for U.S. workers and their employers.