Lost-time Claims Research Articles

The impact of regulatory workplace safety inspections on workers' compensation claim rates.

Studies on the impact of workplace safety inspections on work injuries have found mixed effectiveness. Most studies are from the United States, examining Occupational Health and Safety Administration (OSHA) regulatory inspections in manufacturing firms with more than 10 employees. This study examines whether regulatory inspections in Alberta, Canada, result in reductions in workers' compensation claims rates for inspected firms relative to comparable non-inspected firms. Firm and claim-level data from the Workers' Compensation Board of Alberta were linked with regulatory enforcement data from the Government of Alberta for construction, manufacturing, and transportation firms with at least one full-time employee for 37 consecutive months. A matched difference-in-differences study design was used to estimate changes in lost-time claim rates for work-related injuries and musculoskeletal diseases of inspected and comparable non-inspected firms between the year pre-inspection and 2 years, post-inspection, controlling for firm-level characteristics. Inspections were not effective in reducing firm-level claim rates, with the exception of transportation firms with more than one inspection experiencing a 28% decrease in their claim rate in the second year post-inspection, relative to the change in non-inspected firms. In construction, inspected firms experienced a 12% increase in their claim rate in the first year post-inspection. No effect was observed in the manufacturing sector. Regulatory workplace safety inspections in Alberta generally do not result in greater reductions in firm-level claim rates in the construction, manufacturing, and transportation sectors. Inspections alone may not be sufficient to induce compliance or hazard management changes that lead to reductions in firm-level injuries.

Precarious employment and the workplace transmission of COVID-19: evidence from workers’ compensation claims in Ontario, Canada

ObjectiveTo examine the association between precarious employment and risk of work-related COVID-19 infection in Ontario, Canada.MethodsWe combined data from an administrative census of workers’ compensation claims with corresponding labour force...

Is precarious employment an occupational hazard? Evidence from Ontario, Canada

ObjectivesTo examine the association between precarious employment and risk of occupational injury or illness in Ontario, Canada.MethodsWe combined accepted lost-time compensation claims from the Workplace Safety and Insurance Board with...

Comparison of internal and external reference populations for occupational cancer surveillance in a cohort drawn from a diverse workforce.

Prior analyses of the Occupational Disease Surveillance System (ODSS) have compared cancer rates using internal referent groups. As an exploratory analysis, we sought to estimate cancer risk using general population reference rates to evaluate the impact that the comparison population has on findings from our surveillance program. A cohort of approximately 2.3 million workers in Ontario, Canada with an accepted lost-time workers' compensation claim were followed for all cancer diagnoses between 1983 and 2018. Standardized incidence ratios (SIRs) and 95% confidence intervals were calculated for workers in specific occupational groups using (1) all other workers in the ODSS cohort, and (2) the general population of Ontario. SIRs using the general population reference group were generally equal to or modestly lower compared to SIRs using the internal reference group. Within occupation groups, SIRs had a discordant direction of association (increased rate in the internal comparison and decreased in the external comparison) for some cancer sites including urinary, prostate, and colorectal. Findings emphasize the importance of the choice of reference group when evaluating cancer risks in large occupational surveillance cohorts. Importantly, the magnitude of confounding and the healthy worker hire bias may depend on the occupation group and cancer site of interest.

Oil and Gas Extraction Industry Workers' Compensation Claims and Proposed Safety Interventions.

This study analyzed Ohio workers' compensation data to identify potential prevention strategies for common oil and gas extraction industry claims. Claim rates for 2001-2018 were calculated per full-time equivalent employee. Descriptive analyses on free-text descriptions of lost-time (LT) claims (>7 days away from work) identified common characteristics among claims and injured workers. Among 3134 claims, 860 (27%) were LT. The industry group, drilling contractors, experienced the highest LT claims rate, whereas the cost from servicing contractors was the highest. Contact with objects and equipment caused the highest LT claims rate. The most frequent LT occupation was roustabout, and the most frequent LT work activity was material handling. Transportation incidents caused most fatalities and hospitalizations. Over half of LT claims were from short-tenured workers. Both proven and innovative approaches are needed to reduce severe workers' compensation claims in this industry.

Mining Injuries 2012-2019: Using Workers' Compensation Claims Data From 35 States to Identify Rates and Costs Associated by Nature of Injury, Event/Exposure, and Body Part Affected.

This study summarized the frequency and cost of mining-related injuries. Mining-related workers' compensation (WC) claims data from 35 states were summarized to report counts, claim rates, and costs for 2012-2019. These data were compared with Mine Safety and Health Administration injury and employment data for the same period. Despite system differences, both WC and Mine Safety and Health Administration counts and rates declined over time and injury patterns were similar. Total WC costs were approximately $2.325B. Medical-only claims represented 59.4% of the claims by count, but only 3.3% of costs. Lost-time nonfatal claims represented 40.2% of the claims by count, but 90.2% of costs. Claims frequency and costs varied greatly by injury event/exposure, part of body, and nature. Injury frequency has declined but costs remain high. The most costly and disabling cases were identified.

Is Arthroscopic Meniscectomy Associated With an Increased Risk of Total Knee Arthroplasty for Claimants in the Workers' Compensation System? A 10-Year Study of Workers' Compensation Claims From a Large Nationwide Workers' Compensation Insurance Carrier.

Total knee arthroplasty (TKA) is a commonly performed knee surgery and prior arthroscopic meniscectomy (AM) has been linked to an increased risk of TKA in the general population. To study the relationship between AM and TKA among injured workers whose medical care is paid for under workers' compensation (WC). A total of 17,247 lost-time claims depicting all arthroscopic knee surgical procedures performed from 2007 to 2017 were followed to the end of 2022 and analyzed. The odds ratio of undergoing a TKA for those with a preceding AM is 2.20, controlling for age, sex, and attorney involvement. Undergoing an AM is associated with an increased risk of TKA in WC claimants.

Exploring sex differences in lung cancer risk among workers in Ontario, Canada's Occupational Disease Surveillance System

BackgroundWhile it is well-established that occupational exposures significantly contribute to the risk of developing lung cancer, there remains a notable gap in understanding the specific sex differences in lung cancer risk, particularly among female workers. This study aimed to examine sex differences in lung cancer risk across various occupations, with an emphasis on the female workforce.MethodsA cohort of approximately 2.37 million workers with lost-time compensation claims were linked to the Ontario Cancer Registry and followed until lung cancer diagnosis, age 85, emigration, death, or end of follow-up (Dec 31, 2020). Cox proportional hazards models were used to estimate sex-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer by occupational group (division, major and minor levels), adjusted for birth-year and age and indirectly adjusted for cigarette smoking.ResultsA total of 12,216 and 30,291 incident lung cancer cases were identified among females and males, respectively. Several occupations demonstrated stronger associations for lung cancer in females, with at least a 20% increased risk compared to males. These occupations at the major level include food and beverage preparation services (HR = 1.19, 95% CI = 1.13–1.26); materials processing (chemical, petroleum, rubber, plastic) (HR = 1.35, 95% CI = 1.19–1.52); wood processing (HR = 1.87, 95% CI = 1.22–2.87); metal machining (HR = 1.56, 95% CI = 1.21–2.00); metal shaping and forming (HR = 1.46, 95% CI = 1.32–1.62); fabricating and assembling metal products (HR = 1.37, 95% CI = 1.25–1.51), other construction trades (HR = 1.54, 95% CI = 1.16–2.05), motor transport operating (HR = 1.69, 95% CI = 1.48–1.94), mechanic and repair work (HR = 1.39, 95% CI = 1.04–1.85); and printing (HR = 1.51, 95% CI = 1.30–1.75). These patterns were similar across minor level occupations.ConclusionsThis study identified sex differences across various occupations, with some occupational groups demonstrating stronger associations among female workers. However, these findings should be interpreted with caution. The observed differences may be attributed to various factors that influence risk, such as occupational exposures, use and effectiveness of personal protective equipment, and other biological or lifestyle factors.

Evaluation of the Ontario Mandatory Working-at-Heights Training Requirement in Construction, 2012‒2019.

The province of Ontario, Canada, implemented mandatory day-long training for construction workers required to use fall-protection equipment. More than 400 000 training sessions were completed by 2017 when the requirement took full effect. The lost-time workers' compensation claim incidence rate attributable to falls targeted by the training was 19% lower in 2017-2019 than in 2012-2014. Rates for two comparator injuries increased or stayed the same. The decline in targeted fall claim incidence rate of the other Canadian provinces was 6%. (Am J Public Health. 2024;114(1):38-41. https://doi.org/10.2105/AJPH.2023.307440).

Occupational Injuries Among Construction Workers by Age and Related Economic Loss: Findings From Ohio Workers' Compensation, USA: 2007–2017

BackgroundThis study examined age-group differences in the rate, severity, and cost of injuries among construction workers to support evidence-based worker safety and health interventions in the construction industry. MethodsOhio workers' compensation claims for construction workers were used to estimate claim rates and costs by age group. We analyzed claims data auto-coded into five event/exposure categories: transportation incidents; slips, trips, and falls (STFs); exposure to harmful substances and environments; contact with objects and equipment (COB); overexertion and bodily reaction. American Community Survey data were used to determine the percentage of workers in each age group. ResultsFrom 2007–2017, among 72,416 accepted injury claims for ∼166,000 construction full-time equivalent (FTE) per year, nearly half were caused by COB, followed by STFs (20%) and overexertion (20%). Claim rates related to COB and exposure to harmful substances and environments were highest among those 18–24 years old, with claim rates of 313.5 and 25.9 per 10,000 FTE, respectively. STFs increased with age, with the highest claim rates for those 55–64 years old (94.2 claims per 10,000 FTE). Overexertion claim rates increased and then declined with age, with the highest claim rate for those 35–44 years old (87.3 per 10,000 FTE). While younger workers had higher injury rates, older workers had higher proportions of lost-time claims and higher costs per claim. The total cost per FTE was highest for those 45–54 years old ($1,122 per FTE). ConclusionThe variation in rates of injury types by age suggests that age-specific prevention strategies may be useful.

Effects of sex and age on work-related upper extremity musculoskeletal disorders in Ontario, Canada.

Effective targeting of workplace upper extremity musculoskeletal disorder (MSD) prevention strategies requires the identification of demographic groups most at risk. Workers' compensation data provides an effective means of surveillance of MSDs at the population level. The primary purpose of this study was to identify the effects of age and sex on rates of tendon injuries of the wrist and hand, carpal tunnel syndrome (CTS), epicondylitis, and soft tissue shoulder injuries in Ontario, Canada between 2000-2019 using workers' compensation data from the Association of Workers Compensation Boards of Canada (AWCBC). Age and sex specific rates of lost-time injury claims from the four identified injury categories as well as "non-specific" upper extremity MSDs which did not fit into the four categories were calculated by standardizing injury claim totals with "at-risk" population estimates from the Canada Labour Force Survey. A multiple regression analysis was used to analyze the effects of age and sex on rates of specific injury claims. Statistically significant age and sex effects were identified for rates of claims from tendon injuries of the wrist and hand, CTS, and shoulder injuries, while only age effects were significant for epicondylitis. Between 2000-2019, rates of claims from the four injury categories studied and the magnitude of the age and sex effects declined substantially over time. Detailed surveillance of workplace ergonomic hazards in Ontario workplaces is needed to determine what is causing rates of upper extremity claims to decline.

Dose Escalations Among Workers' Compensation Claimants Using Opioid Medications-An 8 Year Postinjury Follow up Study.

The aim of the study is to determine the morphine equivalent dose in milligrams (MED)/day escalation trend after initial utilization. A total of 25,108 lost time claims filed between 1998 and 2007 were followed for 8 years from injury date. Claims were stratified by initial MED/day at 3 months after injury into four groups (0, 1 to < 15, 15 to < 30, and ≥30 MED/day). The slopes in MED/year of opioid dose escalation were determined for each initial MED/day group. The slopes of MED/day escalation by initial MED categories were similar ( P ≥ 0.05) ranging from 5.38 to 7.76 MED annually. On average, MED/day increased in a liner pattern with a slope at 6.28 MED/year ( P < 0.01). Opioid MED/day increased in a linear pattern, regardless of initial MED/day dose.

Heat-Related Illness Among Workers in British Columbia, 2001-2020.

The aim of this study was to describe the incidence of heat-related illness among workers in British Columbia (BC), Canada, 2001-2020. Cases of heat-related illness occurring among workers aged 15 years and older were identified from accepted lost-time claims from WorkSafeBC, the provincial workers' compensation board. Incidence rates were calculated using monthly estimates of the working population from Statistics Canada's Labour Force Survey as the denominator. Between 2000 and 2020, there were 528 heat-related illness claims, corresponding to a rate of 1.21 (95% confidence interval, 1.10-1.31) claims per 100,000 workers. Eighty-four percent of claims occurred between June and August. Rates were higher among male workers, younger workers, and among those working in occupations related to primary industry; trades, transport, and equipment operators; and processing, manufacturing, and utilities. In BC, lost-time claims for heat-related illness occurred disproportionately among certain subgroups of the workforce.

Pre-existing anxiety and depression disorders and return to work after musculoskeletal strain or sprain: a phased-based approach.

To examine the impact of pre-existing anxiety and depression disorders on return to work (RTW) using a phase-based approach. Accepted lost-time workers' compensation claims for upper limb or spine strain or sprain from 2009 to 2013 were extracted for workers in the Canadian province of British Columbia (n = 78,186). Pre-existing anxiety and depression disorders were identified using health claims data. Probability of RTW following a first or second work lost-time episode was analyzed using Prentice, Williams and Peterson models for recurrent events (common hazards ratios (cHR)). Probability of a first lost-time recurrence was analyzed using Cox models (HR). All models included two years of follow up and were stratified by gender. For men, anxiety alone (cHR = 0.90, 95% CI: 0.85 to 0.94) or comorbid with depression (cHR = 0.95, 95% CI: 0.92 to 0.99) was significantly associated with a lower probability of RTW, and comorbid anxiety and depression with a higher probability of recurrence (HR = 1.29, 95% CI: 1.13 to 1.48). In women, comorbid anxiety and depression was significantly associated with a lower probability of RTW (cHR = 0.96, 95% CI: 0.93 to 0.99) and a higher probability of recurrence (HR = 1.15, 95% CI: 1.04 to 1.28); and anxiety alone with a higher probability of recurrence (HR = 1.25, 95% CI: 1.09 to 1.43). There was little evidence that depression alone was associated with RTW or recurrence. Workers with a pre-existing anxiety disorder may require additional supports both during lost-time and after initial RTW.

Relationship Analysis of Injured Workers' Average Weekly Wages and Workers' Compensation Indemnity Claims in Maine, US: 1998 to 2017.

Explore the relationship between injured workers' average weekly wages (AWW) and their workers' compensation (WC) claims outcomes in Maine, US. A total of 29,668 indemnity (lost-time) claims categorized into three wage-based percentile groups from a 20-year period (5-year intervals) were analyzed. WC outcomes included medical costs, number of indemnity checks, claim's duration, and claim settlements. Generally, claims within the lower percentile group were less likely to have high medical costs, but were more likely to have an elevated number of indemnity checks when compared to those in the middle percentile group. An inverse relationship was observed for those claims within the higher percentile group. Generalizations about low wage earners' claims being longer-lasting and more expensive or early return to work always reducing the medical cost of claims should be avoided.

Unionisation and injury risk in construction: a replication study

ObjectiveTo replicate, in a more recent time period, a previous cross-sectional study to estimate the association between unionisation and the risk of workers’ compensation injury claims.MethodsThe sampling frame was workers’...

The Impact of a State-Based Workers' Compensation Insurer's Risk Control Services on Employer Claim Frequency and Cost Rates.

This study evaluated the impact of a state workers' compensation (WC) insurer's onsite risk control (RC) services on insured employers' WC claim frequency and cost. We used two methods to model 2004 to 2017 claims data from 4606 employers that received RC visits over time and compare this claims experience to matching employers that did not receive RC services. Relative total WC claim rates increased slightly after RC services, while relative lost-time claims rates either remained similar or decreased and WC cost rates decreased. The impact of RC services on reducing WC costs was cumulative up to the fourth visit but diminished thereafter. The insurer RC consultation program was effective in reducing WC cost rates for serviced employers. This is consistent with other research conducted on insurer RC services and related regulatory visits.

Exploring Differences in Work Disability Duration by Size of Firm in Canada and Australia.

Purpose To identify whether there were differences in work disability duration between injured workers employed by small, medium, large, and self-insured firms and whether these differences varied between workers' compensation jurisdictions in Canada and Australia. Methods Workers' compensation data were used to identify comparable lost-time, work-related injury and musculoskeletal disorder claims in five Canadian and five Australian jurisdictions between 2011 and 2015. Work disability duration was measured using cumulative disability days paid up to one-year post-injury. Jurisdiction-specific quantile regression models were used to estimate differences in cumulative disability days paid to claims from small (< 20 full-time equivalents (FTEs)) medium (20-199 FTEs), large (200 + FTEs) and self-insured firms at the 25th, 50th, and 70th percentiles in the disability distribution, adjusting for confounders. Results Compared to large firms, workers in small firms generally had longer work disability duration at each percentile, particularly in Saskatchewan and Alberta (Canada), Victoria and Australian Capital Territory (Australia), where an additional 31.1, 18.4, 58.5 and 37.0days were paid at the 75th percentiles, respectively. The disability duration of workers from self-insured firms was longer than large firms in all Canadian jurisdictions but was shorter or no different in Australian jurisdictions. Smaller differences were observed between claims from large and medium-sized firms. Conclusions Workers in small firms had longer work disability duration than those in large firms in all but one of the study jurisdictions. Claims management processes need to be sensitive to the challenges that small firms face in accommodating and returning injured workers back to work.

Evaluating effectiveness of an integrated return-to-work and vocational rehabilitation program on work disability duration in the construction sector.

ObjectiveThe aim of this study was to investigate whether an integrated return-to-work (RTW) and vocational rehabilitation (VR) program – the Work Reintegration (WR) program – was associated with reduced work disability duration in the construction sector in Ontario, Canada.MethodsWorkers’ compensation data from the Ontario Workplace Safety and Insurance Board were extracted for lost-time construction worker claims following work-related injuries between 2009 and 2015. Claims receiving referrals to RTW and VR specialists (treatments) were matched with claims receiving no referrals (controls) during the periods before and after the WR program introduction. Multivariable difference-in-differences linear and quantile regression models were used to examine differences in cumulative disability days paid during two-years post-injury between treatment and control groups before and after the program change and the difference in these differences, overall, and at different disability distribution percentiles.ResultsThe WR program introduction was associated with reductions in cumulative disability days paid for all claims but most notably among longer duration claims referred to RTW specialists (reduction of 274 days at the 90th percentile in the disability distribution) and shorter duration claims referred to VR specialists (reductions of 255 and 214 days at the 25th and 50th percentiles in the disability distribution, respectively).ConclusionsThe WR program introduction was effective in reducing cumulative disability days paid for construction worker claims but the effects varied at different percentiles in the disability distribution, as well as by specialist referral. The findings highlight the benefits of better integrated RTW and VR services to injured workers in the construction sector.

Workers’ compensation claim counts and rates by injury event/exposure among state-insured private employers in Ohio, 2007–2017

Introduction: This study analyzed workers’ compensation (WC) claims among private employers insured by the Ohio state-based WC carrier to identify high-risk industries by detailed cause of injury. Methods: A machine learning algorithm was used to code each claim by U.S. Bureau of Labor Statistics (BLS) event/exposure. The codes assigned to lost-time (LT) claims with lower algorithm probabilities of accurate classification or those LT claims with high costs were manually reviewed. WC data were linked with the state’s unemployment insurance (UI) data to identify the employer’s industry and number of employees. BLS data on hours worked per employee were used to estimate full-time equivalents (FTE) and calculate rates of WC claims per 100 FTE. Results: 140,780 LT claims and 633,373 medical-only claims were analyzed. Although counts and rates of LT WC claims declined from 2007 to 2017, the shares of leading LT injury event/exposures remained largely unchanged. LT claims due to Overexertion and Bodily Reaction (33.0%) were most common, followed by Falls, Slips, and Trips (31.4%), Contact with Objects and Equipment (22.5%), Transportation Incidents (7.0%), Exposure to Harmful Substances or Environments (2.8%), Violence and Other Injuries by Persons or Animals (2.5%), and Fires and Explosions (0.4%). These findings are consistent with other reported data. The proportions of injury event/exposures varied by industry, and high-risk industries were identified. Conclusions: Injuries have been reduced, but prevention challenges remain in certain industries. Available evidence on intervention effectiveness was summarized and mapped to the analysis results to demonstrate how the results can guide prevention efforts. Practical Applications: Employers, safety/health practitioners, researchers, WC insurers, and bureaus can use these data and machine learning methods to understand industry differences in the level and mix of risks, as well as industry trends, and to tailor safety, health, and disability prevention services and research.