An epidemiological and risk analysis of Virginia workers' compensation burn claims 1999 to 2002: identifying and prioritizing preventive workplace interventions

OBJECTIVE: This study examines workers' compensation burn claims from Virginia to assess risk factors and costs associated with occupational burn injuries. METHODS: Virginia workers' compensation burn claims for the period of 1999 to 2002 were analyzed. Claim rates were determined by using the Bureau of Labor Statistics' Current Population Survey for the working population of Virginia. RESULTS: There were 5810 burn claims reported for the 4-year period examined, with the average burn rate estimated to be 4.3 per 10,000 workers. The total cost of claims was found to average $11,705,939 per year and $8059 per claim. There was over a sixfold increase for burn rates on weekends relative to weekdays. CONCLUSION: Burns are a common injury experienced by workers and are often severe. Assessing personnel issues affecting weekend employees may lead to valuable preventive interventions to reduce burn risk.     

The association of health risks with workers' compensation costs.

The purpose of this study was to investigate the association between health risks and workers' compensation (WC) costs. The 4-year study used Health Risk Appraisal data and focused on 1996-to-1999 WC costs among Xerox Corporation's long-term employees. High WC costs were related to individual health risks, especially Health Age Index (a measure of controllable risks), smoking, poor physical health, physical inactivity, and life dissatisfaction. WC costs increased with increasing health risk status (low-risk to medium-risk to high-risk). Low-risk employees had the lowest costs. In this population, 85% of WC costs could be attributed to excess risks (medium- or high-risk) or non-participation. Among those with claims, a savings of $1238 per person per year was associated with Health Risk Appraisal participation. Addressing WC costs by focusing on employee health status provides an important additional strategy for health promotion programs.     

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.     

Natural rubber latex allergy workers' compensation claims: Washington State healthcare workers, 1991-1999

Occupational reaction to natural rubber latex experienced by healthcare employees was examined using data of all workers' compensation claims filed by state-insured healthcare employees in Washington State for the period 1991-1999 (n = 65,703). As latex reaction is not a condition for which there are specific identification codes, these claims were estimated by coupling source and nature of injury records that were consistent with reactions to latex. It was found that the claim rate was on average 2.66 per 10,000 state-insured healthcare workers annually. The most common condition experienced was dermal (84.3%), and most common body part affected was the hand (70.0%). Because few claims cited respiratory or conjunctivitis as reaction experienced, little evidence was discovered to support that glove powder acted as a widespread latex allergen transmitter in healthcare environments. Most cases did not require indemnity payment for lost work time (81.2%), suggesting most reactions were minor. The average cost per natural rubber latex claim was $2,759.10, compared to $3,178.18 for the average healthcare worker claim for all causes. Overall, the average cost per state-insured healthcare worker employed during this time was under $0.74 per year. Nursing aides/orderlies were the most frequent healthcare occupation filing a claim (33.2%). The majority of claimants were female (87.9%), and unmarried workers (52.0%) filed slightly more claims than married workers (48.0%). In comparison with other workers' compensation claims filed by healthcare workers during this period, 0.34 percent of the total was potentially related to natural rubber latex, with other common healthcare workplace items cited more frequently as source of occupational injury.     

A preliminary investigation of the effects of a provider network on costs and lost-time in workers' compensation

OBJECTIVE: We sought to compare lost-time days and average and median workers' compensation claims costs between injured workers managed by OMNET Gold (OG) physicians and those managed by physicians not participating in OG. OG is a statewide health care provider network coordinated by occupational medicine physicians and established by the Louisiana Workers' Compensation Corporation (LWCC) to manage the medical care of injured workers. METHODS: We identified and contrasted 158 lost-time claims managed by OG physicians and 1,323 claims managed by physicians not participating in OG during the first year of network operation (August 1, 2003 to July 31, 2004). RESULTS: The average and median costs for a non-OG claim was $12,542 and $5,793, whereas the average and median costs for an OG claim was $6,749 and $3,015. The average and median number of lost-time days for an OG claim was 53.4 and 34.0 and 95.0 and 58.0 for a non-OG claim. The mean differences were statistically significant. CONCLUSIONS: A small network of physicians may have an effect on the duration of lost-time and workers' compensation costs.     

Occupational injury among Rhode Island adolescents: an analysis of workers' compensation claims, 1998 to 2002

OBJECTIVES: We sought to examine occupational injuries sustained by adolescent workers during a 5-year period. METHODS: Workers' compensation claims from Rhode Island were used to assess injuries of 15- to 19-year-old employees (n = 8321) from 1998 to 2002. Baseline employee population estimates were derived using the Current Population Survey. RESULTS: The annual estimated adolescent claim rate was 6.6 per 100 workers (95% confidence interval = 6.1-7.1), with annual average costs of $614,182. Injury rates increased with employee age, hours worked, and for day and nightshift employees relative to evening shift workers. The highest proportion of claims by industry was in eating establishments, and the average indemnification duration was 13.0 days. CONCLUSIONS: Specific emphasis should be placed on increasing safety training and preventative interventions for teenagers in hazardous occupations and for those working longer hours.     

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.     

Workplace violence in Oregon: an analysis using workers' compensation claims from 1990-1997

One of the most serious occupational problems in the workplace is the occurrence of violent assaults. This study examined 2028 workers' compensation claims of workplace violence from Oregon between 1990 and 1997, and used Current Population Survey data for risk analysis. The rate of workplace violence was 1.86 per 10,000 employees annually (95% confidence interval, 1.78-1.94), with females and workers under 35 years of age experiencing the most violence. The average claim resulted in approximately 40 days of indemnity and $6200 in costs. Workers on evening and night shifts had significantly higher rates of being victims of violence, as did those working on weekends. Preventative interventions should be targeted at younger workers and those with less tenure. Special measures should be focused on ensuring the safety of evening/night-shift workers and weekend employees.     

Assessment of occupational eye injury risk and severity: an analysis of Rhode Island workers' compensation data 1998-2002

BACKGROUND: Occupational eye injuries have been recognized as a serious health risk to workers and are in need of further investigation to develop effective interventions. METHODS: Rhode Island workers' compensation claims of ocular injury between 1998 through 2002 (n=8,877) were examined. The Current Population Survey was used to estimate occupational employment levels as a baseline for rate calculations. RESULTS: The estimated ocular injury claim rate was 32.9 per 10,000 workers (95% CI=32.3-33.6), with the cost of claims totaling $1,514,666 and averaging $171 per claim. The highest estimated claim rate of all occupations was found for construction laborers of 373.7 per 10,000 workers (95% CI=267.1-480.3). Relative to the durable manufacturing industry, the highest risk of injury resulting in disability indemnification was the wholesale trade industry (OR=2.18, 95% CI=1.19-4.01, P<0.05). CONCLUSIONS: Many of the eye injuries reported were likely preventable. Greater diligence, training, and safety precautions are needed to reduce the risk of eye injury to employees.     

Assessing latex allergy among health care employees using workers' compensation data

Latex allergies among health care workers have garnered considerable attention from medical researchers and practitioners. However, the majority of research on natural rubber latex allergy has focused on clinical methodologies and emphasized the quantification of employee sensitization rates as opposed to actual incidents of reactivity. Workers' compensation data provide information on the number and impact of reactions to latex use. This article presents an analysis of health care workers' compensation data from North Dakota to estimate the prevalence, costs, and nature of claims associated with latex allergic reaction. The results show an annual average claim rate of 1.52 per 10,000 health care workers employed in the state, and annual costs averaging about $.08 per health care worker. Skin disorders were the most commonly reported condition. These findings are compared with previous studies of Minnesota and Rhode Island and demonstrate similar results.     

Barriers to workers' compensation and medical care for injured Personal Assistance Services workers

OBJECTIVES: We documented barriers to workers' compensation and injury-related medical care faced by homecare or Personal Assistance Services (PAS) workers. We explored differences between independent providers and agency-employed workers. METHODS: We conducted in-depth, semi-structured interviews with a diverse sample of 38 injured workers. Participants were primarily female and racial-ethnic minorities. RESULTS: Most participants (82%) were independent providers. Common barriers to reporting injury included commitments to clients and financial pressure. Unlike agency employees, many independent providers knew little about workers' compensation eligibility and injury reporting procedures, and frequently were given "the runaround" by the social service bureaucracy when they attempted to report injury and access injury-related medical care. Among independent providers, delays in filing a claim and receiving timely medical attention were common. CONCLUSIONS: The lack of a traditional employment infrastructure has important implications for vulnerable workers' health and the sustainability of consumer-directed PAS programs. We provide recommendations for improving workers' access to workers' compensation and injury-related medical care.     

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.     

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.     

Alleged B. anthracis exposure claims in a workers' compensation setting

OBJECTIVES: Workers' compensation insurance in some states may not provide coverage for medical evaluation costs of workplace exposures related to potential bioterrorism acts if there is no diagnosed illness or disease. Personal insurance also may not provide coverage for these exposures occurring at the workplace. Governmental entities, insurers, and employers need to consider how to address such situations and the associated costs. The objective of this study was to examine characteristics of workers and total costs associated with workers' compensation claims alleging potential exposure to the bioterrorism organism B. anthracis. METHODS: We examined 192 claims referred for review to the Ohio Bureau of Workers' Compensation (OBWC) from October 10, 2001, through December 20, 2004. RESULTS: Although some cases came from out-of-state areas where B. anthracis exposure was known to exist, no Ohio claim was associated with true B. anthracis exposure or B. anthracis-related illness. Of the 155 eligible claims, 126 included medical costs averaging dollar 219 and ranging from dollar 24 to dollar 3,126. There was no difference in mean cost for government and non-government employees (p = 0.202 Wilcoxon). CONCLUSIONS: The number of claims and associated medical costs for evaluation and treatment of potential workplace exposure to B. anthracis were relatively small. These results can be attributed to several factors, including no documented B. anthracis exposures and disease in Ohio and prompt transmission of recommended diagnostic and prophylactic treatment protocols to physicians. How employers, insurers, and jurisdictions address payment for evaluation and treatment of potential or documented exposures resulting from a potential terrorism-related event should be addressed proactively.     

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.     

Disabling and fatal occupational claim rates, risks, and costs in the Oregon construction industry 1990-1997

This study estimated injury and illness rates, risk factors, and costs associated with construction work in Oregon from 1990-1997 using all accepted workers' compensation claims by Oregon construction employees (N = 20,680). Claim rates and risk estimates were estimated using a baseline calculated from Current Population Survey data of the Oregon workforce. The average annual rate of lost-time claims was 3.5 per 100 workers. More than 50% of claims were by workers under 35 years and with less than 1 year of tenure. The majority of claimants (96.1%) were male. There were 52 total fatalities reported over the period examined, representing an average annual death rate of 8.5 per 100,000 construction workers. Average claim cost was $10,084 and mean indemnity time was 57.3 days. Structural metal workers had the highest average days of indemnity of all workers (72. 1), highest average costs per claim ($16,472), and highest odds ratio of injury of all occupations examined. Sprains were the most frequently reported injury type, constituting 46.4% of all claims. The greatest accident risk occurred during the third hour of work. Training interventions should be extensively utilized for inexperienced workers, and prework exercises could potentially reduce injury frequency and severity.     

Controlling workers' compensation medical care use and costs through utilization management.

Little is known about the performance of utilization management (UM) programs, which are now widely used within the workers' compensation system to contain medical costs and improve quality. UM programs focus largely on hospital care and rely on preadmission and concurrent reviews to authorize hospital admissions and continued stays. We obtained data from a large UM program representing a national sample of 9319 workers' compensation patients whose medical care was reviewed between 1991 and 1993. We analyzed these data to determine the denial rate for hospital admission and outpatient surgery and the frequency of length-of-stay restrictions among hospitalized patients. The denial rate was approximately 2% to 3% overall, but many of the denials were later reversed. On average, the UM program reduced the length of stay by 1.9 days relative to the number of days of care requested. The estimated gross cost savings resulting from reduced hospitalization time and decreased outpatient care was approximately $5 million. UM programs may offer a viable approach to cost containment within the workers' compensation system. Their value as a tool to improve the quality of care for workers' compensation patients remains to be demonstrated.