Majority Of Claimants Research Articles

Opioid use: Case-control analyses of worker's compensation data

Working-age adults are disproportionately impacted by opioid misuse. Factors associated with opioid misuse in people with workers compensation (WC) claims are not well studied. WC in some states is a "captured" market making it a more efficient site for researching the opioids epidemic. A pilot study was conducted to identify factors associated with opioid use using a large WC insurer's claims in Utah. This was a case-control study using a large WC insurer's database. We conducted secondary data analyses of a de-identified dataset originally obtained from the WC insurer. Cases were defined as claims with a morphine equivalent dose (MED)≥50 mg/d in the 30 days after the claim was filed while controls = 0 mg/d. A total of 76 patient's claims (28 cases and 48 controls) were included in the final data analyses. The majority of claimants were male (N = 50, 65.8 percent), worked full time (N = 58, 76.3 percent) and had a mean age of 37.0±11.4 years. The majority of controls filed medical only claims (N = 40, 83.3 percent) while the majority of cases filed indemnity claims (N = 19, 67.9 percent). Cases were prescribed a mean MED of 126.4 (SD = 93.3) within the first month after filing the claim. Most cases visited>3 medical providers (N = 13, 46.4 percent) in the first month after filing the claim while the majority of controls only visited one provider (N = 28, 58.3 percent). Remarkably, the mean number of providers visited within the first month for the cases was 3.8, which was 2-fold greater than the control group. Exploratory multivariate analyses showed that cases were 4.6 times more likely to have visited 2-3 medical providers (p = 0.025), and 41.8 times more likely to have visited more than three medical providers (p < 0.001). Cases had 3.6 higher odds of having been prescribed nonsteroidal anti-inflammatory prescription within the first month as compared to controls (p = 0.014). This pilot study found risk factors, some of which may be modifiable. We aim to conduct a large study using existing WC data to create a scoring system that identifies those claimants at higher risk of adverse opioid-related events that may have preventive applications at a systems-level.

ATV-Related Workers’ Compensation Claims in Montana, 2007–2012

The objective of this study was to analyze workers’ compensation injury and fatality data associated with the occupational use of all-terrain vehicles (ATVs) in Montana. Data were provided by the Montana Department of Labor and Industry Workers’ Compensation Injury and Occupational Disease Database. Claims were identified based on a search of injury codes related to vehicular claims and then narrowed by a keyword search for events related to ATVs. Two hundred and fifteen ATV-related claims were identified between 2007 and 2012. The majority of claimants were identified as male (85%), with 23% of total claims between the ages 20–29 at the time of injury. The agriculture industry accounted for 59% of all claims. The results of this investigation indicated that the cost of occupational ATV injuries and deaths during the study period totaled nearly $2,600,000. The agriculture industry is disproportionally represented in ATV workers’ compensation claims in Montana. Characterizing and understanding the risk factors associated with occupational-related ATV injuries is critical for developing strategies and programs aimed at injury prevention. Evaluating the gaps in data acquisition and reporting could aid in ensuring comprehensive and complete future investigations of ATV incidents.

Scoliosis and litigation

In 2010/2011, 2053 spinal infusions were carried out for scoliosis, of which 1328 were in children. In contrast there were 224 549 admissions in total for spinal disorders1 and therefore scoliosis cases proceeding to litigation are relatively uncommon. There may be other reasons for the lower incidence of litigation in scoliosis patients including the fact that almost all of these operations are carried out in tertiary centres as planned cases during daylight hours. Multidisciplinary teams of surgeons, physicians and other healthcare professionals manage the patients, and in many cases two senior surgeons operate together which may reduce the risks in these cases. Furthermore, the consenting process is generally carried out by more senior members of the team; the patients and their families are usually in no doubt that this is a major operation not without significant risk, and patients are rarely given the impression that complete correction of the deformity will take place. Although curve progression and prevention of pain are the main indications for surgery, improvement in cosmesis is also an important aim of the surgery. However, I am not aware that failure to improve appearance has been a cause for litigation. The majority of claimants in scoliosis cases are children and their families. Because many operations are carried out early in childhood, there is a very long trail of cases. Adults have to commence proceedings within three years of the perceived injury, while children have until the age of 21 to do so. In many cases the surgeon in charge of the case may be retired or may have died. The causes of allegations of negligence/breach of duty include neurological injury; failure of instrumentation or other instrumentation problems; nonunion of fusion; choice of wrong levels; failure to identify pre-operative abnormalities; failure to use spinal cord monitoring; failure …

The Newly Unemployed and the UIF Take-Up Rate in the South African Labour Market

This paper investigates the take-up rate or claim-waiting rate of the unemployed under the South African Unemployment Insurance Fund (UIF) system. The goal is to identify disincentive effects that income replacement rates (IRR) and accumulated credits may have on the claimant's behaviour in terms of their claim waiting period rate (or how quickly they apply for UIF benefits). Utilizing nonparametric and semi-parametric estimation techniques, we find that there is little evidence, if any, for job disincentives or moral hazard problems. More specifically, the majority of claimants that are quickest to claim the UIF benefits are those who have worked continuously for at least four years and accumulated the maximum allowable amount of credits. We also note that claimants' claim-waiting periods are indifferent with regard to levels of income replacements yet extremely sensitive to the amount of credits accumulated. Ultimately, the recipients of the UIF benefits do not depend heavily on the replacement incomes and prefer waiting longer for employment opportunities to arise as opposed to exhausting their accumulated credits. The semi-parametric Cox's Proportional Hazard (PH) model confirms that there is a positive relationship between the claimant's accumulation of credits and the associated take-up rate of the UIF.

The Influence of a Continuum of Care Model on the Rehabilitation of Compensation Claimants With Soft Tissue Disorders

Population-based before-and-after design with concurrent control group. As continuums of care have been little studied, we evaluated the impact of the Workers' Compensation Board of Alberta (WCB-Alberta) model on sustained return to work, satisfaction with care, and cost. Musculoskeletal conditions, such as back pain, continue to be leading causes of disability and work loss. From 1996 through 1997, the WCB-Alberta implemented a continuum of care model to guide rehabilitation service delivery for claimants with soft tissue injury. The model was designed as a decision-making tool to promote a consistent, evidence-based approach to care within the jurisdiction. The model was implemented province-wide so the entire population of workers insured by the WCB-Alberta was studied. Data were extracted from the WCB-Alberta administrative database from 2 years before implementation (1994-1995) to 5 years after (1996-2000). An intervention group was created from patients filing soft tissue injury claims for the low back, ankle, knee, elbow, and shoulder. The comparison group was formed of workers experiencing fractures or other traumatic non-soft tissue injuries. Satisfaction was measured through surveys. Primary outcome was cumulative days receiving wage replacement benefits. Multivariable Cox regression was used to determine the model's effect. Over the entire study period, 70,116 claimants filed soft tissue injury claims while 101,620 claimants experienced non-soft tissue injuries. Significant improvement was observed in intervention group return-to-work outcomes after model implementation (hazard ratio = 1.54). Median duration of benefits decreased from 13 to 8 days. Little change was seen in the control group's disability duration (median duration, consistently 10 days). The majority of claimants were satisfied with care received. Cost savings over a 2-year full implementation period was $21.5 million (Canadian). Implementation of a soft tissue injury continuum of care involving staged application of various types of rehabilitation services appears to have resulted in more rapid and sustained recovery.

Travel insurance claims made by travelers from Australia.

Little is known about travel insurance claims made by travelers returning from abroad. This study was designed to investigate travel insurance claims made by travelers from Australia, particularly examining demographic factors, type of travel insurance coverage, nature and duration of travel, when treatment was sought during travel or when the problem arose, use of emergency assistance, nature of claim, and claim outcome, including cost. A random sample of approximately one in five claims reported during the period 1996 to 1998 to a major Australian travel insurance company were examined. A total of 855 claims were examined, of which 42.6% (356/836) were made by male travelers and 57.1% (477/836) were made by female travelers. The majority of claimants were in the 55 years and over age groups (445/836, 53.2%). Medical and dental conditions accounted for 66.6% of claims (569/854), with the remainder associated with loss, theft, and damage (285/854, 33.4%). The most common medical conditions were respiratory (110/539, 20.4%), musculoskeletal (90/539, 16.7%), gastrointestinal (75/539, 13.9%), ear, nose, and throat (67/539, 12.4%), and dental conditions (39/539, 7.2%). Only one case of venous thrombosis was reported, secondary to a lower limb infection. Use of the travel insurance company's emergency telephone service was reported in 17.1% of claims (146/853). Almost two-thirds (559/853, 65.5%) of claims were fully accepted. Those who claimed medical treatment, assault, and theft were significantly more likely to have their claims accepted compared to those claiming dental conditions, cancellation, curtailment, loss and damage (chi2 = 127.78, df = 40, p <.00001). The majority of medical and dental conditions did not require further medical investigations (427/569, 75.0%). The mean cost of claim refunds was Australian dollars (AUD)991.31 (standard deviation [SD] 6 AUD5400.76) for males and AUD508.90 (SD 6 AUD1446.10) for females. Claims for assault, cancellation, and curtailment were significantly more expensive than other types of claims (Kruskal-Wallis one way analysis of variance [ANOVA]; chi2 = 106.87, df = 8, p <.00001). Claims for treatment of gastrointestinal, cerebrovascular, cardiovascular, musculoskeletal conditions, and pyrexias of unknown origin were significantly more expensive than other medical and dental claims (Kruskal-Wallis one way ANOVA; x2 = 61.68, df = 15, p <.00001). This explorative study highlights the importance of travelers taking out appropriate travel insurance. Claims for medical and dental conditions represent the majority of travel insurance claims made by Australian travelers returning from abroad, although travel insurance also covers against such contingencies as loss, theft, and cancellation. The most common medical conditions claimed were respiratory, musculoskeletal, and gastrointestinal disorders. Travelers should be advised to take out appropriate travel insurance before departure overseas and to take care with preexisting medical and dental conditions, which may not be able to be claimed against travel insurance.

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.

Quantification and risk analysis of occupational burns: Oregon workers' compensation claims, 1990 to 1997.

This study examined all accepted Oregon workers' compensation claims for occupational burn injuries during the period of 1990 to 1997 (N = 3,158). The Current Population Survey was used to derive employee population baselines for establishing rate estimates. It was estimated that the average occupational burn claim rate was 2.89 per 10,000 workers (95% confidence interval [CI] 2.76, 3.02). The majority of claimants (71.7%) were males, the largest proportion (32.6%) was aged 25 years or less, and almost half (48.7%) had less than 1 year of job tenure. The most frequent burn type cited was heat/scald burns (78.9%) followed by chemical burns (19.3%). Costs averaged over 1.6 million dollars annually. The average indemnity period was 16 days. Higher relative risks were found for evening workers (2.97, 95% CI 2.96, 2.98) and night workers (2.13, 95% CI 2.12, 2.13) compared with dayshift workers. Kitchen workers had the highest burn rate of all occupations, with 62.5 claims per 10,000 workers.

Workers' compensation claims related to natural rubber latex gloves among Oregon healthcare employees from 1987-1998.

BackgroundOccupational reaction to natural rubber latex (NRL) glove use by healthcare employees has been an area of increasing concern. Unfortunately, there is little data demonstrating the prevalence and severity of actual reactivity to NRL.MethodOccupational reaction to NRL was estimated using workers' compensation claims filed by healthcare employees in Oregon for the period of 1987–1998. For the first ten years, these claims were estimated by source and conditions consistent with NRL glove reactions, while in the last two years a specific code developed in 1997 for NRL glove reactions was also employed.ResultsThe claim rate was on average 0.58 per 10,000 healthcare workers annually, which constituted 0.29% of all workers' compensation claims. The most common condition experienced was dermatitis (80%) and most common body part affected was the hands (55.4%). The majority of claimants, 45 (69.2%), reported taking less than a month off work, suggesting most reactions were minor in nature, although one fatality was reported. The average NRL claim cost was $8,309.48. Overall the average cost per insured healthcare worker was approximately $0.50 per year. The occupational groups with the highest number of claims were nurses (30.8% of claimants) and nursing aides and orderlies (24.6% of claimants).ConclusionsIn comparison with other workers' compensation claims filed by healthcare workers during this period, 0.25% of the total was potentially related to NRL gloves. The rare incidence of respiratory and ocular claims is inconsistent with the hypothesis that asthmatic or conjunctival reactions to NRL gloves are common.

Natural rubber latex allergy workers' compensation claims: Washington State healthcare workers, 1991-1999.

Occupational reaction to natural rubber latex experienced by healthcare employees was examined using data of all workers' compensation claims filed by state-insured healthcare employees in Washington State for the period 1991-1999 (n = 65,703). As latex reaction is not a condition for which there are specific identification codes, these claims were estimated by coupling source and nature of injury records that were consistent with reactions to latex. It was found that the claim rate was on average 2.66 per 10,000 state-insured healthcare workers annually. The most common condition experienced was dermal (84.3%), and most common body part affected was the hand (70.0%). Because few claims cited respiratory or conjunctivitis as reaction experienced, little evidence was discovered to support that glove powder acted as a widespread latex allergen transmitter in healthcare environments. Most cases did not require indemnity payment for lost work time (81.2%), suggesting most reactions were minor. The average cost per natural rubber latex claim was $2,759.10, compared to $3,178.18 for the average healthcare worker claim for all causes. Overall, the average cost per state-insured healthcare worker employed during this time was under $0.74 per year. Nursing aides/orderlies were the most frequent healthcare occupation filing a claim (33.2%). The majority of claimants were female (87.9%), and unmarried workers (52.0%) filed slightly more claims than married workers (48.0%). In comparison with other workers' compensation claims filed by healthcare workers during this period, 0.34 percent of the total was potentially related to natural rubber latex, with other common healthcare workplace items cited more frequently as source of occupational injury.

Travel insurance claims made by travellers from Australia for dental conditions

Little is known about dental problems suffered by travellers abroad. This study was designed to investigate travel insurance claims made by travellers from Australia for dental conditions, particularly examining demographic factors, type of travel insurance coverage, nature and duration of travel, when dental treatment was sought during travel, use of emergency assistance, type of treatment, and claim outcome, including cost. 1,289 claims submitted during 1998-99 to a major Australian-based travel insurance company were examined for dental claims. 104 (8.1%) claims for dental conditions were submitted, of which 45 (43.3%) were made by male and 59 (56.7%) by female travellers. The majority of claimants were in the 60 years and over age group 54 (52.4%). Dental conditions reported required conservative (mostly fillings) 31 (29.8%), endodontic (mostly root canal treatment) 19 (18.3%), prosthodontic 27 (26.0%), periodontal 8 (7.7%), oral and maxillofacial surgery 2 (1.9%) and other or multiple 17 (16.3%) treatments. Use of the travel insurance emergency telephone service for dental conditions was reported in only seven cases (6.7%). Almost two-thirds 64 (61.5%) of claims were accepted. Claims for prosthodontic treatment were significantly less likely to be accepted. The majority of dental conditions did not require further medical investigations, 74 (71.2%). The mean cost of payouts to claims was AU$238.06 for males and AU$182.58 for females. Claims for endodontic and prosthodontic treatment were significantly more expensive than other types of treatment. Claims for dental conditions represent a noteworthy proportion of travel insurance claims made by Australian travellers abroad. More than three-quarters of claims for dental conditions were for conservative, endodontic or prosthodontic treatment. Travellers should be advised to have a dental check-up before departure overseas and to take care with pre-existing dental conditions, which may not be able to be claimed on travel insurance.

Funding Supported Accommodation: Financial and Administrative Implications of Reforming Housing Benefit

Government proposals to reform the funding of support services in Britain require local authorities to take stock of support schemes in their areas before a new single support budget will replace existing arrangements in April 2003. In the course of the transition, local authorities will also need to scrutinize supported accommodation charges in order to remove charges for services that are unlawfully paid for by Housing Benefit. This paper highlights likely problems in the identification of support schemes and in the estimation of the costs of services. The proposed tightening of the calculation of Housing Benefit will reduce entitlements to the majority of claimants in supported accommodation, many of whom are amongst the poorest people in the country. Efforts must be made to ensure that claimants facing a reduction in their payments are not faced by steady, or even rising, housing costs. In particular, tenants in schemes, which receive no funding under the new single budget, must be protected. The paper discusses the proposals' contribution to bringing housing and community care policies closer together.

Long-Term Disability for Chronic Fatigue Syndrome

SummaryTo determine the quality of medical evaluations leading to long-term disability payments for chronic fatigue syndrome (CFS) we conducted a structured cross-sectional study of 76 patients receiving such benefits for an average of 2.1 years. Most of the subjects were middle-aged, white (99%), women (87%) who had been previously employed in “white-collar” jobs (96%). In all cases the claim of disability was based on subjective reports of substantial impairment in exercise tolerance and cognitive ability. The quality of disability determinations was judged by the fulfillment of four requirements: correct CFS diagnosis, psychiatric evaluation, neuro-psychological testing and physical capacity measurement. The analysis indicated that none of the claims had been fully evaluated and that in 34% of cases none of the requirements had been fulfilled. The diagnosis of CFS was incorrect in 38% of cases. The majority of claimants (84%) had active psychiatric disorders, but only 32% had been evaluated by psychiat...