Precarious employment and workers' compensation

Differential impacts of reduced worktime on work-life balance in Korea

This study analyzes the heterogenous effects of reducing weekly work hour on workers' quality of life in Korea. Using longitudinal household data from the Korean Labor and Income Panel Study (KLIPS) from 2001 to 2017, this study aims to shed light on how the work hour reduction policy may differently affect workers with different levels of resources and support by demographic and socioeconomic status. Our estimates from the difference-in-differences approach exploiting the staggered implementation of the work hour reduction policy indicate that the policy increased leisure satisfaction of female workers with low educational level and female workers in regular or inflexible work setting. Given Korea's exceedingly long working hours and inequities in the labor market, a better understanding of the complex factors that affect work-life balance can be helpful in developing policies supportive of healthy work-life balance for workers. This study, to our knowledge, is the first to investigate the composition of workers in the Korean labor market and examine differential impacts of the workhour reduction policy by demographic and socioeconomic status.

Development and maturation of the occupational health services research field in the United States over the past 25 years: Challenges and opportunities for the future

Work is an important social determinant of health; unfortunately, work-related injuries remain prevalent, can have devastating impact on worker health, and can impose heavy economic burdens on workers and society. Occupational health services research (OHSR) underpins occupational health services policy and practice, focusing on health determinants, health services, healthcare delivery, and health systems affecting workers. The field of OHSR has undergone tremendous expansion in both definition and scope over the past 25 years. In this commentary, focusing on the US, we document the historical development and evolution of OHSR as a research field, describe current doctoral-level OHSR training, and discuss challenges and opportunities for the OHSR field. We also propose an updated definition for the OHSR field: Research and evaluation related to the determinants of worker health and well-being; to occupational injury and illness prevention and surveillance; to healthcare, health programs, and health policy affecting workers; and to the organization, access, quality, outcomes, and costs of occupational health services and related health systems. Researchers trained in OHSR are essential contributors to improvements in healthcare, health systems, and policy and programs to improve worker health and productivity, as well as equity and justice in job and employment conditions. We look forward to the continued growth of OHSR as a field and to the expansion of OHSR academic training opportunities.

What Social Supports Are Available to Self-Employed People When Ill or Injured? A Comparative Policy Analysis of Canada and Australia

Self-employment (SE) is a growing precarious work arrangement internationally. In the current digital age, SE appears in configurations and contours that differ from the labor market of 50 years ago and is part of a ‘paradigm shift’ from manufacturing/managerial capitalism to entrepreneurial capitalism. Our purpose in this paper is to reflect on how a growing working population of self-employed people accesses social support systems when they are not working due to injury and sickness in the two comparable countries of Canada and Australia. We adopted ‘interpretive policy analysis’ as a methodological framework and searched a wide range of documents related to work disability policy and practice, including official data, legal and policy texts from both countries, and five prominent academic databases. Three major themes emerged from the policy review and analysis: (i) defining self-employment: contested views; (ii) the relationship between misclassification of SE and social security systems; (iii) existing social security systems for workers and self-employed workers: Ontario and NSW. Our comparative discussion leads us toward conclusions about what might need to be done to better protect self-employed workers in terms of reforming the existing social security systems for the countries. Because of similarities and differences in support available for SE’d workers in the two countries, our study provides insights into what might be required to move the different countries toward sustainable labour markets for their respective self-employed populations.

Self-employment, work and health: A critical narrative review

BACKGROUND

Self-employment (SE) is a growing precarious and non-standard work arrangement internationally. Economically advanced countries that favor digital labor markets may be promoting the growth of a demographic of self-employed (SE'd) workers who are exposed to particular occupational diseases, sickness, and injury. However, little is known about how SE'd workers are supported when they are unable to work due to illness, injury, and disability.

OBJECTIVE

Our objective was to critically review peer-reviewed literature focusing on advanced economies to understand how SE'd workers navigate, experience, or manage their injuries and illness when unable to work.

METHODS

Using a critical interpretive lens, a systematic search was conducted of five databases. The search yielded 18 relevant articles, which were critically examined and synthesized.

RESULTS

Five major themes emerged from the review: (i) conceptualizing SE; (ii) double-edged sword; (iii) dynamics of illness, injury, and disability; (iv) formal and informal health management support systems; and (v) occupational health services and rehabilitation.

CONCLUSION

We find a lack of research distinguishing the work and health needs of different kinds of SE'd workers, taking into consideration class, gender, sector, and gig workers. Many articles noted poor social security system supports. Drawing on a social justice lens, we argue that SE'd workers make significant contributions to economies and are deserving of support from social security systems when ill or injured.

It may cost an arm and a leg: workers value and occupational fatality rates in the U.S

BACKGROUND

The present study aims to observe how societal indicators of workers' values at the state-level are related to health and safety outcomes, particularly major injuries and fatalities in the U.S. Underscoring workforce flexibility and workability over workforce stability and safety might be indicative of the worth of workers which can be associated with occupational safety and health concerns.

METHODS

Linear regression analysis with a log-transformed dependent variable was adopted to examine how the state-level indicators of worker value in terms of 1) minimum wage, using data from 2015; 2) average of workers' compensations for the loss of an arm, hand, leg, or foot in 2015 were concurrently and prospectively associated with occupational fatality rates averaged across 2015, 2016 and 2017. Socioeconomic contextual variables such as education level, GDP per capita, and population at the state-level were controlled for.

RESULTS

The present study showed that state-level quantitative indicators of how workers are valued at work, namely minimum wage and workers' compensation benefits, were significantly and negatively associated with fatality rates in the following year.

CONCLUSIONS

The present study illustrates the gap in how workers are valued across the U.S. The study speaks to the importance of contextual factors regarding worker value, as they can affect outcomes of health and safety culminating at a state-level.

Organisational factors and under-reporting of occupational injuries in Sweden: a population-based study using capture-recapture methodology

Objective

To estimate the magnitude of under-reporting of non-fatal occupational injuries (OIs) by different organisational factors in Sweden for the year 2013.

Methods

Capture–recapture methods were applied using two data sources: (1) the national OI register and (2) records from a labour market insurance company. To assure comparability of data sources, the analysis was restricted to the public sector and private companies with at least 50 employees. OIs were matched using personal identification number and reported injury dates (±7 days). Organisational factors were obtained from the national labour market register and injury severity (no healthcare/only outpatient/hospitalised) from the National Patient Register. Total number of OIs and ascertainment by data sources were estimated assuming data source independence.

Results

There were an estimated 98 493 OIs in 2013. Completeness of reporting OIs to the national register and to the insurance company was estimated at 73% and 43%, respectively. No report to either source was estimated at 15 000 OIs (~15%). Under-reporting to the national register differed by selected organisational factors, being higher among organisations in the public sector, those with more females, with a younger workforce and with a higher proportion of immigrants. Overall under-reporting was more common in agriculture (19.7%), other services (19.3%), commerce and hospitality (19.1%), health (18.4%) and education (18.4%). Under-reporting decreased as injury severity increased, with little variations across sectors of economic activity.

Conclusions

Results suggest considerable under-reporting of OIs in Sweden and differential under-reporting by organisational factors. Results are relevant for official estimates of burden and for setting priorities for workplace safety and prevention.

Lack of English proficiency is associated with the characteristics of work- related injury and recovery cost in the Victorian working population

BACKGROUND

Migrant workers have been identified in Europe, North America, Asia and Australia as a particularly vulnerable working population with a higher risk of work-related injury and mortality compared to non-migrant workers. Lack of English language proficiency is associated with an increased risk of work-related injury. Whether lack of English proficiency influences post-injury recovery or return to work outcomes remains unknown.

OBJECTIVE

Using administrative data from a population based workers' compensation dataset in the state of Victoria, Australia, we aimed to examine work-related injury rates, worker characteristics and compensation outcomes in workers who were not proficient in English. We hypothesized that the use of an interpreter service would be associated with a poorer post-injury recovery profile and worse return to work outcomes.

METHODS

WorkSafe Victoria accepted non-fatal claims for injuries and illnesses reported between January 1, 2003, and December 31, 2012 by workers aged 15 to 74 (n = 402, 828 claims) were analysed. Consistent with prior research, we selected "use of an interpreter service" as the indicator of English language proficiency. The total and categorical compensable cost of recovery was used as recovery outcomes.

RESULTS

Of these claims, 16,286 (4%) involved the use of an interpreter service (LOTE workers). Our analysis revealed that Victorian injured LOTE workers have significantly different demographic, occupational and injury characteristics compared to non-LOTE injured workers. Furthermore, we present novel evidence that LOTE status was associated with poorer long-term injury outcomes, observed as a greater healthcare utilisation and larger paid income benefits, after controlling for occupation, employment status and injury type compared to non-LOTE injured workers.

CONCLUSIONS

These data suggest that English language proficiency is associated not only with the risk of work-related injury but also to the long-term recovery outcomes. We conclude that despite access to language interpreter services, injured LOTE workers experience English language proficiency dependent, and injury severity independent, recovery barriers which need to be overcome to improve long term recovery outcomes.

Concerns About Claiming, Postclaim Support, and Return to Work Planning: The Workplace's Impact on Return to Work

OBJECTIVE

The aim of this study was to determine how injured Australian workers perceived employer emotional (eg, empathy) and instrumental [eg, return-to-work (RTW) planning] support during the RTW process and examine associations between support and RTW.

METHODS

Using data from the 2014 National Return to Work Survey of injured workers with a workers' compensation claim, multinomial regression models examined relationships between support and RTW.

RESULTS

Receiving support and developing RTW plans were significantly associated with a greater likelihood of RTW. When controlled for one another in a single model, postclaim support had the strongest association with RTW, with RTW planning also significantly and positively associated with RTW.

CONCLUSION

Provision of both emotional and instrumental support are important employer-led work disability management interventions. Research is required to develop strategies for increasing employer support to lead to improved RTW outcomes for injured workers.

Potential Unintended Effects of Standardized Pain Questionnaires: A Qualitative Study

OBJECTIVE

Low back pain is a common musculoskeletal condition with substantial individual and societal costs. Standardized self-report questionnaires are commonly used in clinical practice to identify prognostic risk factors and tailor interventions for low back pain. However, most of these low back pain questionnaires have been developed in Western cultures and may not be clinically applicable to other cultures. These cultural aspects have not been explored. This study aimed to investigate the cultural assumptions underlying back pain questionnaires and the potential implications of using standardized questionnaires with non-Western populations.

DESIGN

An interpretive qualitative design was employed.

SUBJECTS

Participants (N = 16) self-identified as coming from culturally and linguistically diverse backgrounds.

METHODS

Data collection and analysis were guided by thematic analysis. Four focus groups of three to five participants were conducted during which participants discussed two questionnaires commonly used in low back pain settings: the Fear-Avoidance Beliefs Questionnaire and Örebro Musculoskeletal Pain Questionnaire.

RESULTS

Analysis identified four themes: questionnaires affect the patient-clinician encounter; results are not only about back pain; questionnaires affect people's understanding of their back pain; and results potentially affect people's lives beyond their back condition.

CONCLUSIONS

Findings suggest that questionnaires could potentially negatively affect the patient-clinician rapport and lead to inaccurate and unanticipated results when used with culturally and linguistically diverse populations. Findings are also likely to be applicable to people with low back pain more broadly, regardless of culture. Implications include a need for cultural sensitivity when using questionnaires, greater consideration of when to use these measures, and adaptations to the use/design of standardized questionnaires.

Work injuries in internal migrants to Alberta, Canada. Do workers' compensation records provide an unbiased estimate of risk?

INTRODUCTION

It is not known whether out-of-province Canadians, who travel to Alberta for work, are at increased risk of occupational injury.

METHODS

Workers' compensation board (WCB) claims in 2013 to 2015 for those injured in Alberta were extracted by home province. Denominator data, from Statistics Canada, indicated the numbers from Alberta and Newfoundland and Labrador (NL) employed in Alberta in 2012. Both datasets were stratified by industry, age, and gender. Logistic regression estimated the risk of a worker from NL making a WCB claim in 2013 or 2014, stratified by time lost from work. Bias from under-reporting was examined in responses to injury questions in a cohort of trades' workers across Canada and in a pilot study in Fort McMurray, Alberta.

RESULTS

Injury reporting rate in workers from NL was lower than those from Alberta, with a marked deficit (odds ratio [OR] = 0.17; 95% confidence interval [CI], 0.12-0.27) for injuries resulting in 1 to 30 days off work. Among the 1520 from Alberta in the trades' cohort, 327 participants reported 444 work injuries: 34.5% were reported to the WCB, rising to 69.4% in those treated by a physician. A total of 52 injuries in Alberta were recorded by 151 workers in the Fort McMurray cohort. In logistic regression, very similar factors predicted WCB reporting in the trades and Fort McMurray cohorts, but those from out-of-province or recently settled in Alberta were much less likely to report (OR = 0.02; 95% CI, 0.00-0.40).

CONCLUSION

Differential rates of under-reporting explain in part the overall low estimates of injuries in interprovincial workers but not the deficit in time-loss 1 to 30 days.

Coverage Gaps and Cost-Shifting for Work-Related Injury and Illness: Who Bears the Financial Burden?

The heavy economic burden of work-related injury/illness falls not only on employers and workers' compensation systems, but increasingly on health care systems, health and disability insurance, social safety net programs, and workers and their families. We present a flow diagram illustrating mechanisms responsible for the financial burden of occupational injury/illness borne by social safety net programs and by workers and their families, due to cost-shifting and gaps in workers' compensation coverage. This flow diagram depicts various pathways leading to coverage gaps that may shift the burden of occupational injury/illness-related health care and disability costs ultimately to workers, particularly the most socioeconomically vulnerable. We describe existing research and important research gaps linked to specific pathways in the flow diagram. This flow diagram was developed to facilitate more detailed and comprehensive research into the financial burden imposed by work-related injury/illness, in order to focus policy efforts where improvement is most needed.

The anti-therapeutic effects of workers' compensation in China: The case of seafarers

Workplace injuries are a serious public health problem, potentially leading to loss of earnings, medical expenses, disability and even death for working people. Maritime transport workers - seafarers - are exposed to higher risks of workplace injuries than is the general land-based workforce. China has the world's largest population of international seafarers. Under Chinese law, as elsewhere, losses from workplace accidents are compensated in the form of financial entitlements. However, Chinese seafarers face tremendous challenges in the workers' compensation claim process. This paper investigates the experiences of Chinese seafarers in claiming this compensation, in order to assess the protective capacity of Chinese workers' compensation, known as the Work-Related Injury Insurance System. Drawing on therapeutic jurisprudence, it explores the anti-therapeutic effects that Chinese seafarers confront in the claims process. Based on an analysis of regulatory documents and interview data with the informants - including seafarers, their family members and managerial professionals in the shipping industry - the findings suggest that current work-related injury insurance is unable to provide sufficient assistance for Chinese seafarers. Instead of obtaining effective therapeutic remedies following accidental trauma, Chinese seafarers (and their families) are indeed likely to suffer additional harm in the process of claiming compensation. The paper suggests that further measures should be adopted to improve work-related injury insurance coverage among seafarers, and that efficient sanctions should be strengthened against infringements of seafarers' rights.

Nurses' Inclination to Report Work-Related Injuries: Organizational, Work-Group, and Individual Factors Associated with Reporting

Work-related injuries such as back strain are common among health care workers. Work-related injury data are a primary data source with which managers can assess workplace safety, yet many work-related injuries go unreported. This study examined organizational, work-group, and individual factors, and nurses' inclination to report a work-related injury. Using a cross-sectional mailed survey, a probability sample of currently employed nurses (N = 1,163) indicated their inclination to report a workplace injury. Inclination to report injuries was higher in organizations with onsite health programs and when health and safety committees included non-management nurses and occupational health representatives. Reporting was reduced when nurses felt a lack of concern for staff welfare from supervisors and a climate of blame for worker injuries were present Nurses were also less inclined to report work-related injuries when working in jobs with non-standard work arrangements. Improvements in the reporting climate may influence the completeness and, thus, the value of injury data for identifying hazards in the workplace. These data could provide valuable information for targeting preventive initiatives.

Disparities in precarious workers' health care access in South Korea

BACKGROUND

This study explored whether precarious workers have difficulties in health care access as compared with non-precarious workers.

METHODS

The 2008 Korean Community Health Survey data were used for this study. Information was obtained on 51,322 participants (40,514 non-precarious workers and 10,808 precarious workers). Precarious workers were defined as part-time or contingent workers.

RESULTS

Precarious workers had significantly higher risk of limited access to hospitals (OR = 1.14; 95% CI: 1.06-1.22) and dentists (OR = 1.28; 95% CI: 1.21-1.36) than non-precarious workers; disparities in doctor contacts among precarious workers were mostly linked to not having enough money. The risk of not receiving preventive care-medical checkups (OR = 0.52; 95% CI: 0.49-0.55) or cancer screenings (OR = 0.82; 95% CI: 0.77-0.86)-was also significantly elevated among precarious workers.

CONCLUSION

We found that precarious workers had more difficulty accessing health care or receiving health checkups or cancer screenings than their non-precarious counterparts. Am. J. Ind. Med. 59:1136-1144, 2016. © 2016 Wiley Periodicals, Inc.

Wounding the Messenger: The New Economy Makes Occupational Health Indicators Too Good to Be True

The U.S. Bureau of Labor Statistics and workers' compensation insurers reported dramatic drops in rates of occupational injuries and illnesses during the 1990s. The authors argue that far-reaching changes in the 1980s and 1990s, including the rise of precarious employment, falling wages and opportunities, and the creation of a super-vulnerable population of immigrant workers, probably helped create this apparent trend by preventing employees from reporting some injuries and illnesses. Changes in the health care system, including loss of access to health care for growing numbers of workers and increased obstacles to the use of workers' compensation, compounded these effects by preventing the diagnosis and documentation of some occupational injuries and illnesses. Researchers should examine these forces more closely to better understand trends in occupational health.

Industrial Injury Hospitalizations Billed to Payers Other Than Workers' Compensation: Characteristics and Trends by State

OBJECTIVE

To describe characteristics of industrial injury hospitalizations, and to test the hypothesis that industrial injuries were increasingly billed to non-workers' compensation (WC) payers over time.

DATA SOURCES

Hospitalization data for 1998-2009 from State Inpatient Databases, Healthcare Cost and Utilization Project, and Agency for Healthcare Research and Quality.

STUDY DESIGN

Retrospective secondary analyses described the distribution of payer, age, gender, race/ethnicity, and injury severity for injuries identified using industrial place of occurrence codes. Logistic regression models estimated trends in expected payer.

PRINCIPAL FINDINGS

There was a significant increase over time in the odds of an industrial injury not being billed to WC in California and Colorado, but a significant decrease in New York. These states had markedly different WC policy histories. Industrial injuries among older workers were more often billed to a non-WC payer, primarily Medicare.

CONCLUSIONS

Findings suggest potentially dramatic cost shifting from WC to Medicare. This study adds to limited, but mounting evidence that, in at least some states, the burden on non-WC payers to cover health care for industrial injuries is growing, even while WC-related employer costs are decreasing-an area that warrants further research.

NIOSH national survey of long-haul truck drivers: Injury and safety

Approximately 1,701,500 people were employed as heavy and tractor-trailer truck drivers in the United States in 2012. The majority of them were long-haul truck drivers (LHTDs). There are limited data on occupational injury and safety in LHTDs, which prompted a targeted national survey. The National Institute of Occupational Safety and Health conducted a nationally representative survey of 1265 LHTDs at 32 truck stops across the contiguous United States in 2010. Data were collected on truck crashes, near misses, moving violations, work-related injuries, work environment, safety climate, driver training, job satisfaction, and driving behaviors. Results suggested that an estimated 2.6% of LHTDs reported a truck crash in 2010, 35% reported at least one crash while working as an LHTD, 24% reported at least one near miss in the previous 7 days, 17% reported at least one moving violation ticket and 4.7% reported a non-crash injury involving days away from work in the previous 12 months. The majority (68%) of non-crash injuries among company drivers were not reported to employers. An estimate of 73% of LHTDs (16% often and 58% sometimes) perceived their delivery schedules unrealistically tight; 24% often continued driving despite fatigue, bad weather, or heavy traffic because they needed to deliver or pick up a load at a given time; 4.5% often drove 10miles per hours or more over the speed limit; 6.0% never wore a seatbelt; 36% were often frustrated by other drivers on the road; 35% often had to wait for access to a loading dock; 37% reported being noncompliant with hours-of-service rules (10% often and 27% sometimes); 38% of LHTDs perceived their entry-level training inadequate; and 15% did not feel that safety of workers was a high priority with their management. This survey brings to light a number of important safety issues for further research and interventions, e.g., high prevalence of truck crashes, injury underreporting, unrealistically tight delivery schedules, noncompliance with hours-of-service rules, and inadequate entry-level training.

Administering the cost of death: organisational perspectives on workers' compensation and common law claims following traumatic death at work in Australia

Quite apart from its devastating human and psychological effects, the death of a worker can have significant, life-changing effects on their families. For many affected families, workers' compensation entitlements represent the primary financial safeguard. Where the worker was self-employed, the family will generally be excluded from this remedy and have to take the more problematic option of claiming damages at common law. Despite the centrality of workers' compensation, little attention has been given to how effectively workers' compensation agencies address the needs of bereaved families or the views of other organisations involved, such as safety inspectors, unions, employers and victim advocates. Based on interviews with forty eight organisational representatives in five Australian states, this study examines how workers' compensation regimes deal with work-related death from the perspective of those organisations involved directly or indirectly in the process. The study highlighted a number of problems, including the exclusion of self-employed workers and dealing with 'mixed families'.

Work-injury absence and compensation among partnered and lone mothers and fathers

BACKGROUND

The purpose of this study is to examine the risk of a work-injury absence and the likelihood of receiving compensation among partnered and lone mothers and fathers.

METHODS

This study utilized data from an annual survey of Canadian residents. Logistic regression models examined the association between family status and the receipt of workers' compensation, and absences due to work-related injury or illnesses of 7 or more days.

RESULTS

Being a lone mother was significantly associated with the risk of work-injury absence. Gender differences were observed for workers' compensation: mothers were half as likely as fathers to receive workers' compensation benefits, which may be attributed to differences in work experiences between men and women.

CONCLUSIONS

Findings may help in understanding whether some parental situations are more vulnerable than others and may contribute to identifying policies that could help workers sustain employment or return to work following an injury.

Precarious Employment, Ill Health, and Lessons from History: The Case of Casual (Temporary) Dockworkers 1880–1945

An international body of scientific research indicates that growth of job insecurity and precarious forms of employment over the past 35 years have had significant negative consequences for health and safety. Commonly overlooked in debates over the changing world of work is that widespread use of insecure and short-term work is not new, but represents a return to something resembling labor market arrangements found in rich countries in the 19th and early 20th centuries. Moreover, the adverse health effects of precarious employment were extensively documented in government inquiries and in health and medical journals. This article examines the case of a large group of casual dockworkers in Britain. It identifies the mechanisms by which precarious employment was seen to undermine workers and families' health and safety. The article also shows the British dockworker experience was not unique and there are important lessons to be drawn from history. First, historical evidence reinforces just how health-damaging precarious employment is and how these effects extend to the community, strengthening the case for social and economic policies that minimize precarious employment. Second, there are striking parallels between historical evidence and contemporary research that can inform future research on the health effects of precarious employment.

Who pays for work-related traumatic injuries? Payer distribution in washington state by ethnicity, injury severity, and year (1998-2008)

BACKGROUND

Acute work-related trauma is a leading cause of death and disability for U.S. workers but it is difficult to obtain information about injured workers not covered by workers' compensation (WC). This study aimed to: (1) describe trends in expected payer and linkage to WC claims, (2) compare characteristics of injured workers who did and did not have a linked WC claim, and (3) describe variation in expected payer and linkage to WC claims by ethnicity and injury severity.

METHODS

Data for injuries occurring from 1998 through 2008 were obtained from the Washington State Trauma Registry and linked to WC claims.

RESULTS

We found that 27% of work-related traumatic injuries did not have WC listed as a payer, while 37% did not link to a WC claim. Among those with WC listed as a payer, the odds of having a linked WC claim were 57% lower for workers with other non-WC insurance compared with the otherwise uninsured. Latinos were more likely to have a linked WC claim compared with non-Latinos, but there was no significant difference after partially controlling for WC-covered employment and other insurance.

CONCLUSIONS

This study demonstrated the importance of considering differential access to other insurance coverage and adaptation by health care settings to financial pressures when assessing trends in occupational injury incidence and reporting, especially when using WC as a proxy for work-relatedness. The addition of occupation, industry, and work status to trauma registries and hospital discharge databases would improve surveillance, research, policy and prevention efforts.

The incidence and impact of recurrent workplace injury and disease: a cohort study of WorkSafe Victoria, Australia compensation claims

OBJECTIVE

To determine the incidence and impact of recurrent workplace injury and disease over the period 1995-2008.

DESIGN

Population-based cohort study using data from the state workers' compensation system database.

SETTING

State of Victoria, Australia.

PARTICIPANTS

A total of 448 868 workers with an accepted workers' compensation claim between 1 January 1995 and 31 December 2008 were included into this study. Of them, 135 349 had at least one subsequent claim accepted for a recurrent injury or disease during this period.

MAIN OUTCOME MEASURES

Incidence of initial and recurrent injury and disease claims and time lost from work for initial and recurrent injury and disease.

RESULTS

Over the study period, 448 868 workers lodged 972 281 claims for discrete occurrences of work-related injury or disease. 53.4% of these claims were for recurrent injury or disease. On average, the rates of initial claims dropped by 5.6%, 95% CI (-5.8% to -5.7%) per annum, while the rates of recurrent injuries decreased by 4.1%, 95% CI (-4.2% to -0.4%). In total, workplace injury and disease resulted in 188 978 years of loss in full-time work, with 104 556 of them being for the recurrent injury.

CONCLUSIONS

Recurrent work-related injury and disease is associated with a substantial social and economic impact. There is an opportunity to reduce the social, health and economic burden of workplace injury by enacting secondary prevention programmes targeted at workers who have incurred an initial occupational injury or disease.

Preserving workers' dignity in workers' compensation systems: an international perspective

BACKGROUND

Workers' compensation systems are among the most generous disability insurance systems in North America, although they are also known to be potentially adversarial and may have iatrogenic effects on claimants. This article examines issues to be considered to ensure fair compensation provided in a way that respects the dignity of workers.

METHODS

An overview of the literature on characteristics and effects of workers' compensation systems is followed by an analysis based on classic legal methods, including those of comparative law, complemented with interview data to examine three models of disability compensation.

RESULTS

The first part of the article identifies cross cutting issues to be considered in the examination of the equity of compensation systems and the protection of the dignity of claimants. These include three underpinnings of workers' compensation: the links between a "no-fault" system and the adversarial process, the appropriate use of medical and scientific evidence in the determination of compensability and the application of appropriate measures for promoting return to work. The second part looks at accident compensation in New Zealand, where compensation is available regardless of the cause of the accident, and disability insurance in the Netherlands, where compensation is available regardless of the cause of the disability. It then describes a composite of characteristics favorable to equity drawn from the thirteen workers' compensation systems in Canada.

CONCLUSION

Systems that succeed in reducing opportunities for adversarial interactions and that provide substantive protection could better promote the dignity of claimants.

Stressors among Latino day laborers. A pilot study examining allostatic load

This pilot study evaluated the feasibility of conducting a research project focused on stressors and allostatic load (AL) among day laborers. A total of 30 Latino men were recruited from CASA Latina, a worker center in Seattle. Participants completed an interview and researchers measured six indicators of AL (body mass index, waist-to-hip ratio, systolic blood pressure, diastolic blood pressure, C-reactive protein, and cortisol). Percentages and mean scores were calculated for several self-reported stressors in work, economic, and social contexts and were compared between low and high AL groups. Overall, participants with high AL reported experiencing more stressors than those with low AL. Additionally, those with high AL generally reported being less healthy both physically and mentally. Findings suggest that Latino day laborers experience stressors that place them at risk for high AL. Also, a study of this nature is possible, but must be conducted with trust and collaboration between researchers and community partners.

Stressors among Latino Day Laborers

This pilot study evaluated the feasibility of conducting a research project focused on stressors and allostatic load (AL) among day laborers. A total of 30 Latino men were recruited from CASA Latina, a worker center in Seattle. Participants completed an interview and researchers measured six indicators of AL (body mass index, waist-to-hip ratio, systolic blood pressure, diastolic blood pressure, C-reactive protein, and cortisol). Percentages and mean scores were calculated for several self-reported stressors in work, economic, and social contexts and were compared between low and high AL groups. Overall, participants with high AL reported experiencing more stressors than those with low AL. Additionally, those with high AL generally reported being less healthy both physically and mentally. Findings suggest that Latino day laborers experience stressors that place them at risk for high AL. Also, a study of this nature is possible, but must be conducted with trust and collaboration between researchers and community partners.

Time to Call it Quits? The Safety and Health of Older Workers

The workforces of many countries are aging, creating pressure for older workers to retire later despite greater vulnerability to various occupational safety and health (OSH) risks. Some specific risks to older workers arise from age-related physical or psychological changes, while others reflect exposures to poor work organization or employment conditions. This article reviews evidence on the nature of the OSH risks faced by older workers, focusing on work ability, contingent work, and working hours. Work ability, the capacity to meet the physical, mental, and social demands of a job, has been linked to positive health outcomes for older workers. However, work characteristics seem to be more critical than workers' individual capacities. Contingent work is generally associated with poorer OSH outcomes, and older workers are more likely to be contingent, with special implications for their safety and health. There has been limited research on age and working hours, but risks for many physical and mental health problems are known to increase with shift work experience, and physiological and psychosocial changes associated with age may also increase injury risks. The authors discuss organizational practices and regulatory policies to protect and enhance the OSH of older workers.

Work-related hand fracture injuries in British Columbia, Canada: a population-based BC-linked health data-set study

Objective

To define population-based incidence, demographics and claim rates, as well as clinical presentation and claims duration and costs for work-related hand fractures in British Columbia (BC), Canada in 2001.

Methods

A BC-linked health data-set one-year retrospective review of all reported work-place hand fracture injuries in BC in 2001 with additional evaluation of individual health care and claims data from randomly selected individuals with a compensation claim in 2001.

Results

There were 14,654 hand fractures, of which 14% (2085) were work related; an annual incidence rate of 11/10,000 workers. Males accounted for 88% (1488/2085) of the fractures and the mean age was 39 (SD: ±12). Only 60% (290/482) of randomly selected people filed a compensation claim. Of these claims, 90% (260) had a validated hand fracture injury, 72% (218) were non-articular and 13% (38) had complex associated tissue injuries. About 69% (180) had no or simple closed reduction, 82% (213) had no additional fixation, 63% (163) were immobilized for at least 21 days and 9% (24) developed a secondary complication that required surgery. Average days off work was 46 (range 0–290) and average claims cost was $5500 CDN (range $145–$56,900).

Conclusions

Hand fractures are a common workplace injury in BC, with a significant proportion of workers not claiming compensation. These injuries generally presented clinically as simple fractures that were managed conservatively with few complications. Despite this, there was still a significant socioeconomic burden primarily due to lost work-place productivity due to time loss from work. These findings likely reflect similar trends for work-related hand fractures throughout Canada and other countries with similar health care and workers' compensation systems.

Globalization and the Marginalization of Unskilled Labor: Potential Impacts on Health in Developed Nations

The objective of this investigation was to determine the impacts of economic globalization on labor markets and outline potential pathways for these changes to affect health status in industrialized nations. A systematic review of the economic globalization and health literature revealed that, under the impact of globalization and market deregulation, the past 25 years have witnessed de-industrialization, shifts to nontraditional, insecure work arrangements, and relatively high levels of unemployment in most developed nations. This has occurred in the context of hypermobility of capital, relative immobility of labor, and declining market position for unskilled labor. Such structural changes in the labor markets in conjunction with shifts in educational opportunities and requirements have resulted in the increasing marginalization of unskilled workers from the labor market. Aside from direct effects on health due to the threat and experience of unemployment, and given that income inequality within nations is a main driver of national health status, lowered relative wages for the unskilled will probably affect national health status through increased income inequality.

Under Pressure, Out of Control, or Home Alone? Reviewing Research and Policy Debates on the Occupational Health and Safety Effects of Outsourcing and Home-Based Work

The practice of outsourcing or subcontracting of work has grown rapidly in most countries over the past two decades. Outsourcing, de-institutionalization, and a range of other practices have also resulted in a growth of home-based work. Home-based workers, even when not part of a subcontracting process, operate in an isolated situation remote from their employer and other workers. Do such work arrangements expose workers to greater risk of injury, illness, or assault? The authors reviewed international studies of the occupational health and safety (OHS) effects of subcontracting and home-based work undertaken over the past 20 years. Of the 25 studies analyzed, 92 percent found poorer OHS outcomes. The studies were examined for clues about the reasons for these negative outcomes. The authors also identified similarities and differences between subcontracting and home-based work. Despite the evidence of poor OHS outcomes, research into outsourcing has stalled in recent years. With notable exceptions, governments have taken little account of findings on these work arrangements in their laws and policies, in part because neoliberal ideas dominate national and global policy agendas. The authors examine policy challenges and regulatory responses and make suggestions for future research and policy interventions.

Outsourcing and Employer Responsibility

The widespread use of outsourcing in the service industry has major consequences for the employment relationship. In particular, outsourcing diminishes absolute employer control of firm operations. This article focuses on this new relationship through a study of the occupational health and safety requirements established in connection with the outsourcing of public bus transport in Denmark.

Women's Experience in the Workers' Compensation System

INTRODUCTION

Gender differences is a question of major importance within workers' compensation given the increased role of women in the workforce over the past several decades. This article reviews literature relating to women's experiences following work injury.

METHODS

An Australian study is used as background to exploring the broad issue of the question of gender equity in workers' compensation. In doing so it takes account of historical, legal and medical issues.

RESULTS

Women's experience in the workers' compensation system is different to that of men due to a range of factors. It is heavily influenced by the industrial environment in which they work. Women are paid less than men in many instances and work in gender-segregated circumstances, which often reduces their industrial bargaining power. Women also suffer different forms of injury and disease to men because of the different nature of their work.

CONCLUSION

The Australian experience suggests that as a consequence of the combination of lesser industrial bargaining power, lower wages and differing forms of injury and disease women often receive less than men in compensation payments, struggle to obtain equity in the dispute resolution process and experience greater difficulties in returning to work following injury or disease.

How many injured workers do not file claims for workers' compensation benefits?

BACKGROUND

Anecdotal evidence suggests that there are injured workers who do not file for workers' compensation (WC). Several recent studies support this, and we aim to quantify the extent of under-reporting.

METHODS

A Canadian survey asked about work injuries in the previous year, and several questions established eligibility for WC and whether a claim had been filed. The proportion of eligible injuries with a claim was estimated. Logistic regression identified predictors of claim submission.

RESULTS

Of 2,500 respondents, 143 had incurred an eligible injury, of whom 57 (40%, 95% CI 32-48%) had not filed a WC claim. Severity of injury was the strongest predictor of not claiming.

CONCLUSIONS

Survey respondents reported a substantial degree of under-claiming of WC benefits, contrasting with public attention on fraudulent over-claiming. Policy makers should ensure that all relevant parties are aware of their obligations to report work injuries. This will create a more accurate picture of work safety.

The social consequences of occupational injuries and illnesses

BACKGROUND

Most outcome studies of occupational injuries and illnesses have tended to focus on direct economic costs and duration of work disability. Rarely have the broader social consequences of work-related disorders or their impacts on injured workers' families, coworkers, and community been investigated. This paper examines a wide range of social consequences including workers' psychological and behavioral responses, vocational function, and family and community relationships.

METHODS

Literature review and development of conceptual framework.

RESULTS

Complex and multifactorial relationships are described whereby occupational injuries and illnesses produce a variety of social consequences involving filing and administration of workers' compensation insurance claims, medical care experiences, domestic function and activities of daily living, psychological and behavioral responses, stress, vocational function, rehabilitation and return to work, and equity and social justice.

CONCLUSION

A research agenda is proposed for guiding future investigations in this field.

The global expansion of precarious employment, work disorganization, and consequences for occupational health: a review of recent research

In this review of a range of studies on the health and safety effects of precarious employment in industrialized societies published since 1984, the authors examine the overall findings and methodological issues and identify areas in need of further research. Of the 93 published journal articles and monographs/book chapters reviewed, 76 studies found precarious employment was associated with a deterioration in occupational health and safety (OHS) in terms of injury rates, disease risk, hazard exposures, or worker (and manager) knowledge of OHS and regulatory responsibilities. Of the more than 25 studies each on outsourcing and organizational restructuring/downsizing, well over 90 percent find a negative association with OHS. The evidence is fairly persuasive for temporary workers, with 14 of 24 studies finding a negative association with OHS. The evidence is less strong for small business, and a handful of studies on part-time workers found no clear association with negative OHS outcomes (in some cases the reverse). Further research is needed to more clearly link health effects to particular business practices and neoliberal policies and to explore the regulatory implications of the growth of precarious employment. The authors suggest some ways to conceptualize the association between precarious employment and occupational health.