The effectiveness of insurer-supported safety and health engineering controls in reducing workers' compensation claims and costs

Construction industry workers' compensation injury claims due to slips, trips, and falls - Ohio, 2010-2017

PROBLEM

Compared to other industries, construction workers have higher risks for serious fall injuries. This study describes the burden and circumstances surrounding injuries related to compensable slip, trip, and fall (STF) claims from private construction industries covered by the Ohio Bureau of Workers' Compensation.

METHODS

STF injury claims in the Ohio construction industry from 2010-2017 were manually reviewed. Claims were classified as: slips or trips without a fall (STWOF), falls on the same level (FSL), falls to a lower level (FLL), and other. Claim narratives were categorized by work-related risk and contributing factors. Demographic, employer, and injury characteristics were examined by fall type and claim type (medical-only (MO, 0-7 days away from work, DAFW) or lost-time (LT, ≥8 DAFW)). Claim rates per 10,000 estimated full-time equivalent employees (FTEs) were calculated.

RESULTS

9,517 Ohio construction industry STF claims occurred during the 8-year period, with an average annual rate of 75 claims per 10,000 FTEs. The rate of STFs decreased by 37% from 2010 to 2017. About half of the claims were FLL (51%), 29% were FSL, 17% were STWOF, and 3% were "other." Nearly 40% of all STF claims were LT; mostly among males (96%). The top three contributing factors for STWOF and FSL were: slip/trip hazards, floor irregularities, and ice/snow; and ladders, vehicles, and stairs/steps for FLL. FLL injury rates per 10,000 FTE were highest in these industries: Foundation, Structure, and Building Exterior Contractors (52); Building Finishing Contractors (45); and Residential Building Construction (45). The highest rate of FLL LT claims occurred in the smallest firms, and the FLL rate decreased as construction firm size increased. Discussion and Practical Applications: STF rates declined over time, yet remain common, requiring prevention activities. Safety professionals should focus on contributing factors when developing prevention strategies, especially high-risk subsectors and small firms.

Workers' compensation injury claims among firefighters in Ohio, 2001-2017

BACKGROUND

Firefighters are at high risk for nonfatal and fatal occupational injuries. While some past research has quantified firefighter injuries using various data sources, Ohio workers' compensation injury claims data largely have not been used.

METHODS

Public and private firefighter claims, including volunteer and career firefighters, from Ohio's workers' compensation data for 2001-2017 were identified based on occupational classification codes and manual review of the occupation title and injury description. The task during injury (firefighting, patient care, training, other/unknown, etc.) was manually coded based on the injury description. Injury claim counts and proportions were described across claim type (medical-only or lost-time), worker demographics, task during injury, injury events, and principal diagnoses.

RESULTS

33,069 firefighter claims were identified and included. Most claims were medical-only (66.28%, <8 days away from work) and involved males (93.81%) aged 25-54 years (86.54%). While the task during injury could not be categorized for many narratives (45.96%), the largest percentage that could be categorized occurred during firefighting (20.48%) and patient care (17.60%). The most common injury events were overexertion involving outside sources (31.33%) and struck by objects or equipment (12.68%). The most frequent principal diagnoses were back, lower extremity, and upper extremity sprains (16.02%, 14.46%, and 11.98%, respectively).

CONCLUSIONS

This study provides a preliminary basis for the development of focused firefighter injury prevention programming and training. Obtaining denominator data, enabling rate calculation, would strengthen the risk characterization. Based on the current data, prevention efforts focusing on the most frequent injury events and diagnoses may be warranted.

The Role of Worker Age in Ohio Workers' Compensation Claims in the Landscaping Services Industry

OBJECTIVE

This study employed analysis of workers' compensation (WC) claims in the landscaping services industry to identify occupational factors associated with claims from workers of different ages.

METHODS

Private sector claims for 2005 to 2017 to the Ohio Bureau of Workers' Compensation (OHBWC) and their free-text descriptions were used along with data from the US Census Bureau American Community Survey to examine rates and types of WC claims by worker age.

RESULTS

Although the claim rate for younger workers was higher than that for older workers overall (593 vs 261 per 10,000 full-time equivalent employees, P < 0.001), claims from older workers had higher nonzero median cost ($1002 vs $522, P < 0.001).

CONCLUSIONS

Analysis of WC claim rates shows significant differences between claims in different age groups. These differences can be used to target safety interventions for the greatest impact.

Case Studies of Robots and Automation as Health/Safety Interventions in Small Manufacturing Enterprises

This paper reviews the experiences of 63 case studies of small businesses (< 250 employees) with manufacturing automation equipment acquired through a health/safety intervention grant program. The review scope included equipment technologies classified as industrial robots (n = 17), computer numerical control (CNC) machining (n = 29), or other programmable automation systems (n = 17). Descriptions of workers' compensation (WC) claim injuries and identified risk factors that motivated acquisition of the equipment were extracted from grant applications. Other aspects of the employer experiences, including qualitative and quantitative assessment of effects on risk factors for musculoskeletal disorders (MSD), effects on productivity, and employee acceptance of the intervention were summarized from the case study reports. Case studies associated with a combination of large reduction in risk factors, lower cost per affected employee, and reported increases in productivity were: CNC stone cutting system, CNC/vertical machining system, automated system for bottling, CNC/routing system for plastics products manufacturing, and a CNC/Cutting system for vinyl/carpet. Six case studies of industrial robots reported quantitative reductions in MSD risk factors in these diverse manufacturing industries: Snack Foods; Photographic Film, Paper, Plate, and Chemical; Machine Shops; Leather Good and Allied Products; Plastic Products; and Iron and Steel Forging. This review of health/safety intervention case studies indicates that advanced (programmable) manufacturing automation, including industrial robots, reduced workplace musculoskeletal risk factors and improved process productivity in most cases.

The Impact of a State-Based Workers' Compensation Insurer's Risk Control Services on Employer Claim Frequency and Cost Rates

OBJECTIVE

This study evaluated the impact of a state workers' compensation (WC) insurer's onsite risk control (RC) services on insured employers' WC claim frequency and cost.

METHODS

We used two methods to model 2004 to 2017 claims data from 4606 employers that received RC visits over time and compare this claims experience to matching employers that did not receive RC services.

RESULTS

Relative total WC claim rates increased slightly after RC services, while relative lost-time claims rates either remained similar or decreased and WC cost rates decreased. The impact of RC services on reducing WC costs was cumulative up to the fourth visit but diminished thereafter.

CONCLUSIONS

The insurer RC consultation program was effective in reducing WC cost rates for serviced employers. This is consistent with other research conducted on insurer RC services and related regulatory visits.

Reliability and validity of an employer-completed safety hazard and management assessment questionnaire

INTRODUCTION

Managing and improving occupational safety and health requires evaluating performance. Organizations are encouraged to use both lagging indicators (such as injury rates and costs) and leading indicators (such as questionnaire-assessed safety hazards and management practices) for this purpose, but the association between types of indicators over time can be complex. Longitudinal data can assist in clarifying these associations and increasing indicator utility.

METHOD

Employer data were used to evaluate the reliability and predictive validity of a safety management questionnaire. Employers' longitudinal questionnaire responses and workers' compensation (WC) claims data were analyzed using a marginal model with time-dependent covariates. Multivariable Poisson and linear regression analyses with claim rate and logarithmic cost, respectively, as dependent variables were carried out after adjusting for industry sector and size. Questionnaire data were used to evaluate questionnaire scaling properties and to assess generalizability of results.

RESULTS

One safety management scale was associated with a better WC outcome as predicted and two scales were unexpectedly associated with poorer WC claim outcomes. Analyses assisted in interpreting the latter results, suggesting that WC outcomes were a stimulus for change in some cases. Twelve hazards assessed on the questionnaire were associated with poorer WC claim outcomes as predicted.

CONCLUSIONS

This study extends leading indicator research using longitudinal questionnaire and WC claims data from employers. Analyses provided insight into associations between leading and lagging indicators, emphasizing the importance of both for safety improvement. Safety management questionnaire scales were predictive of WC claim outcomes, although support for hazard assessments as leading indicators was stronger.

PRACTICAL APPLICATIONS

This study supports the use of employer-completed hazard assessment questionnaires for targeting and prioritizing improvement efforts. Employer-completed safety management scales may be useful for directing improvement efforts, although the conditions under which they are completed, including submission to insurers, require additional consideration.

Workers' compensation claim counts and rates by injury event/exposure among state-insured private employers in Ohio, 2007-2017

INTRODUCTION

This study analyzed workers' compensation (WC) claims among private employers insured by the Ohio state-based WC carrier to identify high-risk industries by detailed cause of injury.

METHODS

A machine learning algorithm was used to code each claim by U.S. Bureau of Labor Statistics (BLS) event/exposure. The codes assigned to lost-time (LT) claims with lower algorithm probabilities of accurate classification or those LT claims with high costs were manually reviewed. WC data were linked with the state's unemployment insurance (UI) data to identify the employer's industry and number of employees. BLS data on hours worked per employee were used to estimate full-time equivalents (FTE) and calculate rates of WC claims per 100 FTE.

RESULTS

140,780 LT claims and 633,373 medical-only claims were analyzed. Although counts and rates of LT WC claims declined from 2007 to 2017, the shares of leading LT injury event/exposures remained largely unchanged. LT claims due to Overexertion and Bodily Reaction (33.0%) were most common, followed by Falls, Slips, and Trips (31.4%), Contact with Objects and Equipment (22.5%), Transportation Incidents (7.0%), Exposure to Harmful Substances or Environments (2.8%), Violence and Other Injuries by Persons or Animals (2.5%), and Fires and Explosions (0.4%). These findings are consistent with other reported data. The proportions of injury event/exposures varied by industry, and high-risk industries were identified.

CONCLUSIONS

Injuries have been reduced, but prevention challenges remain in certain industries. Available evidence on intervention effectiveness was summarized and mapped to the analysis results to demonstrate how the results can guide prevention efforts. Practical Applications: Employers, safety/health practitioners, researchers, WC insurers, and bureaus can use these data and machine learning methods to understand industry differences in the level and mix of risks, as well as industry trends, and to tailor safety, health, and disability prevention services and research.

Cost, Severity and Prevalence of Agricultural-Related Injury Workers' Compensation Claims in Farming Operations from 14 U.S. States

(1) Background: There is no national surveillance of agricultural injuries, despite agricultural occupations being among the most hazardous in the U.S. This effort uses workers' compensation (WC) data to estimate the burden of agricultural injuries and the likelihood of experiencing an injury by body part involved, cause, and nature in farming operations. (2) Methods: WC data from 2010 to 2016 provided by a large insurance company covering small to medium-sized farm operations from 14 U.S. states was used. We investigated the associations between injury characteristics and WC costs and the risk of having a more severe versus a less severe claim. The proportion of costs attributable to specific claim types was calculated. (3) Results: Of a total 1000 claims, 67% were medical only. The total cost incurred by WC payable claims (n = 866) was USD 21.5 million. Of this, 96% was attributable to more severe claims resulting in disabilities or death. The most common body part injured was the distal upper extremity. Falling or flying objects and collisions were the most expensive and common causes of injury. (4) Conclusions: Characterizing the cost and severity of agricultural injury by key injury characteristics may be useful when prioritizing prevention efforts in partnership with insurance companies and agricultural operations.

Workers' compensation claims among private skilled nursing facilities, Ohio, 2001-2012

INTRODUCTION

Skilled nursing facilities have one of the highest rates of occupational injury and illness among all industries. This study quantifies the burden of occupational injury and illness in this industry using data from a single state-based workers' compensation (WC) system.

METHODS

Ohio Bureau of Workers' Compensation claims from 2001 to 2012 were analyzed among privately owned, state-insured skilled nursing facilities and are presented as claim counts and rates per 100 full-time equivalents (FTE). Worker, employer, incident, and injury characteristics were examined among all claims and by medical-only (medical care expenses and/or less than eight days away from work) and lost-time (eight days or more away from work) claim types.

RESULTS

There were 56,442 claims in this population of Ohio skilled nursing facilities from 2001 to 2012. Overexertion and bodily reaction, slips, trips, and falls, and contact with objects and equipment accounted for the majority of all WC claims (89%). Overexertion and bodily reaction, and slips, trips, and falls comprised 85% of the 10,793 lost-time claims. The highest injury event/exposure rates for all claims were for overexertion and bodily reaction (3.7 per 100 FTE for all claims), followed by slip, trips, and falls (2.1), and contact with objects and equipment (1.9).

CONCLUSION

Understanding the details surrounding injury events and exposures resulting in WC claims can help better align prevention efforts, such as incorporation of safe patient handling policies and lifting aids, improvement in housekeeping practices, and employee training within skilled nursing facilities to prevent worker injury and mitigate related expenses.

The effectiveness of ergonomic interventions in material handling operations

This study evaluated the effectiveness of ergonomic interventions in material handling operations involving 33 employers and 535 employees from 2012 to 2017. Outcomes included employee-reported low back/upper extremity pain and safety incidents at baseline, every three months, and annually for up to two years. A total of 32.5% of employees completed at least one survey, while 13.6% completed all nine surveys over two years. Among highly exposed employees (who reported handling >= 50 lbs. > 33% of the time), upper extremity pain frequency and severity were lower among those who reported using the intervention routinely versus those that reported using their body strength alone to handle objects >= 50 lbs. After excluding from analyses one employer that used anti-fatigue mats, low back pain frequency was also significantly lower among highly exposed intervention users. In conclusion, there was some evidence that the interventions were effective in reducing employee-reported pain for highly exposed employees.

Applying Machine Learning to Workers' Compensation Data to Identify Industry-Specific Ergonomic and Safety Prevention Priorities: Ohio, 2001 to 2011

OBJECTIVE

This study leveraged a state workers' compensation claims database and machine learning techniques to target prevention efforts by injury causation and industry.

METHODS

Injury causation auto-coding methods were developed to code more than 1.2 million Ohio Bureau of Workers' Compensation claims for this study. Industry groups were ranked for soft-tissue musculoskeletal claims that may have been preventable with biomechanical ergonomic (ERGO) or slip/trip/fall (STF) interventions.

RESULTS

On the basis of the average of claim count and rate ranks for more than 200 industry groups, Skilled Nursing Facilities (ERGO) and General Freight Trucking (STF) were the highest risk for lost-time claims (>7 days).

CONCLUSION

This study created a third, major causation-specific U.S. occupational injury surveillance system. These findings are being used to focus prevention resources on specific occupational injury types in specific industry groups, especially in Ohio. Other state bureaus or insurers may use similar methods.

Workers' compensation insurer risk control systems: Opportunities for public health collaborations

INTRODUCTION

Workers' compensation (WC) insurers offer services and programs for prospective client selection and insured client risk control (RC) purposes. Toward these aims, insurers collect employer data that may include information on types of hazards present in the workplace, safety and health programs and controls in place to prevent injury/illness, and return-to-work programs to reduce injury/illness severity. Despite the potential impact of RC systems on workplace safety and health and the use of RC data in guiding prevention efforts, few research studies on the types of RC services provided to employers or the RC data collected have been published in the peer-reviewed literature.

METHODS

Researchers conducted voluntary interviews with nine private and state-fund WC insurers to collect qualitative information on RC data and systems.

RESULTS

Insurers provided information describing their RC data, tools, and practices. Unique practices as well as similarities including those related to RC services, policyholder goals, and databases were identified.

CONCLUSIONS

Insurers collect and store extensive RC data, which have utility for public health research for improving workplace safety and health.

PRACTICAL APPLICATIONS

Increased public health understanding of RC data and systems and an identification of key collaboration opportunities between insurers and researchers will facilitate increased use of RC data for public health purposes.