Rousmaniere: The 250K Most Important Injuries

Return to work is not a neutral concept. The premise of the workers’ comp system is that we make injured workers whole. That means restoring capacity to earn an income. which leads to targeting a timely return to work. And this points out the persistent challenge to managing injuries that generate a lot of disability. 

Some 250,000 injuries involve at least a month’s absence of work. They account for about 7 percent of all injuries, 30 percent of all injuries with any lost time, about 50 percent of lost time compensable claims, and likely 90 percent of the cost of claims.

Since 2000, the number of all lost time injuries has declined by about half. But injuries with over a month’s disability declined by less than 30 percent. They make up an increasing share of claims.

No one has as yet brought together in a public way all the influences of prolonged disability.  We have to construct a picture from disparate sources. This should be the work of the leading research centers, such as the Workers Compensation Research Institute and Rand. So much industry cost and system performance are at stake.  

It is lazy thinking to explain longer than necessary disability on one factor, such as law, the job, or the worker’s characteristics. The evidence I present below suggests a composite explanation, which we need the WCRI to document.

The WCRI published in 2018 the average durations for its Compscope participating. There was an unsettlingly large variance among states. It was not explained. My guess is that much of the variance, but not all, can be explained by looking at these longer disability claims. State laws may play a big role.  

Indeed, Wisconsin, noted for its quick claims resolution process, has an average duration one-third of that of Louisiana, which has a notoriously recalcitrant resolution process. I suspect that Wisconsin has relatively much fewer durations over a month.

Troy Prevot, EVP at LCTA Workers’ Comp, says the difference is that Louisiana is a wage loss state. Also, the court system and attorney involvement extend disability, he says. The medical treatment guidelines “have not been effective,” Prevot told me, and duration guidelines are not useful in-state. This means we have to customize our expectations by state, not to overlook durations.

What do we know about these injuries?

Let’s use data from the Bureau of Labor Statistics to see how, on a nationwide basis, these longer duration claims look. The BLS data contains some scintillating insights. This is what it says about injuries with over a month’s duration of disability (“longer duration injuries”):

Shoulder injuries and multiple body part injuries make up 19 percent of them.

Among all industries, they are most prevalent in mining and non-residential construction. However, if you look at individual occupations, you see that these are scattered among many industries: athletes, painters, roofers, oil derrick workers, power line installers, flight attendants and motor vehicle operators. Truck drivers alone account for one out of ten longer duration injuries.

Think about what may be extending disability: possibly a combination of the severity of injury, and barriers to modified duty. Can an athlete or a flight attendant perform in modified duty at all? Longer duration does not necessarily mean high medical severity.

Consider the circumstances of the injuries. Eighty percent of rail accidents have long durations. When we group together falls of at least six feet and jumping, we account for 8 percent of all longer duration injuries.

Combining vehicular related injuries with serious falls and jumps, we account for almost 30 percent of all longer duration injuries.

Workers over 55 account for 22 percent of all lost time injuries but 30 percent of longer duration injuries.

What do workers think about them?

We know little about worker personal responses to injuries, but what we know is fascinating and should influence how we respond to injuries just after they occur. For at that early time perceptions are forged and behavior can be accurately assessed.

Injured workers often have unrealistic expectations about how long they will be out on disability. A study by Amanda Young revealed that among those workers who expected to return to work within seven days, a quarter of them under-estimated their actual time off by at least a month.  

And consider those who, days after injury, predicted long recoveries. Among those who predicted disability for at least six months, half over-estimated their actual time away from work by at least 100 percent.

What about co-morbidities?

We want to measure the influence on recovery by obesity, diabetes, chronic obstructive pulmonary disease (COPD) and other factors. They vary by occupation. Among registered nurses, 10 percent smoke and 22 percent are obese. Among truck drivers, 34 percent smoke and 39 percent are obese. Does this have something to do with truck drivers being much more likely to be out of work longer?

What about screening?

It’s been proven that screening newly injured workers to predict delayed recovery works. A well-established, simple screening tool expertly predicts who will and will not be disabled from back pain months in the future. Albertsons, under the guidance of Denise Algire, has been using such a tool for 10 years.

A consensus?

Now that medical inflation has been largely tamed, now that we know what we can do to greatly influence opioid treatment, and that premium costs are dropping by double digits, is it not time do pay attention to these key 250,000 injuries?

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