Occupational health nursing interventions to reduce third-party liability in workplace injuries

This article explores general principles of workers' compensation law and the ability to sue third parties for employee injuries by using case law and the treatise Larson's Workers' Compensation Law. This overview provides occupational health nurses with a background on workers' compensation law, who is liable for employee injuries, and how recovery from third parties is distributed between the employer or insurer and the employee. The author then explores interventions that occupational health nurses can implement to reduce employee injury and employer costs for providing workers' compensation. The goal of this article is to stimulate occupational health nurses' critical-thinking and problem-solving skills so they may identify risks and implement cost-effective solutions that will prevent injuries to employees.     

Factors influencing the costs of workers' compensation

This article presents several factors believed to have shaped the costs of workers' compensation. Of these factors, the most notable influence on claims severity is related to the way medical care is delivered to treat occupational injuries and illnesses. Although medical care providers may have some influence on the other factors responsible for increased claims severity, such as attorney costs and differences in state workers' compensation laws, they have a tremendous impact on the way medical care is delivered and its resultant costs. This places physicians, nurse practitioners,physical therapists, chiropractors, nurses, and physician assistants in a unique role of being able to assist US business in improving productivity through a reduction in workers' compensation costs.     

Workers' compensation reform in New York State: A proposal to address medical,ergonomic, and psychological factors associated with work disability

This paper presents testimony before the New York State Assembly Joint Hearings on Workers' Compensation. The testimony first establishes the background of the speaker in relation to the problems in the workers' compensation system. A brief summary of the problem including the increased prevalence of work-related musculoskeletal disorders and their contribution to work disability, the rising costs of insurance premiums, indemnity, and medical costs, and the percentage of payroll that workers' compensation costs consume in New York State is then presented. A review of problems injured workers and health care providers face is also considered. Following this, two proposals that represent a compromise position in relation to business and labor concerns are presented. The first relates to the implementation of state mandated prevention programs to reduce the risk of injury/illness and associated disability in areas accounting for the majority of the workers' compensation injuries/illnesses—low back and upper extremity disorders. It is proposed that individual employers receive incentives in the form of premium savings based upon actual program outcomes. The second proposal relates to the establishment of mutually agreed upon standards of health care for low back and upper extremity disorders similar to what currently exists in Minnesota. The potential benefits of these plans are discussed in relation to increasing costs and human suffering associated with work-related injuries/illness and disability. This paper is presented as an example of an approach to advocacy that health care providers can take to contribute to reform in the workers' compensation systems of their own states.     

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.     

Workers' compensation costs: still a challenge

The workers' compensation system in the United States, comprised of independent state based and national programs for federal workers, covers approximately 127 million workers and has evolved and grown since its inception in 1911. Coverage has significantly broadened in scope to allow for the inclusion of most occupational injuries and illnesses. The cost of workers' compensation care has also increased. Some of the cost drivers have been identified,and various approaches have been taken to address medical cost containment. There is a need to balance cost control with ensuring benefit adequacy and quality of medical care. It is likely that managing workers' compensation costs will continue to be a challenge in the foreseeable future. The cost of workers' compensation care affects all stakeholders including workers, employers,providers, state workers' compensation regulators, legislatures,and insurers. A continued commitment to quality, accessibility to care, and cost containment, and being alert to emerging issues that can affect these elements, will help ensure that workers are afforded accessible, high quality, and cost-effective care.     

EDI clears a path for simplifying workers' comp

In an effort to cut costs in the paperchoked workers' compensation insurance system, states, insurers, employers and third-party administrators are testing new electronic data interchange applications. Proponents say EDI will not only reduce administrative costs, but also will speed the flow of information so that workers can receive proper care sooner and return to work faster. Two groups are developing standard electronic formats for workers' compensation transactions to simplify the conversion to EDI.     

Musculoskeletal Overexertion Injuries in the United States: Mitigating the Problem Through Ergonomics and Engineering Interventions

Rehabilitating and accommodating injured workers when they return to work is a contemporary issue that is being addressed by rehabilitation experts in a variety of ways. Even though the Americans with Disabilities Act (ADA) and the Occupational Safety and Health Administration (OSHA) are mandating that employers provide reasonable accommodation to returning workers, it is the need to control increasing workers' compensation costs that is forcing employers to rethink their injury management strategies. Historically, the preventive approach has been advocated by ergonomists in the belief that all injuries can be prevented. However, available injury data from different sources, such as the National Safety Council and the Bureau of Labor Statistics presented in the initial sections of this paper, show that both the incidence and costs of occupational injuries in the United States continue to rise. It is clear, that no matter what preventive measures are taken, some injuries will happen. With this in mind, this paper examines the current injury management approach, and suggests an integrated injury management model incorporating the principles of ergonomics and engineering design, and the principles of disability management. Further, this paper highlights ergonomics interventions that industries should follow for injury management. The paper also provides guidelines and recommendations from ergonomics research for identification, quantification, and control of risk factors associated with musculoskeletal injuries of the back and the upper extremities.     

Reducing workers' compensation costs

Employers can reduce their workers' compensation costs by encouraging internal communication and education before and after injuries occur. Comprehensive workers' compensation programs can be developed by integrating the management of employee benefits and workers' compensation claims.     

Medical costs and sources of payment for work-related injuries among Hispanic construction workers

OBJECTIVE: To assess medical costs of occupational injuries and sources of payment among Hispanic and non-Hispanic construction workers. METHODS: More than 7000 construction workers, including 1833 Hispanic workers were examined using the Medical Expenditure Panel Survey, 1996 to 2002. Univariate and multivariate analyses were conducted using SUDAAN. RESULTS: Annually, work-related injuries in construction cost $1.36 billion (2002 dollars), with 46% paid by workers' compensation. Compared with non-Hispanic workers, Hispanic workers were 53% more likely to have medical conditions resulting from work-related injuries, but 48% less likely to receive payment for medical costs from workers' compensation (P < 0.05). CONCLUSIONS: This study suggests an urgent need to reform the current workers' compensation system to reduce the burden shifted to injured workers and society. Such reforms should include easier access and more assistance for Hispanic and other immigrant workers.     

The integration movement in California's workers' compensation market

Over the past two decades the California workers' compensation industry has been responding to rapidly rising medical costs. The first response was to attempt to adopt principles of managed care; the second, to increase efficiency by integrating activities, first within companies, then between companies and providers, and finally across companies providing both group health and workers' compensation. This article chronicles the integration movement, analyzes the forces driving it, and discusses how contradictory government incentives have both propelled and hindered integration.     

Managing workers' compensation costs in the military setting: the Army's story

Direct and indirect costs for the Army's workers' compensation payments have increased to more than 2 billion US dollars. Increasing attention is putting the spotlight on the problems at all levels, and a promising cooperative approach to injury prevention and case management is emerging. This article addresses the system within which the Army's workers' compensation program operates, provides some organizational history, gives an update on current status,and describes what is needed for sustained improvement. The onus is on the Army to develop and implement strategies that use available data to target high-risk occupations and employees to prevent accidents, injuries, and illnesses. Front-line managers bear the responsibility for educating the workforce and providing safe workplaces. Employees become the beneficiaries, not of medical and compensation benefits but of safe and healthy work environments.     

Workers' compensation reform

Workers' compensation reform efforts respond to the competing interests of business, labor and insurers. Early reforms expanded programs in response to inadequate benefits and coverage while in the 1980s and 1990s states responded to increasing costs by tightening fee schedules, limiting physician choice, restricting eligibility,lowering benefits, and integrating managed care into workers' compensation. Although managed care has resulted in significant medical savings, the cost of workers' compensation is again rapidly increasing in some states, where workers' compensation legislation is again at the center of debate. Increasing the use of treatment guidelines, placing limitations on use of services, developing more objective criteria for determining level of disability, and streamlining dispute resolutions have been offered as solutions. Controlling costs alone, however, cannot solve other problems of workers' compensation. Future reform efforts will need to focus not only on the costs of the system but also its inclusiveness and support of the workers and their families it was intended to protect.     

Work-related eye injuries among union carpenters

Union administrative records were combined with workers' compensation data to identify a cohort of 12,958 active union carpenters, their person-time at risk, and their documented work-related eye injuries between 1989 and 1995 in the state of Washington. The injuries were described using ANSI codes for injury nature, type (mechanism), and source or object associated with the event. Injuries which resulted in paid lost time from work were also described based on the ICD-9 codes attached to claims for their medical treatment. Overall rates of filing compensation claims for eye injuries as well as age, gender, and union local specific rates were calculated. To identify high risk subgroups and explore incident and recurrent events, the person-time and events were stratified by age, gender, time in the union, claim status, and predominant type of work of the union local with which each carpenter was affiliated for multivariate analyses with Poisson regression. Eye injuries were responsible for 12 percent (n = 1730) of workers' compensation claims during this time period, exceeded only by back and finger injuries. Thirty-one claims resulted in paid lost time from work and these cases accounted for one-third of all costs for medical care for eye injuries. At least 10 percent of all medical costs for eye injuries and 35.5 percent of medical costs for eye injuries which resulted in paid lost time were associated with injuries sustained while hammering--a very common carpenter exposure. Claims were filed at an estimated rate of 6.1 per 200,000 hours worked. Individuals with previous compensation claims for eye injuries had rates of injury 1.6 times higher than individuals without previous eye injuries. Rates decreased significantly with age and time in the union. Eye injuries among these union carpenters were very common, but the rate of injuries severe enough to require paid time off work was quite low. These findings raise questions about factors which might influence the failure to use appropriate protection including availability and acceptability of eye protection, use by peers, and perception of risk.     

Work-related injuries in drywall installation

Administrative data sources were used to describe the work-related injuries of drywall carpenters, to calculate rates of occurrence, and to explore high risk sub-groups. Health insurance eligibility files were used to identify a cohort of active union carpenters affiliated with a union local whose predominant work involved drywall installation in the state of Washington. These files contained the hours worked by each individual for each month between January 1989 and December 1995, providing person-hours at risk as a union carpenter. The Washington Department of Labor and Industries (L&I) provided records of workers' compensation claims filed by these individuals. Over seven years 1773 drywall carpenters filed 2567 workers' compensation claims representing an overall rate of 53.3 per 200,000 hours worked. These claims were filed by 1046 different individuals, or 59.0 percent of the cohort. Claims resulting in paid lost time from work were filed at a rate of 12.5 per 200,000 hours worked (n = 609) by 445 (25.1%) different individuals. The most common mechanisms of injury involved being struck (38.3%), overexertion (28.1%), and falls (13.2%). Struck by injuries most commonly involved cuts to the upper extremity. Overexertion injuries were most commonly described as sprains or strains involving the back. Sheetrock was associated with over 40 percent of these injuries. Falls most commonly involved injuries to the knee followed by the back and multiple injuries. Struck by injuries decreased steadily with increasing age and increasing time in the union. There was a steady increase in the rate of falls with increasing age. Overexertion injuries were responsible for the greatest proportion of costs for medical care, permanent impairment, and paid lost days. The high rates of overexertion injuries among these workers is consistent with known ergonomic stresses on drywall jobs. However, these workers are also at high risk of acute traumatic injuries.     

Methodologic issues in the use of workers' compensation databases for the study of work injuries with days away from work. I. Sensitivity of case ascertainment

BACKGROUND: Case ascertainment costs vary substantially between primary and secondary data sources. This review summarizes information on the sensitivity of state administrative databases in workers' compensation systems for the ascertainment of days-away-from-work (DAFW) work injuries for use in modeling studies. METHODS: Review of the literature supplemented by data from governmental or organizational reports or produced for this report. RESULTS: Employers currently appear to provide workers' compensation insurance coverage for 98.9% of wage and salary workers. Wage and salary jobs account for approximately 90% of jobs in the United States. In industries such as manufacturing, the fraction of covered jobs is probably closer to 98%. In Minnesota, the number of DAFW cases ascertained by the Bureau of Labor Statistics' annual survey of occupational injuries and illnesses is approximately 92-97% concordant with the number of wage compensation claims for injuries producing DAFW over the period 1992-2000, once adjustments are made to permit direct comparisons of the numbers. The workers' compensation databases provide information for more than 95% of the total DAFW resulting from work injuries. Covariate estimates are unaffected by this less than 5% loss because effects appear dependent on time from injury. CONCLUSIONS: Statewide workers' compensation administrative databases can have substantial utility for epidemiologic study of work injuries with DAFW because of their size, using high sensitivity for case ascertainment as the evaluative criterion.     

Risk factors for recurrent episodes of care and work disability: case of low back pain

Recurrences of injuries are common and have significant socioeconomic consequences; it is important to identify associated risk factors as potential opportunities for prevention. This study was conducted to identify risk factors for low back pain (LBP) recurrence and the extent that variation in recurrence definition impacts identified risk factors. Patients with new claims for LBP reported in New Hampshire to a workers' compensation provider were selected (n = 2023) with a minimum of 3-year follow up. Alternative definitions of recurrence included a new episode of medical care and a new episode of lost work time (work disability). Risk factors better predicted disability-based than treatment-based recurrence. Longer durations of the initial episode of care or work disability were the most powerful predictors of recurrence, implying that shorter episodes of care and early return to work contribute to better outcomes.     

The Workers' Compensation System: Worker friend or foe?

BACKGROUND: The workers' compensation system was designed to help injured workers who have substantial medical expenses and perhaps have lost a great deal of income. This study determines both similarities and differences in how workers experience their interactions with the workers' compensation systems in Florida and Wisconsin. METHODS: Ethnographic open-ended interviews with 204 workers from Florida and 198 workers in Wisconsin were conducted. All the workers had back injuries in 1990 and were either paid workers' compensation temporary disability benefits for at least 4 weeks or received permanent disability benefits or compromise settlements. RESULTS: Some interactions with the workers' compensation system were positive. However, the majority of respondents in both states experienced their encounters with the workers' compensation system as cumbersome, frustrating, and demeaning. CONCLUSIONS: Mistrust, stigmatization, payment delays, and refusal of insurer personnel to pay benefits contribute to workers' negative experiences with the workers' compensation system. These insurer behaviors raise the costs to injured workers of workers' compensation benefits and thus may reduce the propensity of eligible workers to apply for benefits.     

New possibilities in safety performance and the control of workers' compensation costs

This article describes successful behavioral interventions that improved safety performance and reduced workers' compensation costs in two corporations. The development of a four part program that: (1) shifted the paradigm for positive performance by workers and managers, (2) strengthened the community of work, (3) managed the crises of accidents, and (4) accelerated the return of injured employees to meaningful work is presented. In the two companies, lost time accidents were reduced by 95% and 87%, and accident costs were reduced by 90% and 70%, respectively. The results are discussed in terms of the critical roles played and choices made by managers in establishing a meaningful work culture, and the ethics which guide workers' and managers' behavior in decisions related to the use and abuse of the workers' compensation system.Reebok International, Ltd.     

Modified Work and Return to Work: A Review of the Literature

Workplace injuries which result in lost time from work can have considerable financial repercussions for employer and employee alike, not to mention their physical and emotional impact on the employee. In order to lessen workers' compensation costs and facilitate the rehabilitation process, some employers offer modified work to their injured employees in order to allow an earlier return to work than would ordinarily be possible. Although modified work is regarded by many as a cornerstone in the job rehabilitation process, little is known about the structure, effectiveness, and efficiency of such programs. This report is a systematic review of the scientific literature on modified work published since 1975. Its objective is to synthesize and critically appraise the research on modified work, and, specifically, to assess the effectiveness of modified work programs. Using a systematic keyword search in three online libraries, 29 empirical studies of modified work programs were selected for review. The studies were evaluated for methodological quality, from which 13 higher quality studies were identified. On the basis of these 13 studies, the effectiveness of modified work programs was evaluated. The main finding of this review is that modified work programs facilitate return to work for temporarily and permanently disabled workers. Injured workers who are offered modified work return to work about twice as often as those who are not. Similarly, modified work programs cut the number of lost work days in half. The available evidence also suggests that modified work programs are cost-effective. Comprehensive cost-benefit analyses are needed to confirm this finding.