The Relationship Between Attorney Involvement, Claim Duration, and Workers’ Compensation Costs

Is Arthroscopic Meniscectomy Associated With an Increased Risk of Total Knee Arthroplasty for Claimants in the Workers' Compensation System? A 10-Year Study of Workers' Compensation Claims From a Large Nationwide Workers' Compensation Insurance Carrier

BACKGROUND

Total knee arthroplasty (TKA) is a commonly performed knee surgery and prior arthroscopic meniscectomy (AM) has been linked to an increased risk of TKA in the general population.

OBJECTIVE

To study the relationship between AM and TKA among injured workers whose medical care is paid for under workers' compensation (WC).

METHOD

A total of 17,247 lost-time claims depicting all arthroscopic knee surgical procedures performed from 2007 to 2017 were followed to the end of 2022 and analyzed.

RESULTS

The odds ratio of undergoing a TKA for those with a preceding AM is 2.20, controlling for age, sex, and attorney involvement.

CONCLUSIONS

Undergoing an AM is associated with an increased risk of TKA in WC claimants.

Increasing Physical Therapy Visits as a Marker for Time Lost From Work and High Workers' Compensation Claim Costs

OBJECTIVE

To quantify the association between physical therapy (PT) visits and workers' compensation costs and lost time.

METHOD

A total of 40,203 lost-time claims (1998 to 2018) were analyzed.

RESULTS

The odds ratio of total paid claim costs more than or equal to $100,000 increased with the number of PT visits from 1.91 with 1 to 3 PT visits (95% confidence interval [CI]: 1.62 to 2.26) to 5.56 (95% CI: 4.86 to 6.37) for workers with a surgical procedure and more than or equal to 50 PT visits versus those without PT visits, when controlling for confounding factors. The risk of remaining at an off work status is greatest among claims involving surgery, escalating among claims with 15 or more PT visits (hazard ratio more than or equal to 3.76).

CONCLUSIONS

PT visits may be used as a marker for high workers' compensation cost and delayed return-to-work.

The rational for and efficacy of subchondroplasty in the injured worker

Objective

Evaluation and treatment of workplace knee injuries with pre existing arthritis is difficult from both a causality and a clinical perspective. The current study evaluates the relevance and treatment of the bone marrow edema (BME) in injured workers.

Methods

179 patients who injured their knee at work and were found to have arthritis and BME and subsequently underwent subchondral calcium phosphate injections (subchondroplasty) were reviewed.

Results

Radiographic arthritic status was Kellgren Lawrence 3-4 in 56%. Cartilage status was outerbridge III/IV. 86% reported marked improvement at 6 months. 74% at 3 years and 83% at 5 years. RTW was 78% at 3 months & 85% by 6 months. Survivorship was 98% at one year, 86% at 2 years, 81% at 5 years & 76% at 7 years post op.

Conclusions

BME (associated with trabecular fracture) is an objective measure of causality in the injured worker. The treatment of BME positive arthritis in injured workers is highly successful in terms of decreasing pain, improving function and expediting return to work.

The Relationship of the Amount of Physical Therapy to Time Lost From Work and Costs in the Workers' Compensation System

: Physical therapy (PT) is perceived as a cost driver in the US workers' compensation system. We conducted a 5-year (2013 to 2017) retrospective analysis utilizing 192,197 claims from a large Texas based workers' compensation insurance company to describe the relationship between the amount of physical therapy delivered and workers' compensation costs and lost-time. Closed, indemnity claims with 15 or more PT visits were six times more likely (95% confidence interval [CI]: 5.50, 86.58) to result in high medical costs (>$7000, excluding PT costs) and were four times more likely (95% CI: 3.77, 4.42) to result in more than or equal to 6 months of lost-time, when controlling for confounders. When the number of PT visits more than or equal to 15 visits for a lost time claim, this level of PT exceeds all other predictors (opioid use, comorbidities, legal involvement, surgery, etc) of medical cost and extended time out from work.

Significant Decreasing Trend in Back Injuries in a Multiemployer Environment: A Follow-Up Study

BACKGROUND

A significant decrease in back injury claims was observed in a single employer.

OBJECTIVE

The aim of this study was to validate whether back injury claims are decreasing in a multiemployer environment within a non-monopolistic state and quantify the risk of delayed return-to-work and adverse cost of injured workers with back injuries.

METHODS

Thirty-six thousand four hundred sixty-three claims from 1998 to 2015 were analyzed with descriptive statistics and multivariate logistic and Cox-Proportional Hazards models.

RESULTS

Back injury claims decreased three-fold (5.02 to 1.60 per 1000 employees) and were more likely to have claim costs over $100,000 (odds ratio = 2.41) and delayed return-to-work (hazard ratio = 1.16).

CONCLUSION

Back injury claims are decreasing in a multiemployer environment within a non-monopolistic state.

Is Obesity Associated With Adverse Workers' Compensation Claims Outcomes?

BACKGROUND

A pilot study indicated that obesity was associated with an increased time lost from work and higher costs among workers' compensation claimants sustaining severe, but not minor injuries.

OBJECTIVE

The aim of this study was to further test the hypotheses by increasing sample size and controlling for additional confounding factors.

METHOD

Cost and lost time outcomes were assessed for 2301 lost time workers' compensation claims filed in 2011 and 2012 followed to the end of the first quarter of the third postinjury year.

RESULT

Adjusting for gender, age, marital status, attorney involvement, and spinal procedures, the odds ratios of incurring a claim expense at least $100,000 after a severe injury for an overweight or obese versus normal weight claimant was 2.11 [95% confidence interval (95% CI): 1.04 to 4.29] and 2.23 (95% CI:1.12-4.46), respectively.

CONCLUSION

Obesity was associated with increased costs among workers' compensation claimants sustaining severe, but not minor injuries.

Occupational Injury Surveillance Among Law Enforcement Officers Using Workers' Compensation Data, Illinois 1980 to 2008

OBJECTIVE

Injuries among law enforcement officers are common, but poorly understood; workers' compensation (WC) data are an underutilized tool for occupational surveillance.

METHODS

A stratified analysis of WC claims among four categories of law enforcement officers used descriptive techniques, linear and robust regression.

RESULTS

Eighteen thousand eight hundred ninety-two officers filed claims from 1980 to 2008. Correctional officers had the highest rates, with leading causes of falls and assaults; motor vehicle crashes were the most common cause of injury among state police. Total monetary compensation was lower for correctional officers, but was explained by lower time lost and lower average weekly wage.

CONCLUSION

The rate and types of injuries varied by subgroups, with correctional officers having the majority of injuries, but lower severity. WC data elucidate causes and outcomes of occupational injuries, which can guide prevention.

Is Employer-Directed Medical Care Associated With Decreased Workers' Compensation Claim Costs?

BACKGROUND

The financial impact regarding choice of physician within the workers' compensation domain has not been well studied.

OBJECTIVE

The aim of this study was to assess the difference in claim cost between employee- and employer-directed choice of treating physician after injury.

METHODS

Thirty-five thousand six hundred forty indemnity lost time claims from a 13-year period at a nationwide company were analyzed with multivariate logistic regression to determine the association of medical direction with risk of high-cost claims.

RESULTS

States that have employer-directed physician choice were associated with a lower risk of having high-cost claims (≥$50,000) but higher attorney involvement than employee direction. The net effect of this enhanced presence of attorneys offsets the benefits of employer choice of treating physician.

CONCLUSION

States that permit employer selection of treating physician have slightly higher cost due to the higher prevalence of attorney involvement in the claims process.

Factors associated with the duration of disability benefits claims among Canadian workers: a retrospective cohort study

BACKGROUND

Disability insurance protects workers from total loss of income in case of a disabling injury or illness by providing wage-replacement benefits. To better inform early identification of claims at risk of prolonged recovery, we explored predictors of the duration of disability benefits claims.

METHODS

We conducted a retrospective cohort study using claims data provided by SSQ Life Insurance Company Inc., a private Canadian disability insurer. We examined all claims SSQ approved for short- and long-term disability benefits from Jan. 1, 2007, to Mar. 31, 2014, and evaluated the association between 9 variables and duration of short- and long-term disability benefits using Cox proportional hazards regression analyses.

RESULTS

For both short- (n = 70 776) and long-term disability (n = 22 205) claims, and across all disorders, older age, female sex, heavy job demands, presence of comorbidity, attending an independent medical evaluation, receipt of rehabilitation therapy and longer time to claim approval were associated with longer claim duration. Higher predisability salary was associated with longer short-term disability claim duration. Quebec residency was associated with longer short-term disability claim duration among workers with psychological disorders, but shorter short-term disability claim duration among those with musculoskeletal complaints and other illnesses. For long-term disability claims, however, residing in Quebec was associated with shorter claim duration, although the size of the association differed across clinical conditions.

INTERPRETATION

The factors we found to be associated with the duration of short- and long-term disability claims may be helpful to identify claims at risk of prolonged recovery. Our study has limitations, however, and well-designed prospective studies are needed to confirm our findings and identify other promising predictors.

Analysis of ethnic disparities in workers' compensation claims using data linkage

OBJECTIVE

The overall goal of this research project was to assess ethnic disparities in monetary compensation among construction workers injured on the job through the linkage of medical records and workers' compensation data.

METHODS

Probabilistic linkage of medical records with workers' compensation claim data.

RESULTS

In the final multivariable robust regression model, compensation was $5824 higher (P = 0.030; 95% confidence interval: 551 to 11,097) for white non-Hispanic workers than for other ethnic groups when controlling for injury severity, affected body region, type of injury, average weekly wage, weeks of temporary total disability, percent permanent partial disability, death, or attorney use.

CONCLUSIONS

The analysis indicates that white non-Hispanic construction workers are awarded higher monetary settlements despite the observation that for specific injuries the mean temporary total disability and permanent partial disability were equivalent to or lower than those in Hispanic and black construction workers.

Natural history of opioid dosage escalation post-injury: a cohort study of injured workers in the State of Louisiana

OBJECTIVE

To determine the relationship between opioid dosage and claim duration.

METHODS

Closure rates and morphine-equivalent dose were analyzed over a 7-year period for 11,394 lost-time claims filed with the Louisiana Workers' Compensation Corporation.

RESULTS

The percentage of claims in which opioids were ever prescribed increased from 43.3% in year 1 to 80.8% in year 7 post-injury. The percentage of claims in which individuals were prescribed long-acting (LA) opioids increased from 5.2% to 29.6%, and the percentage of claims in which individuals were prescribed only short-acting (SA) opioids increased from 38.1% to 51.2%. Morphine-equivalent dose increased from 10.0 mg/day (year 1) to 143.2 mg/day (year 7) for claims in which individuals were prescribed LA opioids. The average claim duration for claims in which individuals were prescribed no opioids, only SA opioids, and LA opioids was 415, 930, and 2025 days, respectively.

CONCLUSION

Opioid dosage escalates as claims mature.

Exploring Lawyer-Client Interaction: A Qualitative Study of Positive Lawyer Characteristics

Personal injury victims involved in compensation processes have a worse recovery than those not involved in compensation processes. One predictor for worse recovery is lawyer engagement. As some people argue that this negative relation between lawyer engagement and recovery may be explained by lawyers’ attitude and communications to clients, it seems important to investigate lawyer–client interaction. Although procedural justice and therapeutic jurisprudence had previously discussed aspects relevant for lawyer–client interaction, the client’s perspective has been rather ignored and only few empirical studies have been conducted. In this qualitative study, 21 traffic accident victims were interviewed about their experiences with their lawyer. Five desirable characteristics for lawyers were identified: communication, empathy, decisiveness, independence, and expertise. Communication and empathy corresponded with aspects already discussed in literature, whereas decisiveness, independence and expertise had been addressed only marginally. Further qualitative and quantitative research is necessary to establish preferable lawyer characteristics and to investigate what would improve the well-being of personal injury victims during the claims settlement process.