Lost-time Claims Research Articles

Back injuries among union carpenters in Washington State, 1989–2003

There is limited information on occupational back pain specific to carpenters despite their known exposures to recognized occupational risk factors and limited opportunities for modified work due to the predominantly heavy nature of their work. By combining union records with worker's compensation claims, we describe work-related back injuries, including associated medical diagnoses, among a well-defined cohort of union carpenters between 1989 and 2003. High risk subgroups were explored based on age, gender, union tenure, and predominant type of work. Paid lost time claims were contrasted to less serious events, and injuries sustained from overexertion activities were contrasted with those sustained through more acute trauma. Back injuries occurred at an overall rate of 6.2/200,000 hours worked. Most injuries were coded in the compensation records as sprains, but there was little agreement between these nature of injury codes and ICD9 diagnosis codes. Injury rates declined most significantly over time for injuries secondary to overexertion. In multivariate analyses, we observed similar patterns of risk for the types of claims evaluated despite disparate mechanisms and severity. Those who worked predominantly in residential carpentry or drywall installation were consistently at greatest risk. Overexertion injuries from manual materials handling activities are responsible for the largest burden of back injuries among these carpenters, but a growing proportion of injuries result from acute traumatic events. Interventions are called for which specifically address risk among residential carpenters and drywall installers. These data provide additional evidence that Bureau of Labor Statistics data underestimate work-related injuries.

The Prevalence and Incidence of Work Absenteeism Involving Neck Pain

Cohort study. To measure the prevalence and incidence of work absenteeism involving neck pain in a cohort of claimants to the Ontario Workplace Safety & Insurance Board (WSIB). According to workers’ compensation statistics, neck pain accounts for a small proportion of lost-time claims. However, these statistics may be biased by an underenumeration of claimants with neck disorders. We studied all lost-time claimants to the Ontario WSIB in 1998 and used 2 methods to enumerate neck pain cases. We report the prevalence and incidence of neck pain using 2 denominators: (1) annual number of lost-time claimants and (2) an estimate of the Ontario working population covered by the WSIB. The estimated percentage of lost-time claimants with neck pain ranged from 2.8% (95% CI 2.5–3.3) using only codes specific for neck pain to 11.3% (95% CI 9.5–13.1) using a weighted estimate of codes capturing neck pain cases. The health care sector had the highest percentage of claims with neck pain. The annual incidence of neck pain among the Ontario working population ranged from 6 per 10,000 full-time equivalents (FTE) (95% CI 5–6) to 23 per 10,000 FTE (95% CI 20–27) depending on the codes used to capture neck pain. Male workers between the ages of 20 and 39 years were the most likely to experience an episode of work absenteeism involving neck pain. Neck pain is a common and burdensome problem for Ontario workers. Our study highlights the importance of properly capturing all neck pain cases when describing its prevalence and incidence.

The Prevalence and Incidence of Work Absenteeism Involving Neck Pain

Cohort study. To measure the prevalence and incidence of work absenteeism involving neck pain in a cohort of claimants to the Ontario Workplace Safety & Insurance Board (WSIB). According to workers' compensation statistics, neck pain accounts for a small proportion of lost-time claims. However, these statistics may be biased by an underenumeration of claimants with neck disorders. We studied all lost-time claimants to the Ontario WSIB in 1998 and used 2 methods to enumerate neck pain cases. We report the prevalence and incidence of neck pain using 2 denominators: (1) annual number of lost-time claimants and (2) an estimate of the Ontario working population covered by the WSIB. The estimated percentage of lost-time claimants with neck pain ranged from 2.8% (95% CI 2.5-3.3) using only codes specific for neck pain to 11.3% (95% CI 9.5-13.1) using a weighted estimate of codes capturing neck pain cases. The health care sector had the highest percentage of claims with neck pain. The annual incidence of neck pain among the Ontario working population ranged from 6 per 10,000 full-time equivalents (FTE) (95% CI 5-6) to 23 per 10,000 FTE (95% CI 20-27) depending on the codes used to capture neck pain. Male workers between the ages of 20 and 39 years were the most likely to experience an episode of work absenteeism involving neck pain. Neck pain is a common and burdensome problem for Ontario workers. Our study highlights the importance of properly capturing all neck pain cases when describing its prevalence and incidence.

Prevalence of lost-time claims for mild traumatic brain injury in the working population: Improving estimates using workers compensation databases

Primary objective: To test the usefulness of a method to improve the measurement of prevalent mild traumatic brain injury (MTBI) among injured workers with a workers compensation claim.Methods: Database codes were selected to identify MTBI cases in the Ontario workers compensation lost-time claims database. A random sample of 210 claims was selected, classified as MTBI or not, and used to calculate proportions with MTBI among code groups. The annual prevalence of MTBI in 1997 and 1998 was calculated by weighting the numerators with the appropriate proportions of MTBI within each code group.Results: Four code groups were created: the head region, cranial region, concussion code group and the brain region. The proportion of MTBI in each group was 29%, 19%, 92% and 32%, respectively. The 1997 prevalence depended on the codes used, from 39/10 000 (95% confidence interval (CI): 35–44) for a weighted version of the ‘concussion’ code to 58/10 000 (95% CI: 50–65) for inclusion of all identified MTBI codes.Conclusions: Restricting the enumeration of MTBI to specific ‘concussion’ codes can lead to under-estimation of the prevalence of MTBI in epidemiological studies using workers compensation data. Approximately six out of every 1000 lost-time claims are associated with MTBI. Given lost-time estimates of disability under-estimate the prevalence of this mild injury, MTBI, is an important workplace injury.

Health status, work limitations, and return-to-work trajectories in injured workers with musculoskeletal disorders

BackgroundThe purpose of this study was to describe the health status and work limitations in injured workers with musculoskeletal disorders at 1 month post-injury, stratified by return-to-work status, and to document their return-to-work trajectories 6 months post-injury.MethodsA sample of 632 workers with a back or upper extremity musculoskeletal disorder, who filed a Workplace Safety and Insurance Board lost-time claim injury, participated in this prospective study. Participants were assessed at baseline (1 month post-injury) and at 6 months follow-up.ResultsOne month post-injury, poor physical health, high levels of depressive symptoms and high work limitations are prevalent in workers, including in those with a sustained first return to work. Workers with a sustained first return to work report a better health status and fewer work limitations than those who experienced a recurrence of work absence or who never returned to work. Six months post-injury, the rate of recurrence of work absence in the trajectories of injured workers who have made at least one return to work attempt is high (38%), including the rate for workers with an initial sustained first return to work (27%).ConclusionsThere are return-to-work status specific health outcomes in injured workers. A sustained first return to work is not equivalent to a complete recovery from musculoskeletal disorders.

Return to Work—From Research to Practice

Return to Work—From Research to Practice

An Investigation of the Effects of a Healthcare Provider Network on Costs and Lost Time in Workers??? Compensation

The objective of this study was to evaluate the number of lost time days and cost of workers' compensation claims at a median claim duration (maturity) of 25 months for individuals injured between August 1, 2003, and July 31, 2004, who chose a statewide (Louisiana) network (Omnet Gold) of healthcare providers not subject to utilization review. We identified and contrasted 176 lost time claims (143 closed) managed by Omnet Gold (OG) healthcare providers and 1464 lost time claims managed by healthcare providers not participating in OG. The average frequency of lost workdays for a closed OG claim was 53 days versus 99 days for a closed non-OG claim and the average cost of a closed OG claim was 12,554 dollars, whereas the average cost of a closed non-OG claim was 20,400 dollars. Both days lost from work and costs were significantly lower among claims managed by OG healthcare providers. This outcome was consistent with the findings of a previous study performed on the same claims in which a significant difference was demonstrated analyzing primarily open (unresolved) claims with a median claim duration of 6 months. The ability of OG healthcare providers to return a higher proportion of injured workers to work early and shorten claims durations were the major factors influencing these outcomes. In a state where claimants are permitted choice of medical provider, a network of healthcare providers can achieve superior lost time and cost outcomes than out of network healthcare providers.

Capturing cases in workers' compensation databases: The example of neck pain

There is a need to more accurately enumerate workers with musculoskeletal injuries who make lost-time claims to workers compensation boards. The objective of this study is to develop an approach to more accurately enumerate these workers. Lost-time claims to the Ontario Workplace Safety & Insurance Board (WSIB) were reviewed. Using neck pain as an example, nature of injury and part of body codes were identified to classify cases. Claims of a random sample of 434 claimants were reviewed. The proportion of claimants classified as having neck pain was computed. The proportion of claimants classified with soft-tissue injuries to the neck varied from 0.88 for codes including "neck/cervical region," 0.69 for "back region" to 0.05 for those coded as "shoulder/upper arm." Restricting the enumeration of injuries to specific part of body codes can lead to a gross underestimation of the magnitude of soft-tissue disorders in epidemiological studies using workers' compensation data. The proposed approach leads to more accurate enumeration.

Early Healthcare Provider Communication with Patients and Their Workplace Following a Lost-time Claim for an Occupational Musculoskeletal Injury

One of the key players in the return-to-work (RTW) and work accommodation process is the healthcare provider (HCP). This study examines the association between RTW approximately one month post injury and early, proactive HCP communication with the patient and workplace. In this cross-sectional study 187 Ontario workers completed a telephone survey 17-43 days post injury. All had accepted or pending lost-time claims for back, neck or upper extremity occupational musculoskeletal injuries. Logistic regression was used to analyze the effects of three self-reported items "your HCP told you the date you could RTW," "your HCP advised you on how to prevent re-injury or recurrence," "your HCP made contact with your workplace" on self-reported RTW. Fourteen potential confounders were also tested in the model including sex, age, income, education, occupational classification, worksite size, co-morbidity, psycho-physical work demands, pain, job satisfaction, depression, and time from injury to interview. The HCP giving a patient a RTW date (adjusted OR=3.33, 95% CI=1.62-6.87) and giving a patient guidance on how to prevent recurrence and re-injury (adjusted OR=2.71, 95% CI=1.24-5.95) were positively associated with an early RTW. Contact by the HCP with the workplace was associated with RTW, however, this association became weaker upon adjusting for confounding variables (crude OR=2.11, 95% C1=1.09-4.09; adjusted OR=1.72, 95% CI=0.83-3.58). Our study lends support to the HCP playing an active role early in the RTW process, one that includes direct contact with the workplace and proactive communication with the patient.

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.

Trial by fire: a multivariate examination of the relation between job tenure and work injuries

Aims: This study examined the relation between months on the job and lost-time claim rates, with a particular focus on age related differences. Methods: Workers’ compensation records and labour force...

Effects of premium discount on workers' compensation claims in agriculture in Finland

The objective of this study was to measure changes in injury claim rates after a premium discount program was implemented in the Finnish farmers' workers' compensation insurance. We focused on measures that could indicate whether the changes occurred in the true underlying injury rate, or only in claims reporting. Monthly injury claim rates were constructed at seven disability duration levels from January 1990 to December 2003. We conducted interrupted time series analyses to measure changes in the injury claim rates after the premium discount was implemented on July 1, 1997. Three additional policy change indicators were included in the analyses. The overall injury claim rate decreased 10.2%. Decreases occurred at four severity levels (measured by compensated disability days): 0 days (16.3%), 1-6 days (14.1%), 7-13 days (19.5%), and 14-29 days (8.4%). No changes were observed at higher severity levels. Minor injuries had a seasonal pattern with higher rates in summer months while severe injuries did not have a seasonal pattern. The premium discount decreased the overall claim rate. Decreases were observed in all categories up to 29 disability days. This pattern suggests that under-reporting contributes to the decrease but may not be the only factor. The value of the premium discount is lower than the value of a lost-time claim, so there was no financial reason to under-report lost-time injuries. Under-reporting would be expected to be greatest in the 0 day category, but that was not the case. These observations suggest that in addition to under-reporting, the premium discount may also have some preventive effect.

A Preliminary Investigation of the Effects of a Provider Network on Costs and Lost-Time in Workers’ Compensation

We sought to compare lost-time days and average and median workers' compensation claims costs between injured workers managed by OMNET Gold (OG) physicians and those managed by physicians not participating in OG. OG is a statewide health care provider network coordinated by occupational medicine physicians and established by the Louisiana Workers' Compensation Corporation (LWCC) to manage the medical care of injured workers. We identified and contrasted 158 lost-time claims managed by OG physicians and 1,323 claims managed by physicians not participating in OG during the first year of network operation (August 1, 2003 to July 31, 2004). The average and median costs for a non-OG claim was $12,542 and $5,793, whereas the average and median costs for an OG claim was $6,749 and $3,015. The average and median number of lost-time days for an OG claim was 53.4 and 34.0 and 95.0 and 58.0 for a non-OG claim. The mean differences were statistically significant. A small network of physicians may have an effect on the duration of lost-time and workers' compensation costs.

Work‐Related Disability in Canadian Nurses

To determine factors contributing to high registered nurse (RN) injury claim rates in Canadian hospitals. Cross-sectional study of secondary 1998-99 data for RNs (N = 8,044) in Ontario, Canada, linked at the hospital level (n = 127). Descriptive statistics, correlations, and logistic regression analyses were conducted. The odds of a high RN lost-time claim rate increased by 70% for each quartile increase in the percentage of RNs reporting more than 1 hour of overtime per week. The odds of a high RN musculoskeletal lost-time claim rate decreased by 64% for every one unit increase in the hospital-level score on the nurse-physician relationship subscale. To retain and optimize scarce hospital nursing resources, strategies to address overtime, sick time, and nurse-physician relationships might provide fiscal and human benefits.

Disabling and Fatal Occupational Claim Rates, Risks, and Costs in the Oregon Construction Industry 1990–1997

This study estimated injury and illness rates, risk factors, and costs associated with construction work in Oregon from 1990–1997 using all accepted workers' compensation claims by Oregon construction employees (N = 20,680). Claim rates and risk estimates were estimated using a baseline calculated from Current Population Survey data of the Oregon work force. The average annual rate of lost-time claims was 3.5 per 100 workers. More than 50% of claims were by workers under 35 years and with less than 1 year of tenure. The majority of claimants (96.1%) were male. There were 52 total fatalities reported over the period examined, representing an average annual death rate of 8.5 per 100,000 construction workers. Average claim cost was $10,084 and mean indemnity time was 57.3 days. Structural metalworkers had the highest average days of indemnity of all workers (72.1), highest average costs per claim ($16,472), and highest odds ratio of injury of all occupations examined. Sprains were the most frequently reported injury type, constituting 46.4% of all claims. The greatest accident risk occurred during the third hour of work. Training interventions should be extensively utilized for inexperienced workers, and prework exercises could potentially reduce injury frequency and severity.

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.

Occupational injuries and illnesses in the sawmill industry of Alberta

A comprehensive Workers Compensation Board of Alberta claims database for the sawmill industry describing 3779 claims was analyzed for the years 1997–2002. A total of 48,025 days were lost due to claim and total claims cost were $ 8,640,886.06. The objectives of this descriptive study were to: identify claims trends in terms of nature of injury, type of accident or exposure, source of injury, and body part injured; determine the effect of work experience and worker age on the above classifications; assess the impact of observed claims trends in terms of cost and duration of claim; and compare incidence rates of nonfatal injuries resulting in workers compensation board claims in Alberta, Canada to those reported by the Bureau of Labor Statistics in the United States. The majority of injuries resulting in claims were experienced by males 24–35 years of age with 1–6 months of work experience. Musculoskeletal injuries were the most common nature of injury (46.7%). The upper extremity was the most frequently injured region of the body (45.5%). The majority of claims (54.5%) were defined as lost time claims and 46% as medical aid only. Comparison of the incidence rates of specific injury/illness characteristic categories indicate that incidence rates reported by the BLS based on the survey of occupational injuries and illness are not representative of incidence rates observed in Alberta, Canada. Relevance to industry The description of injury trends within the sawmill industry stands to positively impact the effectiveness of prevention and rehabilitation programs addressing workplace injuries/illnesses. In addition, comparison of incidence rates observed in Alberta to those estimated by the Survey of Occupational Injuries and Illnesses provides a useful insight into the differences between the respective statistical sources.

Exploring Variables among Medical Center Employees with Injuries: Developing Interventions and Strategies

Data for this study were collected via retrospective chart review. The study shows the variables associated with work related injury (WRI) in Central Arkansas Veterans Healthcare System medical center employees from 1998 to 2000 in terms of age, gender, employment type, employment status, shift length, body mass index (BMI), workers' compensation claims prior to current employment, employee health and wellness activity attendance, lost time claims, medical/loss of productivity costs. Notable characteristics of injured employees included advancing age, female gender, long working hours, increased BMI, history of prior back and upper extremity injuries, no health and wellness activity attendance, and lost time with injury. Back and shoulder strain, falling accidents, and repetitive motion injuries were the most severe and costly injuries. Further study of medical center employees is warranted to determine risk factors for WRI and develop appropriate protective interventions and safety promotion strategies.

Declining trends in work-related morbidity and disability, 1993-1998: a comparison of survey estimates and compensation insurance claims.

This study compared trends in the incidence of work-related morbidity and disability across 3 sources of surveillance data in a Canadian province. Time series estimates of workplace injuries and work-related disability based on 2 panel surveys in the province of Ontario, Canada, for the period 1993-1998 were compared with rates of work-related injury and illness compensation claims during the same period. Lost-time compensation claims declined by 28.8% over this 6-year period. The incidence of self-reported work-related injury declined by 28.2%, and the self-reported incidence of work absence for work-related causes declined by 32.2%. Parallel reductions in work-related morbidity were seen in 3 independent data sources. These results support an interpretation that there has been an important reduction in injury risk in Ontario workplaces over the past decade.

Ten Years’ Experience Using an Integrated Workers’ Compensation Management System to Control Workers’ Compensation Costs

This work presents 10 years of experience using an Integrated Workers' Compensation Claims Management System that allows safety professionals, adjusters, and selected medical and nursing providers to collaborate in a process of preventing accidents and expeditiously assessing, treating, and returning individuals to productive work. The hallmarks of the program involve patient advocacy and customer service, steerage of injured employees to a small network of physicians, close follow-up, and the continuous dialogue between parties regarding claims management. The integrated claims management system was instituted in fiscal year 1992 servicing a population of approximately 21,000 individuals. The system was periodically refined and by the 2002 fiscal year, 39,000 individuals were managed under this paradigm. The frequency of lost-time and medical claims rate decreased 73% (from 22 per 1000 employees to 6) and 61% (from 155 per 1000 employees to 61), respectively, between fiscal year 1992 and fiscal year 2002. The number of temporary/total days paid per 100 insureds decreased from 163 in fiscal year 1992 to 37 in fiscal year 2002, or 77%. Total workers' compensation expenses including all medical, indemnity and administrative, decreased from $0.81 per $100 of payroll in fiscal year 1992 to $0.37 per $100 of payroll in fiscal year 2002, a 54% decrease. More specifically, medical costs per $100 of payroll decreased 44% (from $0.27 to $0.15), temporary/total, 61% (from $0.18 to $0.07), permanent/partial, 63% (from $0.19 to $0.07) and administrative costs, 48% ($0.16 to $0.09). These data suggests that workers' compensation costs can be reduced over a multi-year period by using a small network of clinically skilled health care providers who address an individual workers' psychological, as well as physical needs and where communication between all parties (e.g., medical care providers, supervisors, and injured employees) is constantly maintained. Furthermore, these results can be obtained in an environment in which the employer pays the full cost of medical care and the claimant has free choice of medical provider at all times.