Workers Compensation Claims Research Articles

Evaluation of Factors Affecting Return to Work Following Carpal Tunnel Release: A Statewide Cohort Study of Workers' Compensation Subjects

Most randomized trials comparing open carpal tunnel release (OCTR) to endoscopic carpal tunnel release (ECTR) are not specific to a working population and focus mainly on how surgical technique has an impact on outcomes. This study's primary goal was to evaluate factors affecting days out of work (DOOW) following carpal tunnel release (CTR) in a working population and to evaluate for differences in medical costs, indemnity payments, disability ratings, and opioid use between OCTR and ECTR with the intent of determining whether one or the other surgical method was a determining factor. Using the Ohio Bureau of Workers' Compensation claims database, individuals were identified who underwent unilateral isolated CTR between 1993 and 2018. We excluded those who were on total disability, who underwent additional surgery within 6 months of their index CTR, including contralateral or revision CTR, and those not working during the same month as their index CTR. Outcomes were evaluated at 6 months after surgery. Multivariable linear regression was performed to evaluate covariates associated with DOOW. Of the 4596 included participants, 569 (12.4%) and 4027 (87.6%) underwent ECTR and OCTR, respectively. Mean DOOW were 58.4 for participants undergoing OCTR and 56.6 for those undergoing ECTR. Carpal tunnel release technique was not predictive of DOOW. Net medical costs were 20.7% higher for those undergoing ECTR. Multivariable linear regression demonstrated the following significant predictors of higher DOOW: preoperative opioid use, legal representation, labor-intensive occupation, increasing lag time from injury to filing of a worker's compensation claim, and female sex. Being married, higher income community, and working in the public sector were associated with fewer DOOW. In a large statewide worker's compensation population, demographic, occupational, psychosocial, and litigatory factors have a significant impact on DOOW following CTR, whereas differences in surgical technique between ECTR and OCTR did not. Therapeutic III.

Reliability and validity of an employer-completed safety hazard and management assessment questionnaire

Introduction: Managing and improving occupational safety and health requires evaluating performance. Organizations are encouraged to use both lagging indicators (such as injury rates and costs) and leading indicators (such as questionnaire-assessed safety hazards and management practices) for this purpose, but the association between types of indicators over time can be complex. Longitudinal data can assist in clarifying these associations and increasing indicator utility. Method: Employer data were used to evaluate the reliability and predictive validity of a safety management questionnaire. Employers’ longitudinal questionnaire responses and workers’ compensation (WC) claims data were analyzed using a marginal model with time-dependent covariates. Multivariable Poisson and linear regression analyses with claim rate and logarithmic cost, respectively, as dependent variables were carried out after adjusting for industry sector and size. Questionnaire data were used to evaluate questionnaire scaling properties and to assess generalizability of results. Results: One safety management scale was associated with a better WC outcome as predicted and two scales were unexpectedly associated with poorer WC claim outcomes. Analyses assisted in interpreting the latter results, suggesting that WC outcomes were a stimulus for change in some cases. Twelve hazards assessed on the questionnaire were associated with poorer WC claim outcomes as predicted. Conclusions: This study extends leading indicator research using longitudinal questionnaire and WC claims data from employers. Analyses provided insight into associations between leading and lagging indicators, emphasizing the importance of both for safety improvement. Safety management questionnaire scales were predictive of WC claim outcomes, although support for hazard assessments as leading indicators was stronger. Practical Applications: This study supports the use of employer-completed hazard assessment questionnaires for targeting and prioritizing improvement efforts. Employer-completed safety management scales may be useful for directing improvement efforts, although the conditions under which they are completed, including submission to insurers, require additional consideration.

Workers’ Compensation Patients Improved After Hip Arthroscopy for Labral Tears: A 5-Year Outcome Propensity Score–Matched Study

Background: The workers’ compensation (WC) status has been associated with inferior outcomes in orthopaedic procedures and is usually excluded from clinical outcome studies. Therefore, comparative studies based on WC status are scarce. Purpose: (1) To determine outcomes of patients with WC claims treated with hip arthroscopy for labral tears at a minimum 5-year follow-up and (2) to compare these findings with a propensity score–matched control group without WC claims. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were propensity score matched to a control group without WC claims. Data were prospectively collected for all patients undergoing hip arthroscopy. Patients were included if they received primary hip arthroscopy for labral tears in the setting of femoroacetabular impingement, had a WC claim, and had preoperative and minimum 5-year follow-up patient-reported outcomes ([PROs]; modified Harris Hip Score [mHHS], Non-Arthritic Hip Score [NAHS], Hip Outcome Score–Sports Specific Subscale [HOS-SSS], and visual analog scale [VAS] for pain). Clinical outcomes were measured using the Patient Acceptable Symptom State (PASS), minimal clinically important difference (MCID), and maximum outcome improvement satisfaction threshold (MOI). Results: A total of 111 from 132 (84.1%) eligible WC patients met the inclusion criteria with an average follow-up time of 80.3 ± 37.3 months. WC cases demonstrated significant improvement from preoperatively to a minimum 5-year follow-up for mHHS, NAHS, HOS-SSS, and VAS for pain (P < .05). WC patients returned to work at a 66% rate, with an average clearance time of 4.7 months to light duty and 9.5 months to heavy duty. When compared with the control group, the WC group demonstrated lower pre- and postoperative PROs (P < .05); however, WC cases had a greater magnitude of improvement (ΔmHHS [P = .0012], ΔNAHS [P < .001], and ΔHOS-SSS [P = .012]). Rates of achieving MCID and MOI were similar in both groups (P > .05). The WC group went on to receive a future arthroscopy in 19 cases (17.1%), while 10 cases (4.5%) in the control group required revision arthroscopy (P < .001). Patients in both the WC and the control groups converted to total hip arthroplasty at similar rates (13.3% and 15.4%, respectively; P > .05). Conclusion: Patients with WC claims treated with hip arthroscopic surgery showed significant improvement and high rates of returning to work at a minimum 5-year follow-up. Although having lower scores in PROs and achieving PASS rates, no differences were found in MCID and MOI rates. Furthermore, WC patients had a greater magnitude of improvement from preoperatively to a minimum 5-year follow-up after hip arthroscopy. Therefore, even though more studies are needed to determine the causes of inconsistent outcomes in the WC population, hip arthroscopy can effectively treat labral tears in the setting of femoroacetabular impingement, regardless of the WC status.

Physical therapy utilization, costs, and return-to-work status following lumbar spine surgery: A retrospective analysis of workers compensation claims in Australia

BackgroundNo study to our knowledge has explored physical therapy utilization following lumbar spine surgery in a workers’ compensation setting. ObjectivesDescribe physical therapy utilization and costs, and return-to-work status in patients following lumbar spine surgery under a workers’ compensation claim. MethodsUsing data from the New South Wales (NSW) State Insurance Regulatory Authority (Australia), we audited physical therapy billing codes for patients who received lumbar spine surgery from 2010 to 2017. We summarised, by fusion versus decompression, the number of physical therapy sessions patients received up to 12 months post-operatively, total cost of physical therapy and time to initiation of physical therapy. Number of physical therapy sessions and physical therapy utilization at 12 months were summarised by return-to-work status at 12 months. ResultsWe included 3524 patients (1220 had fusion; 2304 decompression). On average, patients received 22 ± 22 physical therapy sessions to 12 months post-operatively (mean cost=AU$1902, US$1217); 24% were receiving physical therapy at 12 months. Most had 9–24 (31%) or 25–50 sessions (25%); 11% had > 50 sessions, whereas 11% had no physical therapy. Patients who had fusion (compared to decompression) had more physical therapy and incurred higher physical therapy costs. Time post-surgery to initiate physical therapy increased from 2010 to 2017. Patients with > 50 sessions and still having physical therapy by 12 months were least likely to be working. ConclusionsFor most patients, physical therapy utilization following lumbar spine surgery aligns with the best available evidence. However, some patients may be receiving too much physical therapy or initiating physical therapy too early.

Attributes of Long Duration COVID-19 Workers' Compensation Claims.

To examine the attributes associated with long duration COVID- 19 workers' compensation (WC) claims. A study was conducted on 13,153 COVID-19 WC claims accepted by a workers' compensation insurance carrier between January 1, 2020 and November 30, 2021. 1) Ninety-five percent of accepted WC claims were closed within the study period; 2) five percent of claims had 30 days or longer of lost time accounting for 65% of total paid WC costs; 3) medical costs increased 8-fold once paid days lost crossed the threshold of 60 days or greater; 4) age was the strongest risk factor associated with increased WC costs and prolonged impairment. Age at the time of infection was the major factor associated with prolonged impairment and high costs of COVID-19 related WC claims.

Characteristics of workers' compensation claim applications for COVID-19 infections in South Korea.

This study aimed to identify the major industries and jobs with the highest proportion of workers' compensation (WC) claims for COVID-19, characterize COVID-19 WC claims in terms of their demographic properties and disease severity, and identify factors influencing the approval of COVID-19 WC claims as occupational disease. A total of 488 workers who submitted COVID-19-related claims to the Korea Workers' Compensation and Welfare Service (KWCWS) from January 2020 to July 2021 were analyzed. A Fisher's exact test was employed to associate the severity of COVID-19 infection with demographic properties. The highest proportion of all COVID-19 WC claims compensated as occupational disease (N=462) were submitted by healthcare workers (HCW=233, 50%), while only 9% (N=41) of the total originated from manufacturing industries. The 5% (N=26) of the COVID-19 WC claims accepted were evaluated as severe (N=15) and acute respiratory distress syndrome (N=9). A total of 71% (N=329) of the COVID-19 patients compensated (N=462) were from workplaces with infection clusters. A total of 26 WC cases were rejected for various reasons, including unclear infection routes, infection at private gatherings (including within families), no diagnosis, and more. Given our findings, we suggest an official system should be established to detect and compensate more job-associated infectious diseases like COVID-19.

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.

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.

Screws Only Primary Subtalar Arthrodesis for Calcaneus Fractures

Category:Hindfoot; TraumaIntroduction/Purpose:The initial management of displaced intraarticular calcaneus fractures (DIACFs) is a difficult problem. The results of open reduction internal fixation (ORIF) have been disappointing. Alternatively, ORIF with primary subtalar arthrodesis (PSTA) has gained increasing popularity. The purpose of this study is to review patient-centered and radiographic outcomes of ORIF plus PSTA using screws alone through a sinus tarsi approach.Methods:A retrospective study of all patients from 2013-2019 who underwent ORIF+PSTA for DIACFs was conducted. The same surgical technique was utilized in all cases consisting of only screws, no plates were utilized. Delayed surgeries past 8 weeks were excluded. Demographic and radiographic data was collected. Worker's compensation (WC) claims were noted and analyzed separately. Plain radiographs were assessed preoperatively and post-operatively and Sander's classification was used to characterize injuries. Patient reported outcomes (PROs), complications, and need for revision surgeries was also noted and analyzed at final follow-up.Results:In total, forty-eight DIACFs underwent PSTA with a median follow-up of 194 days. Median time to weight-bearing was 60 days post-operatively. Three fractures were documented as Sanders II, 22 as Sanders III, and 23 as Sanders IV. Seventy-five percent of the WC group returned to work compared to just 58.3% in the non-WC group (p=0.0003). Patients in the WC group were more likely to have had an abnormal pre-operative Bohler's angle (p=0.047) but the two groups did not differ significantly in postoperative Gissane or Bohler angles. Nearly 85% (N=41) achieved >=2 zones of fusion on radiographs by final follow up and 95.8% (N=46) had at least one. Four patients had a complication and 3 required a return to the operative room.Conclusion:Utilizing Screws only primary subtalar arthrodesis for the treatment of DIACFs through a sinus tarsi approach shows promising results with high rates of return to work and fusion, even in the workers' compensation population.

A Detailed Analysis of Workplace Foot and Ankle Injuries

Category:Trauma; Ankle; Hindfoot; Midfoot/ForefootIntroduction/Purpose:In 2018 over 96,000 foot and ankle injuries resulted in lost workdays. The average 2017-2018 workers compensation claim for ankle injuries was $17,210 for medical costs with an additional $13,276 of indemnity. Workplace foot injuries were similarly expensive, averaging $15,762 in medical costs and $11,866 in indemnity. These costs highlight the burden workplace foot and ankle injuries place on both workers and employers. This study analyzes the incidence, rate, and days lost from work due to foot and ankle injuries across different industries, age groups, and genders and compares these findings to other musculoskeletal injuries. These findings will help us better understand which industries are greater impacted by foot and ankle injuries and what factors may influence the occurrence and severity of these injuries.Methods:Workplace injury data was obtained using a special query from the Bureau of Labor Statistics Workplace Injuries and Illnesses Nonfatal Cases Involving Days Away From Work: Selected Characteristics database. Data included injury incidence, incidence rate per 10,000 workers, and median days missed from work due to injury. The data was grouped by injury location (all injuries, ankle injuries, and foot injuries), type of injury (fracture, sprain, amputation), and industry. Spearman correlation, one-way ANOVA, and independent samples t-test were used to identify the industries, sex, and ages associated with the highest rates and median days missed from work for each of these groups. Regression analysis was used to analyze changes in incidence rate over time. Incidence rate data was obtained for a seventeen-year period (2003-2019) and days lost from work data was obtained for a nine-year period (2011-2019). Data analysis was performed using SPSS statistics software, version 25.0.Results:The mining (44.85 foot,17.09 ankle), transportation/warehousing (16.82,16.29), and utilities (24.41,26.69) industries had three of the five highest average median days missed from work for both foot and ankle injuries. Of these, only transportation/warehousing (11.06,13.80) was among the five industries with the highest rates of foot and ankle injuries. There was a strong negative correlation (P<0.001) between age and rate of both foot and ankle injuries and a strong positive correlation (P<0.001) between age and median days missed from work. Males had significantly higher rates of foot injuries (5.31) than females (3.80; P<.0001). Males also had higher rates of ankle injuries (4.96) than females (4.88; P=.453). Regression analysis showed the incidence rate of ankle sprains, ankle fractures, foot sprains, and foot fractures decreased from 2003-2019.Conclusion:This study demonstrates that the incidence rate and severity of workplace foot and ankle injuries are influenced by workers' age, gender, and the industry they work in. It shows that industries with higher days missed often did not have higher rates of injuries. Our results have the potential to be used to identify industries in need of additional safeguards to protect workers from injury and provide companies with information about the industry norm for rates of employee injuries and days missed from work for these injuries.

Younger Age, Capsular Repair, and Larger Preoperative Alpha Angles Are Associated With Earlier Achievement of Clinically Meaningful Improvement After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

The purpose of the study was to analyze demographic, radiographic, and intraoperative factors that influence the time to achieve the minimal clinically important difference (MCID) and maximum outcome improvement satisfaction threshold (MOIT) after primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and labral tear. Included patients had undergone hip arthroscopy with labral repair or reconstruction for FAIS with labral tear between February 2008 and October 2018. Patients were excluded if they had a prior ipsilateral hip surgery, prior hip conditions, a Tonnis grade > 1, or were unwilling to participate. Multiple demographic, radiographic, and intraoperative variables were collected. The modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) were collected before surgery and at 3 months, 1 year, and 2 years after surgery. The MCID and MOIT for the mHHS and NAHS were either calculated or determined through previously published values. A time-to-event analysis was performed to determine variables predictive of early or delayed achievement of MCID or MOIT. Early achievement was defined as achieving MCID or MOIT at the 3-month timepoint. Six hundred thirty-two hips (632 patients) were included. Of those that achieved MCID and MOIT, 428 (73.0%) and 414 (73.0%) patients achieved MCID and 253 (47.9%) and 264 (52.5%) patients achieved MOIT by 3 months after surgery for mHHS and NAHS, respectively. Younger age, capsular repair, and increasing alpha angle were associated with earlier achievement for either MCID or MOIT. Increasing age, worker's compensation claims, and higher baseline patient-reported outcome measure scores were associated with delayed achievement for either MCID or MOIT. Most of the patients who achieved MCID and MOIT for mHHS and NAHS did so by 3 months after surgery. Younger age, capsular repair, and increasing alpha angle were associated with earlier achievement of MCID and MOIT after hip arthroscopy. Level IV, case series.

Immigrant status, gender and work disability duration: findings from a linked, retrospective cohort of workers’ compensation and immigration data from British Columbia, Canada

ObjectivesTo compare differences in work disability durations of immigrant men and women injured at work to comparable Canadian-born injured workers in British Columbia, Canada.MethodsData on accepted workers compensation claims and...

Rheumatoid Arthritis Disability and Absence Trends in the United States

Objectives: Employers increasingly focus on absence benefits and connections with employee health. United States absence benefits include Sick Leave (SL), Short- and Long-Term Disability (STD and LTD, respectively) for non-work-related injuries/illnesses, and Workers’ Compensation (WC) for work-related injuries/illnesses. This research explores all-cause absence (SL, STD, LTD, and WC) utilization and changes from baseline for eligible employees with rheumatoid arthritis to determine if the use a constant payment factor is appropriate for models. Study Design: Retrospective multi-year database analysis. Methods: The Workpartners database (1/1/2001-12/31/2019) was used to identify employees with rheumatoid arthritis with adjudicated medical claims. Annual prevalence, benefit utilization, mean days of leave, and median payments (as % of salary) were analyzed. Annual outcomes were calculated as a percent of baseline (2001). Results: Rheumatoid arthritis prevalence averaged 0.5% between 2001 and 2019. At baseline, the percent of eligible employees using STD = 15.5%, LTD = 0.7%, WC = 1.7%, SL = 61.7%. Mean absence days were 48.5, 367.5, 43.8 for STD, LTD, WC, respectively and median payments were 70.5%, 22.2%, 65.7% of salary for STD, LTD, WC, respectively. From 2002-2019: 11.7%-16.9% of eligible employees filed STD claims for 82.1%-995.9% of baseline days and 80.4%-125.9% median payments; 0.6%-2.9% of eligible employees filed LTD claims for 66.6%-114.7% of baseline days and 63.2%-254.8% median payments; 0.3%-1.6% of eligible employees filed WC claims for 44.0%-472.8% of baseline days and 70.4%-271.5% median payments. Median payments were highest in 2012, 2019, 2003 for STD, LTD, WC, respectively and the most absence days were used in 2017 for SL and LTD, 2008 for STD, and 2005 WC. Conclusion: Employees with rheumatoid arthritis used absence benefits at differing rates over time with varying leave-lengths and payments. Using a constant cost or salary replacement factor for absence costs over time and across benefits is not accurate.

To stand or not to stand? Implications of prolonged standing for perioperative nurses: A discussion paper

Perioperative nurses, including perianaesthesia, instrument and circulating nurses, stand for most of their shift – anywhere from one to eight hours at a time. This prolonged standing has been linked to negative effects on health, increasing the incidence of musculoskeletal disorders, such as lower back pain and neck pain, and cardiovascular diseases, such as oedema, varicose veins and venous pooling. Given the impact these workplace injuries have on nurses, and on workplaces through financial costs associated with sick leave and/or workers compensation claims, surely prevention would be better than cure. While limited research exists to categorically suggest what prevention strategies are best, several options are available for consideration. The use of anti-fatigue mats has been associated with lower incidence of back pain. It is suggested that perioperative nurses consider using sit–stand stools, if available, and compression socks at 15–20 mmHg, if standing in a static position for long periods. Proper posture while standing – described as a neutral pelvis, natural thoracic curvature, flat abdomen, aligned shoulder, hip and ankles and an erect head – can assist in preventing disorders associated with prolonged standing. A combination of stretching and strength training for perioperative staff can help improve musculoskeletal symptoms experienced due to poor posture and tension, and the introduction of microbreaks has also seen improvements in concentration and comfort while reducing fatigue and discomfort. This paper will discuss the health effects of prolonged standing and provide information about ergonomic interventions, compression socks or stockings, stretching programs and microbreaks for perioperative nursing teams to consider.

A Passive Back-Support Exoskeleton for Manual Materials Handling: Reduction of Low Back Loading and Metabolic Effort during Repetitive Lifting

OCCUPATIONAL APPLICATIONS Globalization and eCommerce continue to fuel unprecedented growth in the logistics and warehousing markets. Simultaneously, the biggest bottleneck for these industries is their human capital. Where automation and robotic solutions fail to deliver a return on investment, humans frequently take over handling tasks that place harmful loads and strains on the body. Occupational exoskeletons can reduce fatigue and strain by supporting the lower spine and are designed to prevent work-related musculoskeletal disorders and other injuries. They are a mid- to long-term investment for industries to improve ergonomic conditions in workplaces, with the potential for reducing absences from work, sick days logged, and workers compensation claims. To examine the effectiveness of the newly introduced Paexo Back exoskeleton, a study was completed with 10 participants who completed manual load handling tasks with and without the exoskeleton. Key findings include significant reductions in metabolic effort and low back loading when the exoskeleton is worn.

IoT Based Fire Accident Detection System with Deep Learning Intelligence

A fire accident can be caused by many hazards, such as a propane tank, a defective product, a vehicle crash, or poor workplace safety. Because accidents involving fire are often unexpected and sudden, there isn’t a standard legal process for dealing with them, other than filing a negligence or workers compensation claim. This project aims to detect and monitor Fire Accident incidents well in advance and alert the surroundings to minimize the losses. This is an integration of IoT and Deep Learning Technologies, where sensors are used to collect the relevant data under the supervision of a controller unit. The controller unit collects and sends this data to a cloud database, from where the data for the Deep Learning model is fetched. This data is then used for making some insights and further predictive analytics. From the insights, many variables were found to be one of the reasons for a fire accident to take place. We considered the information about variables like Flame sensor, Temperature, Heat Index, GPS coordinates, Smoke, Type of Gases, Date, and Time for feature set generation and fed the model to a deep neural network for making future predictions. Comparing to existing conventional methods, this proposed method is different in terms of integrating deep learning with IoT. This method of approach will predict the chance of accidents priorly by classification of data.

A Retrospective Cohort Analysis of the Impact of Osteoarthritis on Disability Leave, Workers' Compensation Claims, and Healthcare Payments.

Objectives:Examine short-term disability (STD) and workers’ compensation (WC) associated leave and wage replacements, and overall direct healthcare payments, among employees with osteoarthritis (OA) versus other chronically painful conditions; quantifying the impact of opioid use.Methods:Analysis of employees with more than or equal to two STD or WC claims for OA or pre-specified chronically painful conditions (control) in the IBM MarketScan Research Databases (2014 to 2017).Results:The OA cohort (n = 144,355) had an estimated +1.2 STD days, +$152 STD payments, and +$1410 healthcare payments relative to the control cohort (n = 392,639; P < 0.001). WC days/payments were similar. Differences were partially driven by an association between opioid use, increased STD days/payments, and healthcare payments observed in pooled cohorts (P < 0.001).Conclusions:OA is associated with high STD days/payments and healthcare payments. Opioid use significantly contributes to these and this should be considered when choosing treatment.

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.

The stigma of digital amputation: a survey of amputees with analysis of risk factors.

The purpose of this study was to quantify the stigma associated with digital amputation and examine factors associated with it. One hundred and sixty-four digital amputees completed the Neurological Quality of Life-Stigma questionnaire and a battery of Patient-Reported Outcome Measurement Information System instruments. Multivariable analysis examined factors associated with stigma experience. The mean observed stigma score of 47 (SD 8, range 36-64) was similar to the mean value of the normal population. Younger age, a worker's compensation claim and depression were each independently associated with a more severe experience of stigma after digital amputation. Socioeconomic variables, anatomical details and mechanism of injury were not independently associated with stigma. Digital amputation is not highly stigmatizing overall. Surgeons should consider referring at-risk patients to a mental health provider for support during the coping and adjustment process after amputation.Level of evidence: III.

Disability and workers' compensation trends for employees with mental disorders and SUDs in the United States.

IntroductionUS employee absence benefits may include workers' compensation (WC) for work-related injuries/illnesses, short- and long-term disability (STD and LTD, respectively) for non–work-related injuries/illnesses, and discretionary sick leave (SL). Absences can significantly impact business performance, and employers are intensifying efforts to manage benefits and connections with employee health. This research compares all-cause STD/LTD/WC/SL use and variation from baseline (2002) for eligible employees (EMPs) with mental disorders (MDs) and SUDs to determine if use/payments varied over time.MethodsEmployees incurring medical claims with Agency for Healthcare Research and Quality MD and SUD ICD-9/10 codes were identified in the WorkPartners database (January 1, 2002 to December 31, 2019). Retrospective analysis was performed on annual prevalence, benefit use, mean days of leave, and median payments as a percent of salary (including lump-sum distributions and potentially extending beyond initiation year). WC claims without work absences were excluded. For each benefit, annual outcomes were calculated as a percent of baseline to show variability.ResultsUse was 48.1% to 202.2% (median, 102.8%) of baseline rates for SL (SUD-EMPs), and 87.3% to 108.4% (median, 97.3%) for STD (MD-EMPs). Days of LTD leaves were 21.5% to 657.8% (median, 359.2%) of baseline days (MD-EMPs), and 122.7% to 1042.2% (median, 460.0%) of baseline days for (SUD-EMPs). Median payments for WC were 78.6% to 253.6% (median, 114.6%) of baseline (MD-EMPs) and 97.9% to 481.6% (median, 104.0%) for SUD-EMPs.DiscussionEmployees with MD/SUD used absence benefits at differing rates over time with varying days of leave and payments as a percent of salary. Using a constant cost or salary replacement factor over time for all benefits is not accurate or appropriate.