The Americans with Disabilities Act and injured workers: Implications for rehabilitation professionals and the workers' compensation system.

Examines theoretical and practical interactions between the Americans with Disabilities Act of 1990 (ADA) and the workers' compensation system. The ADA changes the workplace and assists the rehabilitation psychologist to intervene in the process that turns impairments into disabilities. The practical focus of employers must change from paying workers off to keep them from the workplace to aggressively trying to return them to work. Injured workers can be an "individual with a disability" under the ADA and qualified, with or without reasonable accommodation, to perform a job's essential functions if they are permanently disabled for workers' compensation purposes. The ADA's benefits and pitfalls for the rehabilitation psychologist and other rehabilitation professionals are outlined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preserving workers' compensation benefits in a managed health care environment

Managed care techniques are increasingly being applied in the workers' compensation setting. Many workers, labor representatives and public health advocates fear that the introduction of managed care into workers' compensation may reflect a broader employer-driven campaign to erode benefits, tighten eligibility criteria, and weaken employees' control over health care and compensation issues. The potential threats to workers can be mitigated by involving them in the design of the workers' compensation health plan and selection of provider organization, assuring access to appropriate specialists and diagnostic testing, minimizing delays, increasing accountability through contract provisions and government oversight, and enhancing communications through the use of ombudsmen and alternative dispute resolution approaches. Additional outcomes studies assessing the long-term impact of managed care in workers' compensation are needed.     

Control of workers' compensation claims and costs in the U.S. Army

The Army Medical Department has been implementing initiatives to reduce workers' compensation claims and costs since 1983. After years of an upward trend, reductions in both costs and claims were reported for 1995 and 1996. To assess efforts at managing workers' medical care and compensation in the Army, we reviewed Department of Defense and Department of the Army documents and studied data on claims and costs. We found several programs that were launched to control claims and associated costs. None of these programs adequately addressed the absence of real-time financial incentives for reducing compensation costs, a lack of acceptable workers' compensation data collection and data management systems, and a lack of emphasis on medical case management. To sustain this trend of decreased costs and claims, the Army must focus on (1) incentives, (2) data management systems, and (3) a comprehensive plan for medically managing workers' compensation claims and costs.     

Health benefits for the terminally ill: reality and perception

This paper examines the availability and scope of hospice benefits as well as employers' attitudes and knowledge about care for the terminally ill. Data are drawn from a national random sample of 1,502 employers with 200 or more workers and from focus groups with employee benefits managers and their insurance advisers, brokers, and consultants. Major findings are that 83 percent of employers offer explicit hospice benefits, with most other firms covering hospice through high-cost case management. Most employers support the concept of hospice care because they believe that it reduces medical expenses.     

Under-reporting of work-related disorders in the workplace: a case study and review of the literature

Accurate reporting of work-related conditions is necessary to monitor workplace health and safety, and to identify the interventions that are most needed. Reporting systems may be designed primarily for external agencies (OSHA or workers' compensation) or for the employer's own use. Under-reporting of workplace injuries and illnesses is common due to a variety of causes and influences. Based on previous reports, the authors were especially interested in the role of safety incentive programmes on under-reporting. Safety incentive programmes typically reward supervisors and employees for reducing workplace injury rates, and thus may unintentionally inhibit proper reporting. The authors describe a case study of several industrial facilities in order to illustrate the extent of under-reporting and the reasons for its occurrence. A questionnaire and interview survey was administered to 110 workers performing similar tasks and several managers, health, and safety personnel at each of three industrial facilities. Although less than 5% of workers had officially reported a work-related injury or illness during the past year, over 85% experienced work-related symptoms, 50% had persistent work-related problems, and 30% reported either lost time from work or work restrictions because of their ailment. Workers described several reasons for not reporting their injuries, including fear of reprisal, a belief that pain was an ordinary consequence of work activity or ageing, lack of management responsiveness after prior reports, and a desire not to lose their usual job. Interviews with management representatives revealed administrative and other barriers to reporting, stemming from their desire to attain a goal of no reported injuries, and misconceptions about requirements for recordability. The corporate and facility safety incentives appeared to have an indirect, but significant negative influence on the proper reporting of workplace injuries by workers. A variety of influences may contribute to under-reporting; because of under-reporting, worker surveys and symptom reports may provide more valuable and timely information on risks than recordable injury logs. Safety incentive programmes should be carefully designed to ensure that they provide a stimulus for safety-related changes, and to discourage under-reporting. A case-control study of similar establishments, or data before and after instituting safety incentives, would be required to more clearly establish the role of these programmes in under-reporting.     

Differential efficiency of expression of humanized antibodies in transient transfected mammalian cells

BACKGROUND: Wide variations in disability duration and magnitude have been noted among recipients of workers' compensation for low back pain. Findings from recent studies have indicated that inclusion of a broad array of variables (i.e., physical, occupation, social, economic) is needed to understand differences in workers' responses to occupational low back pain. METHODS: Workers' compensation and questionnaire data from 340 Oregon workers with low back claims were merged to develop multivariate models predicting: (1) absenteeism days, (2) residual symptoms, (3) functional impairment, and (4) medical costs. RESULTS: Forty-two percent of the variation in low back symptoms was explained by: discontinuing physical fitness activities post-injury (beta = -.419), self-reported low energy/high fatigue (beta = -.227), poorer general health (beta = .137), and attorney involvement in claim (beta = .117), (adjusted R2 = .418, p < 0.001). Survival curves revealed significantly longer claim durations among workers who discontinued physical fitness activities post-injury, compared with workers who did not; these differences remained significant even after controlling for severity of the initial injury. CONCLUSION: Continuation of physical fitness activities during the recovery process was found to be a significant predictor in three of four regression models, providing evidence on behalf of a relationship between fitness and positive health outcomes. However, it was not possible to clearly differentiate pre-morbid from post-injury fitness, nor to determine if this relationship was due to a therapeutic effect on the back, the general restorative benefits of remaining active, or represents a proxy variable for workers' self-care efforts during recovery.     

The credible forensic psychiatric evaluation in multiple chemical sensitivity litigation

The forensic psychiatrist must be able to perform a credible psychiatric evaluation and render a competent psychiatric opinion in hotly contested multiple chemical sensitivity (MCS) litigation. Forensic psychiatrists are often requested to evaluate MCS claimants by third party payers, employers, lawyers, and government agencies regarding health care costs and disability payments, workers' compensation claims, unemployment benefits, workplace accommodation reimbursements for special housing and environmental needs, civil litigation, and other claims. The credible forensic psychiatric evaluation of MCS litigants is described using the multiaxial diagnostic system of DSM-IV. Forensic psychiatrists must avoid becoming polarized by the current MCS controversy. The ethical requirements of honesty and striving for objectivity can be met by keeping separate the roles of therapist and expert, staying abreast of the scientific literature regarding MCS, and understanding the role of the psychiatric expert in MCS litigation.     

Microcirculation of the islets of Langerhans. Long Beach Veterans Administration Regional Medical Education Center Symposium

The passing of the Prevention of Occupational Hazards Act, (Ley 31/1995), constituted a change in direction in the development of occupational safety and health in Spain. This article describes the most salient points of this new legislation, from the criteria and principles that have to govern preventive activities, to the obligations and rights of both employers and workers, together with the co-operation and co-ordination of the activities of the various Administrations which have jurisdiction and the participation of employers' and workers' organisations, as the backbone of policy in matters concerning the prevention of occupational hazards.     

Occupational injuries among working adolescents in New York State

OBJECTIVE: To determine the number, distribution, determinants, and health consequences of occupational injuries among working adolescents in New York State. DESIGN: A retrospective, population-based analysis of New York State workers' compensation award data and the Annual Demographic File, a supplement to the US Bureau of the Census Current Population Survey. PARTICIPANTS: Adolescents, aged 14 through 17 years, who received workers' compensation awards for occupational injury from 1980 through 1987. MAIN OUTCOME MEASURES: (1) Numbers, types, and rates of occupational injuries in working adolescents by age, sex, industry, and occupation; (2) health consequences of injury, especially disability and death; and (3) secular trends in injury award rates. RESULTS: A total of 9656 adolescents were compensated for occupational injuries; 4201 compensated adolescents (43.5%) suffered permanent disability; 31 working adolescents died. The annual mean rate of compensated occupational injury was 28.2 per 10,000 adolescent workers. Rates were higher in males than in females and ranged from 8.2 per 10,000 in 14-year-old male workers to 46.8 per 10,000 in 17-year-old male workers. Highest rates by industry were seen in manufacturing (49.0/10,000 adolescent workers) and agriculture (46.2/10,000). Unskilled labor was the most dangerous occupation (52.3/10,000). CONCLUSION: Occupational injuries are a substantial and underrecognized contributor to the continuing epidemic of injury among adolescents.     

Premium-Rating Model for Workers’ Compensation Insurance in Construction

Providing adequate workers’ compensation insurance (WCI) is mandatory by legislation in most countries for employers to hire workers. It is enforced to safeguard the interests of occupational injury victims while eliminating their employers’ financial burden of compensation. WCI’s significance in construction is immeasurable because the construction industry appears to be recording higher injury and fatality rates globally. On the other hand, insurance companies must be meticulous in deciding premiums for WCIs for construction projects. Traditionally, insurers have been adopting the experience modification rating technique for premium-rating of WCI. However, this technique has been proven ineffective for construction applications due to the unique characteristics of construction projects. Hence, a new premium-rating model for construction was developed and tested in the Singapore general insurance industry. The proposed model streamlines structured analyses of project hazards, contractors’ safety management systems, market conditions, and insurers’ internal factors to decide optimal premiums. Moreover, it infuses the partnering notion in WCI for construction. The implementation of the proposed model in the insurance industry would facilitate accident control in the construction industry and thereby loss minimization for insurers.     

Health insurance and workers' compensation: the delivery of medical and rehabilitation services for construction workers

The construction industry has one of the highest proportions of workers without health insurance. The authors review the two types of insurance systems that are generally used to cover the cost of health care for construction workers in the U.S.: health and welfare funds and workers' compensation. Recent developments in health care delivery in the U.S. are discussed, as are the more comprehensive occupational medicine services offered in France, Germany, The Netherlands, and Sweden.     

The hypothenar fat pad flap for management of recalcitrant carpal tunnel syndrome

The hypothenar fat pad flap interposes adipose tissue from the hypothenar eminence between the median nerve and overlying transverse carpal ligament and surgical scar. This retrospective study reviews 62 hands in 58 patients (46 non-workers' compensation and 16 workers' compensation) with recurrent symptoms after failed open carpal tunnel release who underwent revision carpal tunnel decompression and in whom a hypothenar fat pad flap was used. The follow-up period averaged 33 months. Patient satisfaction was 6 in the non-workers' compensation group and 4 in the workers' compensation group. Average time to return to work for the non-workers' compensation group was 12 weeks, compared to 37 weeks for the workers' compensation group. Study results indicate that the hypothenar fat pad flap produces excellent results in procedures designed to alleviate recalcitrant idiopathic carpal tunnel syndrome.     

Acute epididymitis: a work-related injury?

Occupational medicine physicians frequently are presented with requests by employers to determine the work-relatedness of medical illnesses or injuries. Occasionally, this involves a sudden onset of acute epididymitis in the male employee after strenuous activity in the workplace. Because the vast majority of acute epididymitis cases have an underlying sexually transmitted disease component, this poses a real dilemma for the consulting physician. This article discusses the etiology and pathogenesis of acute epididymitis along with its epidemiologic significance and reviews workers' compensation and its possible legal interpretation when acute epididymitis occurs at the worksite.     

Recognition of psychologists in workers' compensation law.

Reviews the workers' compensation laws with reference to the recognition of psychologists as diagnosticians of mental injuries and treatment providers for workers with work-related mental injuries. It is shown that with the exception of California, Florida, Hawaii, and the federal system, psychological services are not explicitly recognized as available to, nor are psychologists explicitly recognized as diagnosticians or treatment providers for, the mentally injured worker. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Workplace health friendliness: A cross level model for predicting workers' health.

Two separate studies conceptualized the health friendliness of a workplace, the first qualitatively through content analysis of interviews with 69 nursing superiors about the means employed by their workplace to promote staff health. Findings supported the conceptualization of workplace health friendliness, which was further validated against the staff's health indicators. The second study tested a model explaining the cross-level effects of workplace health-friendliness initiatives on workers' health. The model depicted workers as rational human beings calculating costs/benefits in deciding whether to commit to those initiatives. Benefits represent workers' potential gains through compliance; costs represent their potential losses. Perceived social costs were noted as a possible cost; a worker's perceived stress signaled that he or she might benefit from joining health-friendly initiatives. Analysis of data from 45 nursing units supported the cross-level model: workplace health friendliness was positively associated with workers' health and perceived social costs and stress moderated that link. Accordingly, workplace health friendliness should be regarded as the joint responsibility of the workers and the organization, and attention should be paid to the processes whereby these initiatives become enhancers or inhibitors of workers' health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting work stress compensation claims and return to work in welfare workers.

Occupational stress is prevalent in work areas in which there is high contact with distressed or dependent members of the public. However, little is known about the prediction and management of stress-related compensation claims, which can be expensive for employers. The authors interviewed all staff members of a large public sector welfare agency who had made a compensation claim for work-related stress during a 12-month period (N?=?19) and obtained in-depth information from 16 of the 17 who were still available. A clear relationship was found between type of stress precipitant and length of stress-related leave, suggesting that the organizational response to specific stressful incidents was much more effective than its response to chronic work stressors. Demographic data for all 19 claimants showed that they had taken twice as many days of sick leave as the organizational average in the year preceding their claim. There are important implications for personnel management practices that may reduce and prevent work stress for vulnerable workers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed care in workers' compensation: analysis of cost drivers and vendor selection

1. Managed care for employee benefits provides a model of cost containment for workers' compensation; however, significant differences must be understood. 2. Purchasers of managed care services must perform an internal assessment to determine the cost drivers for workers' compensation. Managed care does not address all cost drivers. 3. A model for evaluating managed care vendors places them on a continuum of risk, similar to insurance risk, where a variety of cost containment strategies may be used together. 4. By reviewing seven key aspects of a managed care vendor, a purchaser can rate the vendor's ability to meet their needs.     

Trends in disability duration and cost of workers' compensation low back pain claims (1988-1996)

Previously published epidemiologic studies of low back pain (LBP) have reported that the prevalence of low back disability has increased dramatically. These studies based their findings on either the number of disability claims filed, the disability duration, or both. This information was from countries other than the United States or from the US Social Security Disability Insurance data, with findings reported only to the early 1980s. More recent studies of US workers' compensation LBP claims reported a decrease in the incidence rate from the late 1980s to the mid-1990s. No studies have been found that report on the trends of disability duration for workers' compensation LBP claims. This study examined recent trends in the length of disability (LOD) for LBP claims and associated costs, using a large sample of claims from the privately insured US workers' compensation market. LOD and cost information were derived for injuries from 1988, 1990, 1992, 1994, and 1996. For each year, the distributions of LOD and cost were skewed, with the small percentage of claims that lasted more than one year (4.6%-8.8%, depending on the year) accounting for a large percentage of the total disability days (77.6%-90.1%) and cost (64.9%-84.7%). From 1988 to 1996, the average LOD decreased 60.9%, from 156 days to 61 days. The probability of being on disability for a long period of time has decreased over the years. Over the study period, the average cost of a claim decreased 41.4%, while the median cost increased 19.7%. The most influential change in the LOD and cost distributions was a reduction in expensive claims with a long disability duration. The evolution of LOD and cost is also detailed for different disability durations for the study period.     

Banking on bonuses

Performance incentives cover a wider--and deeper--swath of health care than ever, according to the latest Hay Group surveys. Yet it's clear that most organizations are homegrowing compensation strategies that blend base and incentive pay into a cohesive package.