Lost-time Claims Research Articles

Does gradually returning to work improve time to sustainable work after a work-acquired musculoskeletal disorder in British Columbia, Canada? A matched cohort effectiveness study

ObjectiveThis study investigates if gradual return to work (GRTW) is associated with full sustainable return to work (RTW) for seriously injured workers with a musculoskeletal disorder (MSD), in British Columbia,...

Prevalence and risk factors for anxiety and depression disorders in workers with work-related musculoskeletal strain or sprain in British Columbia, Canada: a comparison of men and women using administrative health data

ObjectiveTo examine the prevalence and risk factors for medically treated anxiety and depression disorders among men and women with musculoskeletal strain or sprain work injury in British Columbia, Canada.MethodsA retrospective...

Lessons learned from Ohio workers' compensation claims to mitigate hazards in the landscaping services industry.

The landscaping services industry is one of the more dangerous in the United States, with higher rates of both fatal and nonfatal injuries than the all-industry average. This study uses claims from the Ohio Bureau of Workers' Compensation (OHBWC) database to identify high rates of occupational injuries and illnesses in this industry in Ohio. The causes of those illnesses and injuries are highlighted to identify common factors. The OHBWC database includes injured-worker industry identification, occupation, business size, demographics, diagnoses, and free-text descriptions of injury circumstances. We identified landscaping service industry claims from 2001 to 2017, and describe annual claim counts and rates. Over the 17-year period, 18,037 claims were accepted, with "Struck by object or equipment" and "Overexertion involving outside sources" being the most common events or exposures. Sprains and fractures were the most prevalent of the more serious lost-time (LT) injuries. Free-text descriptions of claims indicate that arborist work and loading/unloading of work vehicles and trailers are particularly hazardous. Younger and shorter-tenured workers were injured most frequently, although the average workers' age was higher for LT claims. The total cost of claims to the OHBWC from the landscaping services industry for 2001-2017 was over $226,000,000. Almost $214,000,000, or 94.4%, was for LT injuries and illnesses, even though LT claims comprise only 18% of total claims. Targeted improvements in landscaper safety could come from controlling events leading to LT claims. Engineering controls and improved training are strongly recommended to reduce falls, overexertion, and struck-by injuries.

Prevention, Medical Management, and Adjudication of Workplace Injuries: A Thirty-Two Year Follow-up of an Integrated Workers' Compensation Program.

Objective:To describe the cost outcomes of an integrated workers’ compensation program.Methods:We studied a population that increased from 20K to 59K, incurring 8807 lost-time claims between 1988 and 2020.Results:Lost-time claims decreased from 22.15 to 4.32 per 1000 employees (1988 to 2020), and total closed lost-time claim costs per $100 payroll, decreased from $0.62 to $0.17 (1988 to 2017). The percent of claims resolved within 3 years of the accident increased from 10% to 89% (1988 to 2017). Adjusting for medical inflation and wage increases, total workers’ compensation benefits paid per claim decreased $124 per year, medical benefits decreased $45 per year and indemnity benefits decreased $79 per year.Conclusion:On both a population (per employee) and on a per claim basis, workers’ compensation costs decreased substantially, which is attributable to improvements in accident prevention and decreases in claim duration.

Impact of anxiety and depression disorders on sustained return to work after work-related musculoskeletal strain or sprain: a gender stratified cohort study.

Objective:The aim of this study was to examine the impact of anxiety and depression disorders on sustained return to work (RTW) for men and women with musculoskeletal strain or sprain.Methods:Accepted lost-time claims for spine and upper-extremity strain or sprain were extracted for workers in the Canadian province of British Columbia from 2009 to 2013 (N=84 925). Pre-existing and new onset anxiety and depression disorders were identified using longitudinal health claims data. Probability of sustained RTW was analyzed using Cox proportional hazards models, stratified by gender and adjusted for potential confounders.Results:For pre-existing disorders, compared to men with no anxiety and no depression, men with anxiety only [hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.84–0.93], depression only (HR 0.94, 95% CI 0.89–1.00), and anxiety and depression (HR 0.93, 95% CI 0.90–0.97) had lower probabilities of sustained RTW in adjusted models. The same direction of effect was found for women, but anxiety only had a smaller effect size among women compared to men (HR anxiety only 0.95, 95% CI 0.92–0.99; HR depression only 0.98, 95% CI 0.93–1.03, HR anxiety and depression 0.94, 95% CI 0.91–0.97). Among men and women, new onset disorders were associated with lower probability of sustained RTW and the effect estimates were larger than for pre-existing disorders.Conclusions:Findings suggest that workers’ compensation benefits and programs intended to improve RTW after musculoskeletal injury should take pre-existing and new onset anxiety and depression disorders into consideration and that gender-sensitive work disability strategies may be warranted.

Incidence of acute myocardial infarction in the workforce: Findings from the Occupational Disease Surveillance System.

Increased risks of acute myocardial infarction (AMI) may be attributable to the workplace, however, associations are not well-established. Using the Occupational Disease Surveillance System (ODSS), we sought to estimate associations between occupation and industry of employment and AMI risk among workers in Ontario, Canada. The study population was derived by linking provincial accepted lost-time workers' compensation claims data, to inpatient hospitalization records. Workers aged 15-65 years with an accepted non-AMI compensation claim were followed for an AMI event between 2007 and 2016. Adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for each industry and occupation group, compared to all other workers in the cohort. Sex-stratified analyses were also performed. In all, 24,514 incident cases of AMI were identified among 1,502,072 Ontario workers. Increased incidence rates of AMI were found across forestry (HR 1.37, 95% CI 1.19-1.58) and wood processing (HR 1.50, 1.27-1.77) job-titles. Elevated rates were also detected within industries and occupations both broadly related to mining and quarrying (HR 1.52, 1.17-1.97), trucking (HR 1.32, 1.27-1.38), construction (HR 1.32, 1.14-1.54), and the manufacturing and processing of metal (HR 1.41, 1.19-1.68), textile (HR 1.41, 1.07-1.88), non-metallic mineral (HR 1.30, 0.82-2.07), and rubber and plastic (HR 1.42, 1.27-1.60) products. Female food service workers also had elevated AMI rates (HR 1.36, 1.23-1.51). This study found occupational variation in AMI incidence. Future studies should examine work-related hazards possibly contributing to such excess risks, like noise, vibration, occupational physical activity, shift work, and chemical and particulate exposures.

Workers' compensation claims among private skilled nursing facilities, Ohio, 2001-2012.

Skilled nursing facilities have one of the highest rates of occupational injury and illness among all industries. This study quantifies the burden of occupational injury and illness in this industry using data from a single state-based workers' compensation (WC) system. Ohio Bureau of Workers' Compensation claims from 2001 to 2012 were analyzed among privately owned, state-insured skilled nursing facilities and are presented as claim counts and rates per 100 full-time equivalents (FTE). Worker, employer, incident, and injury characteristics were examined among all claims and by medical-only (medical care expenses and/or less than eight days away from work) and lost-time (eight days or more away from work) claim types. There were 56,442 claims in this population of Ohio skilled nursing facilities from 2001 to 2012. Overexertion and bodily reaction, slips, trips, and falls, and contact with objects and equipment accounted for the majority of all WC claims (89%). Overexertion and bodily reaction, and slips, trips, and falls comprised 85% of the 10,793 lost-time claims. The highest injury event/exposure rates for all claims were for overexertion and bodily reaction (3.7 per 100 FTE for all claims), followed by slip, trips, and falls (2.1), and contact with objects and equipment (1.9). Understanding the details surrounding injury events and exposures resulting in WC claims can help better align prevention efforts, such as incorporation of safe patient handling policies and lifting aids, improvement in housekeeping practices, and employee training within skilled nursing facilities to prevent worker injury and mitigate related expenses.

Analysis of Thoroughbred horse farm workers' compensation insurance claims in Kentucky: Injury frequency, cost, lost time, and associated occupational factors.

Thoroughbred horse farm workers self-report a high frequency of work-related injuries and pain. However, an analysis of Thoroughbred horse farm workers' compensation injury claims is absent from the literature, yet may benefit worker safety. We analyzed workers' compensation insurance firm data containing 2276 claims filed between 2008 and 2015. Injury frequency, cost, and lost time per cause, nature, and body part injured were examined qualitatively and via univariate tests. Factors associated with high cost and high duration lost time claims were modeled via multivariable logistic regression. The average Thoroughbred worker claim cost $4,198 and accrued 10 days lost time, involving strikes (57% of total claims), sprains/strains (34%), and wrist/hand injuries (18%). Injuries primarily occurred on mornings (54%), weekdays (79%), and during the transition from breeding to sales (23%). Jobs with a high level of horse contact had significantly higher cost ($6,487) and higher duration lost time (16.8 days) claims, with significantly higher cost claims on the weekends ($6,471) and from the oldest workers ($7466), vs reference groups. Logistic models indicate significantly increased odds of a high-cost injury among high horse contact jobs (OR = 1.87; 95% C.I. = 1.53-2.29) and older age tertiles (1.38; 1.08-1.75; 1.70, 1.32-2.18). The odds of a high duration lost time injury are significantly increased among high horse contact jobs (1.91; 1.53-2.39) and males (1.50, 1.13-1.98), with significantly reduced odds among the most tenured workers (0.74; 0.56-0.99). Our findings elucidate factors to reduce injury frequency, cost, and lost time among Thoroughbred horse farm workers.

Preventing fall-from-height injuries in construction: Effectiveness of a regulatory training standard

Introduction: A regulatory training standard for construction workers using fall protection equipment became mandatory in 2015 in the province of Ontario, Canada. By the end of the transition period in 2017, 418,000 workers had been trained to the new standard. Two primary research questions were posed: (1) To what extent does the WAH training affect practices at the worksite? and (2) Has there been a change in the incidence of fall-from-height injuries coincident with the introduction of the WAH Training Standard? Materials and methods: A longitudinal survey of 633 learners was conducted in 2017 at one-, four- and seven-week post-training. A quasi-experiment estimated the incidence of lost-time injuries attributed to falls from heights in 2017 compared to 2012–2014 for a census of construction workers insured for work disability in Ontario, Canada. Results: Learners self-reported substantial increases in knowledge of and improvements in safe work practices when working at heights. The incidence rate of lost-time claim injuries attributed to falls targeted by the training declined by 19.6% (95% CI: 10.7, −27.6), compared to corresponding declines of 2.1% (95% CI: −6.3, 9.9) for other fall injuries and 7.2% (95% CI: 1.8, 12.3) for non-fall traumatic injuries. The observed decline was largest among the smallest employers (<5 full-time equivalent employees). Conclusion: The evaluation findings provide consistent support for a conclusion that the mandatory training standard was effective in reducing the incidence of injuries targeted by the training. However, the effects were modest and did not eliminate the problem. Practical application: A mandatory training standard should be considered as one approach to preventing traumatic injuries. However, other approaches higher in the hierarchy of risk controls should also be considered.

Increasing Physical Therapy Visits as a Marker for Time Lost From Work and High Workers' Compensation Claim Costs.

To quantify the association between physical therapy (PT) visits and workers' compensation costs and lost time. A total of 40,203 lost-time claims (1998 to 2018) were analyzed. The odds ratio of total paid claim costs more than or equal to $100,000 increased with the number of PT visits from 1.91 with 1 to 3 PT visits (95% confidence interval [CI]: 1.62 to 2.26) to 5.56 (95% CI: 4.86 to 6.37) for workers with a surgical procedure and more than or equal to 50 PT visits versus those without PT visits, when controlling for confounding factors. The risk of remaining at an off work status is greatest among claims involving surgery, escalating among claims with 15 or more PT visits (hazard ratio more than or equal to 3.76). PT visits may be used as a marker for high workers' compensation cost and delayed return-to-work.

Descriptive Epidemiology of Gradual Return to Work for Workers With a Work-Acquired Musculoskeletal Disorder in British Columbia, Canada.

This study investigates the injury, socio-demographic, workplace, and temporal characteristics related with gradual return to work (RTW) among workers with a work-acquired musculoskeletal disorder in British Columbia, Canada. Accepted workers' compensation lost-time claims were extracted between 2010 and 2015 (n = 141,490). A multivariable logistic regression model was used to analyze the determinants of Gradual RTW. Within 1 year after injury, 41.0% of workers had at least 1 day of Gradual RTW. Serious injury severity, female sex, increasing age, wage, and firm size, longer sickness absence, and recent previous claims increased the proportion of workers being provided with Gradual RTW. Consideration of injury, socio-demographic, workplace, and temporal variability in the provision of Gradual RTW can identify inequalities in the provision and increase effective use of Gradual RTW for workers with musculoskeletal disorders.

Time to return to work following workplace violence among direct healthcare and social workers

ObjectivesThis study examined time to return-to-work (RTW) among direct healthcare and social workers with violence-related incidents compared with these workers with non-violence-related incidents in British Columbia, Canada.MethodsAccepted workers’ compensation lost-time...

The Relationship of the Amount of Physical Therapy to Time Lost From Work and Costs in the Workers' Compensation System.

: Physical therapy (PT) is perceived as a cost driver in the US workers' compensation system. We conducted a 5-year (2013 to 2017) retrospective analysis utilizing 192,197 claims from a large Texas based workers' compensation insurance company to describe the relationship between the amount of physical therapy delivered and workers' compensation costs and lost-time. Closed, indemnity claims with 15 or more PT visits were six times more likely (95% confidence interval [CI]: 5.50, 86.58) to result in high medical costs (>$7000, excluding PT costs) and were four times more likely (95% CI: 3.77, 4.42) to result in more than or equal to 6 months of lost-time, when controlling for confounders. When the number of PT visits more than or equal to 15 visits for a lost time claim, this level of PT exceeds all other predictors (opioid use, comorbidities, legal involvement, surgery, etc) of medical cost and extended time out from work.

Dermatitis among workers in Ontario: results from the Occupational Disease Surveillance System

ObjectivesDermatitis is the most common occupational skin disease, and further evidence is needed regarding preventable risk factors. The Occupational Disease Surveillance System (ODSS) derived from administrative data was used to...

Factors associated with musculoskeletal pain and discomfort among Canadian truck drivers: A cross-sectional study of worker perspectives

Background & ObjectivesMusculoskeletal disorders (MSDs) among truck drivers are increasingly being recognized as detrimental to health, accounting for nearly one-half of all work-related illnesses and one-quarter of all lost-time claims. Despite this, we have little understanding of what factors are associated with musculoskeletal (MSK) pain and discomfort leading to MSDs in Canadian truck drivers. ObjectivesTo assess the prevalence of musculoskeletal pain and discomfort in Canadian truck drivers and its association with various factors in the trucking work environment. MethodsUsing a cross-sectional design, 107 truckers at two truck stops in Southern Ontario were surveyed. Information on physical, organizational, and individual factors were collected using a newly developed questionnaire. The prevalence of musculoskeletal pain and discomfort was assessed using the Standardized Nordic Questionnaire. ResultsFrom the total cohort, 61 truck drivers (57%) reported experiencing musculoskeletal pain and discomfort, while 46 (43%) did not. Logistic regression analyses revealed that only level of risk and hours spent driving the truck over a 7-day span were positively associated with MSK pain and discomfort. The final multivariable regression model, for drivers reporting MSK pain and discomfort, demonstrated a significant association with individual (marital status and education), organizational (safety factors including control on the job, frequency of safety meetings, management involvement when a worker is injured/ill and presence of safety equipment), as well as physical factors (level of risk and worker perception of job and associated tasks). ConclusionFindings reveal that most factors are largely modifiable, suggesting the need to develop or tailor organizational guidelines to the needs of workers at multiple levels.

Impact of a Safe Resident Handling Program in Nursing Homes on Return-to-Work and Re-injury Outcomes Following Work Injury.

Purpose This study examined the impact of a Safe Resident Handling Program (SRHP) on length of disability and re-injury, following work-related injuries of nursing home workers. Resident handling-related injuries and back injuries were of particular interest. Methods A large national nursing home corporation introduced a SRHP followed by three years of training for 136 centers. Lost-time workers' compensation claims (3years pre-SRHP and 6years post-SRHP) were evaluated. For each claim, length of first episode of disability and recurrence of disabling injury were evaluated over time. Differences were assessed using Chi square analyses and a generalized linear model, and "avoided" costs were projected. Results The SRHP had no impact on length of disability, but did appear to significantly reduce the rate of recurrence among resident handling-related injuries. As indemnity and medical costs were three times higher for claimants with recurrent disabling injuries, the SRHP resulted in significant "avoided" costs due to "avoided" recurrence. Conclusions In addition to reducing overall injury rates, SRHPs appear to improve long-term return-to-work success by reducing the rate of recurrent disabling injuries resulting in work disability. In this study, the impact was sustained over years, even after a formal training and implementation program ended. Since back pain is inherently a recurrent condition, results suggest that SRHPs help workers remain at work and return-to-work.

Examining lung cancer risks across different industries and occupations in Ontario, Canada: the establishment of the Occupational Disease Surveillance System

BackgroundThe Occupational Disease Surveillance System (ODSS) was established in Ontario, Canada by linking a cohort of workers with data created from Workplace Safety and Insurance Board (WSIB) claims to administrative...

Is Employer-Directed Medical Care Associated With Decreased Workers' Compensation Claim Costs?

The financial impact regarding choice of physician within the workers' compensation domain has not been well studied. The aim of this study was to assess the difference in claim cost between employee- and employer-directed choice of treating physician after injury. Thirty-five thousand six hundred forty indemnity lost time claims from a 13-year period at a nationwide company were analyzed with multivariate logistic regression to determine the association of medical direction with risk of high-cost claims. States that have employer-directed physician choice were associated with a lower risk of having high-cost claims (≥$50,000) but higher attorney involvement than employee direction. The net effect of this enhanced presence of attorneys offsets the benefits of employer choice of treating physician. States that permit employer selection of treating physician have slightly higher cost due to the higher prevalence of attorney involvement in the claims process.

A study of leading indicators for occupational health and safety management systems in healthcare

BackgroundIn Ontario, Canada, approximately $2.5 billion is spent yearly on occupational injuries in the healthcare sector. The healthcare sector has been ranked second highest for lost-time injury rates among 16 Ontario sectors since 2009 with female healthcare workers ranked the highest among all occupations for lost-time claims. There is a great deal of focus in Ontario’s occupational health and safety system on compliance and fines, however despite this increased focus, the injury statistics are not significantly improving. One of the keys to changing this trend is the development of a culture of healthy and safe workplaces including the effective utilization of leading indicators within Occupational Health and Safety Management Systems (OHSMSs). In contrast to lagging indicators, which focus on outcomes retrospectively, a leading indicator is associated with proactive activities and consists of selected OHSMSs program elements. Using leading indicators to measure health and safety has been common practice in high-risk industries; however, this shift has not occurred in healthcare. The aim of this project is to conduct a longitudinal study implementing six elements of the Ontario Safety Association for Community and Healthcare (OSACH) system identified as leading indicators and evaluating the effectiveness of this intervention on improving selected health and safety workplace indicators.MethodsA quasi-experimental longitudinal research design will be used within two Ontario acute care hospitals. The first phase of the study will focus on assessing current OHSMSs using the leading indicators, determining potential facilitators and barriers to changing current OHSMSs, and identifying the leading indicators that could be added or changed to the existing OHSMS in place. Phase I will conclude with the development of an intervention designed to support optimizing current OHSMSs in participating hospitals based on identified gaps. Phase II will pilot test and evaluate the tailored intervention.DiscussionBy implementing specific elements to test leading indicators, this project will examine a novel approach to strengthening the occupational health and safety system. Results will guide healthcare organizations in setting priorities for their OHSMSs and thereby improve health and safety outcomes.

Return-to-work for multiple jobholders with a work-related musculoskeletal disorder: A population-based, matched cohort in British Columbia.

IntroductionMultiple jobholders (MJHs) have a higher risk of injury compared to single jobholders (SJHs), but it is unknown if return-to-work (RTW) after a work injury is affected by multiple jobholding. This study examined the association between multiple versus single jobholding and time to RTW for workers with a work-related musculoskeletal disorder (MSD).MethodsWe used administrative workers’ compensation data to identify injured workers with an accepted MSD lost-time claim between 2010–2014 in British Columbia, Canada (n = 125,639 SJHs and 9,029 MJHs). The outcome was days until RTW during twelve months after the first day of time-loss. The MJH and SJH cohorts were balanced using coarsened exact matching that yielded a final matched cohort of 8,389 MJHs and 8,389 SJHs. The outcome was estimated with Cox regression, using piecewise models, and the hazard ratios were stratified by type of MSD, a serious injury indicator, gender, weekly workdays preceding MSD, and wage categories.ResultsMJHs were less likely to RTW compared to SJHs within the first six months after the first time-loss day, with greater and longer lasting effects for males, workers with a serious injury, and a higher wage. No difference between MJHs and SJHs was found for workers who had a six- or seven-day work week preceding MSD, for workers with dislocations, and for workers who were still off work after six months.ConclusionsOverall, MJHs with a workweek of maximum five days are disadvantaged compared to SJHs in terms of RTW following a work-related MSD within the first six months after the first time-loss day. This difference might be caused by more precarious job contracts for MJHs that challenges RTW because of lack of support for modified work, higher workload, and reduced likelihood that MJHs file a workers’ compensation claim. Despite adjusting for type of MSD, severity of injury and occupation, the differences persisted for the vast majority of the study sample.