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PubMed1992

Workers' compensation: 1984-88 benchmark revisions.

About 93.1 million workers were covered under workers' compensation laws in 1988--an increase of 11 percent from the 1984 total. Benefit amounts totaled $30.7 billion--an increase of about 56 percent since 1984. Of the total payments made under the workers' compensation program, $17.6 billion went to disabled workers, $1.6 billion to their survivors, and $11.5 billion for medical care. The Social Security Administration (SSA) is interested in measuring economic security in the United States, and workers' compensation plays a large role in that measurement. This article represents one part of our overall effort to determine the roles the various income-maintenance programs play in helping citizens of the United States achieve economic security. The figures presented here provide readers with an opportunity to review workers' compensation program operations during much of the 1980's. Workers' compensation is also important to SSA because that program is directly related to the Social Security Disability Insurance program. Since 1965, Social Security disability benefits have been subject to reduction if the beneficiary also receives workers' compensation and the combined benefits exceed 80 percent of previous earnings. In addition, SSA has been directly involved in providing income maintenance for disability from work-related diseases since 1969 when the Federal Black Lung benefits program was established.

Humans↗

PubMed2001

Outcomes of posterolateral lumbar fusion in Utah patients receiving workers' compensation: a retrospective cohort study.

STUDY DESIGN: A retrospective cohort study consisting of a medical record review and a follow-up telephone survey of patients with lumbar fusion, at least 2 years after their surgery, was performed. OBJECTIVE: To identify presurgical correlates and long-term outcomes from posterolateral lumbar fusion in Utah patients receiving workers' compensation. SUMMARY OF BACKGROUND DATA: Lumbar fusion has been criticized for its highly variable outcomes, and compensated workers are at particular risk for poor outcomes. Evidence suggests that presurgical psychosocial factors may be important modifiers of back pain reporting and back surgery outcomes. METHODS: The patients in this study were 185 compensated workers in Utah who underwent posterolateral lumbar fusion. Patient medical records were independently reviewed, and medical and sociodemographic variables were coded. A telephone outcome survey was completed with 130 patients (70%) an average of 4.6 years after their surgery. RESULTS: Reported solid fusion, reoperation, and disability rates for the follow-up sample were 74%, 24%, and 25%, respectively. As reported by the patients, 41% experienced no change or a worsened quality of life. Mean scores from the Roland and Morris Back Pain Disability Questionnaire, the Stauffer-Coventry-Index, and the Short-Form 20 Multidimensional Health Survey indicate that many patients experienced postsurgical dysfunction. Presurgical predictors of outcomes were number of prior low back operations, income at time of injury, age, litigation, and depression. CONCLUSIONS: Outcomes of posterolateral lumbar fusion among compensated workers in Utah are inconsistent. Outcomes can be predicted by presurgical sociodemographic variables. Screening for such presurgical risk factors may be important for prudent surgical decisions and rehabilitation planning.

Adult↗

PubMed1987

Surveillance of work-related cold injuries using workers' compensation claims.

The usefulness of workers' compensation claims for the surveillance of occupational injuries was evaluated by analyzing claims for cold injury. Five hundred ten claims filed in 1983 from 23 states participating in the Bureau of Labor Statistics Supplementary Data System and an additional 147 claims filed with the Division of Safety and Hygiene of the Industrial Commission of Ohio from Jan 1, 1984, to June 30, 1985, were examined. As expected, the number of injuries per winter day increased as temperature decreased and wind speed increased. The rate of injury began to increase when temperatures fell below 10 degrees F and wind speeds exceeded 10 mph. These weather conditions were milder than previously published cold hazard charts suggest. Frostbite injuries of the lower extremities occurred at milder temperatures, required more lost workdays, and were more costly than cold injuries to the head and face or to the upper extremities. Industries with the highest rates of injury included agriculture, oil and gas extraction, trucking and warehousing, protective services, and interurban transportation. Injuries during nonwinter months involved the processing, distribution, and preparation of food. Vehicle breakdown or contact with water, gasoline, alcohol, or cold water were noted as contributing factors on many of the compensation claims. This probe suggests that claims for workers' compensation adequately reflect the expected association of environmental factors and the occurrence of cold injury.

Absenteeism↗

PubMedDate not supplied

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.

Accidents, Occupational↗

PubMed1993

Do workers' compensation laws protect industrial hygienists from lawsuits by injured workers?

Workers' compensation laws provide injured employees with a swifter, more certain, and less litigious system of compensation than existed under the common law. Although workers' compensation is almost always an injured employee's exclusive remedy against the employer, the employee may bring a common-law tort action against a "third party" who may be liable in whole or in part for the employee's injury. This article investigates whether industrial hygienists are "third parties" and therefore subject to suit by injured employees who claim that industrial hygienists negligently caused their injuries. The author concludes that in most states, where the industrial hygienist and the injured worker are fellow employees, the industrial hygienist shares the employer's immunity from suit. As to the consultant who performs industrial hygiene services as an independent contractor, the author concludes that the employer's nondelegable duty to provide a safe workplace offers industrial hygiene consultants an argument that they share the employer's immunity from suit. Countervailing arguments, however, leave the industrial hygiene consultant vulnerable to negligence claims in many jurisdictions. There is a trend among the states to extend the employer's immunity to those who provide safety and health services to the employer.

Consultants↗

PubMed1984

Workers' compensation program experience, 1981.

Although the workers' compensation program covered more workers and paid more in benefits in 1981 than it did a year earlier, the rise in both of these indicators was slightly smaller than those in 1980 and considerably smaller than the increases that took place in the 1970's. Employers paid $22.9 billion in premiums in 1981, less than 3 percent more than the previous year and the smallest annual increase since 1958. The cost-payroll ratio also showed a 12-point drop in 1981, the first such decline since 1959 and a sharp contrast to the almost 9 percentage point average annual rise in the 1970's. The Black Lung program, which made up more than a fifth of the benefit payments under workers' compensation in 1973, accounted for only about an eighth by 1981.

Costs and Cost Analysis↗

PubMed1997

Incentive effects of workers' compensation.

Economic theory and evidence indicate that workers, employers, and healthcare personnel respond to the incentives built into state workers' compensation systems. Although empirical studies cannot provide precise estimates of the quantitative effects resulting from specific policy changes, research is useful in evaluating the qualitative effects of alternative policies. Studies show that workers' compensation claims are higher the more generous the level of benefits, the shorter the waiting period, and the more readily available is information on benefits to workers. States that decrease real benefit levels and lengthen the period required before workers are compensated for lost earnings can constrain future growth in workers' compensation costs, while continuing to provide partial compensation for workers with the most serious injuries. The most difficult problem facing policymakers is to design and implement reforms that take into account what are often the incompatible incentives of workers, employers, and medical care providers.

Eligibility Determination↗

PubMedDate not supplied

SF-36 health status of workers compensation cases with spinal disorders.

BACKGROUND CONTEXT: Poorer outcomes of treatment are reported in patients with spinal disorders who receive workers compensation. The reason for their suboptimal outcomes is unclear. No study has examined the relationship between workers compensation and the Short Form Health Survey (SF-36) health status of patients with spinal disorders. PURPOSE: To compare the self-perceived health status of spinal disorder patients receiving workers compensation with those not receiving workers compensation. STUDY DESIGN/SETTING: A cross-sectional study on 18,389 patients who were evaluated in the 28 centers comprising the National Spine Network. PATIENT SAMPLE: The study data were derived from patients when first evaluated for back or neck pain between January 1998 and April 2000. OUTCOME MEASURES: The outcome measures used were the eight individual and two component scores of the SF-36. METHODS: All first-visit patients enrolled in the National Spine Network from January 1998 to April 2000 were reviewed. Eight individual scores and two component scores of the SF-36 were compared. RESULTS: Of the 18,389 patients, 1,535 (8%) were receiving workers compensation. Bivariate analyses showed all eight individual scores, and two summary scores of the SF-36 were significantly lower (p<.0001) in patients receiving workers compensation. After controlling for confounding covariates, workers compensation status was a significant predictor of lower SF-36 scores for General Health (p<.0001), Physical Functioning (p<.0001), Role Physical (p<.01), Social Functioning (p<.05), and Mental Health (p<.05). CONCLUSIONS: Workers compensation status is associated with poorer physical and mental health of patients with spinal disorders. Because the workers compensation group is younger, has a shorter duration of symptoms, and fewer comorbid medical problems, the lower SF-36 scores most likely reflect psychological factors and not ill health per se. The lower SF-36 scores may also reflect premorbid personality differences in the workers compensation patients, compared with those not receiving workers compensation. SF-36 is a validated tool that can be used to objectively identify the patient at risk for delayed recovery. Future treatment protocols should pay special attention to improve the health-related quality of life, especially general health and physical functioning of spinal patients receiving workers compensation.

Adult↗

PubMedDate not supplied

Symptomatic cervical disc herniation following a motor vehicle collision: return to work comparative study of workers' compensation versus personal injury insurance status.

BACKGROUND CONTEXT: Patients with approved workers' compensation injuries receive guaranteed compensation for the duration of their injury, whereas patients with personal injury claims are only compensated, if at all, at the time of a successful settlement or trial verdict at a time point distant from their injury. PURPOSE: This study compares the financial impact and loss of work patterns due to a workers' compensation (WC) claim or personal injury in patients with a symptomatic cervical disc herniation resulting from a motor vehicle collision. STUDY DESIGN: A prospective study of patients who were seen by a single spine specialist between 1/2/96 and 9/1/01. PATIENT SAMPLE: A consecutive evaluation of 531 patients who were treated for a cervical pain syndrome caused by a motor vehicle collision. OUTCOME MEASURES: Mechanism of injury and insurance type, ie, workers' compensation or personal injury, was recorded for each patient as well as treatment response and return to work patterns. The data were analyzed using the two-way Z test. METHODS: All patients were managed in a similar manner with noninvasive treatment initially, followed by injections, and finally surgical intervention in those who failed conservative measures. Return to work rates and work disability were determined at either final follow-up or at the last doctor's visit before loss to follow-up. RESULTS: 270 of 531 patients were diagnosed with a symptomatic one or two level disc herniation by a cervical magnetic resonance imaging scan. Fifty-four patients were insured through the workers' compensation board, and 216 reported their crash as a personal injury claim. In the WC group the work disability at 3 months follow-up revealed a cumulative 2,262 total lost days of work (average 37.1 days per person). At the point of maximal medical improvement (MMI) or 2-year follow-up, total days lost from work were 7,107 (average 131.6 days per person.) In the personal injury non-WC group, the 3-month follow-up of lost days of work was 1,093 days (average 5.1 days per person.) At 2 years follow-up, the total lost days of work were 6,206 (average 28.7 days per person.) CONCLUSIONS: Participants compensated through the workers' compensation system demonstrated a significant loss of days of work as compared with injured patients who received compensation by other means. This may be a reflection of the guaranteed method of compensation afforded to WC patients as opposed to patients who receive no form of financial support (i.e., personal injury) during the recuperative process. Further analysis as to injury severity and a stratification of non-workers' compensation reimbursement methods are needed to further improve the validity of this study.

Accidents, Traffic↗

PubMedDate not supplied

Workers' compensation and psychiatric disability.

Psychiatric claims under workers' compensation law have increased substantially in recent years. This chapter explores the history and varying jurisdictional standards of workers' compensation law followed by a discussion of issues pertinent to performing a psychiatric evaluation of a claimant for workers' compensation.

Disability Evaluation↗

PubMed1991

The long term workers' compensation patient.

Long term workers' compensation patients can be a source of stress for the treating doctor. They often make little progress in spite of large amounts of time, effort and support. The author explores the reasons for this and suggests ways to minimise doctor burnout in the face of it.

Humans↗

PubMed1998

Preserving workers' compensation benefits in a managed health care environment.

Managed care techniques are increasingly being applied in the workers' compensation setting. Many workers, labor representatives and public health advocates fear that the introduction of managed care into workers' compensation may reflect a broader employer-driven campaign to erode benefits, tighten eligibility criteria, and weaken employees' control over health care and compensation issues. The potential threats to workers can be mitigated by involving them in the design of the workers' compensation health plan and selection of provider organization, assuring access to appropriate specialists and diagnostic testing, minimizing delays, increasing accountability through contract provisions and government oversight, and enhancing communications through the use of ombudsmen and alternative dispute resolution approaches. Additional outcomes studies assessing the long-term impact of managed care in workers' compensation are needed.

Health Services Accessibility↗

PubMed1988

A practical approach to workers' compensation.

An understanding of workers' compensation and of the physician's role in it can significantly improve communication with patients, insurance companies and employers. Early rehabilitation is essential. Treatment of difficult patients can be enhanced by recognizing and treating the factors that are delaying recovery, encouraging activity and minimizing the use of narcotics. Factors delaying recovery include depression, alcoholism and pending litigation against the employer.

Accidents, Occupational↗

PubMed1994

The dermatologist and workers' compensation. Theory and practice.

Workers' compensation law is poorly understood by many physicians, including dermatologists. The tenets of this law throughout the country are basic and fairly straight forward, and the most important of them are nearly the same for all of the states. By understanding how the law operates and what is required of physicians, helping patients with their work-related dermatoses can be a gratifying experience.

Adult↗

PubMed2003

Workplace health and safety regulations: Impact of enforcement and consultation on workers' compensation claims rates in Washington State.

BACKGROUND: There has been considerable debate in the public policy arena about the appropriate mix of regulatory enforcement and consultation in achieving desired health and safety behavior across industries. Recently there has been a shift in federal policy toward voluntary approaches and constraining the scope of enforcement programs, although there is little evidence that this might improve health and safety outcomes. To address this, we examined changes in lost time workers compensation claims rates for Washington State employers who had (1) no OSHA State Plan (WISHA) activity, (2) enforcement, (3) consultation, and (4) both types of visits. METHODS: Compensable claims rates, hours, and WISHA activity were determined for each employer account with a single business location that had payroll hours reported for every quarter from 1997-2000 and more than 10 employees. We used a generalized estimating equations (GEE) approach to Poisson regression to model the association between WISHA activity and claims rate controlling for other external factors. RESULTS: Controlling for previous claims rate and average size, claims rates for employers with WISHA enforcement activity declined 22.5% in fixed site industry SIC codes compared to 7% among employers with no WISHA activity (P < 0.05), and in non-fixed site SICs (e.g., construction) claims rates declined 12.8% for employers with enforcement activity compared to a 7.4% decline for those with no WISHA activity (P > 0.10). WISHA consultation activity was not associated with a greater decline in compensable claims rates (-2.3% for fixed sites and +3.5% for non-fixed sites). WISHA activity did not adversely affect worksite survivability through the study period. CONCLUSIONS: Enforcement inspections are significantly associated with decreasing compensable workers compensation claims rates especially for fixed site employers. We were unable to identify an association between consultation activities and decreasing claims rates.

Government Regulation↗

PubMed1998

Workers compensation. Effect of state law on treatment cost and work status.

Workers compensation legislation is regulated at a state level resulting in different benefits based on the state of employment. The negative effect of workers compensation on the results of surgical treatment has been established previously. A comparison of the results of treatment of patients receiving workers compensation from different states has not been reported. This study prospectively evaluated the effect of the difference in state workers compensation laws on the number of postoperative visits, amount of postoperative therapy, time off from work, and return to work status. The study group consisted of 275 patients. The results indicated a significant increase in the number of postoperative visits, amount of therapy, time off from work, and number of patients who remained out of work in the compensation versus the noncompensation group. A significant increase in these parameters also was present in the Pennsylvania compensation group as compared with the New Jersey compensation group. This study shows that differences in workers compensation benefits have a significant effect on the results of medical treatment, return to work status, and the cost of medical care.

Absenteeism↗

PubMed1995

Medical costs in workers' compensation insurance.

We examine whether patients covered by workers' compensation insurance, which covers the cost of medical care for injured workers without cost sharing and with relatively little oversight, are charged more for treatment or receive more services than patients covered by traditional insurance. Our findings indicate that workers compensation recipients are charged more for treatment. This difference persists in individual services--workers' compensation recipients are charged more per X-ray and per examination than our patients. We consider different explanations and argue that price discrimination probably plays a role.

Accidents, Occupational↗

PubMed1993

Workers' compensation: coverage, benefits, and costs, 1990-91.

Workers' compensation programs provide protection to workers and their families. The programs compensate for lost wages and medical expenses incurred as a result of work-related injuries or illnesses. Survivor benefits are also provided when the disabilities result in death. In 1991, about $16.8 billion in medical benefits and $25.3 billion in wage-loss compensation was paid in settlement of claims filed for disabled or deceased workers. These benefits were paid by private carriers, by State funds, or by self-insuring companies as determined by laws in each State. The employer's cost of providing workers' compensation coverage generally varies according to risk, industrial classification, and experience rating. Nationally, such costs were approximately 2.4 percent of payroll or about $590 for each of the 93.6 million protected employees. This article examines the recent changes in coverage, in benefit levels, and in employer costs and the factors influencing such changes. Over the past decade, workers' compensation benefits have increased by 157 percent and employer costs by 143 percent. In the same period, the number of covered employees has risen 22 percent and the amount of covered wage and salary payroll, 77 percent.

Costs and Cost Analysis↗