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.     

Surveillance of work-related musculoskeletal injuries among union carpenters

Combined data sources, including union administrative records and workers' compensation claims, were used to construct event histories for a dynamic cohort of union carpenters from Washington State during the period 1989–1992. Person-time at risk and the events of interest were stratified by age, sex, time in the union, and predominant type of carpentry work. Poisson regression techniques were used to identify subgroups at greatest risk of filing claims for a variety of musculoskeletal disorders defined by ANSI codes for body part injured and injury nature. Distinguishing different kinds of musculoskeletal disorders, even crudely with ANSI codes, led to different conclusions about the effects of the explanatory variables. Among older workers, the rates of fractures of the foot were higher, while rates of contusions of the hand and foot were lower. Women had higher rates of sprain/strains and nerve conditions of the wrist/forearm. Higher rates of injuries to the axial skeleton were seen among carpenters who did predominantly light commercial and drywall work, while piledrivers had lower rates of these injuries. Drywall workers had higher rates of sprains to the ankle/lower leg. Workers who were members of the union as long as four years had lower risks for the vast majority of musculoskeletal disorders studied. Similar patterns were seen for more serious claims that resulted in paid lost time from work. Am. J. Ind. Med. 32:629–640, 1997. © 1997 Wiley-Liss, Inc.     

Falls among union carpenters

BACKGROUND: Falls are a leading cause of morbidity and mortality in the construction trades. METHODS: We identified a cohort of 16,215 active union carpenters, hours worked, and their workers' compensation claims for a 10-year period. The data on this well-defined cohort were used to describe their work-related falls; to define rates of injury and the associated costs; and to identify high-risk groups. RESULTS: Same level falls occurred at a rate of 1.8/200,000 hours worked; falls from elevations at a rate of 2.3/200,000 hours worked. These injuries resulted in direct payments of 0.30 dollars per hour of work or 2.40 dollars per 8-hr day. Mean costs per fall increased with increasing age. Age was not associated with risk of falls from elevations; younger carpenters had modestly reduced rates of falls from the same level. Rates of falls decreased with increasing time in the union. Carpenters whose usual work involved drywall installation or residential work were at highest risk. CONCLUSIONS: Falls are a significant public health risk for carpenters and they are responsible for a significant burden of work-related injury costs. While there is a need for prevention of falls from elevations--through training, enforcement of fall protection regulations, improved safety climate, or engineering changes--there is also the need to prevent falls from lower elevations. Differences in risk likely reflect varying exposures and safety practices in different areas of carpentry, as well as training, experience, and job assignments based on longevity in the union.     

Health care utilization of carpenters with substance abuse-related diagnoses

BACKGROUND: Persons in the construction trades in the US have high rates of alcohol and substance abuse. We had the unique opportunity to evaluate health care utilization through private insurance and workers' compensation for a group of carpenters at high risk of injury and substance abuse. METHODS: We identified a cohort of union carpenters. Their claims for medical care through union insurance and workers' compensation, and appropriate measures of time at risk were documented. Using methods of indirect standardization, we compared utilization and costs between carpenters with and without alcohol and substance-abuse related diagnoses (ASRD). RESULTS: Through private insurance, those with ASRD had 10% higher outpatient utilization and 2.1 times higher rates of hospitalizations for injury care; 2.6 times higher rates of outpatient care; and 2.9 times higher inpatient admissions for non-injury care. Individuals with ASRD had only modestly increased rates (10%) of outpatient utilization through workers' compensation. CONCLUSIONS: These findings support the need for alcohol and drug abuse prevention and treatment services for this workforce. Operationalizing this among highly mobile workforces, such as the construction trades, is a challenge. While not intending to minimize the problems of alcohol or substance abuse on the job among carpenters, the focus of prevention should not necessarily be in the workplace.     

The relationship between attorney involvement, claim duration, and workers' compensation costs

OBJECTIVE:: To determine the relationship between attorney involvement, claim duration and workers' compensation claim costs. METHODS:: We identified and compared 738 claims with attorney involvement and 6191 claims without attorney involvement submitted by individuals injured between August 1, 2003 and July 31, 2004 whose claims were paid by the Louisiana Workers' Compensation Corporation (LWCC). At the time of assessment (March 20, 2006), 97.7% of claims not involving attorneys and 57.5% of claims involving attorneys were closed (resolved). RESULTS:: After controlling for lost time (temporary/total days paid), attorney involvement was associated with consistently higher medical, indemnity and claims handling costs, as well as increasing claim duration (accident date to closing date). CONCLUSION:: Attorney involvement in workers' compensation claims is associated with increasing claims duration and costs.     

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.     

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.     

Variations in worker compensation claims by company: the potential for achieving a significant reduction in claims

BACKGROUND: The objective of our study was to examine the potential reduction in paid worker compensation claims if the rate of claims were as low as the rates of the top companies in that industry category. METHODS: Using Michigan data for the years 1999-2001, we first excluded companies who had no paid worker compensation claims for wage replacement and then calculated the top 10th, 25th, and 50th percentile rates of paid worker compensation claims for wage replacement of all the remaining companies combined and by 2 digit SIC. The percent reduction was calculated separately for small (<20 employees) and large companies based on the differences in observed minus expected if all companies did as well as the top companies in their industry grouping. RESULTS: Fifty-nine percent of large companies and 90% of small companies had no paid worker compensation claims for wage replacement over the 3-year period. Controlling for industry type there would have been 91,504 fewer paid workers' compensation claims if all companies with at least one claim did as well as the 10th percentile or better as the companies in their industry grouping. Reductions were found across all industries and for both small and large companies. CONCLUSION: Variations in worker compensation claims between states are highlighted when legislators consider "reforms" to reduce workers' compensation costs. These reforms overlook the larger variation between companies within the same type of industry in the same state. Possible reasons for this variation between companies and its implication on reducing morbidity and health care costs are discussed.     

Work-related burns in Washington State, 1994 to 1998

This article describes an investigation of work-related burns in Washington State during 1994-1998. Workers' compensation data were used to describe the general characteristics of burn injuries, estimate industrial claims rates, and compare nonhospitalized and hospitalized burn cases. The completeness of workers' compensation data as a source for surveillance was evaluated. During 1994-1998, a total of 20,213 burn claims were accepted by the workers' compensation system. Hospitalized burn cases represented only 1.5% of burn claims but incurred 55% of the costs. In addition, workers' compensation data underestimated the frequency and rate of burns. Although workers' compensation claims rates decreased during 1994-1998, work-related burns remain a problem in Washington State. Several industries (e.g., roofing, foundries, and aluminum smelting) were identified as priorities for prevention of burn hospitalizations, which incur the greater cost and time loss.     

Workers' compensation managed care: Preliminary findings

The cost of providing care that is effective to return injured workers to the workplace has risen in recent years in a manner that appears to be out of control in the workers' compensation system. In turn, medical care costs are an important component of the rapidly increasing costs of workers' compensation insurance. A model of health care delivery that emphasizes early intervention and return to work is presented. This model focuses on providing aggressive treatment of injuries that historically have been reported to be extraordinarily expensive. This paper is a case study of a managed care treatment model and presents costs of treatment in the first year of utilization. Medical care costs of 295 cases are compared with state and national figures and are found to be substantially better, especially with regard to soft tissue injuries and injuries that involve days lost from work.     

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.     

Cost of compensated injuries and occupational diseases in agriculture in Finland

Although agriculture is one of the most hazardous industries, the costs of agricultural injuries and illnesses are not well known. This study aimed to determine the cost burden from compensated injuries and occupational diseases in Finnish agriculture using workers compensation records. The incidence rates in 1996 were 7.4/100 for injuries and 0.61/100 for occupational diseases. Men had a higher risk of injury (RR = 1.89; 95% CI: 1.81-1.97), but a lower risk of an occupational disease (RR = 0.68; 95% CI: 0.60-0.78), compared to women. The total cost burden was 75 (Euros) per person in 1983, increasing to 215 in 1999. The total insurance cost in 1996 was 23.5 million consisting of medical care (16%), per diem (lost time compensation within one year from the incident) (37%), pension (lost time compensation after one year from the incident) (23%), survivors pension (3%), impairment allowance (7%), rehabilitation (6%), and other costs (9%). The total cost was 0.7% of the national gross farm income and 2.2% of the net farm income. The mean cost of 1996 cases was 1340 for injuries and 6636 for occupational diseases. Injuries represented 92% of the claims and 71% of the total costs. Occupational diseases represented 8% of the claims and 29% of the costs. Twenty percent of the most severe claims represented 79.5% of the total insurance costs. Injuries and occupational diseases result in significant costs in agriculture. Lost time was the largest cost item. Overall, injuries were more costly than occupational diseases. This study indicates that the 20%-80% rule applies to agricultural injury and illness costs, and from the cost standpoint, it is important to focus prevention efforts on the most severe incidents.     

Occupational injury costs and alternative employment in construction trades

OBJECTIVE: To present the costs of fatal and non-fatal days-away-from-work injuries in 50 construction occupations. Our results also provide indirect evidence on the cost exposure of alternative construction workers such as independent contractors, on-call or day labor, contract workers, and temporary workers. METHODS: We combine data from the Bureau of Labor Statistics on average annual incidence from 2000 to 2002 with updated per-case costs from an existing cost model for occupational injuries. The Current Population Survey provides data on the percentage of alternative construction workers. RESULTS: Construction laborers and carpenters were the two costliest occupations, with 40% of the industry's injury costs. The 10 costliest construction occupations also have a high percentage of alternative workers. CONCLUSIONS: The construction industry has both a high rate of alternative employment and high costs of work injury. Alternative workers, often lacking workers' compensation, are especially exposed to injury costs.     

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.     

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.     

An investigation of the effects of a healthcare provider network on costs and lost time in workers' compensation

OBJECTIVE: The objective of this study was to evaluate the number of lost time days and cost of workers' compensation claims at a median claim duration (maturity) of 25 months for individuals injured between August 1, 2003, and July 31, 2004, who chose a statewide (Louisiana) network (Omnet Gold) of healthcare providers not subject to utilization review. METHODS: We identified and contrasted 176 lost time claims (143 closed) managed by Omnet Gold (OG) healthcare providers and 1464 lost time claims managed by healthcare providers not participating in OG. RESULTS: The average frequency of lost workdays for a closed OG claim was 53 days versus 99 days for a closed non-OG claim and the average cost of a closed OG claim was 12,554 dollars, whereas the average cost of a closed non-OG claim was 20,400 dollars. Both days lost from work and costs were significantly lower among claims managed by OG healthcare providers. This outcome was consistent with the findings of a previous study performed on the same claims in which a significant difference was demonstrated analyzing primarily open (unresolved) claims with a median claim duration of 6 months. The ability of OG healthcare providers to return a higher proportion of injured workers to work early and shorten claims durations were the major factors influencing these outcomes. CONCLUSIONS: In a state where claimants are permitted choice of medical provider, a network of healthcare providers can achieve superior lost time and cost outcomes than out of network healthcare providers.     

Cost of Compensated Injuries and Occupational Diseases in Agriculture in Finland

Abstract

Although agriculture is one of the most hazardous industries, the costs of agricultural injuries and illnesses are not well known. This study aimed to determine the cost burden from compensated injuries and occupational diseases in Finnish agriculture using workers compensation records.

The incidence rates in 1996 were 7.4/100 for injuries and 0.61/100 for occupational diseases. Men had a higher risk of injury (RR = 1.89; 95% CI: 1.81-1.97), but a lower risk of an occupational disease (RR = 0.68; 95% CI: 0.60-0.78), compared to women. The total cost burden was €75 (Euros) per person in 1983, increasing to €215 in 1999. The total insurance cost in 1996 was €23.5 million consisting of medical care (16%), per diem (lost time compensation within one year from the incident) (37%), pension (lost time compensation after one year from the incident) (23%), survivors pension (3%), impairment allowance (7%), rehabilitation (6%), and other costs (9%). The total cost was 0.7% of the national gross farm income and 2.2% of the net farm income. The mean cost of 1996 cases was €1340 for injuries and €6636 for occupational diseases. Injuries represented 92% of the claims and 71% of the total costs. Occupational diseases represented 8% of the claims and 29% of the costs. Twenty percent of the most severe claims represented 79.5% of the total insurance costs.

Injuries and occupational diseases result in significant costs in agriculture. Lost time was the largest cost item. Overall, injuries were more costly than occupational diseases. This study indicates that the 20%-80% rule applies to agricultural injury and illness costs, and from the cost standpoint, it is important to focus prevention efforts on the most severe incidents.