Excess healthcare costs associated with prior workers' compensation activity

Impact of Occupational Injuries on Nonworkers' Compensation Medical Costs of Patient-Care Workers

OBJECTIVE

The aim of this study was to estimate the extent to which work-related injuries contribute to medical expenditures paid for by group health insurance.

METHODS

Administrative data on OSHA recordable injuries spanning 2010 to 2013 were obtained for female patient care workers (n = 2495). Expenditures were aggregated group health insurance claims for 3 and 6-month periods before/after injury. Group health insurance plan type, age group, and job category were control variables.

RESULTS

Being injured is associated with the odds of having expenditures at both 3 months, odds ratio (OR) 2.17 [95% confidence interval (95% CI) 1.61 to 2.92], and 6 months, 2.95 (95% CI 1.96 to 4.45). Injury was associated with $275 of additional expenditures (95% CI $38 to $549) over 3 months and $587 of additional expenditures (95% CI $167 to $1140) over 6 months.

CONCLUSIONS

Injury was associated with increased odds of positive expenditures and increased expenditures paid for by group health insurance.

Non-reporting of work injuries and aspects of jobsite safety climate and behavioral-based safety elements among carpenters in Washington State

BACKGROUND

Declining work injury rates may reflect safer work conditions as well as under-reporting.

METHODS

Union carpenters were invited to participate in a mailed, cross-sectional survey designed to capture information about injury reporting practices. Prevalence of non-reporting and fear of repercussions for reporting were compared across exposure to behavioral-based safety elements and three domains of the Nordic Safety Climate Questionnaire (NOSACQ-50).

RESULTS

The majority (>75%) of the 1,155 participants felt they could report work-related injuries to their supervisor without fear of retribution, and most felt that the majority of injuries on their jobsites got reported. However, nearly half indicated it was best not to report minor injuries, and felt pressures to use their private insurance for work injury care. The prevalence of non-reporting and fear of reporting increased markedly with poorer measures of management safety justice (NOSACQ-50).

CONCLUSIONS

Formal and informal policies and practices on jobsites likely influence injury reporting.

Workers' compensation claims for musculoskeletal disorders and injuries of the upper extremity and knee among union carpenters in Washington State, 1989-2008

BACKGROUND

Numerous aspects of construction place workers at risk of musculoskeletal disorders and injuries (MSDIs). Work organization and the nature of MSDIs create surveillance challenges.

METHODS

By linking union records with workers' compensation claims, we examined 20-year patterns of MSDIs involving the upper extremity (UE) and the knee among a large carpenter cohort.

RESULTS

MSDIs were common and accounted for a disproportionate share of paid lost work time (PLT) claims; UE MSDIs were three times more common than those of the knee. Rates declined markedly over time and were most pronounced for MSDIs of the knee with PLT. Patterns of risk varied by extremity, as well as by age, gender, union tenure, and predominant work. Carpenters in drywall installation accounted for the greatest public health burden.

CONCLUSIONS

A combination of factors likely account for the patterns observed over time and across worker characteristics. Drywall installers are an intervention priority.

Twenty years of workers' compensation costs due to falls from height among union carpenters, Washington state

BACKGROUND

Falls from height (FFH) are a longstanding, serious problem in construction.

METHODS

We report workers' compensation (WC) payments associated with FFH among a cohort (n = 24,830; 1989-2008) of carpenters. Mean/median payments, cost rates, and adjusted rate ratios based on hours worked were calculated using negative-binomial regression.

RESULTS

Over the 20-year period FFH accounted for $66.6 million in WC payments or $700 per year for each full-time equivalent (2,000 hr of work). FFH were responsible for 5.5% of injuries but 15.1% of costs. Cost declines were observed, but not monotonically. Reductions were more pronounced for indemnity than medical care. Mean costs were 2.3 times greater among carpenters over 50 than those under 30; cost rates were only modestly higher.

CONCLUSIONS

Significant progress has been made in reducing WC payments associated with FFH in this cohort particularly through 1996; primary gains reflect reduction in frequency of falls. FFH that occur remain costly.

Do zero-cost workers' compensation medical claims really have zero costs? The impact of workplace injury on group health insurance utilization and costs

OBJECTIVE

Previous research suggests that non-workers' compensation (WC) insurance systems, such as group health insurance (GHI), Medicare, or Medicaid, at least partially cover work-related injury and illness costs. This study further examined GHI utilization and costs.

METHODS

Using two-part model, we compared those outcomes immediately after injuries for which accepted WC medical claims made zero or positive medical payments.

RESULTS

Controlling for pre-injury GHI utilization and costs and other covariates, our results indicated that post-injury GHI utilization and costs increased regardless of whether a WC medical claim was zero or positive. The increases were highest for zero-cost WC medical claims.

CONCLUSION

Our national estimates showed that zero-cost WC medical claims alone could cost the GHI $212 million per year.

Uncompensated consequences of workplace injuries and illness: long-term disability and early termination

PROBLEM

Costs related to early retirement, termination, or long-term disability could fall outside workers' compensation (WC).

METHOD

Statistical models examined early retirement, long-term disability status, or early termination related to WC claims.

RESULTS

The WC-associated early-termination rate ratio was 1.20 (95% CI=1.14-1.28) for hourly nonunion employees, 1.05 (95% CI=0.97-1.13) for hourly union employees, and 3.43 (95% CI=3.11-3.79) for salaried nonunion employees. In the manufacturing-durable sector the WC-associated rate ratio was 1.58 (95% CI=1.42-1.76) for hourly nonunion employees and 1.23 (95% CI=1.10-1.38) for union hourly employees. In contrast, in transportation-utilities-communications, the rate ratio was 0.52 (95% CI=0.46-0.59) for hourly nonunion and 1.22 (95% CI=1.08-1.38) for union hourly employees.

DISCUSSION

Uncompensated costs of workplace injuries and illnesses may result from adverse events previously compensated by WC. In some workplaces reduced termination rates with prior WC suggests added costs to employers.

SUMMARY

Conditions leading to WC claims have cost implications related to early - or delayed - removal from the workforce.

IMPACT ON INDUSTRY

Additional costs from work-related injury or illness that are not covered by workers compensation may result from the effect of continuing impairment on the subsequent early termination (or prolonging) of employment. These costs would accrue to both employers and employees and are not generally included in global estimates of the burden of workplace injuries and illnesses.