Workmen's Compensation Research Articles

American Risk and Insurance Association Presidential Address is ARIA Facing a Mid-Life Crisis?

Almost any publication one picks up today discusses mid-life crises of individuals. Questions such as following often are asked: Where has one been? What should one really be doing? What does one want to do with rest of one's life? Since ARIA is entering its 50th Anniversary year, it seems appropriate to look at what ARIA has achieved and to speculate on what it wants to be and do for rest of its life. In pursuing this theme, I was looking at a publication in our field, and some of articles reflected many of today's major themes. Among them were: Effect of Inflation Upon Life Insurance, 1 Would Federal Control of Insurance Mean Improvements? '2,9 Is a Change in Investment Policy of Life Insurance Companies Toward Greater Liquidity Desirable?3, Should Surrender and Loan Values be Restricted?4, Instruction in Insurance Curricula and Teaching Methods, 5 University Instruction for Insurance Leadership, 6 and Condition of Workmen's Compensation Business. 7 What is interesting is that these titles did not come from June issue of Journal of Risk and Insurance, Best's Insurance Review, or The National Underwriter, but from Proceedings of first two Annual Meetings of this Association fifty years ago. The validity of adage the more things change, more they remain same is evident in risk management and insurance field. It is appropriate to study history to see what lessons we can learn from our past. In reviewing our Association's Proceedings and Journals of past

Study on the Low Back Pain Caused by Strain (5) : Problems of the Application of Workmen's Compensation

Study on the Low Back Pain Caused by Strain (5) : Problems of the Application of Workmen's Compensation

Outputs and Outcomes of State Workmen's Compensation Laws

OVER THE PAST TWO DECADES, political scientists have given a great deal of attention to questions concerning variations in state policies. The primary focus of these studies has been on the relative impact of socioeconomic and political variables on state policy. The most frequent conclusion of most of the studies was that politics played only a marginal role in explanations of state policy variations.' Obviously these findings did not bode well with many political scientists who viewed this as a challenge to their raison d'etre.2 Later studies that reconceptualized political variables and policy

Insurance Practices of Utility Contractors

The experiences and practices concerning construction-related insurance were the focus of a nationwide survey conducted with utility contractors. The survey obtained information related to: contract requirements for insurance, general liability coverage, workmen's compensation insurance, particular services provided by insurance companies, and specific practices of contracting firms relating to insurance matters. The results show specific differences of the practices of contractors depending on whether the owner is public or private. Additional differences were noted in the practices of firms in differing sizes. In general, the different practices of contractors appear to reflect differences in business philosophy or in the in-house capability of company personnel.

The Role of the Defense Psychiatrist in Workmen's Compensation Cases

Tomorrow's psychiatrist should be more cognizant, competent, and comfortable in forensic science matters. Psychiatric cases are increasingly the subjects of litigation, but justice in the court depends on able advocacy by all parties. Advocacy for patient-plaintiffs is more similar to customary clinical roles than is advocacy for defendant insurance companies, which nevertheless are as needful of competent psychiatric experts as patient-plaintiffs if justice is to be done. Ironically, defense psychiatrist can do much to help patient-plaintiffs if they understand their roles correctly. Since legal systems are designed to produce justice, not therapy, the forensic competence of future psychiatrists will help to make litigation more therapeutic and just for patients. This paper describes the peculiarities of psychiatric work in litigated workmen's compensation cases, focusing on the role of the defense psychiatrist. We will highlight the constructive and therapeutically gratifying potentials of this work. Greater familiarity with the process will help to enlist the interest and participation of psychiatrist in workmen's compensation cases for the ultimate benefit of the patients and improvement of the legal system.

Pain control: mastery through group experience.

This paper describes a group program which is part of the therapeutic management of out-patients with chronic pain at the multidisciplinary Pain Clinic in Hamilton, Ontario (McMaster Division, Chedoke-McMaster Hospital). The programme seeks to assist chronic pain sufferers in developing more adaptive coping styles. Groups of 12--14 patients meet for 9 weeks, 3 h/week, under the co-leadership of a physiotherapist and an occupational therapist with backgrounds in psychology and psychiatry. Seventy-five patients with diverse aetiologies of chronic pain have completed these "pain control classes". Outcome was assessed on the basis of several parameters. Results indicate a considerable reduction in depression, pain perception and analgesic intake. Conversely, employment figures increased from 20 to 48% after completion of the program. 21% were considered failures. Significant variables differentiating successes from failures were sex, marital status, work incentive, employment and absence of litigation or Workmen's Compensation claims.

Imperfect job risk information and optimal workmen's compensation benefits

If workers have imprecise, but unbiased risk perceptions, they will accept a lower wage and less of a marginal wage reduction in response to an increase in injury compensation or a reduction in risk. Market outcomes will provide too little compensation and too great a job risk, as compared with the perfect information case. The optimal workmen's compensation policy will provide a supra-optimal benefit level in an effort to create incentives for safety. The signaling function of market-provided injury compensation will eliminate the bias in worker priors and increase their precision, eliminating the market failure in some instances.

Sensitivity Analysis of Workers' Compensation Costs

The authors develop a deterministic model to review several factors influencing workers' compensation costs and the decision to self-insure. Variables examined include magnitude of losses, the relationship between primary and excess losses, differences in costs among states, interest rates, wage rate increases, and loss payout patterns. The study shows the effect that a given change causes. It provides evidence that suggests that firms with relatively low primary losses would be more likely to insure. Also, relatively short payout schedules and low interest rates favor the decision to insure. Sensitivity Analysis of Workers' Compensation Costs Workers' compensation has been a major commercial line of insurance for many years. It has become even more important since the National Commission of State Workmen's Compensation Laws published its report in 1973. This report made numerous recommendations to increase the level and scope of workers' compensation benefits. Besides making the recommendations, it threatened to create and make federal standards applicable to all states if actions were not taken by the states to improve their laws. As a direct result of the commission's work, the state workers' compensation laws have been modified to give more persons coverage and have increased benefits. This action, coupled with high rates of inflation, has caused the cost of workers' compensation to skyrocket the last several years. Insurance premium rates have been escalating and yet they still are inadequate. Employers are concerned because the already high rates face the possibility of further increases. For this reason, alternative plans of action including loss retention are being investigated. Purpose. The objective of this paper is to develop a deterministic model that can be used to examine various factors that affect workers' compensation costs. Some of the factors investigated include the relationship between primary and excess losses, differences in benefits among states, interest rates, wage rate increases, and loss payout patterns. The purpose of these sensitivity

Skin Telangiectases in Workers at an Aluminum Plant

OCCUPATIONAL-HEALTH physicians from a large Canadian aluminum company recently noticed the presence of numerous telangiectases on the skin of some production workers. Called to investigate, the Workmen's Compensation Commission confirmed the presence of these lesions. Some affected workers complained of the appearance of the lesions and worried about their effects on health. Researchers from the Soviet Union have reported the presence of telangiectases in workers at an aluminum electrolysis plant,1 but the lesion has received little or no attention in the Western medical literature.We attempted to determine whether these skin lesions were related to work in aluminum and to . . .

"Supraspinatus slide" for rotator cuff repair.

The supraspinatus slide procedure described by Debeyre et al. (1965) offers an opportunity for the surgeon to repair certain large and late ruptures of the rotator cuff. In order to re-appraise this procedure and clarify its indications, the authors performed the following study: Firstly 37 rotator cuff ruptures repaired by this method were reviewed. Most of the patients were supplied by the Workmen's Compensation Board of Ontario. The review period was from 1968 to 1977. Secondly, the surgical anatomy of the area was reviewed. Twenty-two (60%) of the patients obtained satisfactory results. They were relieved of pain, gained functional improvement and returned to their previous or a modified occupation. Although the vulnerability of the suprascapular nerve and artery was demonstrated in anatomical dissections, no neurological sequelae were noted and the muscle remained viable in all patients. Electro-myographical studies failed to show supraspinatus muscle denervation in any case. The procedure proved to be useful in the repair of large rotator cuff ruptures that are not amenable to other methods of repair. A young well motivated patient with chronic disability may benefit from this procedure.

Workmen's compensation hearing loss claims.

This presentation deals with the evaluation of occupational hearing loss claims, the tests used over the years to determine the hearing status of the claimants, and the various methods used to convert the results of the audiometric tests in terms of percentage of hearing impairment. A significant modification of the 1961 American Medical Association formula has recently been adopted by the Board of Directors of both the American Academy of Otolaryngology and the American Council of Otolaryngology. The modified formula has been published: "Guide for the Evaluation of Hearing Handicap," JAMA, 241, (19): May 11, 1979. The reasons for this modification and its application in the evaluation of occupational hearing loss claims are discussed. Otolaryngologists are urged to become acquainted with the modified AAO formula and to apply it in the evaluation of hearing loss claims.

The Future of Workers' Compensation

Dissatisfied with state workers' compensation laws, business interests, labor unions, state compensation bureaus, self insurers, and private insurance carriers, despite their disparate interests, increasingly agree that such laws are in need of significant revision. But the call for reform has been heard before. In 1972, the National Commission on State Workmen's Compensation Laws (hereinafter referred to as the National Commission) reported to the President and Congress that “… the protection furnished by workmen's compensation to American workers presently is, in general, inadequate and inequitable.”Between 1972 and 1977 hundreds of state laws were enacted in response to the recommendations of the National Commission and the threat of federalization. Yet, in its 1977 report to the President and Congress, the Policy Group of the Interdepartmental Workers' Compensation Task Force concluded:

Sounding board. The future of chiropractic.

What is to be done about chiropractors? Efforts by organized medicine to eliminate them have been unsuccessful. The label "quack" has not stuck. Despite the most strenuous opposition, they have attained licensure in every state in the United States and in Canada and many foreign countries. Over 23,000 chiropractors treat some 8 million Americans for a wide variety of conditions. Reimbursement for their services has been authorized by Medicare, Medicaid, Workmen's Compensation plans, and by many Blue Shield plans and other private insurance carriers. Chiropractors received more than $30 million of Medicare funds in 1978. Over 2000 new chiropractors will . . .

The effect of prolonged exposure to industrial noise on otosclerosis.

More than 3000 workers referred by the Workmen's Compensation Board of Ontario have been evaluated for pension for industrial hearing loss. They include the normal proportion of otosclerotics, many of whom have had surgical therapy. The operations have been done by a wide variety of surgeons in the province of Ontario, and the results are representative of those which will be obtained in a large section of the Canadian community. The results are significantly worse than generally quoted, and some of the deficiencies are attributable to occupation. These include perilymph fistula from excessive straining and sensorineural hearing loss due to noise exposure. Detailed results will be presented.

The Administrative Cost of Income Security Programs: Ontario and Canada

This is a study of the administrative costs of six income security programs, three Ontarian (provincial allowances, workmen's compensation, and municipal allowances) and three national (unemployment insurance, old age programs, and family allowances). M. Mendelson attacks two 'popular opinions,' or hypotheses. The first is that a great deal of the expenditures on income security programs is used to retain armies of civil servants (such as those toiling in Queen's Park and Ottawa) rather than being used to help the recipients. The second is that the amount spent on the former in comparison with the latter has been increasing in recent years. Perhaps to no informed person's surprise, Mendelson demonstrates that administration runs as little as less than 1 per cent to about as much as 8 per cent of total program costs. He concludes that 'there appears to be little scope for reducing the total budgets of income security programs through reducing administrative expenses' (p.83 ). Two specific questions are asked: have individual income security programs tended towards greater or lesser administrative costs per case over time, and what is the percentage of administrative cost to total costs? Mendelson selects a variety of measures of administrative cost to suit each program studied. For family allowances and old age programs he uses administrative cost per enrolled case. For unemployment insurance and workmen's compensation, he selects cost per claim submitted, a measure of case load flow. In the case of provincial allowances he has used caseload stock, the average number of persons enrolled. Mendelson's discussion of the methodology and selection of measurements is concise, clear, and correct. Workmen's compensation and unemployment insurance have enjoyed greater notoriety in recent years than the other programs studied. In the former, Mendelson concludes that administrative costs have remained a constant or decreasing proportion of total costs of the seventeen years for which he obtained data, about 8 per cent. In unemployment insurance costs have been very unstable over the past eleven years. With greater demand, administrative costs in relation to total costs have fallen from over 13 per cent in 1965-66 to 51/2 per cent ten years later. But the trend of costs per claim is less clear, although Mendelson calculates that they have risen since the introduction of the new Act in 1971. Mendelson vigorously suggests that those wishing to lower government expenditures had better forget singling out the administrative costs of unemployment insurance. While in absolute terms a reduction of 5-10 per cent of these costs might mean a saving of $10-20 million, a 10 per cent reduction only means about Y per cent of total transfers. A grand reduction of costs could be achieved by replacing all programs with one single demogrant program providing fixed monthly payments to every Canadian. But as Mendelson points out, the reduced costs would be only one of the possible consequences of that action. Policy planners will find his study useful. While it does not provide solutions to current problems associated with income security programs (and that was not its intention), it does shed enough light to suggest that reformers had better think of grander designs. Merely tinkering with administrative costs is only a very small contribution to a more adequate and efficient security delivery system.

Workmen's Compensation

Workmen's Compensation

STATE COMPLIANCE WITH WORKMEN'S COMPENSATION RECOMMENDATIONS

ABSTRACTThe Occupational Safety and Health Act of 1970 established the National Commission on State Workmen's Compensation Laws. The National Commission was directed to “undertake a comprehensive study and evaluation of State workmen's compensation laws in order to determine if such laws provide an adequate, prompt, and equitable system of compensation”. In 1972 the Commission issued its report, and “criticized many aspects of state workmen's compensation programs”. In its report the Commission made eighty–four recommendations for a “moder” workmen's compensation program and designated nineteen of these as “essential”. This research traces state progress in complying with each of these nineteen essential recommendations. Between 1972 and 1977 many states made significant improvements in their workmen's compensation programs and overall there was a 34 percent increase in compliance during this period. Higher levels of compliance were found to be related to two factors: changes in industrial diversification and the involvement and activity of vitally concerned interest groups.

Worker's Compensation Coverage for the Self-Employed: The Israeli Experience

self-employed typically are excluded from workers' compensation coverage because of alleged high administrative costs and fear that they will claim benefits for non-work accidents. Israel has covered the selfemployed for more than 20 years; its experience, therefore, is useful assessing these two allegations. Israel's administrative cost for the selfemployed is much higher than that for wage and salary workers. While little support exists for the view that the self-employed claim benefits for non-work accidents, the number of work days lost per accident by the selfemployed is much higher than that for wage and salary workers. Virtually all countries have some system of compensation for work-connected injuries and occupational illness. These programs cover wage and salary workers, and typically exclude the self-employed. In this 1973 study of social security programs ten major developed countries, Kaim-Caudle concluded: The self-employed benefited only rarely from protection against workconnected injuries. only countries which provided schemes for certain of the self-employed were Austria, Germany, and Denmark and even there the conditions and terms were less favorable than those applying to [1, p. 100]. According to the Department of Health, Education, and Welfare's 1977 survey of Social Security Programs Throughout the World, about a fourth of the 129 countries with workers' compensation statutes provide some kind of coverage for the self-employed [5, pp. xviii-xix]. self-employed are not covered because of (a) alleged high administrative costs and (b) the danger of abuse. According to Kaim-Caudle, in any scheme restricted to industrial accidents, it is fairly easy for the self-employed to claim benefit for accidents which are not work-connected. quantitative importance of this can easily be exaggerated, but the fear of abuse is Joseph Krislov is Professor of Economics at the University of Kentucky. He holds the Ph.D. degree. Professor Krislov has been Visiting Professor at Tel-Aviv University and a Fulbright Professor at Trinity College, Dublin. He was employed six years as a Research Analyst for the U.S. Social Security Administration. Yehuda Kahane is Senior Lecturer and Academic Director, Erhard Insurance Center, Faculty of Management, Tel-Aviv University. He holds the Ph.D. degree. Dr. Kahane taught at Hebrew University of Jerusalem, University of Florida, University of Toronto, and currently is visiting at the Research Center for Risk and Insurance at the Instituto de Estudios Superiores de Administration, Caracas, Venezuala. authors would like to thank Mrs. Yechiela Bern, Ms. Rivka Pri-Or, and Mr. Igal Volozni, deputy actuary, the National Insurance Institute (Israeli Social Security), for help preparing the data and for their critical comments. This content downloaded from 157.55.39.162 on Thu, 11 Aug 2016 05:38:02 UTC All use subject to http://about.jstor.org/terms 114 Journal of Risk and Insurance uppermost the minds of many policy-makers all over the world [1, p. 1001. Israel has covered its self-employed from 1957 [2, pp. 252-2541, and that country's experiences should be helpful deciding whether the two objections are Specifically this paper seeks to determine (1) the extent of abuse by the selfemployed and (2) the administrative cost providing coverage. If the objections to coverage are valid, then some estimates of the increased costs would emerge. Presumably, other countries contemplating coverage of the selfemployed would incur similar costs and then would be a position to make a political decision whether to incur these additional costs. Some interest has been expressed the United States workers' compensation for the self-employed. 1972 National Commission of State Workmen's Compensation Laws pointed out that workers' compensation originated by covering employees only, and that coverage has not been extended beyond this group. Commission concluded, however, that we are not convinced that the practice of confining workmen's compensation to employees remains valid. It specifically recommended that coverage be made available, on an optional basis, for the self-employed [6, p. 48]. Optional coverage for some self-employed was available some jurisdictions even before 1972, but only a few individuals apparently elected such coverage. Administrative Costs At the authors' request, the Israel National Insurance Institute prepared some special tabulations allocating the administrative costs for the fiscal years 1974, 1975, and 1976. agency's administrative cost data for fiscal 1977 are not strictly comparable with those for previous years, and therefore that year was not included the analysis. Table 1 indicates that total administrative costs as a percentage of premium income for the self-employed and the wage and salary worker have fluctu-

Failed lumbar disc surgery and repeat surgery following industrial injuries.

One hundred and seventy-nine of the compensation patients in this study who had one low-back operation had to have repeat back surgery. One hundred and three Workmen's Compensation Board patients who were reoperated on by a number of surgeons in the Toronto area were independently reviewed with one to two years of follow-up. Many had residual back pain, limited lumbar movement, presisting nerve-root deficits, and psychological disturbances. Forty per cent of the second operations were successful. Subsequent operations yielded progressively poorer results and made more patients worse than better. Operations were frequently undertaken without clear indications or evidence of correctable organic lesions. The results of repeat operations were better when the preceding operation had given more than six months' relief, when sciatica overshadowed back pain, and when a definite recurrent disc herniation was found. Scarring and neurolysis, previous infection, repair of a pseudarthrosis, and adverse psychological factors precluded a good result. Careful patient selection based on total evaluation of the disability including psychological assessment, accurate localization of the lesion by detailed investigation, and, most important, a logical sequence of decisions based on clear, objective criteria are prerequisites for this complex and demanding surgery. Caution and restraint are required when contemplating repeat back surgery.

Legal ramifications of the medical definition of back disease.

Back pain occurring without external force is extraordinarily prevalent in all segments of society. The practicing internist is often faced with the complaint, a need to define its cause, and a request to render an opinion as to whether the patient is disabled in the context of his employment. This opinion will have some weight in determining compensability under workmen's compensation law. This essay examines the inferences, as regards back pain, upon which compensation law is based. These inferences are then tested in light of our current understanding of the pathophysiology of back pain. A number of fallacies become apparent that may provide impetus for remedial legislation and clearly mandate further clinical investigation.