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PubMed2003

Low back pain after traffic collisions: a population-based cohort study.

STUDY DESIGN: A population-based, incidence cohort study was conducted. OBJECTIVE: To measure the incidence and prognosis for collision-related low back pain before and after a change in the insurance compensation system. SUMMARY OF BACKGROUND DATA: Low back pain is a common and costly occupational injury. It also occurs after traffic collisions, but less is known about its frequency and recovery in this setting. METHODS: An incidence cohort of 4473 low back pain injury claims was formed between July 1, 1994 and December 31, 1995 in Saskatchewan. On January 1, 1995 the public insurance system changed from a tort system to a no-fault system, eliminating compensation for pain and suffering. The incidence of claims and the time to claim closure were calculated before and after this change. Prognostic models were built using baseline and follow-up data. RESULTS: The 6-month incidence of claims decreased from 256 to 176 per 100,000 after the insurance change. The median time to claim closure dropped from 505 days for tort claims to 210 days and 216 days for claims made during the first and second 6 months of the no-fault period. Improvements in bodily pain and physical functioning and the absence of depressive symptoms were associated with faster claim closure. High pain intensity, female gender, full-time employment, concentration problems, and lawyer involvement early in the claim process delayed claim closure. CONCLUSIONS: Low back pain is a common traffic injury with a prolonged recovery. Its incidence and prognosis are affected by multiple factors, including the type of compensation system. Our study suggests that biopsychosocial factors are important in determining prognosis.

Accidents, Traffic↗
PubMed1996

The Work Rehabilitation Impact Quotient: a tool to assess the effectiveness of early rehabilitation of injured workers.

The Work Rehabilitation Impact Quotient (WRIQ) compares the percentage of long term claimants in a classification group with the percentage of long term claimants overall in the scheme, a value greater than one indicating that more people than expected remain on compensation. We studied the Accident Rehabilitation and Compensation Insurance Corporation of New Zealand (ACC) claims from 1988 to 1994 and data from the 1986 and 1991 census. High WRIQs were found in workers over the age of 50, people injured in motor vehicle crashes, those with head and multiple location injuries, and those with amputations, dislocations, injuries to internal organs, and OOS (Overuse syndromes). Analysis by occupation and industry identified certain groups with high and very high WRIQs. The WRIQ value was not related to the rate of injury or to job availability, but was related to mean claim cost. Thirty six percent of claim costs paid in 1994 were in groups with high or very high WRIQs. Reduction of the WRIQ in these groups to low levels would produce savings of over $100 million in 1994 dollars.

Accidents, Occupational↗
PubMed1994

Backache and work incapacity in Japan.

No one is spared a regional backache. Some episodes will compromise function to the extent of work incapacity. Throughout the industrialized world, workers' compensation insurance programs provide recourse for the segment of people whose incapacitating backache is held to have arisen out of and in the course of employment. Most programs have evolved from the Prussian paradigm introduced a century ago. That evolution represents country specific, de facto experiments in health policy. In the case of Japan, the Prussian paradigm was imposed on a very distinctive tradition at the end of World War II. Therein lies one of the more dramatic experiments of health policy. This essay attempts to document the process that resulted. To gain such insight, relevant physicians and bureaucrats in Japan were interviewed and government documents reviewed. This information was supplemented by nonsystematic culling of relevant reflections of scholars also pursuing the heuristic method but with different, usually nonclinical, tempering. It is clear that Japan has evolved an approach to the worker with an incapacitating backache that favors options other than recourse in workers' compensation for redress.

Back Pain↗
PubMed2001

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.

Accidents, Occupational↗
PubMed1998

Health care and indemnity costs across the natural history of disability in occupational low back pain.

STUDY DESIGN: The administrative database maintained by the National Council on Compensation Insurance (United States) was used to compare health care use and indemnity costs within the natural history of work-related low back pain disability. OBJECTIVES: To determine the relative costs of health care services and indemnity at different phases of work disability. SUMMARY OF BACKGROUND DATA: Existing studies have compared total costs along the work disability continuum. This study replicates and extends these earlier studies by providing detailed evaluations of costs by service categories along this continuum. METHODS: Total health care and indemnity costs accrued along the disability curve were examined. Based on the number of days workers were absent from work and receiving indemnity payments (disability days), detailed mean health care costs by type of medial service were computed and compared across four time intervals for the sample. RESULTS: Health care costs were disproportionately distributed along the disability curve, with 20% of claimants disabled 4 months or more, accounting for 60% of health care costs. The most costly service category was diagnostic procedures (25% of total medical costs), with surgical costs (21%) and physical therapy (20%) representing the next two most costly categories. Mental health and chiropractic care represented a small percentage of overall costs (0.4% and 2.9%, respectively). CONCLUSIONS: These data provide policy-makers, program development, and health care industry groups with cost information from which to establish benchmarks for future decisions that facilitate the allocation of resources for more cost-effective management and prevention of work disability.

Absenteeism↗
PubMedDate not supplied

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.

Adult↗
PubMed2001

Access to medical care for occupational disorders: difficulties and disparities.

Despite state laws guaranteeing full insurance coverage for work-related disorders, many injured workers have difficulty obtaining access to appropriate medical care. Barriers to access arise because: patients are unable to prove that their conditions are caused occupationally; they are discouraged by employers from reporting occupational injuries; workers' compensation insurance carriers aggressively contest claims; and other reasons. Evidence suggests that minority subpopulations of workers are most affected. Overcoming these barriers will require a multifaceted approach involving regulatory oversight, participation of workers in the design of health plans and the selection of providers, and specific measures to detect and prohibit discriminatory care.

Health Services Accessibility↗
PubMed1978

Cumulative injury.

A few states, notably California, are experiencing large increases in the number and cost of disability settlements under workers' compensation. Claims of cumulative injury for coronary heart disease, hypertension, stroke, cancer and neuropsychiatric problems have all been interpreted as compensable under workers' compensation, even when these conditions are clearly related to the aging process. Legal precedents for such claims are building rapidly throughout the country. The resultant costs may lead to the demise of the workers' compensation system. The situation in California is discussed in detail including the legal aspects, cumulative injury claims by type of disease and age of claimants, legal costs to the individual and the employer, and the economic outlook for the workers' compensation insurance system.

Adult↗
PubMed1984

[Cost-carrying responsibility in unsuccessful extracorporeal fertilization].

In-vitro fertilisation has been practised for a number of years, but the results have not always been successful. However, even unsuccessful attempts are expensive and have to be paid for. Legal proceedings had been initiated some time ago at the Provincial High Court at Nuremberg-Furth, West Germany, to determine whether a private insurance company would be compelled to bear the cost of an unsuccessful extracorporeal fertilisation of a women patient holding a sickness insurance policy. On 3 April 1984 the court took the stand--and passed a verdict to that effect--that this was an insurance case in accordance with the terms of insurance in so far as the patient's childlessness could be considered as an illness liable to sickness insurance compensation and that by now in-vitro fertilisation was generally recognised and accepted as a scientific therapeutic method. The judgement, which is not yet final, decreed that the insurance company was liable to bear the expenses of the unsuccessful fertilisation amounting to DM 8706,70.

Fees, Medical↗
PubMed1982

Workers' compensation file as a potential source for community diagnosis.

In providing comprehensive care, family physicians may utilize community diagnosis to analyze the needs of their local community. Existing data bases such as Medicaid and workers' compensation can provide an inexpensive source for community diagnosis. This paper compares the data from an in-depth survey of trauma in a rural community with the medical files of the Washington State workers' compensation insurance for the same time period. Only 45 percent of those patients claiming on-the-job injury when initially treated actually appear on medical claim files of workers' compensation. However, when comparing the categorical distributions for type, mechanism, and body part of injury, the two data sets are similar. Thus, workers' compensation files may potentially be useful as a source of data for community diagnosis.

Accidents, Occupational↗
PubMed2005

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.

Accidents, Occupational↗
PubMed1990

Estimates of new compensated cases of occupational diseases in Finland in 1977-1983.

The increase in the new cases of occupational disease reported in Finland in 1977-1983 has been analyzed. First, the technical nature of the concept of occupational disease as used in the context of compensation insurance is described and a disability grading for the severity of occupational diseases is presented. It is then shown, with the use of a stratified probability sample, that the fraction of compensated cases has remained roughly constant during the study period. However, evidence is presented indicating that the severity of the cases compensated in 1977-1983 has, on the average, decreased.

Disability Evaluation↗
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↗
PubMed1996

Clinical impact of contrast-enhanced MR imaging reports in patients with previous lumbar disk surgery.

OBJECTIVE: We wanted to assess the clinical impact of the reports of contrast-enhanced MR imaging on the decision to repeat surgery and on the results of repeat surgery in patients with previous lumbar disk surgery. SUBJECTS AND METHODS: We interviewed 257 patients who had undergone lumbar disk surgery and who showed symptoms suggesting persistent or new disk herniation. We conducted our interviews 6-18 months after patients had undergone contrast-enhanced MR imaging. We then correlated patient outcome with original MR findings. RESULTS: Fifty-two patients underwent new surgical procedures after their MR examination. Findings of disk herniation on MR images were associated with a significantly greater frequency of repeat surgery. The size of main herniation seen on MR images was also a significant variable. Patients with Worker's Compensation Insurance files had significantly worse prognoses: Only two (8%) of 26 of these patients reported 50% improvement 1 year after repeat surgery. However, only 6 (23%) of 26 non-Worker's Compensation patients reported 50% improvement 1 year after surgery. CONCLUSION: Despite its documented high anatomic accuracy, the clinical usefulness of enhanced MR imaging for patients with previous lumbar disk surgery needs further evaluation. In our series, findings of disk herniations on enhanced MR examinations were associated with a greater frequency of repeat surgery, but such surgery relieved symptoms in few patients. The influence of enhanced MR imaging on the decision for repeat surgery and on the type of surgery may be misleading. Selection criteria for repeat surgery need to be reassessed using rigorous outcome research protocols.

Adult↗
PubMed1999

Occupational exposure to Mycobacterium tuberculosis. Legal issues in workers' compensation.

Occupational exposure to TB remains a significant threat in select high risk occupations despite 5 years of declining disease incidence rates in the United States. TB kills more people on a global scale than any other infectious disease. One third of the global population is currently infected with TB. Workers' compensation insurance may be inadequate to cover lost wages and medical bills in cases of occupational exposure to TB if the source patient is unknown. There is a need to reform state laws for workers' compensation so TB infections in high risk employees are presumed to be work related unless a community exposure to the disease is identified.

Humans↗
PubMed2002

WorkCover's physiotherapy forms: purpose beyond paperwork?

We retrospectively analysed 219 consecutive treatment plans submitted to a large New South Wales workers' compensation insurer for workers coded by the insurer as suffering from back pain. The purpose was to (i) describe the quality of goals of treatment provided to insurers by physiotherapists for workers with back pain using guidelines provided by the WorkCover Authority of New South Wales (WorkCover); (ii) compare the physiotherapists' prognoses against prognoses indicated in clinical practice guidelines; and (iii) make recommendations about the communication system between physiotherapists and insurers. The back pain of most treated workers was classified as acute and the majority of physiotherapists estimated that treatment would be of short duration, which is concordant with current treatment guidelines. However, most physiotherapists did not provide precise, measurable or time-specific treatment goals, despite this being emphasised by WorkCover. We propose ways of improving communication practices between physiotherapists and insurers.

Communication↗
PubMedDate not supplied

World Trade Organization, ILO conventions, and workers' compensation.

The World Trade Organization, the World Bank, and the International Monetary Fund can assist in the implementation of ILO Conventions relating to occupational safety and health in developing countries. Most countries that seek to trade globally receive permission to do so from the WTO. If the WTO required member countries to accept the core ILO Conventions relating to occupational safety and health and workers' compensation, it could accomplish something that has eluded international organizations for decades. International workers' compensation standards are seldom discussed, but may at this time be feasible. Acceptance of a minimum workers' compensation insurance system could be a requirement imposed on applicant nations by WTO member states.

Commerce↗