Lost-time Cases Research Articles

Workers' compensation injury claims among workers in the private ambulance services industry-Ohio, 2001-2011.

Ambulance service workers frequently transfer and transport patients. These tasks involve occupational injury risks such as heavy lifting, awkward postures, and frequent motor vehicle travel. We examined Ohio workers' compensation injury claims among state-insured ambulance service workers working for private employers from 2001 to 2011. Injury claim counts and rates are presented by claim types, diagnoses, and injury events; only counts are available by worker characteristics. We analyzed a total of 5882 claims. The majority were medical-only (<8 days away from work). The overall injury claim rate for medical-only and lost-time cases was 12.1 per 100 full-time equivalents. Sprains and strains accounted for 60% of all injury claims. Overexertion from patient handling was the leading injury event, followed by motor vehicle roadway incidents. Study results can guide the development or improvement of injury prevention strategies. Focused efforts related to patient handling and vehicle incidents are needed.

National Trends in Occupational Injuries before and after 1992 and Predictors of Workers' Compensation Costs

Numbers and costs of occupational injuries and illnesses are significant in terms of morbidity and dollars, yet our understanding of time trends is minimal. We investigated trends and addressed some common hypotheses regarding causes of fluctuations. We pulled data on incidence rates (per 100 full-time employed workers) for injuries and illnesses from the U.S. Bureau of Labor Statistics and on costs and benefits from the National Academy of Social Insurance for 1973 through 2007. Rates reflected all injury and illness cases, lost work-time cases, and cases resulting in at least 31 days away from work. We adjusted dollar costs (premiums) and benefits for inflation and measured them per employed worker. We plotted data in time-trend charts and ran linear regressions. From 1973 to 1991, there was a weak to nonexistent downward trend for injury and illness rates, and rates were strongly and negatively correlated with the unemployment rate. From 1992 to 2007, there were strong, consistent downward trends, but no longer were there statistically significant correlations with unemployment. Significant predictors (and signs) of workers' compensation premiums for 1973-2007 included medical price inflation (positive), number of lost-time injuries (positive), the Dow Jones Industrial Average (negative), and inflation-adjusted interest rate on U.S. Treasury bonds (negative). Dollars of benefits were positively and significantly predicted by medical inflation and number of lost-time cases. For 1992-2007, the Dow Jones variable was the only robust predictor of premiums; the number of injuries was not a significant positive predictor. We had two major conclusions. First, the year 1992 marked a sharp contrast in trends and correlations between unemployment and incidence rates for occupational injuries and illnesses. Second, for the entire time period (1973-2007), insurance carriers' premiums were strongly associated with returns on investments.

A framework for evaluating OSH program effectiveness using leading and trailing metrics

Introduction Many employers and regulators today rely primarily on a few past injury/ illness metrics as criteria for rating the effectiveness of occupational safety and health (OSH) programs. Although such trailing data are necessary to assess program success, they may not be sufficient for developing proactive safety, ergonomic, and medical management plans. Methods The goals of this pilot study were to create leading metrics (company self-assessment ratings) and trailing metrics (past loss data) that could be used to evaluate the effectiveness of OSH program elements that range from primary to tertiary prevention. The main hypothesis was that the new metrics would be explanatory variables for three standard future workers compensation (WC) outcomes in 2003 (rates of total cases, lost time cases, and costs) and that the framework for evaluating OSH programs could be justifiably expanded. For leading metrics, surveys were developed to allow respondents to assess OSH exposures and program prevention elements (management leadership/ commitment, employee participation, hazard identification, hazard control, medical management, training, and program evaluation). After pre-testing, surveys were sent to companies covered by the same WC insurer in early 2003. A total of 33 completed surveys were used for final analysis. A series of trailing metrics were developed from 1999-2001 WC data for the surveyed companies. Data were analyzed using a method where each main 2003 WC outcome was dichotomized into high and low loss groups based on the median value of the variable. The mean and standard deviations of survey questions and 1999-2001 WC variables were compared between the dichotomized groups. Hypothesis testing was performed using F-test with a significance level 0.10. Results/Discussion Companies that exhibited higher musculoskeletal disorder (MSD) WC case rates from 1999-2001 had higher total WC case rates in 2003. Higher levels of several self-reported OSH program elements (tracking progress in controlling workplace safety hazards, identifying ergonomic hazards, using health promotion programs) were associated with lower rates of WC lost time cases in 2003. Higher reported exposures to noise and projectiles were also associated with higher rates of WC cases and costs in 2003. Impact on Industry This research adds to a growing body of preliminary evidence that valid leading and trailing metrics can be developed to evaluate OSH effectiveness. Both the rating of OSH efforts and the regular trending of past loss outcomes are likely useful in developing data-driven improvement plans that are reactive to past exposures and proactive in identifying system deficiencies that drive future losses.

The Implementation and Maintenance of a Behavioral Safety Process in a Petroleum Refinery

A values-centered and team-based behavioral safety process was implemented in a petroleum oil refinery. Employee teams defined the refinery's safety values and related practices, which were used to guide the process design and implementation. The process included (a) a safety assessment; (b) the clarification of safety-related values and related practices; (c) process design and executive overview; (d) safety-observation training; (e) feedback, recognition, and celebration; and (f) process maintenance. Data that span 20 years are presented to show the long-term impact on recordable incidents, lost-time cases, and direct costs of injuries. The implementation was associated with an 81% decrease in recordable incidents, a 79% decrease in lost-time cases, and a 97% savings in annual workers' compensation costs over an eight-year period. An interview with the vice president of the refinery is presented to highlight the process's influence on the refinery's safety culture.

Guidance for Occupational Health Services in Medical Centers

Guidance for Occupational Health Services in Medical Centers

The effect of a health care management initiative on reducing workers' compensation costs.

The effect of both a cost control and health care management initiative (HCMI) on Workers' Compensation costs at a self-insured University Hospital was assessed. Seven cohorts of injured workers were studied. Cost control measures started in 1993 included early return to work and injury prevention programs, internal administration of legal cases, and utilization of modified duty assignments. The health care management initiative fully in place in 1997 included aggressive case management and preferred provider panel utilization. Workers' Compensation indemnity costs and lost workdays incurred by each cohort were compared. A 41 to 59% reduction in indemnity payments and 46 to 67% reduction in lost time cases were realized after the health care management initiative was fully in place. During this time, accepted claims were reduced by 10 to 15%. The quality of the provider panel, as measured by academic credentials, experience and board certification, did not change. Cost control measures, without comprehensive case management, did not decrease these parameters significantly. The health care management initiative realized reductions in lost time cases and Workers' Compensation indemnity costs.

Workplace risk factors and occupational musculoskeletal disorders, Part 2: A review of biomechanical and psychophysical research on risk factors associated with upper extremity disorders.

Injuries and disorders caused by overexertion and repetitive motion are the leading causes of compensable lost-time cases in the United States. Epidemiological and laboratory-based research methods have been used to evaluate the significance of various risk factors associated with overuse injuries and disorders. The National Institute for Occupational Safety and Health performed a comprehensive review of over 600 epidemiological studies in 1997 and concluded that there was evidence of a causal relationship between workplace exposures to forceful exertions, repetition, awkward posture, and vibration and disorders of the neck, shoulder, and upper extremities. Although epidemiological studies provide important insights to understanding the causes of work-related overuse disorders, they are sometimes criticized for their inability to measure precisely how people respond to specific risk factors found in the workplace. This article presents a review of recent laboratory studies and biomechanical models of work factors believed to be associated with increased risk of upper extremity injuries and disorders. Biomechanical models and laboratory studies do not replace epidemiological studies. However, these approaches provide important complementary information that is needed to understand the complex process of how exposures to physical risk factors result in strain that may ultimately lead to injury or disease. These studies also provide important insights as to how people react and respond to specific physical risk factors found in the workplace. Combined with epidemiological research, laboratory studies are an essential element in understanding the causes and prevention of work-related overexertion injuries.

Workplace Risk Factors and Occupational Musculoskeletal Disorders, Part 1: A Review of Biomechanical and Psychophysical Research on Risk Factors Associated with Low-Back Pain

Injuries and disorders caused by overexertion and repetitive motion are the leading causes of compensable lost-time cases in the United States. Epidemiological and laboratory-based research methods have been used to evaluate the significance of various risk factors associated with overuse injuries and disorders. The National Institute for Occupational Safety and Health performed a comprehensive review of over 600 epidemiological studies in 1997 and concluded that there was evidence of a causal relationship between low-back injuries and disorders and workplace exposures to forceful exertions, awkward posture, and vibration. Although epidemiological studies provide important insights to understanding the causes of work-related overuse disorders, they are sometimes criticized for their inability to measure precisely how people respond to specific risk factors found in the workplace. This article presents a review of recent laboratory studies and biomechanical models of work factors believed to be associated with increased risk of low-back injuries and disorders. Biomechanical models and laboratory studies do not replace epidemiological studies. However, these approaches provide important complementary information that is needed to understand the complex process of how exposures to physical risk factors result in strain that may ultimately lead to injury or disease. These studies also provide important insights as to how people react and respond to specific physical risk factors found in the workplace. Combined with epidemiological research, laboratory studies are an essential element in understanding the causes and prevention of work-related overexertion injuries.

Workplace Risk Factors and Occupational Musculoskeletal Disorders, Part 1: A Review of Biomechanical and Psychophysical Research on Risk Factors Associated with Low-Back Pain

Injuries and disorders caused by overexertion and repetitive motion are the leading causes of compensable lost-time cases in the United States. Epidemiological and laboratory-based research methods have been used to evaluate the significance of various risk factors associated with overuse injuries and disorders. The National Institute for Occupational Safety and Health performed a comprehensive review of over 600 epidemiological studies in 1997 and concluded that there was evidence of a causal relationship between low-back injuries and disorders and workplace exposures to forceful exertions, awkward posture, and vibration. Although epidemiological studies provide important insights to understanding the causes of work-related overuse disorders, they are sometimes criticized for their inability to measure precisely how people respond to specific risk factors found in the workplace. This article presents a review of recent laboratory studies and biomechanical models of work factors believed to be associated with increased risk of low-back injuries and disorders. Biomechanical models and laboratory studies do not replace epidemiological studies. However, these approaches provide important complementary information that is needed to understand the complex process of how exposures to physical risk factors result in strain that may ultimately lead to injury or disease. These studies also provide important insights as to how people react and respond to specific physical risk factors found in the workplace. Combined with epidemiological research, laboratory studies are an essential element in understanding the causes and prevention of work-related overexertion injuries.

Workers' compensation experience of North Carolina residential construction workers, 1986-1994.

A total of 31,113 workers' compensation claims among 7,400 North Carolina Homebuilders Association (NCHA) members and their subcontractors for the period 1986-1994 were analyzed to calculate workers' compensation claim incidence density rates. For the 7 years studied, the average rate (cases/200,000 work hours) for all claims was 16.40 and the rate for medical or lost time cases was 10.78. Highest rates for cases involving medical costs or paid lost time by mechanism of injury were observed for being struck by an object (3.1), lifting/movement (1.97), falls from a different level (1.13), striking against an object (0.87), and falls on the same level (0.46). Rates by mechanism of injury were highest for muscle strains (2.34), wounds/punctures (2.33), bruises/contusions (1.24), fractures/dislocations (0.98), and injuries to the eyes (0.81). Among medical cost or lost work time cases, body parts with highest injury rates were back/shoulders (1.99), fingers (1.31), leg/knee (1.00), hand/wrist (1.00), foot/ankle (0.86), and eyes (0.82). Injury rates were found to vary substantially among the residential construction trades. For more serious injuries involving medical costs greater than $2,000 or any lost work time, rates were highest for welders and cutters (28.1), insulators (24.3), roofers (19.4), and carpenters (15.3). The same general trends by trade were observed for cases involving paid lost time except that roofers were highest, with a rate of 9.1, followed by insulators (8.5), welders and cutters (5.8), and carpenters (5.8). Rates of falls from a different level resulting in medical costs or lost work time were highest for roofers (5.54), insulators (3.53), carpenters (2.05), and drywall installers (1.99). Descriptive information for falls from a different level resulting in paid lost time during 1993-1994 (n = 219) were reviewed to better determine the causes and circumstances of injuries. Falls from a roof accounted for 25.4 percent of the cases followed by falls involving scaffolds (23.9%) and ladders (20.6%), and falls from ceiling joists, floor joists, or framing (14.8%). Twenty-six work-related deaths occurred with vehicle accidents (n = 6) being the major known cause of death, followed by falls (n = 3), being struck by an object (n = 3), electric shock (n = 2), and contact with energy or chemicals (n = 2). Consistent with other analyses of workers' compensation data, chronic occupational diseases are not well captured in the workers' compensation claims among home builders; therefore, a companion study has examined mortality patterns among North Carolina construction workers.

Managed care for workers' compensation: three years of experience in an "employee choice" state.

Managed care techniques are becoming increasingly available to manage the medical indemnity losses associated with injuries paid for under the workers' compensation system. The authors describe 3 years' experience of identifying and abating workplace hazards and medically managing cases utilizing a preferred provider organization established solely for workers' compensation cases. In the model described, the occupational physician/nurse case-management team coordinates the entire process, from prevention of accidents to facilitated return to work. During the study period (1992 to 1995), per-capita losses were reduced by 23%, from $241 in fiscal year 1992 (the year before the managed care initiative), to $185 in fiscal year 1995. (Hereafter, each year referred to indicates that fiscal year.) In 1992, 22 lost-time cases per 1000 employees occurred, whereas the number of lost-time cases in the years 1993 to 1995 averaged 12 to 14 per 1000 employees. The rate of "medical only" cases dropped significantly from 155 per 1000 in 1992 to 96 per 1000 in 1995. The per-capita amount of monies spent on medical care decreased from $81 in 1992 to $63 in 1995. The most significant savings in medical costs related to claims associated with new occupational injuries, injuries that occurred during the fiscal year. In 1992, the per-capita loss on such cases was $23 and in 1995 it was $13, a 43% decrease. The number of temporary/total days dropped significantly from 163 per 100 employees in 1992 to 70 days in 1995. Concurrently, the per-capita loss for temporary total disability was reduced from $53 in 1992 to $26 in 1995. Per-capita administrative costs, as well as other indemnity losses (predominantly permanent partial disability), decreased only slightly over the study period ($58 to $54 and $60 to $51, respectively). We feel that these results indicate that environmental-risk management and medical-care management can be integrated to produce substantial savings. It also suggest that managed-care techniques, which are becoming more available to employers, can even be applied in status that do not have managed care legislation.