Analysis of mortality patterns and workers' compensation awards among asbestos insulation workers in Ontario

Mortality and workers' compensation patterns were studied among 1,064 Ontario asbestos insulation workers. A proportional mortality analysis of 153 asbestos worker deaths found increased mortality from malignant diseases (65 deaths observed; 35.1 expected), cancers of the lungs and pleura (32 deaths observed; 11.5 expected), peritoneal mesothelioma (4 deaths), and respiratory diseases (14 deaths observed; 7.9 expected). Despite the publicity given to asbestos-associated diseases, dependents of many men potentially eligible for workers compensation awards have not received pensions because claims were not filed. These findings suggest that much occupationally related disease is not being recognized in Ontario.     

Effects of premium discount on workers' compensation claims in agriculture in Finland

BACKGROUND: The objective of this study was to measure changes in injury claim rates after a premium discount program was implemented in the Finnish farmers' workers' compensation insurance. We focused on measures that could indicate whether the changes occurred in the true underlying injury rate, or only in claims reporting. METHODS: Monthly injury claim rates were constructed at seven disability duration levels from January 1990 to December 2003. We conducted interrupted time series analyses to measure changes in the injury claim rates after the premium discount was implemented on July 1, 1997. Three additional policy change indicators were included in the analyses. RESULTS: The overall injury claim rate decreased 10.2%. Decreases occurred at four severity levels (measured by compensated disability days): 0 days (16.3%), 1-6 days (14.1%), 7-13 days (19.5%), and 14-29 days (8.4%). No changes were observed at higher severity levels. Minor injuries had a seasonal pattern with higher rates in summer months while severe injuries did not have a seasonal pattern. CONCLUSIONS: The premium discount decreased the overall claim rate. Decreases were observed in all categories up to 29 disability days. This pattern suggests that under-reporting contributes to the decrease but may not be the only factor. The value of the premium discount is lower than the value of a lost-time claim, so there was no financial reason to under-report lost-time injuries. Under-reporting would be expected to be greatest in the 0 day category, but that was not the case. These observations suggest that in addition to under-reporting, the premium discount may also have some preventive effect.     

Outcomes research in Washington state workers' compensation

The extensive claim and medical bill payment databases of the Washington state workers' compensation system have been used to conduct epidemiologic and outcome studies of work-related conditions. Computerized administrative data must be supplemented with medical record review and structured interview of workers in outcome studies in order to adequately adjust for baseline severity and to address functional and patient satisfaction outcomes, respectively. Three examples of surgical outcome studies are described (carpal tunnel, lumbar fusion, thoracic outlet). Duration of disability prior to surgical intervention is an important predictor of duration of disability following surgery, even when other biologic markers of severity are included in multivariate modeling. Sufficient follow-up time is required to adequately assess longer-term outcomes, such as return-to-work status and the substantial effects of residual impairment even after claim settlement. Finally, well-conducted outcome studies may be linked to the development of surgical treatment guidelines in workers' compensation. © 1996 Wiley-Liss, Inc.     

Silica and progressive systemic sclerosis (scleroderma): Evidence for workers' compensation policy

The occurrence of several confirmed cases of progressive systemic sclerosis (scleroderma) among male miners prompted a request by a member of the provincial parliament (MPP) of Ontario that the Industrial Disease Standards Panel (IDSP) evaluate the evidence for an occupational connection. A number of publications in reputable peer-reviewed medical journals offer case-control evidence gathered over four decades on three continents showing a rather clear-cut relationship between occupational exposure to crystalline silica and scleroderma. This article summarizes the evidence for a causal relationship and describes the process by which the members of the panel, using the criteria developed by Sir Austin Bradford Hill as a guide, made a finding of probable connection, the term mandated by the Workers' Compensation Act of Ontario. It provides insight into the difficulties encountered by those setting occupational disease policy when scientific certainty is unobtainable. © 1996 Wiley-Liss, Inc.     

Outcome of carpal tunnel surgery in washington state workers' compensation

All cases of occupational carpal tunnel syndrome (OCTS) who received surgery for this condition in the Washington State workers' compensation system were identified using claim and physician billing databases. One hundred ninety-one incident surgical cases were identified between July 1, 1987 and December 31, 1987, and were followed up a mean of 3 years postoperatively for clinical, disability, and return to work outcomes. Medical record and claim file review was required for clinical and employment information. The mean age of all patients was 36.6 years, 48% were female, and 40% received bilateral surgery. The mean time from claim filing to surgery was 187 days. Ninety-eight percent of cases met the National Institute for Occupational Safety and Health (NIOSH) case definition for OCTS. Relief of pain was complete or modest in 86% (124/145) and only 14% of cases reported no improvement in symptoms. Mean duration of disability (time loss) postoperatively was nearly 4 months, and 8% of cases exceeded 1 year of time loss. The majority of cases returned to their same job (67%) or to a different job (15%). Workers in high risk occupations were less likely to return to the same job after CTS surgery compared to those in lower risk occupations (61% vs. 75%, p = 0.08). In this population, no association was seen between any outcome and age, gender, marital status, or baseline wage. Duration of disability was not significantly related to preoperative severity of OCTS or to more specific case criteria for this condition. These findings suggest that disability following surgery for OCTS may be related to other medical, psychosocial, administrative, legal, or work-related factors not evaluated in this study. © 1994 Wiley-Liss, Inc.     

Occupational exposure monitoring data collection,storage, and use among state-based and private workers' compensation insurers

Despite substantial financial and personnel resources being devoted to occupational exposure monitoring (OEM) by employers, workers' compensation insurers, and other organizations, the United States (U.S.) lacks comprehensive occupational exposure databases to use for research and surveillance activities. OEM data are necessary for determining the levels of workers' exposures; compliance with regulations; developing control measures; establishing worker exposure profiles; and improving preventive and responsive exposure surveillance and policy efforts. Workers' compensation insurers as a group may have particular potential for understanding exposures in various industries, especially among small employers. This is the first study to determine how selected state-based and private workers' compensation insurers collect, store, and use OEM data related specifically to air and noise sampling.

?Of 50 insurers contacted to participate in this study, 28 completed an online survey. All of the responding private and the majority of state-based insurers offered industrial hygiene (IH) services to policyholders and employed 1 to 3 certified industrial hygienists on average. Many, but not all, insurers used standardized forms for data collection, but the data were not commonly stored in centralized databases. Data were most often used to provide recommendations for improvement to policyholders. Although not representative of all insurers, the survey was completed by insurers that cover a substantial number of employers and workers. The 20 participating state-based insurers on average provided 48% of the workers' compensation insurance benefits in their respective states or provinces. These results provide insight into potential next steps for improving the access to and usability of existing data as well as ways researchers can help organizations improve data collection strategies. This effort represents an opportunity for collaboration among insurers, researchers, and others that can help insurers and employers while advancing the exposure assessment field in the U.S.     

Capturing cases in workers' compensation databases: the example of neck pain

BACKGROUND: There is a need to more accurately enumerate workers with musculoskeletal injuries who make lost-time claims to workers compensation boards. The objective of this study is to develop an approach to more accurately enumerate these workers. METHODS: Lost-time claims to the Ontario Workplace Safety & Insurance Board (WSIB) were reviewed. Using neck pain as an example, nature of injury and part of body codes were identified to classify cases. Claims of a random sample of 434 claimants were reviewed. The proportion of claimants classified as having neck pain was computed. RESULTS: The proportion of claimants classified with soft-tissue injuries to the neck varied from 0.88 for codes including "neck/cervical region," 0.69 for "back region" to 0.05 for those coded as "shoulder/upper arm." CONCLUSIONS: Restricting the enumeration of injuries to specific part of body codes can lead to a gross underestimation of the magnitude of soft-tissue disorders in epidemiological studies using workers' compensation data. The proposed approach leads to more accurate enumeration.     

An assessment and quantification of the rates, costs, and risk factors of occupational amputations: analysis of Kentucky workers' compensation claims, 1994-2003

BACKGROUND: Assessments of the impact of occupational amputations with outcomes of pain, disfigurement, and often an inability to return to the same job, are limited. The present study examines and quantifies the rates, risk factors, and costs of occupational amputations in the workplace in the State of Kentucky. METHODS: Worker's compensation data from 1994 through 2003 from Kentucky was used to investigate job-related amputations (n = 2,297). The US Department of Labor's Current Population Survey (CPS) was used to estimate injury rates. RESULTS: The average amputation claim rate for all Kentucky workers was 1.37 per 10,000, with an average per-claim indemnity cost of $8,822. A declining trend was found in the rate over the last 7 years studied. Accidents resulting in amputations occurred at twice the rate on weekends than on weekdays. Amputations affecting the hand constituted 94.6% of all injuries. Workers in the mining industry had the highest estimated claim rate of 5.92 (95% CI 5.23-6.66), and machine operators and assemblers had the highest rate of all occupations with 3.35 (95% CI 3.23-3.47). CONCLUSIONS: Workplace amputations remain a significant workplace concern and represent a particular hazard for those in the mining and manufacturing industries. Future research should examine causes of the weekend effect to develop human resource and safety interventions for risk reduction.     

New workers' compensation legislation: expected pharmaceutical cost savings

BACKGROUND: California Workers' Compensation (WC) system costs are under review. With recently approved California State Assembly Bill (AB) 749 and Senate Bill (SB) 228, an assessment of proposed pharmaceutical cost savings is needed. METHODS: A large workers' compensation database provided by the California Workers' Compensation Institute (CWCI) and Medi-Cal pharmacy costs obtained from the State Drug Utilization Project are utilized to compare frequency, costs and savings to Workers' Compensation in 2002 with the new pharmacy legislation. RESULTS: Compared to the former California Workers' Compensation fee schedule, the newly implemented 100% Medi-Cal fee schedule will result in savings of 29.5% with a potential total pharmacy cost savings of $125 million. Further statistical analysis demonstrated that a large variability in savings across drugs could not be controlled with this drug pricing system. CONCLUSIONS: Despite the large savings in pharmaceuticals, inconsistencies between the two pharmaceutical payment systems could lead to negative incentives and uncertainty for long-term savings. Proposed alternative pricing systems could be considered. However, pain management implemented along with other cost containment strategies could more effectively reduce overall drug spending in the workers' compensation system.     

Repackaged pharmaceuticals in the California workers' compensation system: from distribution and pricing options to physician and retail dispensing

OBJECTIVE: The California Workers' Compensation (WC) pharmaceutical pricing system cannot price 60% of National Drug Codes (NDCs) (mostly repackaged pharmaceuticals). This study will estimate the lost savings due to repackaged pharmaceuticals and potential cost savings associated with alternative pharmacy fee schedules for repackaged pharmaceuticals. In addition, we will determine what characteristics explain repackaged costs to identify reasons for repackaged pharmaceutical use. METHODS: All pain-related repackaged pharmaceuticals were identified by NDC using claims data from the California Workers' Compensation Institute (CWCI) database during 2002. RESULTS: Repackaged pharmaceuticals represented 55% of all NDCs and 92% of all Medi-Cal non-equivalent NDCs, but only 22% ($8,494,297/$38,968,233) of total pharmacy costs. Total repackaged pharmaceutical costs could be reduced by 36% ($3,059,177) using an alternative formula based on Medi-Cal. Compared with Medi-Cal priced manufacturer-packaged pharmaceuticals, repackaged pharmaceuticals are approximately 85% more expensive on a cost-per-pill basis. CONCLUSION: We propose limiting the generous pricing of repackaged pharmaceuticals. However, Medi-Cal payment rates may be extreme, and more moderate repricing might compensate physician-dispensing time more fairly and preserve patient access.