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PubMed1999

Workers' compensation experience of North Carolina residential construction workers, 1986-1994.

A total of 31,113 workers' compensation claims among 7,400 North Carolina Homebuilders Association (NCHA) members and their subcontractors for the period 1986-1994 were analyzed to calculate workers' compensation claim incidence density rates. For the 7 years studied, the average rate (cases/200,000 work hours) for all claims was 16.40 and the rate for medical or lost time cases was 10.78. Highest rates for cases involving medical costs or paid lost time by mechanism of injury were observed for being struck by an object (3.1), lifting/movement (1.97), falls from a different level (1.13), striking against an object (0.87), and falls on the same level (0.46). Rates by mechanism of injury were highest for muscle strains (2.34), wounds/punctures (2.33), bruises/contusions (1.24), fractures/dislocations (0.98), and injuries to the eyes (0.81). Among medical cost or lost work time cases, body parts with highest injury rates were back/shoulders (1.99), fingers (1.31), leg/knee (1.00), hand/wrist (1.00), foot/ankle (0.86), and eyes (0.82). Injury rates were found to vary substantially among the residential construction trades. For more serious injuries involving medical costs greater than $2,000 or any lost work time, rates were highest for welders and cutters (28.1), insulators (24.3), roofers (19.4), and carpenters (15.3). The same general trends by trade were observed for cases involving paid lost time except that roofers were highest, with a rate of 9.1, followed by insulators (8.5), welders and cutters (5.8), and carpenters (5.8). Rates of falls from a different level resulting in medical costs or lost work time were highest for roofers (5.54), insulators (3.53), carpenters (2.05), and drywall installers (1.99). Descriptive information for falls from a different level resulting in paid lost time during 1993-1994 (n = 219) were reviewed to better determine the causes and circumstances of injuries. Falls from a roof accounted for 25.4 percent of the cases followed by falls involving scaffolds (23.9%) and ladders (20.6%), and falls from ceiling joists, floor joists, or framing (14.8%). Twenty-six work-related deaths occurred with vehicle accidents (n = 6) being the major known cause of death, followed by falls (n = 3), being struck by an object (n = 3), electric shock (n = 2), and contact with energy or chemicals (n = 2). Consistent with other analyses of workers' compensation data, chronic occupational diseases are not well captured in the workers' compensation claims among home builders; therefore, a companion study has examined mortality patterns among North Carolina construction workers.

Humans↗
PubMed1999

A workers' compensation primer.

BACKGROUND: Workers' Compensation is a no-fault, administrative system designed to provide injured workers with medical care and wage replacement benefits without the delay, expense, and uncertainty of civil litigation. The system evolved from common law at the beginning of the twentieth century and was designed as a compromise between workers and employers in which each group surrendered certain legal rights and privileges in exchange for a speedier and more certain outcome. Compensation for occupational diseases like occupational asthma, rhinitis, or dermatitis is often complicated by the difficulty of proving that the condition "arose out of and in the course of employment." Physicians play an important role in these determinations through their expert opinion. RESULTS: Physicians must develop a consistent model to address these issues, and then present their findings and conclusions in a clear, well-reasoned, and compelling manner. In the end, the causation analysis should not solely depend on unsupported "opinion" or proceed from the conscious or unconscious biases of the physician. CONCLUSION: Biased, illogical, scientifically unsupported, or even incompletely explained conclusions damage the credibility of physicians in the community and undermine the purposes of the workers' compensation system itself.

Humans↗
PubMed1998

Device evaluation and coverage policy in workers' compensation: examples from Washington State.

Workers' compensation health benefits are broader than general health benefits and include payment for medical and rehabilitation costs, associated indemnity (lost time) costs, and vocational rehabilitation (return-to-work) costs. In addition, cost liability is for the life of the claim (injury), rather than for each plan year. We examined device evaluation and coverage policy in workers' compensation over a 10-year period in Washington State. Most requests for device coverage in workers' compensation relate to the diagnosis, prognosis, or treatment of chronic musculoskeletal conditions. A number of specific problems have been recognized in making device coverage decisions within workers' compensation: (1) invasive devices with a high adverse event profile and history of poor outcomes could significantly increase both indemnity and medical costs; (2) many noninvasive devices, while having a low adverse event profile, have not proved effective for managing chronic musculoskeletal conditions relevant to injured workers; (3) some devices are marketed and billed as surrogate diagnostic tests for generally accepted, and more clearly proven, standard tests; (4) quality oversight of technology use among physicians may be inadequate; and (5) insurers' access to efficacy data adequate to make timely and appropriate coverage decisions in workers' compensation is often lacking. Emerging technology may substantially increase the costs of workers' compensation without significant evidence of health benefit for injured workers. To prevent ever-rising costs, we need to increase provider education and patient education and consent, involve the state medical society in coverage policy, and collect relevant outcomes data from healthcare providers.

Cost Sharing↗
PubMedDate not supplied

Occupational medicine. Workers' compensation, impairment and disability.

Workers' compensation laws impose a no-fault status on injuries and illness sustained in the workplace. Under the statutes, victims of industrial injuries or their survivors are assured prompt, equitable payment for medical expenses, lost wages and other expenses associated with their injuries. Each state, territory or province has developed its own laws governing workers' compensation. As a result, the type, amount and duration of benefits vary. The cost of workers' compensation benefits is paid by the employer. The National Safety Council estimates that these benefits cost employers almost $35 billion in 1986. Employers pay for these benefits through the purchase of insurance, by becoming self-insured, or by participating in a state-run fund. Each state has an agency, commission or board to oversee compliance with the law.

Disability Evaluation↗
PubMed1997

HMOs, moral hazard and cost shifting in workers' compensation.

Previous research has shown that workers respond to the economic incentives provided in workers' compensation. In particular, claim frequency rises with increased benefits, and claim duration, on net, seems to increase. Here we provide additional evidence of another incidence of behavioral responses to incentives. We find that doctors in health maintenance organizations (HMOs) have a greater tendency to classify claims as compensable under workers' compensation than do other physicians. Our evidence suggests that the rapid expansion of HMOs over the 1980-1990 period resulted in a significant increase in workers' compensation claim frequency.

Cost Allocation↗
PubMed1980

Workers' compensation: 1978 program update.

Workers' compensation is one of the few State-administered income-maintenance programs operating throughout the United States. The national "system" to provide benefits for work-caused disability and death actually consists of 50 independent State operations and several special Federal programs. The Social Security Administration developed and continues to improve basic statistics to measure trends and progress in workers' compensation and to evaluate the program, especially in relation to income-maintenance programs under the Social Security Act. A standardized set of State and national estimates of amounts expended for workers' compensation benefits--as well as national estimates on coverage, payroll, and costs to employers--are compiled and analyzed each year. This article includes an historical perspective on the estimates, dating from 1940.

Costs and Cost Analysis↗
PubMed1994

Workers' compensation law: an overview.

1. The workers' compensation system provides benefits to workers who are injured or made ill in the course of employment or their dependents regardless of fault. 2. The current workers' compensation laws benefit both the employer and the employee; however, workers' compensation is an exclusive remedy which bars recovery through a negligence lawsuit. 3. Workers' compensation regulations interact with other federal statutes such as the Americans With Disabilities Act and the Family Medical Leave Act. 4. Workers' compensation covers occupational injuries and occupational diseases, which may include cumulative trauma and mental stress claims. Nurses may be instrumental in evaluating and planning for an injured employee's return to work and occasionally in detecting fraudulent claims.

Persons with Disabilities↗
PubMed1988

Workers' compensation: 1980-84 benchmark revisions.

The first workers' compensation program was introduced 80 years ago. Its purpose was to compensate occupationally injured workers and their families for lost wages and medical expenses from job-related injury, regardless of fault. Today, each of the State and Federal programs that provides coverage to more than 86 percent of the work force uses a combination of private insurance, State or Federal funds, and self-insurance to meet its benefit obligations. The workers' compensation program is of continuing interest to the Social Security Administration (SSA) for several reasons. Since 1965, Social Security Disability Insurance benefits have been subject to reduction if such benefits, when combined with those provided under workers' compensation laws, exceed 80 percent of the worker's earnings. Because the two programs have gaps in protection as well as duplication in coverage, a periodic review of the workers' compensation program is necessary. In addition, SSA administers Part B of the Black Lung program--established to provide income-maintenance protection to coal miners disabled by pneumoconiosis--to about 1 million beneficiaries whose claims were filed before July 1973. This article provides revised benchmark data on the workers' compensation programs and presents a review of program operations during the early 1980's.

Costs and Cost Analysis↗
PubMed2001

Outcomes of pain center treatment in Washington State workers' compensation.

BACKGROUND: Injured workers with chronic pain who have failed conventional therapies often receive treatment at pain centers. This study evaluated the effect of pain center treatment on time loss status of Washington State injured workers. The primary hypothesis was that treatment at a pain center would lead to a reduction in the probability of a worker's receiving time loss benefits at a 2-year follow-up. METHODS: A population-based retrospective cohort study was performed on 2,032 Washington State workers' compensation patients who underwent pain center evaluations. Subjects who received pain center treatment were compared to those who were evaluated but not treated with respect to time loss status at 2-year follow-up. RESULTS: Univariate analysis revealed that at 2-year follow-up, 35% of treated subjects were receiving time loss payments vs. 40% of evaluated only subjects (P < 0.05). Subjects who were younger, female, and less chronic were more likely to undergo pain center treatment and were less likely to be on time loss at 2-year follow-up. In multivariate analyses, which statistically controlled baseline differences between the two groups, there was no difference between treated subjects and evaluated only subjects. CONCLUSIONS: There was no evidence that pain center treatment alters 2-year time loss status of already disabled workers.

Adult↗
PubMedDate not supplied

Presurgical biopsychosocial variables predict medical and compensation costs of lumbar fusion in Utah workers' compensation patients.

BACKGROUND CONTEXT: Elective lumbar fusion surgery is a prevalent and costly procedure that requires a lengthy rehabilitation. It is important to identify presurgical biopsychosocial predictors of medical and compensation costs in such patients. PURPOSE: To determine if presurgical biopsychosocial variables are predictive of compensation and medical costs in a cohort of Utah lumbar fusion patients receiving workers' compensation. STUDY DESIGN/SETTING: A retrospective-cohort study consisting of a review of presurgical medical records and accrued medical and compensations costs. PATIENT SAMPLE: A consecutive sample of 203 compensated workers from Utah who underwent lumbar fusion from 1990 to 1995. Patients were at least 2 years postsurgery. OUTCOME MEASURES: Total accrued medical and compensations costs. METHODS: A retrospective review of presurgical biopsychosocial variables and total accrued medical and compensation costs was conducted. RESULTS: Presurgical variables from each of the biopsychosocial domains were statistically significantly correlated with medical and compensation costs. Social and biological variables were the best predictors of total compensation costs, whereas psychological variables were better predictors of total medical costs. CONCLUSIONS: Compensation and medical costs associated with posterolateral lumbar fusion can be predicted by preintervention biopsychosocial variables. Cost reduction programs might benefit from identifying biopsychosocial factors related to increased costs.

Adult↗
PubMed2004

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.

Cost Control↗
PubMed1995

Workers' compensation introduction for physicians.

Workers' compensation is an important part of the employment system in this country, and its development was born out of necessity. In 1991, over 93 million employees were covered by workers' compensation statutes and laws for work related injuries and conditions. The costs over the past 20 years have increased at an overwhelming rate. These increases are being met by various cost containment strategies that are not omnipresent in all jurisdictions but instead, are being accepted and structured independently by each jurisdiction. Legislative changes are expected in the next few years to deter rising costs. The emerging patterns of cost containment are: limited initial provider choice, limited provider change, medical fee schedule, hospital payment regulation, utilization review, and bill review. The medical evaluation of impairment is a process that is not precise; however, impressive gains have arisen in this area through the use of the AMA Guides and DSM-IV.

Cost Control↗
PubMedDate not supplied

Utilization management of workers' compensation: outpatient physical therapy.

Workers' compensation insurance carriers are becoming aware of the potentially high cost of physical therapy. Utilization management of outpatient physical therapy by means of a precertification process is a relatively new development in workers' compensation. Physical therapy treatment plans are reviewed by peers to ensure that proposed care is appropriate and cost-effective and that past care has resulted in measurable, objective, functional progress. Treatment plans are thus either certified or noncertified, or changes are negotiated. Ongoing care is monitored to facilitate the patient's progress through appropriate phases of physical therapy toward "maximum medical improvement."

Ambulatory Care↗
PubMed1984

Workers' compensation: coverage, benefits, and costs, 1982.

Workers' compensation provides medical care and income maintenance protection to workers disabled from work-related injury or illness. This program is of considerable interest to the Social Security Administration (SSA) from several perspectives. For example, since 1965 Social Security Disability Insurance (DI) benefits and workers' compensation payments have been integrated. Information on the experience under workers' compensation provides a framework for examining questions concerning gaps and overlaps in the Nation's social insurance system. In addition, since December 1969 SSA has administered claims filed through 1973 under part B of the Black Lung program--the program providing income maintenance protection to coal miners disabled by pneumoconiosis. The workers' compensation experience reported here consists of information on benefits for work-related injury and disease, including data on the combined benefits paid under the entire Federal Black Lung program administered by the Labor Department and SSA.

Coal Mining↗
PubMed1979

Workers' compensation program in the 1970's.

Workers' compensation has become a focus of public attention in the 1970's to a degree unprecedented in its 70-year history. Federal legislation, two national study groups, a rush of State reform amendments, and congressional hearings and bills proposing Federal standards have all contributed to the ferment of inquiry about the relevance and adequacy of the present system of State workers' compensation. Among the questions raised are: Does the system cover all the workers that should be protected? Are the benefits provided adequate? And what are the cost implications to employers of the changing program? For many years, the Social Security Administration has published estimates of the number of workers covered, the benefits paid, and the costs of workers' compensation. This article provides benchmark data to bring coverage and benefit estimates up to date and analyzes statutory provisions measuring several aspects of benefit adequacy.

Costs and Cost Analysis↗
PubMed2005

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.

California↗