Workers Compensation Benefits Research Articles

Why presumptions are important in occupational health: The example of COVID-19 infection as an occupational disease.

Workers who become ill or injured on the job while undertaking extraordinary risks on behalf of the public are, at times, granted facilitated access to workers' compensation (WC) benefits through the application of presumptions in the compensation process. Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, a broad range of occupational groups faced an elevated risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure at work to perform vital services to maintain our food supply, sustain needed transportation, provide health care, assure energy supply and others. Some states or jurisdictions in the United States recognized both the risk and the service of these workers by enacting COVID-19 presumption laws to streamline selected essential workers' eligibility for WC benefits. Other states did not. Results of these contrasting public approaches permit an examination of the impact of presumptions in compensation by examining the frequency and outcomes of COVID-19 claims in "COVID-19 presumption" and "nonpresumption" states. Despite state-level variations in economic response to the pandemic, industry mix, and presumption eligibility criteria, the use of COVID-19 presumptions appears to have substantially increased claim filing rates and improved access to benefits. Lastly, the additional costs of COVID-19 claims to employers and insurers were lower than initially predicted. In response to future airborne infectious disease outbreaks, workers' compensation presumption laws should be universally implemented to permit a broad range of high-risk workers to work on the public's behalf without fear of losing wages and incurring medical expenses associated with a work-related viral exposure.

Transition between social protection systems for workers with long term health problems: A controlled retrospective cohort study

Many nations have established workers' compensation systems as a feature of their social protection system. These systems typically provide time-limited entitlements such as wage replacement benefits and funding for medical treatment. Entitlements may end for workers with long-term health conditions before they have returned to employment. We sought to determine the prevalence of transitions to alternative forms of social protection, specifically social security benefits, among injured workers with long-term disability, when workers' compensation benefits end. We linked Australian workers' compensation and social security data to examine receipt of social security payments one year before and after workers' compensation benefit cessation. Study groups included (1) injured workers whose workers' compensation benefits ceased due to reaching a 260-week limit introduced by legislative reform (N = 2761), (2) a control group of injured workers with at least 104 weeks workers compensation income support (N = 3890), and (3) a matched community control group (N = 10,114). Adjusted binary logistic regression examined the odds of transitions to social security in the injured worker groups relative to the community control group. Within 12 months of workers' compensation benefit cessation, 60% (N = 1669) of the exposed group received social security payments, of which 41% (N = 1120) received the unemployment allowance and 19% (N = 516) the disability pension. Among the work injured control group, 42% (N = 1676) received social security payments after workers compensation benefits ceased. Transitions to social security payments were significantly more common than community levels for both exposed (OR 25.0, 95%CI = 20.7, 30.1) and work injured control groups (OR 4.7, 95%CI = 4.2, 5.3). Many injured workers with long-term health problems transition to social security when their workers’ compensation benefits cease. Transitions were more common among workers whose claims ended due to legislative reform which time-limited benefits. Design and implementation of system level policy reform should consider the social and economic impacts of transitions between separate social protection systems.

Functional Outcomes, Complications, and Failure Rates in Workers’ Compensation Patients Following Hip Arthroscopic Repair: A Systematic Review

Background: Studies on the feasibility of hip arthroscopy in workers’ compensation (WC) patients have been largely inconsistent or limited by study design, necessitating the need for a systematic review. Purpose: We sought to systematically compare clinically significant differences between WC patients and their counterparts in relation to (1) functional outcomes, (2) complications, and (3) failure rates after hip arthroscopy. Methods: We searched MEDLINE, EMBASE, and PubMed databases for studies published between January 1996 and February 2021. In combination with “AND” or “OR” Boolean operators, the following keywords were implemented: “hip arthroscopy,” “workers’ compensation,” “outcomes,” “complications,” “revision,” and “failure rates.” Two reviewers screened eligible studies, evaluated methodological quality, and abstracted data. Results: In the 13 studies pooled, comprising 1874 patients, 276 (14.7%) patients received WC benefits. Twelve studies utilized functional outcomes, 2 studies assessed pain, and 3 studies evaluated satisfaction. Despite scoring lower in these measures preoperatively, WC patients demonstrated significant improvements after hip arthroscopy. Three studies linked compensation with marginally inferior functional scores, but this association was not significant at longer follow-up. Seven studies examined complication incidence, and 6 studies addressed failure rates, with all reporting no significant differences in rates of complications, secondary arthroscopies, or conversion to total hip arthroplasty. Conclusions: The findings of this systematic review suggest that hip arthroscopy offers clinically significant benefits, regardless of WC status. Postoperative results in WC patients, including functional scores, pain, satisfaction, complications, and failure rates, were favorable, and the degree of improvement was at least comparable with their counterparts. Further studies should consider prospective study designs with larger cohorts and extended follow-up.

Workplace Injuries and Receipt of Benefits From Workers' Compensation and Social Security Disability Insurance.

We examine whether workers who experience permanently disabling injuries covered by workers' compensation (WC) end up on Social Security Disability Insurance (SSDI) and whether Social Security Administration (SSA) seems to offset WC payments for permanently disabling injuries against SSDI benefits, when appropriate. Methods: We capture data on WC benefit receipt from the Health and Retirement Study and link it to SSA data on WC and SSDI recipients to study descriptive information on these questions. Results: We find that SSA seems to be missing data on WC benefits for a sizable share of recipients of WC benefits and that the frequency with which SSDI benefits are reduced because of the WC offset seems surprisingly low. Conclusions: For a variety of reasons, WC benefits for permanently disabling injuries may not be appropriately offset against SSDI benefits, possibly shifting the cost of these workplace injuries to SSDI.

Worker and employer experiences with COVID-19 and the California Workers' Compensation System: A review of the literature.

BackgroundGiven workplace risks from COVID‐19, California policymakers passed Senate Bill (SB) 1159 to facilitate access to workers' compensation (WC) benefits for frontline workers. However there has been no review of the available evidence needed to inform policy decisions about COVID‐19 and WC.MethodsWe conducted a literature review on worker and employer experiences surrounding COVID‐19 and WC, adhering to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines.ResultsForty articles were included (16 about worker experiences and 24 about employer practices). Most were not about experiences and practices related to COVID‐19 and WC. Worker studies indicated that paid sick leave reduced new COVID‐19 cases and COVID‐19 activity. Studies also found that rural agricultural and food processing workers lacked sick leave protection and faced severe housing and food insecurity. Studies on workplace health and safety indicated that healthcare workers with access to personal protective equipment had lower stress levels. Studies about employer practices found that unrestricted work in high‐contact industries was associated with increased risks to at‐risk workers, and with health disparities. No studies examined worker COVID‐19 experiences and WC claims or benefits, job loss, retaliation, workers' medical care experiences, and return‐to‐work or leave practices.ConclusionsOur review identified experiences and practice related to COVID‐19 and the WC system, but not specifically about WC and COVID‐19 WC claims or benefits. Further research is needed to document and understand evidence underpinning the need for WC coverage for COVID‐19 and to evaluate the impact of the current SB 1159 bill on WC in California.

,,,“Death by a Thousand Paper Cuts” – How the Kansas Supreme Court Should Stop the State Legislature’s Systematic Decimation of Workers Compensation Benefits

,,,“Death by a Thousand Paper Cuts” – How the Kansas Supreme Court Should Stop the State Legislature’s Systematic Decimation of Workers Compensation Benefits

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P126. Early surgery yields better outcomes after cervical fusion for radiculopathy in a workers’ compensation population

BACKGROUND CONTEXT Patients with workers’ compensation (WC) undergoing cervical surgery have been shown to have inferior outcomes compared with the general population. Previous studies have suggested that the reason behind this discrepancy is multifactorial. Within this clinically distinct population, the ability to return to work (RTW) is particularly important, especially when considering that the economic ramifications from treating patients with cervical injuries. Given the high costs associated with both nonoperative and operative treatments for cervical conditions in the WC population as well as the risk of residual disability, it is critically important to identify whether time to surgery has any significant effect on the clinical and financial outcomes in this population. PURPOSE Determine if outcomes of surgery for cervical radiculopathy in a WC population are affected by time to surgery. More specifically, we studied differences in RTW rates, chronic opioid use, depression, disability and medical costs in patients receiving cervical fusion based on the time between the index injury and their index surgery. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Patients included were subjects qualified for WC benefits for work-related injuries. The study population included patients underwent cervical fusion for radiculopathy and had a minimum of 3years of follow-up after surgery. OUTCOME MEASURES Return to work, opioid prescription use, newly diagnosed clinical depression, permanent disability, reoperation and total medical costs incurred at 3years follow-up after surgery. METHODS A total of 3,171 Ohio WC subjects were identified who underwent cervical fusion for radiculopathy between 1993 and 2013. We allocated patients into 4 groups based on the time from injury to surgery (Time to surgery [TTS]): TT 3years. Logistic regression was used to assess TTS correlation with the outcomes of interest: Return to work (RTW), opioid prescription use, newly diagnosed clinical depression, permanent disability, reoperation and total medical costs incurred at 3years follow-up after surgery. RESULTS Univariate analysis showed, Shorter TTS was associated with higher RTW rate (p=.0001), lower chronic opioid use (p=.0001), lower residual disability (p=.0001), and lower medical costs (p=.0001). Logistic regression showed, after ajusting for other covariates, TTS was significant predictor of stable RTW (OR=0.67; 95%CI [0.59-0.76], p=.0001), residual permanent disability (OR=1.38; 95%CI [0.99-1.92], p=.056), and chronic opioid use (OR=1.46; 95%CI [0.53–0.70], p=.0001). However, it was not a predictor of postoperative depression or reoperation within 3years after surgery. CONCLUSIONS Overall, time to surgery had a significant impact on clinical outcomes in WC subjects receiving cervical fusion for radiculopathy. Patients who received their operation within 1 year had a higher RTW rate, lower use of opioid prescriptions, and overall lower medical costs at 3years after index surgery. The results presented can perhaps be used to guide surgical decision-making and provide predictive value for the WC population.

Occupational Exposures and Health Outcomes Among Immigrants in the USA.

Immigrants experience higher rates of occupational injury and fatality than their native-born counterparts. This review summarizes the current data related to occupational/environmental exposures and explores potential reasons for the disparities. Immigrant workers are employed in sectors that expose them to dangerous working conditions. They experience increased risk for exposure to heat, pesticides, hazardous chemicals, and cleaning agents, as well as physical hazards such as falls. Immigrant workers are at increased risk for occupational injury and fatality due to the nature of the work they traditionally perform, a lack of enforced safety regulations, and limited access to health care or worker's compensation benefits.

Promulgating the Kingdom: Social Gospel Muckraker Josiah Strong

Social gospel leaders in the United States and England edited newspapers to educate the masses on key social issues in hopes of ushering in the kingdom of God, both prior to and alongside their secular muckraking peers. US Congregationalist Josiah Strong, much maligned for the pro-Anglo-Saxon nature of his domestic missions book Our Country, spent his last seventeen years documenting the problems cities faced and possible solutions. He fought for factory safety, as well as eight-hour days, living wages, worker's compensation benefits, and social secretaries to care for employees' needs. An examination of Strong's journals, Social Engineering, Social Service, and Gospel of the Kingdom, shatters stereotypes about the reformer and shows how he used muckraking techniques to promote social reform.

Cluster Sample Inference with Very Few Groups

If the number of clusters equals the number of cluster-invariant regressors the usual clusters-specific standard errors cannot be computed. One important example is the difference in differences setting with two groups and two time periods. This paper introduces a new method to calculate how large the within cluster correlation of the model errors can be yet still enable OLS coefficients to retain statistical significance at a desired level. This sensitivity approach is applied to previous results regarding the effects of workers compensation benefits.

Immigrant dairy workers' perceptions of health and safety on the farm in America's Heartland.

Dairy farming is dangerous. Yearly, farms grow fewer and larger by employing immigrant workers, who have limited industrial agriculture experience and safety and health training. We examined results of five focus groups with 37 Hispanic, immigrant dairy workers. Analysis followed a grounded theory approach and employed ATLAS.ti. Reported injury experience affirmed the hazardous nature of dairy. Some workers received appropriate worker compensation benefits, whereas others were instructed to deny work-relatedness. Some employers covered medical injury costs out-of-pocket, whereas others did not. Cows were a major injury source. Pressure to work and weather were noted as injury risk factors. Worker compensation was poorly understood, and immigration status and fear of deportation influenced injury and hazard reporting. Injury management practices range from benevolent to threatening. Workers compensation is poorly understood and undocumented status is an occupational hazard. We underscore the need for further research and immigration policy change.

Anatomic total shoulder arthroplasty for patients receiving workers' compensation

Studies have demonstrated that receiving workers' compensation (WC) benefits can be a negative predictor of outcomes after orthopedic procedures. This study compares postoperative outcomes of anatomic total shoulder arthroplasty (TSA) between patients receiving WC benefits and a control group that did not. A cohort of 13 consecutive TSA patients with WC benefits were compared with a control group of 63 consecutive patients with a minimum of 2 years of follow-up during the same period. Patient demographics, American Shoulder and Elbow Surgeons scores, 12-Item Short Form Health Survey scores, return to work status, and time out of work were evaluated. The WC TSA cohort consisted of 13 men and no women with a mean age of 55.9 years. Twelve of the 13 were laborers. The TSA control group consisted of 36 men and 27 women with a mean age of 63.2 years (P = .01). The American Shoulder and Elbow Surgeons scores at final follow-up were significantly lower in the WC cohort (73.6) compared with the control group (86.6; P = .01). However, the 12-Item Short Form Health Survey physical and mental component summary scores were not significantly different (P = .09 and P = .6). Only 4 of the 13 WC patients returned to work. Compared with a non-WC population, patients with WC who received an anatomic TSA are more likely to be male, younger, and a laborer. Outcomes are generally excellent and better than those of other WC shoulder surgery cohorts in the literature; however, the outcomes are relatively worse than in the non-WC TSA patients. A significant number of WC patients are unable to return to work after TSA.

Work-related trauma, PTSD, and workers compensation legislation: Implications for practice and policy.

The current review examines work-related traumatic events, with particular focus on posttraumatic stress disorder (PTSD) as a potential mental health outcome. Despite considerable empirical knowledge about trauma and PTSD, a gap exists with respect to laws undergirding Workers Compensation (WC) insurance coverage for work-related mental health injuries. In this article, state and federal WC statutes are examined with an eye toward coverage of PTSD following work-related trauma. Examples of differences between states, as well as state-specific idiosyncratic facets of WC laws, are discussed. Federal WC programs are also examined. Two policy issues are highlighted: (a) lack of parity between WC coverage for work-related physical versus mental health injuries and (b) lack of reliance on psychological science in scripting legislation and determining WC benefits. The cost of untreated PTSD following work-related trauma is examined, focusing on costs to the individual, the employer, and society at large. The authors provide 3 recommendations designed to address discrepancies related to compensable psychological injuries following work-related trauma exposure.

Medical expenditures associated with nonfatal occupational injuries among U.S. workers reporting persistent disabilities

BackgroundNo prior study has investigated the medical expenditures associated with occupational injuries among U.S. workers with persistent disabilities, including those with physical disabilities or cognitive limitations. ObjectiveUsing the 2004–2011 Medical Expenditure Panel Survey (MEPS) data (Panels 9–15), we estimated the 2-year incidence and the expenditures associated with occupational injuries in U.S. workers with and without persistent disabilities. MethodsExpenditures were compared by type of service and sources of payment. We estimated the mean medical expenditures using linear regression analysis to adjust for sociodemographics. The statistical analysis accounted for the sample survey design of MEPS and the highly skewed expenditure data. ResultsThe 2-year cumulative incidence of occupational injuries was 13.6% (95% CI: 11.6%–15.6%) in workers with persistent disabilities and 7.1% (95% CI: 6.8%–7.4%) in workers without persistent disabilities. The average medical expenditure associated with new occupational injuries in the 2-year follow-up period was $3778 in workers with disabilities, $2212 in workers without disabilities after adjusting for sociodemographics and medical insurance coverage status (in 2011 U.S. dollars, p-value = 0.0004). Of the total expenditures for occupational injuries, workers' compensation paid 54.6% in workers with disabilities and 58.9% in workers without disabilities. There was no significant difference in the proportion of injured workers with and without disabilities who reported receiving workers' compensation benefits (46.7% vs. 48.2%, p-value = 0.718). ConclusionsWorkers with persistent disabilities had a significantly higher incidence of occupational injuries and higher medical costs compared with workers without persistent disabilities. Many questions with regard to occupational safety and worker's compensation benefits in workers with disabilities remain unexplored.

The Utility of and Risks Associated With the Use of Spontaneous Volunteers in Disaster Response: A Survey

The use of spontaneous volunteers (SV) is common after a disaster, but their limited training and experience can create a danger for the SVs and nongovernmental voluntary organizations (NVOs). We assessed the experience of NVOs with SVs during disasters, how they were integrated into the agency's infrastructure, their perceived value to previous responses, and liability issues associated with their use. Of the 51 National Voluntary Organizations Active in Disasters organizations that were contacted for surveys, 24 (47%) agreed to participate. Of the 24 participating organizations, 19 (72%) had encountered SVs during a response, most (79%) used them regularly, and 68% believed that SVs were usually useful. SVs were always credentialed by 2 organizations, and sometimes by 6 (31%). One organization always performed background checks; 53% provided just-in-time training for SVs; 26% conducted evaluations of SV performance; and 21% provided health or workers compensation benefits. Two organizations reported an SV death; 42% reported injuries; 32% accepted legal liability for the actions of SVs; and 16% were sued because of actions by SVs. The use of SVs is widespread, but NVOs are not necessarily structured to incorporate them effectively. More structured efforts to integrate SVs are critical to safe and effective disaster response.

Underreporting work absences for nontraumatic work-related musculoskeletal disorders to workers' compensation: results of a 2007-2008 survey of the Québec working population.

We examined underestimation of nontraumatic work-related musculoskeletal disorders (WMSDs) stemming from underreporting to workers' compensation (WC). In data from the 2007 to 2008 Québec Survey on Working and Employment Conditions and Occupational Health and Safety we estimated, among nonmanagement salaried employees (NMSEs) (1) the prevalence of WMSDs and resulting work absence, (2) the proportion with WMSD-associated work absence who filed a WC claim, and (3) among those who did not file a claim, the proportion who received no replacement income. We modeled factors associated with not filing with multivariate logistic regression. Eighteen percent of NMSEs reported a WMSD, among whom 22.3% were absent from work. More than 80% of those absent did not file a WC claim, and 31.4% had no replacement income. Factors associated with not filing were higher personal income, higher seniority, shorter work absence, and not being unionized. The high level of WMSD underreporting highlights the limits of WC data for surveillance and prevention. Without WC benefits, injured workers may have reduced job protection and access to rehabilitation.

Workers' compensation and consumption smoothing

This paper investigates the consumption-smoothing benefits of state workers' compensation (WC) programs. These programs are among the largest and most controversial forms of social insurance, with the putative purpose of supporting families affected by unexpected income shocks due to workplace injuries and illnesses. Using Health and Retirement Study (HRS) data for a sample of workers who have experienced a work-related, work-limiting disability, I find that a 10% increase in WC benefit generosity offsets the drop in household consumption upon injury by 3 to 5%. Moreover, my estimates imply that if benefits were very low, the drop in consumption upon injury would be in the range of 30%. A model adapted from the literature on optimal social insurance yields a formula for the optimal level of WC benefits, which depends on empirical estimates of the consumption-smoothing parameter. My calculations suggest that current WC benefit levels are somewhat higher than optimal.

The Effect of Wage Insurance on Labor Supply: A Test for Income Effects

Studies of moral hazard in wage insurance programs such as Unemployment Insurance (UI) or Workers Compensation (WC) have demonstrated that higher benefits discourage work, emphasizing the price distortion inherent in benefit provision. Utilizing administrative data linking WC claim records to wage records from a UI payroll tax database, I find that the effect of WC benefits on the duration of benefit receipt cannot fully account for the effect of these benefits on post-injury unemployment. This indicates that a significant fraction of the effect of WC benefits on employment is due to an income effect rather than a price distortion.

Unsafe Workplaces, Injured Employees, and the Bizarre Bifurcation of Section 7 of the National Labor Relations Act

A particularly pernicious constriction of the scope of protection available under Section 7 of the National Labor Relations Act has occurred with respect to injured employees. Employees who complain about workplace safety and health issues are within the ambit of Section 7, protected against employer retaliation for having complained. Meanwhile, however, employees injured by those same workplace safety and health hazards, and who consequently exercise their state workers compensation law statutory rights to claim workers compensation monetary and medical care benefits, are not protected by Section 7. If the employer retaliates against the injured employee for claiming state workers compensation benefits, the employee's protections against such retaliation are under state workers compensation law, but not under the federal National Labor Relations Act. This undue constriction of Section 7's umbrella has fractured the practical and jurisprudential coherence of Section 7. Furthermore, this bizarre bifurcation has spawned atomistic progeny wholly antithetical to the spirit and purpose of Section 7. Perhaps most egregiously, the National Labor Relations Board now considers employees filing individual sexual harassment complaints with the United States Equal Employment Opportunity Commission to have acted individually, and thus not within Section 7's concerted, protected activities. This essay will critically analyze the genesis and evolution (mutation) of this bizarre bifurcation of Section 7 in this context, and will propose avenues for rectification.

Social and economic consequences of workplace injury: A population‐based study of workers in British Columbia, Canada

Existing research suggests that workplace injuries can have significant economic and social consequences for workers; but there are no quantitative studies on complete populations. The British Columbia Linked Health Database (BCLHD) was used to examine 1994 injured workers who lost work time due to the injury (LT) and a group of injured individuals who did not lose time after their injuries (NLT). Three outcomes were explored: (1) residential change, (2) marital instability, and (3) social assistance use. Logistic regression adjusted for several individual and injury characteristics. LTs were more likely to move and collect income assistance benefits, and less likely to experience a relationship break-up than the NLTs. LTs off work for 12 or more weeks were more likely to receive income assistance than LTs off for less time. The increased risk suggests that the long-term economic consequences of disabling work injury may not be fully mitigated by workers compensation benefits.