Mining Injuries 2012-2019: Using Workers' Compensation Claims Data From 35 States to Identify Rates and Costs Associated by Nature of Injury, Event/Exposure, and Body Part Affected.

OBJECTIVE: This study summarized the frequency and cost of mining-related injuries. METHODS: Mining-related workers' compensation (WC) claims data from 35 states were summarized to report counts, claim rates, and costs for 2012-2019. These data were compared with Mine Safety and Health Administration injury and employment data for the same period. RESULTS: Despite system differences, both WC and Mine Safety and Health Administration counts and rates declined over time and injury patterns were similar. Total WC costs were approximately $2.325B. Medical-only claims represented 59.4% of the claims by count, but only 3.3% of costs. Lost-time nonfatal claims represented 40.2% of the claims by count, but 90.2% of costs. Claims frequency and costs varied greatly by injury event/exposure, part of body, and nature. CONCLUSIONS: Injury frequency has declined but costs remain high. The most costly and disabling cases were identified.

Workers' compensation costs for healthcare caregivers: Home healthcare, long-term care, and hospital nurses and nursing aides.

BACKGROUND: Healthcare workers (nurses and nursing aides) often have different exposures and injury risk factors depending on their occupational subsector and location (hospital, long-term care, or home health care). METHODS: A total of 5234 compensation claims for nurses and nursing aides who suffered injuries to their lower back, knee, and/or shoulder over a 5-year period were obtained from the Ohio Bureau of Workers' Compensation and analyzed. Injury causation data was also collected for each claim. The outcome variables included indemnity costs, medical costs, total costs, and the number of lost work days. The highest prescribed morphine equivalent dose for opioid medications was also calculated for each claim. RESULTS: Home healthcare nurses and nursing aides had the highest average total costs per claim. Hospital nurses and nursing aides had the highest total claim costs, of $5 million/year. Shoulder injuries for home healthcare nursing aides (HHNAs) had the highest average total claim costs ($20,600/injury) for all occupation, setting, and body area combinations. Opioids were most frequently prescribed for home healthcare nurses (HHNs) and nursing aides (18.9% and 17.7% having been prescribed opioids, respectively). Overexertion was the most common cause for HHN and nursing aide claims. CONCLUSIONS: With the rapidly expanding workforce in the home healthcare sector, there is a potential health crisis from the continued expansion of home healthcare worker injuries and their associated costs. In addition, the potential for opioid drug usage places these workers at risk for future dependence, overdose, and prolonged disability. Future research is needed to investigate the specific and ideally reversible causes of injury in claims categorized as caused by overexertion.

Pharmaceutical pricing benchmarks: governmental versus private sector.

Purpose: To explore the best pricing benchmark for workers' compensation drugs reimbursement at retail pharmacies. Materials & methods: We used California workers' compensation system (CAWCS) total cost of pharmacy dispensed medications (2017-2019) as a proxy to estimate drug prices using alternative pricing mechanism fee schedules. Results: CAWCS paid 65.6% of the average wholesale price (AWP), 104.1% of Medi-Cal, 122.1% of the wholesale acquisition cost (WAC), 140.1% of the national average drug acquisition cost (NADAC), and 253.5% of the federal upper limit. In addition, we found the AWP-based formulas: CAWCS = AWP - 34.4%, Medi-Cal = AWP - 36.9%, WAC = AWP - 46.3%, NADAC = AWP - 53.2%, and federal upper limit = AWP - 74.1%. We found that AWP: 50% for generics and AWP - 18.2% for brands are the lowest paying formulas. The estimated median cost savings were $8.7 million (by adapting 97% of the WAC) and $9.5 million (by adapting the NADAC) across all states. Conclusion: NADAC was the best pricing benchmark for reimbursement of pharmacy dispensed drugs.

Reexamining the persisting wage gap between male and female PAs.

OBJECTIVE: To determine the magnitude of any difference in total compensation between male and female physician assistants (PAs) after controlling for personal and workplace factors related to compensation. METHODS: Using data from the 2019 AAPA Salary Survey, the authors conducted a sequential regression analysis to examine the relationship between a variety of personal and practice demographics and total compensation. RESULTS: After controlling for compensation-related factors, a wage gap between male and female PAs persisted: female PAs were paid almost $0.93 for every $1 male PAs were paid in the first year of work ($9,010 less). This wage gap widened by $201 for every year of work experience. CONCLUSIONS: A wage gap between male and female PAs persists even after including all compensation types and controlling for compensation-related factors that may differ between male and female PAs. Proposed policy implications could begin to mitigate the gap.

Morphine Equivalent Dose-Days (MED-D): Predicting the Impact of Opioid Prescription on Total Workers' Compensation Claim Costs for Acute Low Back Pain.

OBJECTIVE: To assess the effect of morphine equivalent dose-days (MED-D) on the total cost for acute low back pain (LBP) workers' compensation claims. METHODS: Simple random samples of 123 opioid and 141 nonopioid acute LBP claims were obtained. Opioid claims were divided into low, medium, and high subgroups for MED-D, MED, and prescription duration. Subgroup mean total costs were compared to the nonopioid group using multivariate regression analyses. RESULTS: MED-D and prescription duration were each, respectively, associated with significantly increased total costs at both medium and high levels. Increasing MED had a negative association with total cost, though stratification by duration abrogated this perceived trend. Interaction testing indicated MED and duration together better explained cost than MED alone. CONCLUSION: MED-D is a better predictor of total cost in acute LBP claims than MED alone.

Analysis of Thoroughbred horse farm workers' compensation insurance claims in Kentucky: Injury frequency, cost, lost time, and associated occupational factors.

BACKGROUND: Thoroughbred horse farm workers self-report a high frequency of work-related injuries and pain. However, an analysis of Thoroughbred horse farm workers' compensation injury claims is absent from the literature, yet may benefit worker safety. METHODS: We analyzed workers' compensation insurance firm data containing 2276 claims filed between 2008 and 2015. Injury frequency, cost, and lost time per cause, nature, and body part injured were examined qualitatively and via univariate tests. Factors associated with high cost and high duration lost time claims were modeled via multivariable logistic regression. RESULTS: The average Thoroughbred worker claim cost $4,198 and accrued 10 days lost time, involving strikes (57% of total claims), sprains/strains (34%), and wrist/hand injuries (18%). Injuries primarily occurred on mornings (54%), weekdays (79%), and during the transition from breeding to sales (23%). Jobs with a high level of horse contact had significantly higher cost ($6,487) and higher duration lost time (16.8 days) claims, with significantly higher cost claims on the weekends ($6,471) and from the oldest workers ($7466), vs reference groups. Logistic models indicate significantly increased odds of a high-cost injury among high horse contact jobs (OR = 1.87; 95% C.I. = 1.53-2.29) and older age tertiles (1.38; 1.08-1.75; 1.70, 1.32-2.18). The odds of a high duration lost time injury are significantly increased among high horse contact jobs (1.91; 1.53-2.39) and males (1.50, 1.13-1.98), with significantly reduced odds among the most tenured workers (0.74; 0.56-0.99). CONCLUSIONS: Our findings elucidate factors to reduce injury frequency, cost, and lost time among Thoroughbred horse farm workers.

Increasing Physical Therapy Visits as a Marker for Time Lost From Work and High Workers' Compensation Claim Costs.

OBJECTIVE: To quantify the association between physical therapy (PT) visits and workers' compensation costs and lost time. METHOD: A total of 40,203 lost-time claims (1998 to 2018) were analyzed. RESULTS: The odds ratio of total paid claim costs more than or equal to $100,000 increased with the number of PT visits from 1.91 with 1 to 3 PT visits (95% confidence interval [CI]: 1.62 to 2.26) to 5.56 (95% CI: 4.86 to 6.37) for workers with a surgical procedure and more than or equal to 50 PT visits versus those without PT visits, when controlling for confounding factors. The risk of remaining at an off work status is greatest among claims involving surgery, escalating among claims with 15 or more PT visits (hazard ratio more than or equal to 3.76). CONCLUSIONS: PT visits may be used as a marker for high workers' compensation cost and delayed return-to-work.

Workers' compensation claims for occupational tuberculosis in South African health workers: Outcomes and workers' experiences.

BACKGROUND: Given the elevated risk of tuberculosis (TB), including drug-resistant disease, experienced by health workers in South Africa (SA), effective workers' compensation for occupational TB is a legal right and an essential social benefit. OBJECTIVES: To investigate the experience of the workers' compensation system among health workers who suffered from TB while working in public service facilities in Western Cape Province, SA. METHODS: In this case series with a qualitative component, 300 claims for occupational TB in health workers were sampled from the provincial health department database of claims submitted. Claim status for each case was ascertained. An attempt was made to contact each health worker for a telephonic interview consisting of both closed- and open-ended (qualitative) questions. Fifty-one interviews were completed. RESULTS: In nearly half of the cases, there was no record of claim status on the state Compensation Fund website. Of the 51 interviewees, only one had received all the compensation benefits for their particular claim circumstances. Health workers' experience of having their cases reported for compensation purposes was marred by perception of poor communication and administration. The experience of contracting TB was further characterised by surprise, perceptions of stigma, financial burden and ongoing ill-health. CONCLUSIONS: Affected health workers' experience of the workers' compensation system was mostly negative, adding to the burden of being ill with TB. Education of management and clinicians, improvement in communication, and timeous and regular checking of claim status and of payment of applicable compensation are required at the provincial level. Dedicated facility-based occupational health units are needed, with a staff complement of knowledgeable persons trusted by their colleagues. However, the effectiveness of the system is ultimately dependent on the ability of the Compensation Fund to register and display claims timeously and administer compensation expeditiously.

Indirect costs of myocardial infarction in Portugal.

INTRODUCTION: Cardiovascular disease, and particularly myocardial infarction (MI), carries a significant economic burden, through productivity losses (indirect costs) associated with temporary absence from work, that has not yet been adequately studied in Portugal. Our objective was to quantify the indirect costs of MI in the first year after admission. METHODS: Consecutive patients admitted to a single center aged <66 years who survived to discharge during a one-year period were included. Employment status on admission was assessed and for every employed patient, their monthly wage was estimated from market wage rates taken from the Ministry of Labor database according to gender and age. The duration of temporary absence from work was assessed in follow-up contacts for up to one year. Indirect costs were calculated in this sample and the results were applied to the number of MIs in Portugal during 2016 and separately to ST-elevation MI (STEMI) and non-ST-elevation acute coronary syndrome. RESULTS: A total of 219 patients were included, of whom 66.2% were working. The mean monthly labor cost was 1802 euros. A total cost of 760 521.55 euros was obtained. At national level there were 4133 patients aged <66 years admitted with acute MI who survived to discharge. Costs were higher in STEMI patients and the total indirect cost was estimated at 10.12 million euros. CONCLUSIONS: In Portugal, the costs to society of disability-generated productivity losses exceed ten million euros in the first year after MI. Strategies to promote an earlier return to work are needed to lower these costs.

Economic analysis of new workplace technology including productivity and injury: The case of needle-less injection in swine.

Increasing intensification in swine production has led to new and specialized technologies, but the occupational health and safety impacts are rarely quantified in the business plans for adoption. Needle-less injection has potential to increase productivity and eliminate needle stick injury in workers, but it is not clear whether these benefits offset high capital investment and potential increases in musculoskeletal loads. This economic evaluation employed probabilistic scenario analysis using injury, cost, and production data gathered from interviews with swine producers in Manitoba and Saskatchewan. After adoption of needle-less injection, rates of needle-stick injury went down with no measureable effect on upper limb musculoskeletal disorders, resulting in lower health and safety costs for needle-less injectors. Needle-less injection duration was 40% faster once workers acclimatized, but large start-up costs mean economic benefits are realized only after the first year. The incremental benefit cost ratio promoted adoption of needle-less injectors over conventional needles for the base case of a 1200 sow barn; the conventional method is beneficial for barns with 600 sows or less. Findings indicate that well-designed technologies have the potential to achieve the dual ergonomics goals of enhancing human wellbeing and system performance. We anticipate that the economic and decision models developed in this study can be applied to other new technologies in agriculture and animal production.

Occupational Injuries Involving Medical Imaging and Radiation Therapy Professionals.

PURPOSE: To determine the types of occupational injuries medical imaging and radiation therapy professionals experience in addition to the length of medical leave of absence, receipt of financial compensation, and ability to perform the same job duties on returning to work. METHODS: Using a quantitative approach, a random sample of 10 000 American Society of Radiologic Technologists members was invited to complete a survey detailing occupational injuries experienced while working as a medical imaging or radiation therapy professional. Data were collected using Qualtrics and analyzed with IBM's SPSS. RESULTS: Of the 401 participants in this study, more than half (251, 62.6%) experienced occupational injuries, with the majority of those being muscular injuries (205, 81.7%). Of the 251 participants who experienced an occupational injury, 109 (43.4%) reported a medical leave of absence of less than 1 week, 61 (24.3%) received financial assistance from their employer, and 231 (92%) indicated they were able to resume their previous job duties on returning to work. DISCUSSION: Many study participants acknowledged that despite being injured they continued to work impaired without taking a medical leave of absence or did not report the injury to administration or risk management. Impaired employees can further aggravate pre-existing medical conditions and possibly trigger a permanent disability or chronic ailment by continuing to perform the same work activities as when they were injured initially. Department managers and supervisors should encourage medical imaging and radiation therapy professionals to report all injuries so that appropriate measures (eg, informing risk management, filing a workers' compensation claim, or modifying job responsibilities) can be initiated. CONCLUSION: Additional research is warranted to explore strategies for preventing or decreasing the incidence of occupational injuries in the medical imaging and radiation therapy profession that can be implemented individually (eg, practicing proper patient handling techniques) or organizationally (eg, staffing an appropriate number of personnel for the workload).

Self-Isolation Compliance In The COVID-19 Era Influenced By Compensation: Findings From A Recent Survey In Israel.

To contain the novel coronavirus disease (COVID-19) pandemic, health and government authorities have imposed sweeping self-quarantine orders for communities worldwide. Health officials assume that the public will have high rates of compliance. However, studies suggest that a major obstacle to compliance for household quarantine is concern about loss of income. A cross-sectional study of the adult population of Israel was conducted in the last week of February 2020 to assess public attitudes toward the COVID-19 outbreak. In particular, public compliance rates with self-quarantine were assessed, depending on whether lost wages would be compensated for. When compensation was assumed, the compliance rate was 94 percent. When compensation was removed, the compliance rate dropped to less than 57 percent. This study demonstrated that providing people with assurances about their livelihoods during self-quarantine is an important component of compliance with public health regulations.

Step-downs reduce workers' compensation payments to encourage return to work: are they effective?

OBJECTIVE: To determine whether step-downs, which cut the rate of compensation paid to injured workers after they have been on benefits for several months, are effective as a return to work incentive. METHODS: We aggregated administrative claims data from seven Australian workers' compensation systems to calculate weekly scheme exit rates, a proxy for return to work. Jurisdictions were further subdivided into four injury subgroups: fractures, musculoskeletal, mental health and other trauma. The effect of step-downs on scheme exit was tested using a regression discontinuity design. Results were pooled into meta-analyses to calculate combined effects and the proportion of variance attributable to heterogeneity. RESULTS: The combined effect of step-downs was a 0.86 percentage point (95% CI -1.45 to -0.27) reduction in the exit rate, with significant heterogeneity between jurisdictions (I2=68%, p=0.003). Neither timing nor magnitude of step-downs was a significant moderator of effects. Within injury subgroups, only fractures had a significant combined effect (-0.84, 95% CI -1.61 to -0.07). Sensitivity analysis indicated potential effects within mental health and musculoskeletal conditions as well. CONCLUSIONS: The results suggest some workers' compensation recipients anticipate step-downs and exit the system early to avoid the reduction in income. However, the effects were small and suggest step-downs have marginal practical significance. We conclude that step-downs are generally ineffective as a return to work policy initiative.Postprint link: https://www.medrxiv.org/content/10.1101/19012286.

Factory benefits to paying workers more: The critical role of compensation systems in apparel manufacturing.

While many stakeholders believe worker wages in global supply chains are too low, there is disagreement about what, if anything, can be done to raise wages. Through a two-year quasi-experiment in an operating apparel factory, we assess the effects on productivity and profits of raising worker wages with a re-designed compensation system. We show that, even within current factory margins and constraints, important wage gains (4.2-9.7%) are possible and profitable. Productivity increased 8-10%-points while turnover decreased markedly. Workers were motivated by the potential for increased wages from an accelerating group rate as well as increased engagement and sense of fair compensation. Workers focused their increased effort on reducing quality defects and tardiness, two behaviors which individual workers largely control. Additional productivity-increasing behaviors were constrained by skill, position, and conflicts arising from free riders. Advanced apparel manufacturing demands a more engaged workforce; this research provides early evidence that compensation systems can be a critical tool to meet multiple needs.

Left In The Dust: Helping Underreporting of Workplace Illnesses.

Workplace illnesses can be difficult for physicians and patients because some take years to develop and frequently are masked or mimicked by other illnesses. Such a disease may not show itself until decades after the patient has left the job that caused the problem. By then, the illness may be so far along that little can be done. That time lag between exposure and illness is just one of several difficulties Texas physicians face in tackling workplace illnesses. Because Texas does not have a federally-approved plan for developing and enforcing workplace health and safety standards, the state defers to OSHA on this responsibility.

An Injury to Justice: Workers' Comp Disputes Could Tilt in Insurers' Favor.

Medicine is working to upend a recent appeals court decision that threatens to give health plans an overwhelming advantage in fee disputes in workers compensation cases.

Mining-Related Lower Back Injuries and the Compensation Process: An Injured Worker's Journey.

Background: In Ontario, when an occupational injury occurs in the mining industry, there is often a need to interact with the Workplace Safety and Insurance Board (WSIB). During this process, miners experience economic, social, and mental health-related issues that can affect their overall well-being. This study aimed to determine the impact of a lower back injury and the WSIB claim process experience expressed by some male, underground miners in Sudbury, Ontario, Canada. Methods: A qualitative descriptive study design that utilized in-depth, individual qualitative interviews was conducted. Twelve male participants (underground miners) were interviewed in Sudbury, Ontario. Interviews were transcribed and thematically analyzed. Findings: The results emphasized the need for improved communication, the necessity for resources to be allocated to enhance public discussion about injury prevention, the social and economic burden that miners and their families face, and the power imbalances between injured miners and the companies that were meant to support them. Conclusion/Application to Practice: The findings indicate that several areas require improvement for an injured miner who submits a WSIB claim. Ideally, participants wanted an improved and streamlined process for reporting an injury and for WSIB claim management. These findings suggest that occupational health practices that foster a safe and healthy work environment in the mining industry must be promoted, which will help to guide future policies that enhance support for an injured worker and the WSIB claim process.

Work-related asthma surveillance in Washington State: time trends, industry rates, and workers' compensation costs, 2002-2016.

Objective: Washington State's work-related asthma (WRA) surveillance program utilizes workers' compensation (WC) data as its primary data source and has spanned a 15-year time period. This study analyses trends for WRA claim incidence rates compared to all WC claim incidence rates. WRA claim incidence rates and WC costs are analyzed by industry. Methods: Potential WRA cases were identified through the WC system and through direct provider report and classified by industry, age, and year of illness onset. WRA claim rates by industry and year were calculated using total work hours reported by employers covered by the WC system. Claim costs for accepted claims were compared by industry and year. Results: WRA claim incidence rates decreased 8.9% (95% CI: -10.6, -7.2) annually for the time period 2002-2016. The decline in WRA claim incidence rate is slightly faster than the incidence rate for all WC claims which had its steepest decrease from 2007 to 2010 at an estimated annual 8.4% decrease (95% CI: -11.8, -5.0). WRA claim rates were highest for workers in Public Administration, Manufacturing, and the Agricultural, Forestry, Fishing and Hunting industries. Median claim costs for WRA did not change significantly by year (p = 0.2, range $595-$1442) and the distribution of WRA WC claim costs by industry were highest in Manufacturing (21.3%) and Construction (16.4%) industries. Conclusion: WRA claim incidence rates are declining in Washington State. The cause for the decline is unclear. Workers across all industries in Washington remain at risk for WRA.

Economic Evaluation and Systematic Review of Publicly Available Workers' Compensation Practice Details and Mod Rate Calculators Applied to Upper Midwest Agriculture.

Background: Agricultural employment is one of the most dangerous occupations in the United States. Workers' compensation coverage requirements for agricultural work vary from state to state, and experience modifier rates (E-mods) affecting insurance premiums sometimes vary drastically across state lines and according to claim severities and farm sizes. We proposed to develop an interactive software application that would educate farmers on the impact of employee time loss on annual E-mod factor change specific to their geographic location and farm size.Methods: We conducted a comparative analysis of workers' compensation formulations, including E-mods among Upper Midwestern states. We performed sensitivity analysis of the formulas to claim amount and payroll to highlight differences related to claim severity and to farm size.Results: The state to state variation and remarkable complexity of these formulas was confirmed. E-Mod factors are shown to increase substantially across states with both claim size and payroll, though are found to be similar across Wisconsin and Minnesota which were examined in detail.Conclusions: The findings confirm that creating a nationally applicable interactive educational software tool for farmers and ranchers to view hypothetical rate changes by inputting on-farm injury scenarios represents a significant challenge and that educational outreach coupled with the use of commercial software, especially as less costly options become available, may serve the role of minimizing misunderstandings by current producers as may other informational sources.