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Identifying workers' compensation as the expected payer in emergency department medical records.

Jackson LL; Derk SJ; Marsh SM; Reichard AA
Use of workers' compensation data for occupational safety and health: proceedings from June 2012 workshop. Utterback DF, Schnorr TM, eds. Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2013-147, 2013 May; :163-167
The National Institute for Occupational Safety and Health (NIOSH) uses the National Electronic Injury Surveillance System- occupational supplement (NEISS-Work), an emergency department (ED) based surveillance system, to produce national estimates of nonfatal occupational injuries and illnesses treated in US hospital EDs [Derk, 2007]. The occupational injury and illness data are collected from a national, probability-based, stratified cluster sample of 67 hospital EDs. At each hospital, abstractors review ED medical records for work-related injuries and illnesses. The abstractors identify cases as work-related if the injuries or illnesses occurred while the patient was doing work for compensation, work or chores related to agricultural production, or work conducted as a volunteer for an organized group. Civilian noninstitutionalized workers without regard to employment arrangement, worker status, age, industry, or business size are included. We use a work-related case definition similar to Occupational Safety and Health Administration (OSHA) Recordkeeping Rules [OSHA, 2012]. Hence, we include injuries and illnesses caused or significantly made worse by work for which the patient was seen in the ED. We presume that being seen in the ED qualifies as medical treatment beyond first aid. NEISS-Work does not capture the medical treatment provided. We exclude common illnesses and selected medical conditions along with cases involving self-medication, alcohol & drug cases, drug screening, and second visits to the ED. Hospital record abstractors review the entire medical record and use narrative and coded information in the ED record to assess the work-relatedness of each case. Workers' compensation insurance as the expected payer, by itself, is sufficient to identify a case as work-related, providing that the narrative information in the medical record does not contradict the injury/illness as being work-related. However, workers' compensation insurance is not required for a case to be identified as work-related. Narrative information in the registrar's, nurse's, and/or doctor's notes indicating that an injury/illness occurred at work is sufficient to identify a case as work-related. To better understand issues in identifying work-related injuries and illnesses in ED medical records, we audited records at about one-third of the hospitals participating in NEISS-Work. The primary goal of the audits was to estimate the number of work-related cases missed or non-work cases misclassified as work-related. A secondary goal was to better understand the various issues that abstractors deal with in identifying work-related cases on a daily basis. This report summarizes some of the issues that we identified qualitatively and in particular, the ability to identify workers' compensation (WC) as the expected payer for the medical care.
Workers; Work-environment; Injuries; Accidents; Risk-factors; Hazards; Health-protection; Surveillance-programs; Preventive-medicine; Traumatic-injuries; Humans; Men; Women; Health-care; Ergonomics; Risk-factors; Agriculture; Agricultural-industry
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Conference/Symposia Proceedings
Utterback DF; Schnorr TM
Fiscal Year
Identifying No.
NIOSH Division
Source Name
Use of workers' compensation data for occupational safety and health: proceedings from June 2012 workshop
Page last reviewed: April 1, 2022
Content source: National Institute for Occupational Safety and Health Education and Information Division