Reporting of work-related musculoskeletal disorder (MSD) to workers compensation

Filing a Workers' Compensation Claim for Low Back Pain and Associated Factors: Analysis of 2015 National Health Interview Survey

OBJECTIVE

The aim of this study was to examine the degree of reporting work-related low back pain (LBP) by workers' compensation (WC) claim filing and associated factors among US workers.

METHODS

We conducted multivariable logistic regression using the 2015 National Health Interview Survey data.

RESULTS

Among 1203 US workers with self-reported work-related LBP diagnosis, only 19.6% filed for WC. Compared with non-Hispanic White workers, Black, Asian, and Hispanic workers were less likely to file for WC. Workers' compensation filing was less frequent among workers in independent work arrangement and who stopped working, changed jobs, or made a change in work and more frequent among workers 45 to 64 years of age and having high LBP frequency.

CONCLUSIONS

Our study findings suggest underreporting of work-related LBP to the WC system is common. Barriers to WC filing should be addressed especially for racial/ethnic minorities and independent workers.

Applying Machine Learning to Workers' Compensation Data to Identify Industry-Specific Ergonomic and Safety Prevention Priorities: Ohio, 2001 to 2011

OBJECTIVE

This study leveraged a state workers' compensation claims database and machine learning techniques to target prevention efforts by injury causation and industry.

METHODS

Injury causation auto-coding methods were developed to code more than 1.2 million Ohio Bureau of Workers' Compensation claims for this study. Industry groups were ranked for soft-tissue musculoskeletal claims that may have been preventable with biomechanical ergonomic (ERGO) or slip/trip/fall (STF) interventions.

RESULTS

On the basis of the average of claim count and rate ranks for more than 200 industry groups, Skilled Nursing Facilities (ERGO) and General Freight Trucking (STF) were the highest risk for lost-time claims (>7 days).

CONCLUSION

This study created a third, major causation-specific U.S. occupational injury surveillance system. These findings are being used to focus prevention resources on specific occupational injury types in specific industry groups, especially in Ohio. Other state bureaus or insurers may use similar methods.

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.

Contrasting patterns of care for musculoskeletal disorders and injuries of the upper extremity and knee through workers' compensation and private health care insurance among union carpenters in Washington State, 1989 to 2008

BACKGROUND

Musculoskeletal symptoms and disorders (MSDIs) are common reasons for visits to medical providers in the general population and they are common work-related complaints. Prior reports raise concerns as to whether declines in workers' compensation (WC) rates represent true improvement in occupational health and safety or shifting of care to other payment systems.

METHODS

By linking administrative records, we compared patterns of WC claims and private health care utilization for disorders of the upper extremity (UE) and knee among a large cohort of union carpenters over a 20-year period.

RESULTS

As WC claim rates declined, private health care utilization increased. The increase was muted somewhat but sustained when adjusting for other patterns of health care utilization.

CONCLUSIONS

Findings suggest the decline of WC claim rates do not solely represent improved occupational safety in this population, but also a considerable shifting of care to their private insurance coverage over time.

Musculoskeletal concerns do not justify failure to use safer sequential trigger to prevent acute nail gun injuries

BACKGROUND

Acute nail gun injuries can be controlled significantly by using tools with sequential triggers and training. Concern has been raised that sequential triggers, which require that the nose piece of the gun be depressed prior to pulling the trigger, could increase risk of musculoskeletal problems.

METHODS

We conducted active injury surveillance among union carpenter apprentices to monitor acute injuries and musculoskeletal disorders between 2010 and 2013.

RESULTS

Acute injury risk was 70% higher with contact trip rather than sequential triggers. Musculoskeletal risk was comparable (contact trip 0.09/10,000 hr (95% CI, 0.02-0.26); sequential 0.08/ 10,000 hr (95% CI 0.02-0.23)).

CONCLUSIONS

Concern about excess risk of musculoskeletal problems from nail guns with sequential triggers is unwarranted. Both actuation systems carry comparable musculoskeletal risk which is far less than the risk of acute injury; there is clearly no justification for failure to prevent acute injuries through use of the safer sequential trigger.

Workers' compensation claims for musculoskeletal disorders and injuries of the upper extremity and knee among union carpenters in Washington State, 1989-2008

BACKGROUND

Numerous aspects of construction place workers at risk of musculoskeletal disorders and injuries (MSDIs). Work organization and the nature of MSDIs create surveillance challenges.

METHODS

By linking union records with workers' compensation claims, we examined 20-year patterns of MSDIs involving the upper extremity (UE) and the knee among a large carpenter cohort.

RESULTS

MSDIs were common and accounted for a disproportionate share of paid lost work time (PLT) claims; UE MSDIs were three times more common than those of the knee. Rates declined markedly over time and were most pronounced for MSDIs of the knee with PLT. Patterns of risk varied by extremity, as well as by age, gender, union tenure, and predominant work. Carpenters in drywall installation accounted for the greatest public health burden.

CONCLUSIONS

A combination of factors likely account for the patterns observed over time and across worker characteristics. Drywall installers are an intervention priority.

The impact of workplace factors on filing of workers' compensation claims among nursing home workers

Background

Injuries reported to workers’ compensation (WC) system are often used to estimate incidence of health outcomes and evaluate interventions in musculoskeletal epidemiology studies. However, WC claims represent a relatively small subset of all musculoskeletal disorders among employed individuals, and perhaps not a representative subset. This study determined the influence of workplace and individual factors on filing of workers’ compensation claims by nursing home employees with back pain.

Methods

Surveys were conducted in 18 skilled nursing facilities in four U.S. states. Self-administered questionnaires obtained information on demographic characteristics, working environment, and health behaviors/status. Employees who reported low back pain at least once in four questionnaire surveys were included. WC claims from the same facilities were obtained from the employer’s workers compensation insurer and matched by employee name. The dichotomous dependent variable was filing of back-related worker’s compensation claim. Association with predictors of interest, including pain severity, physical job demand, job strain, social support, schedule control, and safety climate, was assessed using multivariate regression modeling. Individual characteristics were tested as potential confounders.

Results

Pain severity level was significantly associated with filing low-back related claims (odds ratio (OR) = 1.49, 95% CI = 1.18 – 1.87). Higher physical demands at work (OR = 1.07, 95% CI = 1.01 – 1.14) also increased the likelihood of claim filing. Higher job strain (OR = 0.83, 95% CI = 0.73 – 0.94), social support at work (OR = 0.90, 95% CI = 0.82 – 0.99), and education (OR = 0.79, 95% CI = 0.71 – 0.89) decreased the likelihood of claim filing.

Conclusions

The results suggest that the WC system captured the most severe occupational injuries. Workplace factors had additional influence on workers’ decision to file claims, after adjusting for low back pain severity. Education was correlated with worker’s socioeconomic status; its influence on claim filing is difficult to interpret because of the possible mixed effects of working conditions, self-efficacy, and content knowledge.

Do zero-cost workers' compensation medical claims really have zero costs? The impact of workplace injury on group health insurance utilization and costs

OBJECTIVE

Previous research suggests that non-workers' compensation (WC) insurance systems, such as group health insurance (GHI), Medicare, or Medicaid, at least partially cover work-related injury and illness costs. This study further examined GHI utilization and costs.

METHODS

Using two-part model, we compared those outcomes immediately after injuries for which accepted WC medical claims made zero or positive medical payments.

RESULTS

Controlling for pre-injury GHI utilization and costs and other covariates, our results indicated that post-injury GHI utilization and costs increased regardless of whether a WC medical claim was zero or positive. The increases were highest for zero-cost WC medical claims.

CONCLUSION

Our national estimates showed that zero-cost WC medical claims alone could cost the GHI $212 million per year.

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.

Excess healthcare costs associated with prior workers' compensation activity

BACKGROUND

Workers compensation (WC) does not fully compensate workplace injuries and illnesses. This work examines whether cost shifting occurs to group health insurance for work-related injuries and illnesses.

METHODS

Thomson Reuters MarketScan databases of medical insurance claims were used. WC and other benefit system data, employee status and types of medical insurance coverage were also available. Medical cost was analyzed using two-part models: the first part modeled the monthly probability of a worker having any group health medical claims, and the second part modeled the total monthly cost of those medical claims. Models included an estimate of a worker's annual medical costs prior to a WC claim. The predicted monthly medical costs were derived by retransformation using Duan's smearing factor.

RESULTS

Individuals with prior WC claims were more likely to file a group health medical claim compared to those with no prior WC claims (OR = 1.25) and incurred a higher average monthly medical costs (among nonunion hourly men aged 18-34 years with prior WC claims: $203.72 vs. $160.29 with no prior claim, an increase of $43). These increases were observed in all industrial sectors with the service sector having the highest monthly increase ($66).

DISCUSSION

The results reveal that individuals with prior WC claims had higher probability of filing a group health medical claim and higher average monthly medical costs in all sectors. This suggests that a part of employer liability costs related to WC gets shifted to the group health medical insurance system.

Use of statewide electronic emergency department data for occupational injury surveillance: a feasibility study in Massachusetts

BACKGROUND

Statewide datasets of emergency department (ED) visits may be useful for occupational injury surveillance. Using data from 12 hospitals, we evaluated two indicators of work-relatedness in reported ED data and the availability of employment information in medical charts.

METHODS

Workers' compensation as payer and/or "yes" in an injury-at-work field were used to define probable work-related (PWR) injury visits in the Massachusetts ED dataset. Charts were reviewed for a sample of 1,002 PWR and 250 probable nonwork-related (PNWR) cases.

RESULTS

Using chart information as the gold standard, indicators of work-relatedness had a sensitivity of 82%, specificity of 97%, and predictive value positive of 86%. Employer name was in charts for 89% of PWR and 42% of PNWR cases. Occupation was available for 34% of PWR cases.

CONCLUSION

Electronic ED data are useful for state surveillance of occupational injuries. Improvements in attribution of work-relatedness and collection of available employer identifiers and occupational information would enhance its usefulness. The performance of indicators of work-relatedness in ED datasets should be examined in different states.

A conceptual framework for integrating workplace health promotion and occupational ergonomics programs

Musculoskeletal, cardiovascular, and mental health are all associated with the physical and psychosocial conditions of work, as well as with individual health behaviors. An integrated approach to workplace health-promotion programs should include attention to the work environment, especially in light of recent findings that work organization influences so-called lifestyle or health behaviors. Macroergonomics provides a framework to improve both physical and organizational features of work and, in the process, to empower individual workers. The Center for the Promotion of Health in the New England Workplace (CPH-NEW) is a research-to-practice effort examining the effectiveness of worksite programs that combine occupational safety and health--especially ergonomics--with health promotion, emphasizing the contribution of work organization to both. Two intervention studies are underway in three different sectors: health care, corrections, and manufacturing. Each study features participatory structures to facilitate employee input into health goal-setting, program design and development, and evaluation, with the goal of enhanced effectiveness and longer-term sustainability.

Would a "one-handed" scientist lack rigor? How scientists discuss the work-relatedness of musculoskeletal disorders in formal and informal communications

BACKGROUND

When research results concerning occupational health are expressed ambiguously, compensation and prevention can be affected. This study examined the language used by scientists to discuss the relation between work and musculoskeletal disorders (MSDs).

METHODS

Language regarding work and MSDs in twenty articles from two peer-reviewed journals was compared with that in 94 messages on MSDs posted by published scientists to an internet list.

RESULTS

Almost all the articles found some link between work and MSDs. However, few articles expressed belief in such a link unambiguously in the title or abstract, and language on links was often hard for a non-health scientist to interpret. Language and methods gave excess weight to negative results. On the listserve, many scientists expressed unambiguous views on linkages between work and MSDs.

CONCLUSIONS

Scientists must express their opinions more forthrightly if they wish their results to be used to favour prevention and to foster access to workers' compensation.

Access to medical care for individuals with workers' compensation claims

Experience at a publically funded occupational health clinical center in New York State suggests that patients with work-related illnesses often have great difficulty accessing diagnostic and treatment services. A study was designed to more quantitatively investigate the extent and nature of barriers to medical services for patients with Workers' Compensation claims. Medical practices from 13 selected medical specialties were identified from telephone directories. The directories covered six areas encompassing almost all of a 15-county region. All practices from each selected specialty were contacted by phone and asked a set of standardized questions regarding patient acceptance policies. A number of barriers were identified by the survey including practices closed to new patients and practices closed specifically to patients with Workers' Compensation claims. Barriers also were found to be widespread among practices that did accept Workers' Compensation claims, primarily related to requiring a guarantee of payment prior to seeing the patient. The results were compared by medical specialty and geographic area. While the study showed some of the difficulties patients with occupational illnesses face attempting to access medical services, it most likely underestimated the extent of the problem. Attitudes and practices that impede access, but were not measurable, create additional barriers. Our study strongly suggests that policies that improve access to medical care for individuals with Workers' Compensation claims are necessary to better serve the needs of workers with occupational illnesses.

Occupational medicine: the case for reform

The specialty of occupational medicine is in peril, in large part because of its reliance on financing by industry, which has powerful incentives to limit costs and to favor physicians who are useful to their employers. Occupational physicians generally practice within the framework of the workers' compensation system. Serious flaws in the incentive structure of workers' compensation constrain objectivity in their practice. Under present law they are unavoidably subject to perverse influences from employers and insurance companies. A fundamental reform of workers' compensation law and practice is urgently needed to separate occupational physicians from the control of employers and workers' compensation insurers, whose interests should not be allowed to override the physicians' integrity or to compromise the specialty.

Compensation for musculoskeletal disorders in Quebec: systemic discrimination against women workers?

Criteria for evaluating workers' compensation claims for occupational disease are strongly linked to medical expertise as supported by scientific study, yet decision-makers are not necessarily familiar with the meaning of these studies. While this is a problem for all claimants, who bear the burden of proving that work caused their injury, the adverse impact of misunderstanding of scientific data can have particular consequences for women, whose work more often appears to be benign. This article reports on a study of empirical data drawn from analysis of 314 workers' compensation appeal tribunal decisions on compensation claims, in Quebec, for musculoskeletal disorders alleged to be related to repetitive work. The study considers randomly selected decisions rendered between 1994 and 1996 on diagnoses of tendonitis, epicondylitis, and carpal tunnel syndrome and, in a follow-up, looks at significant legal decisions by the same tribunals, rendered over a longer period (1987-96). Results indicate that women workers are significantly less likely than their male counterparts to have their occupational disease claims accepted by the appeal tribunal. Evidence suggests that inappropriate overreliance on scientific studies for adjudication purposes contributes to a greater rate of refusal of claims by women workers.

The relationship of unions to prevalence and claim filing for work-related upper-extremity musculoskeletal disorders

BACKGROUND

Unionization has been found to be related to higher filing of workers' compensation (WC) claims, but the extent of the relationship and the relationships to other variables have not been previously reported.

METHODS

Telephone interviews were conducted with both a population-based and WC-based samples of musculoskeletal disorder (MSD) cases.

RESULTS

Workers at unionized facilities were 5.7 times (95% CI 2.5-13.1) more likely to file a claim for WC, despite a comparable rate of MSD cases. Higher filing was also associated with several measures of MSD severity (1.8-14.1 odds ratios), economic sector (OR = 10.1 for manufacturing), hourly (vs. salary) wages (OR = 2.6), and for having a personal physician (OR = 2.5). Unions appeared to have a protective effect on social effects of work-related MSD.

CONCLUSIONS

Unions appear to improve filing of work-related MSD, particularly for less severe conditions. The higher filing does not appear to be a case of "moral hazard," but rather improved and earlier reporting, as is advocated by early intervention approaches to reducing MSD.

Occupational injury and illness surveillance: conceptual filters explain underreporting

Occupational health surveillance data are key to effective intervention. However, the US Bureau of Labor Statistics survey significantly underestimates the incidence of work-related injuries and illnesses. Researchers supplement these statistics with data from other systems not designed for surveillance. The authors apply the filter model of Webb et al. to underreporting by the Bureau of Labor Statistics, workers' compensation wage-replacement documents, physician reporting systems, and medical records of treatment charged to workers' compensation. Mechanisms are described for the loss of cases at successive steps of documentation. Empirical findings indicate that workers repeatedly risk adverse consequences for attempting to complete these steps, while systems for ensuring their completion are weak or absent.