Category Archives: Workers’ Compensation

Medical claims paid by workers’ compensation insurance among US Medicare beneficiaries, 1999–2016

Source: Laura Kurth, Megan Casey, Brian Chin, Jacek M. Mazurek, Patricia Schleiff, Cara Halldin, David J. Blackley, American Journal of Industrial Medicine, Early View, First published: January 11, 2021
(subscription required)

From the abstract:
Background
Workers’ compensation claims among Medicare beneficiaries have not been described previously. To examine the healthcare burden of work‐related injury and illness among Medicare beneficiaries, we assessed the characteristics, healthcare utilization, and financial costs among Medicare beneficiaries with claims for which workers’ compensation was the primary payer.

Methods
We extracted final action fee‐for‐service Medicare claims from 1999 to 2016 where workers’ compensation had primary responsibility for claim payment and beneficiary, claim type, diagnoses, and cost information from these claims.

Results
During 1999–2016, workers’ compensation was the primary payer for 2,010,200 claims among 330,491 Medicare beneficiaries, and 58.7% of these beneficiaries had more than one claim. Carrier claims submitted by noninstitutional providers constituted the majority (94.5%) of claims. Diagnosis codes indicated 19.4% of claims were related to diseases of the musculoskeletal system and connective tissue and 12.9% were related to disease of the circulatory system. Workers’ compensation insurance paid $880.4 million for these claims while Medicare paid $269.7 million and beneficiaries paid $37.4 million.

Conclusions
Workers’ compensation paid 74% of the total amount to providers for these work‐related medical claims among Medicare beneficiaries. Claim diagnoses were similar to those of all workers’ compensation claims in the United States. Describing these work‐related claims helps identify the healthcare burden due to occupational injury and illness among Medicare beneficiaries resulting from employment and identifies a need for more comprehensive collection and surveillance of work‐related medical claims.

Workers’ compensation claims among private skilled nursing facilities, Ohio, 2001–2012

Source: Ashley M. Bush, Audrey A. Reichard, Steven J. Wurzelbacher, Chih‐Yu Tseng, Michael P. Lampl, American Journal of Industrial Medicine, Vol. 63, No. 12, December 2020
(subscription required)

From the abstract:
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.

Workers’ Compensation Benefits, Costs, and Coverage – 2017 Data

Source: Elaine Weiss, Griffin Murphy, Leslie I. Boden, National Academy of Social Insurance, October 2019

The 22nd report in the series, Workers’ Compensation: Benefits, Costs, and Coverage (2017 Data) provides the only comprehensive data on workers’ compensation benefits, coverage, and employer costs for the nation, the states, the District of Columbia, and federal programs.

From the press release:
Benefits paid to injured workers continued to decline, while covered employment and wages continued to rise, according to data in the new Workers’ Compensation Benefits, Costs, and Coverage (2017 Data) report. Produced annually by the National Academy of Social Insurance (Academy), this report provides the only comprehensive data on workers’ compensation benefits, coverage, and employer costs for the nation, the states, the District of Columbia, and federal programs.

Employee coverage has increased fairly steadily over the past two decades, but employer costs have fallen from just over $1.50 per $100 of covered wages in 1997 to $1.25 in 2017. Worker benefits decreased even more, from $1.17 twenty years ago to $0.80 per $100 of covered wages in 2017. “This year’s report shows that the trends that have dominated the workers’ compensation system for the past three decades – declines in both workers’ benefits and employers’ costs – continue to be sustained,” noted Les Boden, Chair of the Academy Study Panel on Workers’ Compensation Data and co-author of the report…..

Related:
Executive Summary

Read state-specific findings:
Florida
Missouri
Ohio
Wyoming

Sources and Methods

Comparing disability and return to work outcomes between alternative and traditional workers’ compensation programs

Source: Katherine Schofield, Andrew D. Ryan, Kim N. Dauner, American Journal of Industrial Medicine, Volume 62, Issue 9, September 2019
(subscription required)

From the abstract:
Background:
The Union Construction Workers’ Compensation Program (UCWCP) was developed in 1996 as an alternative workers’ compensation arrangement. The program includes use of a preapproved medical and rehabilitation network and alternative dispute resolution (ADR), and prioritizes a quick and safe return‐to‐work. The aim of this study is to determine if differences in recovery‐related outcomes exist between UCWCP and the statutory workers’ compensation system (SWCS).

Methods:
Claims data from 2003 to 2016 were classified as processed through UCWCP or SWCS. Outcomes included: temporary total disability (TTD), vocational rehabilitation (VR), claim duration and costs, and permanent partial disability (PPD). The relative risk of incurring TTD, VR, and PPD in UCWCP vs SWCS was calculated using log‐binomial regression. Linear regression examined the relationship between programs and continuous outcomes including costs and duration. Estimates were adjusted for age, sex, wage, and severity.

Results:
The UCWCP processed 15.8% of claims; higher percentages of UCWCP claimants were older and earned higher wages. Results point to positive findings of decreased TTD incidence and cost, lower risk of TTD extending over time, higher likelihood of VR participation, and less attorney involvement and stipulation agreements associated with UCWCP membership. Differences were more apparent in workers who suffered permanent physical impairment.

Conclusion:
Findings suggest that the defining programmatic elements of the UCWCP, including its medical provider and rehabilitation network and access to ADR, have been successful in their aims. Claims with increased severity exhibited more pronounced differences vs SWCS, potentially due, in part, to greater use of programmatic elements.

Workers’ compensation injury claims among workers in the private ambulance services industry—Ohio, 2001–2011

Source: Audrey A. Reichard, Ibraheem S. Al‐Tarawneh, Srinivas Konda, Chia Wei, Steven J. Wurzelbacher, Alysha R. Meyers, Stephen J. Bertke, P. Timothy Bushnell, Chih‐Yu Tseng, Michael P. Lampl, David C. Robins, American Journal of Industrial Medicine, Volume 61 Issue 12, December 2018

From the abstract:
Background:
Ambulance service workers frequently transfer and transport patients. These tasks involve occupational injury risks such as heavy lifting, awkward postures, and frequent motor vehicle travel.

Methods:
We examined Ohio workers’ compensation injury claims among state‐insured ambulance service workers working for private employers from 2001 to 2011. Injury claim counts and rates are presented by claim types, diagnoses, and injury events; only counts are available by worker characteristics.

Results:
We analyzed a total of 5882 claims. The majority were medical‐only (<8 days away from work). The overall injury claim rate for medical‐only and lost‐time cases was 12.1 per 100 full‐time equivalents. Sprains and strains accounted for 60% of all injury claims. Overexertion from patient handling was the leading injury event, followed by motor vehicle roadway incidents. Conclusions: Study results can guide the development or improvement of injury prevention strategies. Focused efforts related to patient handling and vehicle incidents are needed.

Workers’ Compensation Benefits, Costs, and Coverage – 2016 Data

Source: Christopher F. McLaren, Marjorie L. Baldwin, Leslie I. Boden, National Academy of Social Insurance, October 2018

From the abstract:
Workers’ Compensation: Benefits, Costs, and Coverage is the twenty-first in a series by the National Academy of Social Insurance to provide the only comprehensive national data on this largely state-run program. The study provides estimates of workers’ compensation payments—cash and medical—for all 50 states, the District of Columbia, and federal programs providing workers’ compensation.

Read the national press release.
Read state-specific findings for Michigan, New York, Ohio, Oklahoma, Tennessee.
Review the sources and methods (PDF) used to produce the state-level estimates in the report.

Shot on the Way to Work: Is Travel Time Work Time?

Source: Fatima Hussein, Daily Labor Report, April 18, 2018
(subscription required)  

• Worker killed on the way to on-call employment draws questions of travel time to work 
• Consequences of case could affect wage and hour claims in Ohio

After an on-call Ohio hospital worker was fatally shot on his way to work, his widow was awarded a worker’s compensation claim in her late husband’s name. ….

Workers’ compensation and the working poor: Occupational health experience among low wage workers in federally qualified health centers

Source: Liza Topete, Linda Forst, Joseph Zanoni and Lee Friedman, American Journal of Industrial Medicine, Early View, January 31, 2018
(subscription required)

From the abstract:
Background:
The working poor are at highest risk of work-related injuries and have limited access to occupational health care.

Objectives:
To explore community health centers (CHCs) as a venue for accessing at risk workers; and to examine the experience, knowledge, and perceptions of workers’ compensation (WC) among the working poor.

Methods:
Key informant interviews were conducted among patients in waiting rooms of rural and urban CHCs.

Result:
Fifty-one interviews of minority workers across sectors identified 23 prior work-related injuries and mixed experiences with the WC system. Barriers to reporting and ways to overcome these barriers were elucidated.

Conclusions:
Patients in CHCs work in jobs that put them at risk for work-related injuries. CHCs are a good site for accessing at-risk workers. Improving occupational healthcare and appropriate billing of WC insurance should be explored, as should best practices for employers to communicate WC laws to low wage workers.

Florida’s disposable workers: Companies profit from undocumented laborers, dump them after injuries

Source: Maria Perez, Naples Daily News, December 14, 2017

Florida law makes some immigrants in high-risk jobs disposable, allowing businesses and insurers to benefit from their work without covering injuries. …. Some Florida businesses profit from the labor of unauthorized immigrants after accepting phony identification when hiring them, and then the employers or their insurers report them after a work injury for using false documents, a yearlong Naples Daily News investigation found. ….

Workers’ Compensation: Benefits, Coverage, and Costs

Source: Christopher F. McLaren and Marjorie L. Baldwin, National Academy of Social Insurance, October 2017

From the abstract:
Workers’ Compensation: Benefits, Coverage, and Costs is the twentieth in a series by the National Academy of Social Insurance to provide the only comprehensive national data on this largely state-run program. The study provides estimates of workers’ compensation payments—cash and medical—for all 50 states, the District of Columbia, and federal programs providing workers’ compensation.
*Note: Due to the large size of the file, the report may take a few moments to download

Related:
View an infographic.
Read the national press release.
Read state-specific findings for California, Illinois, Oklahoma, Washington State, and West Virginia
Download a document detailing the sources and methods used to produce the state-level estimates in the report.