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E6.1 The Economic and Social Consequences of Injury at Sand and Gravel Operations-Camm TW, Ferch S, Boldt CMK
Total economic and social costs of workplace injuries in the sand and gravel industry are being evaluated in this study. The goal is to increase our understanding of the impact of work-related injuries to workers, co-workers, and families. This will provide a reliable basis for targeting and evaluating the effectiveness of investments in prevention for industry safety and health programs.
Injury costs involve more than just direct costs to a mining company or its insurer, and sometimes, indirect costs will exceed direct costs. Direct costs include medical, legal and administrative, workers' compensation administration, and property damage. Indirect costs include lost earnings, lost fringe benefits, lost home production, employer costs of retraining and re-staffing, coworker costs of lost productivity, and time delays.
A cooperating sand and gravel operation was selected to evaluate the questions relevant to measuring direct and indirect costs before applying these questions to a site where an actual accident occurred. This process will allow us the interpretation of measurements and responses without the emotional stresses involved in an actual injury. This case study approach should provide a richness and depth to the data not always obtainable in a statistical study that relies on large, aggregated databases. Upon completion of the study, the methodology and cost sources should be well established to use in subsequent studies.
E6.2 Earnings Losses From Permanent Disability at Private Self-Insured Employers in California-Reville RT
Employers that self-insure for workers' compensation face incentives to return injured workers to work sooner, and since they are larger, often have more opportunities for modified work. We examine the consequences of a disabling workplace injury for workers in 1993-95 at 66 self-insured employers in California. Using data on permanent disability claims provided by the firms linked to longitudinal earnings data before and after the injury from the state of California, we estimate the earnings losses associated with a permanent disability, and examine the return-to-work patterns of permanent disability claimants. We find significant earnings losses for PD claimants at these firms - more than 20 percent over the five years after injury. We then compare the experiences of workers at self-insured firms to workers at insured firms and find lower proportional losses at self-insured firms, but also slightly lower replacement rates. Both findings are largely driven by the higher earnings for all workers at self-insured firms. We also find better return to work (sooner and more likely to be employed at the at-injury employer) at self-insured firms. However, when controlling for preinjury earnings and firm size, differences in earnings losses between workers injured at self-insured and insured firms tend to disappear.
E6.3 The Cost and Consequences of Work-Related Assaults-McGovern P, Kochevar L, Lohman W, Zaidman B, Gerberich S, Nyman J, Findorff M
Objective: To describe the long-term productivity costs of work-related physical assaults.
Methods: The human capital approach was used to describe the long-term costs of work-related assaults using all incidents of non-fatal assaults resulting in indemnity payments that were identified from the Minnesota Department of Labor and Industry (DLI) Workers' Compensation system in 1992. Medical expenditures were obtained from insurers, and data on lost wages, legal fees and permanency ratings were collected from DLI records. Insurance administrative expenses were estimated. Lost fringes and household production losses were imputed. The present value of past losses from 1992-1995, and future losses, for cases open in 1996 were estimated. Cost estimates were adjusted to 1999 dollar values using the Consumer Price Index. A pilot study, employing a case study methodology, was also conducted to describe individuals' perspectives on the social costs of assault.
Results: The total costs for 344 non-fatal work-related assaults were estimated at $6,232,689 (1999 dollars). Calculation of injury incidence and average costs per case and per employee identified populations with an elevated risk of assault. An analysis by industry revealed an elevated risk for workers employed in justice and safety (incidence: 198/100,000; $20,387 per case; $40 per employee), social service (incidence:127/100,000; $25,638 per case; $32 per employee) and health care (incidence: 76/100,000; $13,976 per case; $11 per employee). Case study results suggest that four years post-assault individuals' health and quality of life were significantly affected and resulted in job changes, chronic pain, changes in functional status and depression.
Conclusions: Workers most at risk were lower wage workers. Identified subgroups warrant attention for risk factor identification and prevention efforts. Cost estimates suggest the value of risk management interventions, and can inform the social policy debate on the impact of workplace violence.
E6.4 Followup Study of Musculoskeletal Injuries Among Construction Workers-Hunting KL, Welch LS, Hsu L
To evaluate the contribution of acute trauma to chronic musculoskeletal symptoms, we conducted a followup study of 143 construction workers treated in an emergency department for acute soft-tissue musculoskeletal injuries. Telephone interviews were conducted several weeks, 1 year, and 2 years after the injury. For comparison, we interviewed 213 trade- and age-matched workers who were treated for other types of injuries. The initial interview focused on symptoms at the location of the musculoskeletal injury (the "index location"), as well as recovery patterns, light duty, lost worktime, injury history, and job tasks.
The WMD injuries, though acute in nature, were often related to ergonomic risk factors such as lifting heavy materials or exerting force from awkward working positions. Workers with musculoskeletal injuries were more likely than comparison workers to have previously experienced a serious acute injury to the index body location (27% versus 17%). This difference was seen for all body regions. Only 13% of the workers with musculoskeletal injuries were able to return to work without lost days or light duty, versus 28% of the workers with other injuries.
One-year followup interviews - focusing on health, work, and socioeconomic consequences of the injury - were completed for 201 (56%) of baseline participants. One year after the injury, 13% of the workers with musculoskeletal injuries were not working because of their original injury or a re-injury. In contrast, none of the workers in the comparison group were not working because of their injuries. We will describe symptoms one year after the injury, probability of re-injury, changes in work practices, injury-related functional limitations, and changes in perception of job risks and financial security for these two groups of injured workers. We will also compare outcomes for individuals with and without a history of previous injury to the index body location.
E6.5 Detection, Disease Management, and Compensation: Health and Economic Outcomes of Occupational Carpal Tunnel Syndrome Among Garment Workers in New York City-Fahs MC, Kontos NJ, Herbert R, Plattus R, Job L, Alcala M, Berliner H
This Robert Wood Johnson Foundation funded project evaluates an innovative health care delivery and financing intervention with the Union of Needletrades, Industrial and Textile Employees (UNITE). In collaboration with Mount Sinai School of Medicine, workers in NYC's garment industry received expedited access to timely treatment for occupational carpal tunnel syndrome. The intervention circumvented the greater than 400-day average delay in Workers' Compensation (WC) approval. Results are presented from a combined retrospective/prospective analysis of this largely immigrant population. These low-wage workers are predominantly older, female, and non-white (90% Latino, 10% Asian) and non-English speaking. The majority are sewing machine operators (76%) with an average tenure of 20 years in the garment industry. Clinical and functional status at diagnosis, as well as workers' perceptions of the program's impact on health outcomes, quality of life, work status, and quality of care are analyzed. Results show that workers have suffered severe financial hardships as a result of their occupationally-related condition (46% used up their savings, 29% lost their medical insurance due to their injury). Study participants continue to have substantial impairment 2-3 years after filing their WC claim (mean SF-12 score, physical functioning is 25, p<.0001 compared to general US population score of 50). Most were no longer able to work at diagnosis and many never returned to work (83%). Comparative results from a sample of non-immigrant computer users are presented, documenting large social and economic disparities between these two high-risk groups of workers filing WC claims. Policy implications are discussed.
E6.6 The Concentration of Workers' Compensation Expenditures in a Construction Workforce: Implications for Cost Containment-Bondy J, Glazner JE
Objective: To examine the distribution of workers' compensation (WC) expenditures in a construction workforce that spent over 31 million person-hours building Denver International Airport between 1991 and 1994.
Methods: We used a centralized database containing all claims and payroll for the project-wide insurance plan. An on-site clinic and designated medical provider system for all contractors addressed the problems of underreporting work-related injury and illness and variation in medical practice. Medical and indemnity payments for the project's 4,634 claims represented total lifetime payments and were adjusted to 1994 dollars.
Results: Concentration of WC expenditures exceeded that of U.S. health care expenditures: the top 1% of claims accounted for 34% of the $42.7 million expenditures at DIA; the top 5% accounted for 69% of expenditures. (Indemnity payments accounted for the great majority of expenditures among the top 5% of claims.) Corresponding percentages for health-care expenditures were 30% and 58% in 1987.1 Of claims for injuries in 1991, before the project's safety program was fully operational, 10.8% were in the top 5% of claims, versus 4.1% in subsequent years.
Discussion: These findings suggest that cost containment efforts focusing on the average injured worker-whether by prudent use of medical services, mandating medical provider adherence to practice guidelines, or requiring employer accommodation and return-to-work programs-will not target the sources of greatest expenditure. The alternative of reducing disability payments to severely injured workers, however, would be an unpalatable choice for most Americans. The apparent effect of the project's broad safety program in reducing the proportion of expensive claims suggests that prevention efforts can reduce not only rates, but severity, of injury. Prevention may have greater promise for reducing costs than would focusing on medical services or return-to-work- programs.
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