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Background: In treating occupational hand injuries under workers’ compensation, the 2 most important goals are to maximize patient function, ideally to preinjury levels, and permit a timely return to work (RTW). The purpose of this study was to determine factors affecting total case length, that is, the total time from injury until primary closure of a patient’s claim, and disposition among patients with hand injuries treated under workers’ compensation. Methods: All cases treated under workers’ compensation by a single fellowship-trained hand surgeon within a single year were retrospectively reviewed. A case is defined as the entire management and treatment of a single patient related to a single occupational injury incident. Independent variables included age, sex, body mass index, comorbidity, occupation, injury pattern, and treatment modality. Dependent variables included treatment duration from injury to case closure and final case disposition (RTW, functional capacity evaluation [FCE], or loss to follow-up [LTFU]). Comparison between groups was accomplished with analysis of variance. Multivariate linear and logistic regression analysis was performed to predict case length and disposition. Results: In all, 447 cases involving a workers’ compensation claim were reviewed. Among these, 75 (16.8%) were LTFU, 24 (5.4%) required an FCE, and 346 (77.4%) an RTW. The RTW cases averaged 138.5 days, whereas those requiring FCE averaged 331.5 days. Compared with average case length, crush injuries (76.8 days. P < .001) and fractures (111.8 days, P = .0224) had significantly shorter time to closure. In a multivariate linear model, cases of soft tissue and nerve injury were associated with longer case lengths, remaining open for an additional 56.8 and 347.1 days, respectively ( P < .001). Each treatment modality studied, therapy, injections, and surgery, was associated with an increase in case length. Conclusions: Cases requiring FCE were open significantly longer than those resulting in RTW. In addition, injury pattern and treatment modality were associated with significant variations in total case length. These results imply that a specific subset of patients, namely those with soft tissue and nerve injuries, may experience delayed resolution among patients treated under a workers’ compensation claim.

INTRODUCTION/AIMS: In prior work, higher quality care for work-associated carpal tunnel syndrome (CTS) was associated with improved symptoms, functional status, and overall health. We sought to examine whether quality of care is associated with healthcare expenditures or disability. METHODS: Among 343 adults with workers’ compensation claims for CTS, we created patient-level aggregate quality scores for underuse (not receiving highly beneficial care) and overuse (receiving care for which risks exceed benefits). We assessed whether each aggregate quality score (0-100%, 100% = better care) was associated with healthcare expenditures (18-month expenditures, any anticipated need for future expenditures) or disability (days on temporary disability, permanent impairment rating at 18 months). RESULTS: Mean aggregate quality scores were 77.8% (standard deviation [S.D.] 16.5%) for underuse and 89.2% (S.D. 11.0%) for overuse. An underuse score of 100% was associated with higher risk-adjusted 18-month expenditures ($3,672; 95% CI $324 to $7,021) but not with future expenditures (−0.07 percentage points; 95% CI −0.48 to 0.34), relative to a score of 0%. An overuse score of 100% was associated with lower 18-month expenditures (−$4,549, 95% CI −$8,792 to −$306) and a modestly lower likelihood of future expenditures (−0.62 percentage points, 95% CI −1.23 to −0.02). Quality of care was not associated with disability. DISCUSSION: Improving quality of care could increase or lower short-term healthcare expenditures, depending on how often care is currently underused or overused. Future research is needed on quality of care in varied workers’ compensation contexts, as well as effective and economical strategies for improving quality.

Introduction: Finnish companies are legally required to insure their employees against occupational acci-dents. Insurance companies are then required to submit information about occupational accidents to the Finnish Workers' Compensation Center (TVK), which then publishes occupational accident statistics in Finland together with Statistics Finland. Our objective is to detect silent signals, by which we mean pat-terns in the data such as increased occupational accident frequencies for which there is initially only weak evidence, making their detection challenging. Detecting such patterns as early as possible is impor-tant, since there is often a cost associated with both reacting and not reacting: not reacting when an increased accident frequency is noted may lead to further accidents that could have been prevented. Method: In this work we use methods that allow us to detect silent signals in data sets and apply these methods in the analysis of real-world data sets related to important societal questions such as occupa-tional accidents (using the national occupational accidents database). Results: The traditional approach to determining whether an effect is random is statistical significance testing. Here we formulate the described exploration workflow of contingency tables into a principled statistical testing framework that allows the user to query the significance of high accident frequencies. Conclusions: Our results show that we can use our iterative workflow to explore contingency tables and provide statistical guarantees for the observed frequencies. Practical Applications: Our method is useful in finding useful information from con-tingency tables constructed from accident databases, with statistical guarantees, even when we do not have a clear a priori hypothesis to test. (c) 2022 The Author(s). Published by the National Safety Council and Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

The aim of this study was to examine the degree of reporting work-related low back pain (LBP) by workers' compensation (WC) claim filing and associated factors among US workers.We conducted multivariable logistic regression using the 2015 National Health Interview Survey data.Among 1203 US workers with self-reported work-related LBP diagnosis, only 19.6% filed for WC. Compared with non-Hispanic White workers, Black, Asian, and Hispanic workers were less likely to file for WC. Workers' compensation filing was less frequent among workers in independent work arrangement and who stopped working, changed jobs, or made a change in work and more frequent among workers 45 to 64 years of age and having high LBP frequency.Our study findings suggest underreporting of work-related LBP to the WC system is common. Barriers to WC filing should be addressed especially for racial/ethnic minorities and independent workers.

This study employed analysis of workers' compensation (WC) claims in the landscaping services industry to identify occupational factors associated with claims from workers of different ages.Private sector claims for 2005 to 2017 to the Ohio Bureau of Workers' Compensation (OHBWC) and their free-text descriptions were used along with data from the US Census Bureau American Community Survey to examine rates and types of WC claims by worker age.Although the claim rate for younger workers was higher than that for older workers overall (593 vs 261 per 10,000 full-time equivalent employees, P0.001), claims from older workers had higher nonzero median cost ($1002 vs $522, P0.001).Analysis of WC claim rates shows significant differences between claims in different age groups. These differences can be used to target safety interventions for the greatest impact.

This study aimed to investigate the status of work-related traumatic brain injury (wrTBI) in Korea between 2010 and 2019.This study used Korea Workers' Compensation Insurance data, and the sample comprised workers who claimed compensation for wrTBI from 2010 to 2019. The annual incidence of wrTBI was calculated as the rate per 100,000 workers. Time trends over the 10-year period were assessed using Poisson regression.The mean incidence of wrTBI was 28.4/100,000. Regarding the incidence rate of wrTBI by severity, mild TBI and moderate-to-severe TBI were 12.9/100,000 and 15.5/100,000, respectively. The incidence of mild TBI among workers was higher in 2010, but moderate-to-severe TBI was higher after 2011.Our findings highlight the need for providing information on mild TBI to workers as part of occupational safety and health education.

Older workers are increasingly represented in the U.S. workforce, but frequently work part-timeor intermittently, hindering accurate injury rate estimates. To reduce the impact of reporting barriers on rate comparisons, we focused on reinjury (both injury recurrence and new injury) among workers with a workers' compensation claim, assessing: (1) reinjury risk for workers age 65+ versus65; (2) importance of work-time at-risk measurement for rate estimates and comparisons; and (3) age distribution of potential risk factors.Washington State workers' compensation claims for a retrospective cohort of workers with work-related permanent impairments were linked to state wage files. Reinjury rates were calculated for the cohort (N = 11,184) and a survey sample (N = 582), using both calendar time and full-time equivalent (FTE)-adjusted time. Risk differentials were assessed using rate ratios and adjusted survival models.The rate ratio for workers age 65+ (vs.65) was 0.45 (p 0.001) using calendar time, but 0.70 (p = 0.07) using FTE-adjusted time. Survey-based rates were 35.7 per 100 worker-years for workers age 65+, versus 14.8 for65. Workers age 65+ (vs.65) were more likely to work100% FTE, but were similar regarding job strain, their ability to handle physical job demands, and their comfort reporting unsafe conditions or injuries.Accounting for work-time at risk substantially improves age-based reinjury comparisons. Although the marked elevation in self-reported reinjury risk for older workers might be a small-sample artifact (n = 34), workers age 65+ are likely at higher risk than previously appreciated. Ongoing workforce trends demand increased attention to injury surveillance and prevention for older workers.

INTRODUCTION: Managing and improving occupational safety and health requires evaluating performance. Organizations are encouraged to use both lagging indicators (such as injury rates and costs) and leading indicators (such as questionnaire-assessed safety hazards and management practices) for this purpose, but the association between types of indicators over time can be complex. Longitudinal data can assist in clarifying these associations and increasing indicator utility. METHOD: Employer data were used to evaluate the reliability and predictive validity of a safety management questionnaire. Employers’ longitudinal questionnaire responses and workers’ compensation (WC) claims data were analyzed using a marginal model with time-dependent covariates. Multivariable Poisson and linear regression analyses with claim rate and logarithmic cost, respectively, as dependent variables were carried out after adjusting for industry sector and size. Questionnaire data were used to evaluate questionnaire scaling properties and to assess generalizability of results. RESULTS: One safety management scale was associated with a better WC outcome as predicted and two scales were unexpectedly associated with poorer WC claim outcomes. Analyses assisted in interpreting the latter results, suggesting that WC outcomes were a stimulus for change in some cases. Twelve hazards assessed on the questionnaire were associated with poorer WC claim outcomes as predicted. CONCLUSIONS: This study extends leading indicator research using longitudinal questionnaire and WC claims data from employers. Analyses provided insight into associations between leading and lagging indicators, emphasizing the importance of both for safety improvement. Safety management questionnaire scales were predictive of WC claim outcomes, although support for hazard assessments as leading indicators was stronger. PRACTICAL APPLICATIONS: This study supports the use of employer-completed hazard assessment questionnaires for targeting and prioritizing improvement efforts. Employer-completed safety management scales may be useful for directing improvement efforts, although the conditions under which they are completed, including submission to insurers, require additional consideration.

Workers' compensation and orthopaedic nursing are often intertwined for the treatment of an injured worker and returning them to work. The workers' compensation system can be complex, and knowing the regulations can be beneficial in the treatment of an injured worker and returning them to work safely. Orthopaedic nurses often play an integral role in the evaluation, treatment, and discharge of an injured worker, so understanding workers' compensation, workers' job, and expectations is important for the safe return of a worker back to duty. Orthopaedic nurses are in key positions to assist with the planning, treatment, and return of a worker back to their job.

Acts of violence are the fifth leading cause of nonfatal occupational injuries in the United States. Experiencing a traumatic event at work can have serious mental health consequences, including the development of posttraumatic stress disorder (PTSD). This study aimed to quantify the prevalence of PTSD caused by workplace violence (WPV) in a statewide workers' compensation system and compare the outcomes and treatment of WPV cases versus those caused by other traumatic events. Using a retrospective cohort study design, workers who reported PTSD as the primary reason for a workers' compensation claim and had no coexisting physical injuries were found in California during 2009-2018. A total of 3,772 PTSD cases were identified, 48.9% of which were attributed to WPV. Demographic risk factors associated with WPV PTSD included lower income, younger age, female gender, and employment in retail or finance, p < .001-p = .007. For individuals who returned to work, claims due to WPV resulted in longer medically approved time away from work than non-WPV causes (Mdn = 132.5 days vs. Mdn = 91 days, respectively), p < .001. Three of the top 10 most frequently prescribed medications were administered against evidence-based guidelines. This study found that many treatments prescribed to PTSD patients are based on insufficient evidence, and the provision of existing empirically supported treatments is needed, particularly in generalized populations. The findings support the need for additional recognition of the cause of workplace PTSD to facilitate appropriate referrals to WPV or PTSD specialists to support return-to-work efforts.

Background: Nearly half of U.S. workers have access to workplace wellness programs (WWPs), 58% of workers with access participate. The aim of this study was to assess interest in WWP participation and identify reasons for lack of interest among workers with work-related permanent impairments—a population at elevated risk of adverse health outcomes. Methods: Workers who returned to work after a work-related permanent impairment were interviewed 11 to 15 months after workers’ compensation claim closure. Qualitative content analysis methods were used to code open-ended responses. Findings: Of 560 respondents, 51.4% expressed interest in WWP participation. Numerous adverse health and economic characteristics were associated with WWP interest, for example, interest was expressed by 63.3% of workers reporting fair/poor health status versus 47.1% reporting good/excellent; 56.9% of workers reporting moderate/severe pain versus 41.4% reporting mild/no pain; 64.7% of workers without health insurance versus 50.1% with health insurance; 69.0% of workers reporting depression versus 47.2% without depression; 70.4% of workers reporting obesity versus 48.0% without obesity; and 63.2% of workers often worried about expenses versus 46.9% reporting sometimes/never worried. Specific participation barriers were described by 34.2% of the 272 workers who were not interested. Conclusions/Applications to Practice: A majority of workers with work-related permanent impairments—particularly those with adverse health and economic characteristics—were interested in WWPs. Many workers who reported no interest cited participation barriers. Further research is needed to determine whether addressing such barriers would enhance equitable access. Those undertaking WWP planning, implementation, and outreach should ensure that WWPs are inclusive and serve workers with disabilities.

The objective of this study was to identify the most frequent type, nature, and cause of work-related injuries among distillery workers and the contributing factors for these events to target interventions to reduce injuries.Workers' compensation first reports of injury (FROI) from the years 2010 through 2019 were obtained. Variables were created for "occupational category" and "cause of injury" for evaluation of the injurious events. The ratchet circular scan test was used to assess seasonal variation in injury, and kernel density estimation to assess rates of injury by calendar year.A total of 974 FROIs were recorded over these 10 years; 908 of the injuries resulted in lost time, 65 resulted in no lost time, and 1 resulted in a fatality. The most common injuries reported were strains or tears, lacerations, and contusions (33.4%, 14.7%, and 13.5%, respectively). The most frequent anatomical sites of injury were the shoulders, fingers, and low back area (11.8%, 11.4%, and 8.9%, respectively). Barreling operation activities experienced the greatest frequency of work-related injury at 28.5% of all FROIs. A seasonal peak of injuries was observed during May and June.Implementing ergonomic and safety solutions for transportation and work tasks associated with barreling operations may significantly reduce the rate of work-related injuries in distillery workers. Injury prevention interventions should particularly target strain or tear injuries caused by repetitive motion or bodily reaction and overexertion. Contact with objects or machinery accounted for one-third of distillery industry FROIs.

Occupational asbestos exposure was prevalent in Taiwan, but asbestos-related diseases (ARDs) have rarely been recognized. We conducted in-depth face-to-face interviews with 16 patients with ARDs. All of them had worked in industries known for high asbestos exposure. However, only three patients had filed workers’ compensation (WC) claims, and of them, only two patients were approved. Reasons for the low compensation rate of ARDs could be divided into institutional barriers related to the flaws of the WC system and non-institutional barriers related to the knowledge status, causal interpretation, and social situations of individual workers. The Labor Occupational Accident Insurance and Protection Act passed in April 2021 has responded to the under-compensation of occupational diseases. However, the new act's effects toward improving the recognition of ARDs remain questionable. Our findings indicated that additional efforts are needed to remove non-institutional barriers hindering workers’ ability to ensure their compensation rights.

To describe telehealth trends within a population-based workers' compensation system during the COVID-19 pandemic, and to assess telehealth utilization by sociodemographic characteristics.This cross-sectional study used Washington State workers' compensation claims and medical billing data from January 2019 to October 2020.Telehealth use averaged 1.2% of medical bills pre-pandemic, peaked in April 2020 at 8.8%, and leveled off to around 3.6% from July to October 2020. Telehealth utilization differed significantly by age, sex, number of dependents, injury, industry, and receipt of interpreter services. Workers residing in counties with higher population, lower poverty rates, and greater Internet access had higher telehealth usage.There were dramatic shifts in telehealth; usage differed by sociodemographic characteristics. Further studies evaluating disparities in tele-health access among injured workers are needed.

This study evaluated the impact of a state workers’ compensation (WC) insurer’s onsite risk control (RC) services on insured employers’ WC claim frequency and cost. METHODS: We used two methods to model 2004 to 2017 claims data from 4606 employers that received RC visits over time and compare this claims experience to matching employers that did not receive RC services. RESULTS: Relative total WC claim rates increased slightly after RC services, while relative lost-time claims rates either remained similar or decreased and WC cost rates decreased. The impact of RC services on reducing WC costs was cumulative up to the fourth visit but diminished thereafter. CONCLUSIONS: The insurer RC consultation program was effective in reducing WC cost rates for serviced employers. This is consistent with other research conducted on insurer RC services and related regulatory visits.

Little is known about the work-related injury and illness risk of out-of-province workers. This study examines whether there are differences in work-related injury and illness claim rates between within-province and out-of-province workers in British Columbia (BC), Canada.Workers' compensation claim data for injuries and illnesses in BC from 2010 to 2017 were linked with denominator data from Statistics Canada. Multivariable negative binomial regression estimated the claim rate ratio (RR) and 95% confidence intervals (CI) for out-of-province workers with all, health care-only (HCO), short-term disability, long-term disability, and fatality (SLF), and serious injury (SI) claims, compared to within-province workers.Compared to within-province workers, out-of-province workers had a lower total claim rate (RR: 0.54, 95% CI: 0.52-0.57), adjusting for sex, age, industry sector, and year. Differences in rates differed by claim type, with the largest differences for HCO claims (RR: 0.49, 95% CI: 0.47-0.52) and smallest differences for SI claims (RR: 0.85, 95% CI: 0.78-0.92). Sex-stratified models showed larger differences for males than females, with older female out-of-province workers having elevated SI claim rates. Industry-specific models showed that, even in sectors with high proportions of out-of-province workers' claims, these workers have lower claim rates than within-province workers.Out-of-province workers generally have lower claim rates than within-province workers. The overall duration of work exposure, and underreporting or underclaiming, are factors that may explain these lower claim rates. Understanding the determinants and differences of these claim rates may improve the administration and adjudication of claims while also identifying where further prevention measures may be merited.

Purpose: The objective of this study was to explore how workers’ compensation policies related to healthcare provision for workers with musculoskeletal injuries can affect the delivery and trajectories of care for injured workers. The principal research question was: What are the different ways in which workers’ compensation (WC) policies inform and transform the practices of healthcare providers (HCPs) caring for injured workers? Methods: We conducted a cross-jurisdictional policy analysis. We conducted qualitative interviews with 42 key informants from a variety of perspectives in the provinces of Ontario and Quebec in Canada, the state of Victoria in Australia and the state of Washington in the United States. The main methodological approach was Framework Analysis. Results: We identified two main themes: (1) Shaping HCPs’ clinical practices and behaviors with injured workers. In this theme, we illustrate how clinical practice guidelines and non-economic and economic incentives were used by WCs to drive HCP’s behaviours with workers; (2) Controlling workers’ trajectories of care. This theme presents how WC policies achieve control of the workers’ trajectory of care via different policy mechanisms, namely the standardization of care pathways and the power and autonomy vested in HCPs. Conclusions: This policy analysis shed light on the different ways in which WC policies shape HCP’s day-to-day practices and workers’ trajectories. A better understanding and a nuanced portrait of these policies’ impacts can help support reflections on future policy changes and inform policy development in other jurisdictions.

Background and Purpose. Although most physical therapists experience work-related musculoskeletal disorders (WMSDs) at some time, only a small minority claim workers' compensation. This article describes the experiences of a group of therapists with WMSDs who made compensation claims. Methods. Interviews were used to document the experiences of physical therapists who reported that they had changed their career because of WMSDs. Results and Discussion. Therapists described their experiences in negative terms and found dealing with the workers' compensation system frustrating and unpleasant. They encountered attitudes that labeled them as malingerers and felt their credibility was questioned. Conclusions. Physical therapists' experiences of the workers' compensation system were negative, and they were keen to become independent of it. Those who claimed workers' compensation perceived that a compensable claim could limit their employment opportunities, making confidentiality an important issue when treating other health care professionals.

Research has suggested that workers' compensation (WC) status can result in poor outcomes after anterior cervical diskectomy and fusion (ACDF).To determine the influence WC status has on postoperative clinical outcomes after ACDF.A surgical database was reviewed for patients undergoing primary or revision single-level ACDF. Patients were grouped into WC vs Non-WC, and differences in baseline characteristics were assessed. Postoperative improvement was assessed for differences in mean scores between WC subgroups for visual analog scale (VAS) arm, VAS neck, 12-item Short Form Physical Composite Score, Patient-Reported Outcomes Measurement Information System physical function (PF), and Neck Disability Index (NDI) at preoperative and postoperative time points. Minimum clinically important difference (MCID) achievement was compared between groups.The patient cohort included 44 with WC and 95 without. The cohort was 40% female with an average age of 48 years and mean body mass index of 30. Mean VAS arm, VAS neck, NDI, 12-item Short-Form Physical Composite Score, and Patient-Reported Outcomes Measurement Information System PF scores differed between groups; however, the difference was not sustained at the 1-yr time point. MCID achievement among WC subgroups was different for VAS arm (6 wk through 6 mo, P = .005), VAS neck (3 and 6 mo, P.01), and NDI (3 and 6 mo, P.05). No statistically significant difference was noted between cohorts for overall rates of MCID achievement for all patient-reported outcome measures collected.WC patients reported similar preoperative and 1-yr postoperative neck and arm pain compared with non-WC patients after ACDF. One-yr MCID achievement rates were similar between cohorts for disability and PF scores.

Janitors are a low-wage, ethnically and linguistically diverse, hard-to-reach population of workers with a high burden of occupational injury and illness.Data from an extensive multimodal (mail, phone, web) survey of janitors in Washington State were analyzed to characterize their working conditions and occupational health experiences. The survey included questions on demographics, work organization and tasks, health and safety topics, and discrimination and harassment. The survey was administered in eight languages.There were 620 complete interviews. The majority completed the survey by mail (62.6%), and in English (85.8%). More than half of responding janitors were female (56.9%), and the mean age was 45 years. Twenty percent reported having a (health-care-provider diagnosed) work-related injury or illness (WRII) in the past twelve months. Women and janitors who were Latino had significantly higher relative risk of WRII. Increased risk was also associated with several work organization factors that may indicate poor working conditions, insufficient sleep, and possible depression. Half of injured janitors did not file workers' compensation (WC) claims.Janitors reported a high percentage of WRII, which exceeded previously published estimates from Washington State. Women and Latino janitors had significantly increased risk of WRII, and janitors' working conditions may influence the unequal distribution of risk. WRII surveillance via WC or medical care usage in janitors and other low-wage occupations may reflect substantial underreporting. Characterizing the nature of janitors' work experience can help identify avenues for prevention, intervention, and policy changes to protect the health and safety of janitors.

The aim of this study was to investigate whether an integrated return-to-work (RTW) and vocational rehabilitation (VR) program - the Work Reintegration (WR) program - was associated with reduced work disability duration in the construction sector in Ontario, Canada.Workers' compensation data from the Ontario Workplace Safety and Insurance Board were extracted for lost-time construction worker claims following work-related injuries between 2009 and 2015. Claims receiving referrals to RTW and VR specialists (treatments) were matched with claims receiving no referrals (controls) during the periods before and after the WR program introduction. Multivariable difference-in-differences linear and quantile regression models were used to examine differences in cumulative disability days paid during two-years post-injury between treatment and control groups before and after the program change and the difference in these differences, overall, and at different disability distribution percentiles.The WR program introduction was associated with reductions in cumulative disability days paid for all claims but most notably among longer duration claims referred to RTW specialists (reduction of 274 days at the 90The WR program introduction was effective in reducing cumulative disability days paid for construction worker claims but the effects varied at different percentiles in the disability distribution, as well as by specialist referral. The findings highlight the benefits of better integrated RTW and VR services to injured workers in the construction sector.

Introduction: This study analyzed workers’ compensation (WC) claims among private employers insured by the Ohio state-based WC carrier to identify high-risk industries by detailed cause of injury. Methods: A machine learning algorithm was used to code each claim by U.S. Bureau of Labor Statistics (BLS) event/exposure. The codes assigned to lost-time (LT) claims with lower algorithm probabilities of accurate classification or those LT claims with high costs were manually reviewed. WC data were linked with the state’s unemployment insurance (UI) data to identify the employer’s industry and number of employees. BLS data on hours worked per employee were used to estimate full-time equivalents (FTE) and calculate rates of WC claims per 100 FTE. Results: 140,780 LT claims and 633,373 medical-only claims were analyzed. Although counts and rates of LT WC claims declined from 2007 to 2017, the shares of leading LT injury event/exposures remained largely unchanged. LT claims due to Overexertion and Bodily Reaction (33.0%) were most common, followed by Falls, Slips, and Trips (31.4%), Contact with Objects and Equipment (22.5%), Transportation Incidents (7.0%), Exposure to Harmful Substances or Environments (2.8%), Violence and Other Injuries by Persons or Animals (2.5%), and Fires and Explosions (0.4%). These findings are consistent with other reported data. The proportions of injury event/exposures varied by industry, and high-risk industries were identified. Conclusions: Injuries have been reduced, but prevention challenges remain in certain industries. Available evidence on intervention effectiveness was summarized and mapped to the analysis results to demonstrate how the results can guide prevention efforts. Practical Applications: Employers, safety/health practitioners, researchers, WC insurers, and bureaus can use these data and machine learning methods to understand industry differences in the level and mix of risks, as well as industry trends, and to tailor safety, health, and disability prevention services and research.

Purpose Recent studies have shown increased all-cause mortality among workers following disabling workplace injury. These studies did not account for 2 potentially important confounders, smoking and obesity. We estimated injury-related mortality accounting for these factors. Methods We followed workers receiving New Mexico workers’ compensation benefits (1994–2000) through 2013. Using data from the Panel Study of Income Dynamics, we derived the joint distribution of smoking status and obesity for workers with and without lost-time injuries. We conducted a quantitative bias analysis (QBA) to determine the adjusted relationship of injury and mortality. Results We observed hazard ratios after adjusting for smoking and obesity of 1.13 for women (95% simulation interval (SI) 0.97 to 1.31) and 1.12 for men (95% SI 1.00 to 1.27). The estimated fully adjusted excess hazard was about half the estimates not adjusted for these factors. Conclusions Using QBA to adjust for smoking and obesity reduced the estimated mortality hazard from lost-time injuries and widened the simulation interval. The adjusted estimate still showed more than a 10 percent increase for both women and men. The change in estimates reveals the importance of accounting for these confounders. Of course, the results depend on the methods and assumptions used.

Purpose of Review This study explores legal aspects of migraine in the workplace. While the high prevalence of migraine is well-documented, its effects on the livelihoods of those living with the disease are less understood. Because migraine symptoms are often invisible, discussions concerning migraine in the workplace can be challenging. What are the rights of persons with migraine in the workplace? Time off may provide a brief respite, but it is not a long-term solution. Claiming disability for migraine has challenges, including barriers to doing so and required paperwork. How can persons with migraine remain employed and productive? How can persons with migraine receive accommodation from their employer or take time off to treat their condition? Recent Findings Many employers offer comprehensive benefit packages that allow for sick days, time off, mental health days, and accommodations that may give persons with migraine temporary reprieve. However, it may not be sufficient, particularly for those with chronic migraine. Further, not all employers offer comprehensive benefits. Employees with migraine may need to seek protection under the law. Our research closely examines the primary legal avenues that persons with migraine may pursue while living and working with migraine. In exploring the legal aspects of migraine, we couple our exploration with relevant case law. Summary Through this lens, we conclude that migraine is becoming less stigmatized and more legitimized in the eyes of the court. It is the belief of the authors that at least some of the change in the attitude towards migraine is the result of strong patient advocacy and significant advances in research over the past several years.

BACKGROUND Lumbar spinal fusion (LSF) outcomes for workers' compensation patients are worse than for the general population. The objectives were to examine the long-term work capacity, opioid prescription and mental health outcomes of injured workers who have undergone LSF surgery in Victoria, Australia, and to identify demographic and pre- and post-operative characteristics associated with these outcomes. METHODS Retrospective study of 874 injured workers receiving elective LSF from 2008 to 2016 in the Victorian workers' compensation system. WorkSafe Victoria's claims data were used to infer outcomes for recovery. Association of demographics, pre-surgery and surgery variables with outcomes were modelled using multivariate multinomial logistic regression analyses. RESULTS Twenty-four months after LSF surgery, 282 (32.3%) of the 874 injured workers had substantial work capacity, 388 (44.4%) were prescribed opioids, and 330 (37.8%) were receiving mental health treatment. Opioid prescription and limited work capacity before surgery were independent strong predictors of opioid prescription, reduced work capacity and mental health treatment 24 months after LSF. Pre-operative mental health treatment was associated with the use of mental health treatment at 24 months. Other predictors for poor outcomes included a greater than 12-month duration from injury to surgery, LSF re-operation and common law or impairment benefit lodgement before surgery. CONCLUSION An association between pre-operative factors and post-operative outcomes after LSF in a Victorian workers' compensation population was identified, suggesting that pre-operative status may influence outcomes and should be considered in LSF decisions. The high opioid use indicates that opioid management before and after surgery needs urgent review.

Workers who experience language barriers are more likely to get injured or sick because of their work and have poorer claim and return-to-work outcomes compared to other workers. To better understand the systemic factors that shape access to compensation in contexts of language barriers, we compared language accommodation policies and practices in the Quebec and Ontario workers’ compensation systems. We uncovered gaps limiting access to professional interpreters in both provinces, although gaps were more pronounced in Quebec where workers were responsible for the cost of interpreters. We argue that simply improving the linguistic competence of workers’ compensation systems is not sufficient to tackle access barriers and must be accompanied by efforts to address the root causes of social and economic inequities for workers who experience language barriers.

BACKGROUND Opioid use in the treatment of musculoskeletal injuries is a complex decision where benefits must be balanced with risk. Previous research has shown an association between higher opioid doses and adverse health effects. The study's objective was to investigate whether opioid prescriptions are associated with increased costs and deaths through an injury mechanism or as a direct result of the opioid prescription. METHODS Data for 144,553 deidentified Ohio Bureau of Workers' Compensation claims from 2010 to 2014 with shoulder, knee, and low back injuries were obtained and followed until 2016. Each claim had associated prescription information. Injury claims were further classified using the allowed diagnoses by single or multiple body areas affected and injury severity ("simple" or "complex"). The outcome variables were medical and indemnity costs, lost days, MaxMED (maximum claim-prescribed daily morphine equivalent dose), and death status. Association between maximum opioid dose with deaths was determined by logistic regression analysis. RESULTS Several outcome variables, including claim medical and indemnity costs, and the likelihood of claimant death, showed significant associations with the MaxMED. In the analysis of claim deaths, these associations held for all claim types (except complex), even after adjusting for age, gender, surgery, and lost time. CONCLUSION The association between increasing opioid doses and deaths for low-severity diagnoses was disturbing given the lack of demonstrated efficacy of opioids for treatment of minor injuries. A focus on provider education, increased utilization of non-opioids, and early intervention for minor soft-tissue injuries could reduce claims costs, disability, and future deaths.

Background Evidence suggests that reverse shoulder arthroplasty (RSA) patients receiving workers’ compensation (WC) have worse patient-reported outcomes (PROs) than those not receiving WC. It is unknown whether Social Security Disability Insurance (SSDI) recipients also have worse outcomes of RSA. Our goals were to (1) compare PROs and range of motion (ROM) after RSA according to whether patients were receiving SSDI, WC, or neither form of assistance, and (2) identify factors associated with poor PROs. Methods From a US institutional database of 454 patients who underwent RSA from January 2009 through December 2016, we identified 19 SSDI recipients and 25 WC recipients. From the same database, we created a control group of 81 patients not receiving SSDI or WC, matched by demographic variables. Between groups, we compared age, sex, operative arm dominance, preoperative diagnosis, number of previous shoulder surgeries, primary or revision arthroplasty, and Charlson Comorbidity Index value. Patients were evaluated preoperatively and at a minimum of 2 years postoperatively by physical examination, including range of motion, visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, L'Insalata score, Simple Shoulder Test (SST), and Western Ontario Osteoarthritis of the Shoulder (WOOS) score. Significance was set at P Results Both the SSDI and WC groups experienced statistically significant improvements from preoperatively to postoperatively; these improvements exceeded MCID thresholds for forward flexion and abduction, VAS for pain, ASES (except in WC group), and SST score (all, P Conclusion Among RSA patients, SSDI recipients did not have worse clinical outcomes than WC recipients. Having undergone ≥2 previous procedures on the same shoulder was associated with poor outcomes in both groups. These findings should be considered when determining the appropriateness of RSA for SSDI and WC recipients. Level of evidence Level III; Retrospective Cohort Comparison; Treatment Study

OBJECTIVE: This study examines the relationship between opioid use prevalence and subsequent filing of workers’ compensation claims. METHODS: A retrospective cohort study design was utilized to examine data from drivers’ initial commercial driver medical exam, employment data, and workers’ compensation claims data. RESULTS: Data from 57,733 over 7 years were analyzed. Drivers who reported opioid use at their initial medical exam visit filed subsequent workers’ compensation claims 1.81 times sooner (p = 0.0001; 95% CI 1.34, 2.44) than drivers who did not report opioid use at their CDME when controlling for age, gender, BMI, and diastolic blood pressure. CONCLUSIONS: These findings provide information that may aid in improving regulations to control for incidents, training programs to inform professional drivers of factors that increase accident risk and educating prescribers about increased risks of injury among opioid-using drivers.

The objective of this study was to examine the association between a cumulative number of psychosocial factors and pain, physical disability, mental well-being, clinical examination, and work statu...

IMPACT: Emergency service workers perceived similarly low levels of organizational support compared with professionals and administrative employees. However, both emergency workers and healthcare professionals undertake high levels of emotional labour and therefore are susceptible to high levels of stress and, consequently, require organizational support. Low organizational support contributes to low wellbeing and engagement. If austerity-driven management is the cause of low organizational support, then new management models are required to ensure psychologically safe workplaces. Otherwise, the burden caused by poor management is placed on the community because taxpayers pay for emergency service workers’ stress-related workers’ compensation claims.

Objectives: Examine short-term disability (STD) and workers’ compensation (WC) associated leave and wage replacements, and overall direct healthcare payments, among employees with osteoarthritis (OA) versus other chronically painful conditions; quantifying the impact of opioid use. Methods: Analysis of employees with more than or equal to two STD or WC claims for OA or pre-specified chronically painful conditions (control) in the IBM MarketScan Research Databases (2014 to 2017). Results: The OA cohort (n = 144,355) had an estimated +1.2 STD days, +$152 STD payments, and +$1410 healthcare payments relative to the control cohort (n = 392,639; P

Rationale: The U.S. Department of Labor administers the Federal Black Lung Program (FBLP), an administrative system charged with managing claims by coal miners for workers’ compensation for totally...

Changing public attitudes about cannabis consumption have currently led 36 U.S. states and the District of Columbia to approve laws that make cannabis available to consumers with qualifying medical conditions. This article reviews the 36 states and the District of Columbia with medical cannabis access laws to determine if the state or the District also allows reimbursement of the costs of cannabis for a work-related health condition under that state's or District's workers' compensation insurance (WCI) laws and administrative regulations. The legal basis for a state allowing or not allowing WCI reimbursement is described. The review found that only six of the 36 states expressly allow cannabis WCI reimbursement, six expressly prohibit it, 14 states do not require reimbursement, and 10 states, and the District of Columbia, are silent on the issue. The article describes the role of the insurer, treating physician, and worker in obtaining WCI reimbursement in the six states that expressly allow cannabis WCI reimbursement. Comparisons are made to how selected Canadian provinces and territories administer cannabis reimbursement under Canada's new national cannabis legalization law. The article discusses the future role of cannabis legalization in the United States and the evolving role of cannabis from an international perspective.

Purposes Timely delivery of treatment and rehabilitation is generally acknowledged to support injury recovery. This study aimed to describe the timing of health service use by injured truck drivers with work-related injury and to explore the association between demographic and injury factors and the duration of health service use. Methods Retrospective cohort study of injured truck drivers with accepted workers’ compensation claims in the state of Victoria, Australia. Descriptive analyses examined the percentage of injured truck drivers using health services by service type. Logistic regression model examined predictors of any service use versus no service use, and predictors of extended service use (≥ 52 weeks) versus short-term use. Results The timing of health service use by injured truck drivers with accepted workers’ compensation claims varies substantially by service type. General practitioner, specialist physician, and physical therapy service use peaks within the 14 weeks after compensation claim lodgement, whilst the majority of mental health services were accessed in the persistent phase beyond 14 weeks after claim lodgement. Older age, being employed by small companies, and claiming compensation for mental health conditions were associated with greater duration of health service use. Conclusions Injured truck drivers access a wide range of health services during the recovery and return to work process. Delivery of mental health services is delayed, including for those making mental health compensation claims. Health service planning should take into account worker and employer characteristics in addition to injury type.

IntroductionEducators are exposed to several work-related hazards. Evidence suggests musculoskeletal pain, psychological distress, and student-inflicted violence-related injuries are common. However, there is little evidence on the burden of workplace injury among Australian educators.AimTo compare incidence of injury claims and duration of compensated time off work between educators and non-educators, and associated factors.MethodsRetrospective cohort study of 1,559,676 Australian workers’ compensation claims, including 84,915 educator claims, lodged between July 2009 to June 2015, from the National Dataset for Compensation-based Statistics. Cases were included if aged 18+ years and working in the education sector less than 100 hours per week. Negative binomial regression models estimated the relative risk of making a compensation claim and survival analyses calculated disability duration within educators by sex, age, injury type and mechanism, socioeconomic area, remoteness, and jurisdiction.ResultsCompared to non-educators, educators had lower rates of injury claims and shorter disability durations. However, educators had a higher rate of claims for mental health conditions and assault, with the highest risk being among those in special education and education aides. Among educators, injury claim rates were highest among special educators, education aides, and secondary educators.Discussion and ConclusionThough surveys indicate Australians in the education sector have higher incidences of work-related injuries, this study found lower incidence of injury claims and shorter disability durations than others. Educators’ injury-reporting and absenteeism behaviors may be constrained by ethical, social, and administrative attitudes. Educators had higher rates of claims for mental health and assault-related injury, particularly special educators, and education aides, which suggests a need for targeted prevention efforts.

At a poultry meat processing plant, work-zone group was an influencing factor upon an intervention program aimed at reducing musculoskeletal disorders (MSD), and also upon safety climate and disability management practices. This study aimed to explore if compensation claim outcomes also differed across work-zones in this plant. De-identified workers' compensation claims data from the processor were categorised according to three main work-zones (kill, process, despatch). Multivariable generalised linear modelling explored the compensation claims costs across these work-zones, adjusted for age, shift, and claim type. For MSDs, costs per claim were 3.5 times lower in the kill-zone compared to the despatch-zone. Shift worked and claim type were significant covariates in the modelling. Organisations should prioritize interventions within work-zones with poorer compensation outcomes and consider the association of organisational microclimates upon these claims.

PurposeThe purpose of this paper is to apply Lean in the workers’ compensation industry. It focuses on identifying patterns of repetitive non-value-added transnational activities for physical-therapy patients and healthcare providers. It addresses the research gap in this field.Design/methodology/approachIn this study, we designed and deployed multiple case studies to better understand the journey of an injured worker within the worker compensation system in the United States of America. We partnered with Concentra Inc., a leading national healthcare provider in the field of workers’ compensation having 520 medical centers in 44 states. Both case studies included conducting direct observations, Gemba walk, in five clinics in two states: Florida and Pennsylvania. We analyzed the data of 263 injured workers with 8 or more physical therapy visits who got admitted to Concentra clinics in both states over the period of 31 days.FindingsThe results revealed that the time intervals at which activities associated with physical therapy treatment pre-authorization accounted for 91.59% of the total non-value-added activities and are thus the key administrative factor leading to process inefficiency in the state of Florida. The Process Cycle Efficiency of Pennsylvania was 75.36% compared to 53.16% of Florida. The injured workers in Florida needed 39.58 days on average to complete eight physical therapy visits compared to 27.92 days in Pennsylvania (a median of 34.09 vs 22.15 days).Research limitations/implicationsThis study is limited as it only focuses on processes on the healthcare provider side. An expanded value stream map that includes the treatment pre-authorization process on the insurance side would be beneficial for generating more potential solutions to streamline the process.Practical implicationsThis study shows that Lean could play a critical role in identifying and quantifying continuous improvement opportunities that could accelerate patient’s treatment, reduce administrative burden on healthcare providers and improve the overall claim cost of insurance companies. It provides data-driven argument for insurance companies to consider eliminating physical therapy pre-authorization.Originality/valueThis is the first study to apply Lean methodology in the workers’ compensation field.

Background Following a work-related permanent impairment, injured workers commonly face barriers to safe and successful return to work (RTW). Examining workers' experiences with the workers' compensation (WC) system could highlight opportunities to improve RTW outcomes. Objectives included summarizing workers': (1) appraisal of several WC-based RTW programs, and (2) suggestions for vocational rehabilitation and WC system improvements to promote safe and sustained RTW. Methods In telephone interviews, 582 Washington State workers with work-related permanent impairments were asked whether participation in specified WC-based RTW programs helped them RTW and/or stay at work. Suggestions for program and system improvements were solicited using open-ended questions; qualitative content analysis methods were used to inductively code responses. Results Most respondents reported positive impacts from RTW program participation; for example, 62.5% of vocational rehabilitation participants reported it helped them RTW, and 51.7% reported it helped them stay at work. Among 582 respondents, 28.0% reported that no change was needed to the WC system, while 57.6% provided suggestions or critiques. Reduce delays/simplify process/improve efficiency was the most frequent WC system theme-mentioned by 34.9%. Among 120 vocational rehabilitation participants, 35.8% reported that no change was needed to vocational rehabilitation, while 46.7% (N = 56) provided suggestions or critiques. More worker choice/input into the vocational retraining plan was the most frequent vocational rehabilitation theme-mentioned by 33.9%. Conclusions This study's findings suggest that there is substantial room for improvement in workers' experience with the WC system. In addition, injured workers' feedback may reflect opportunities to reduce administrative burden and to improve worker health and RTW outcomes.

BACKGROUND Effective communication has been demonstrated to impact patient health outcomes, specifically in improving symptom resolution, safety, function, and emotional well-being, and to lower malpractice claims. I hypothesized that the communication process with patients with Workers' Compensation is inadequate. METHODS Prospectively, claimants presenting for an independent medical evaluation or an impairment rating were assessed concerning the education that they received with regard to their claim. Basic principles were based on the Utah Labor Commission Employee's Guide to Workers' Compensation and an employee information sheet. RESULTS There were 556 consecutive claimants assessed. None of the participants expressed any familiarity with the employee information sheet. Although there was a mean of 12 months since the date of claim to the evaluation, 536 participants (96.4%) were effectively unaware of the principles surrounding their claim; of these participants, 6 had attorneys and 23 had prior industrial claims. Of the 3.6% of participants who had received the State Employee Guide, 5 had a prior evaluation with the medical director of the Labor Commission, 6 had located the information online, and 9 had been provided information by their nurse-case manager. Even with this information, the context or importance of the information was not well understood. There were 16.4% of participants who were aware of the mileage compensation. Two claimants were aware that the insurer, not the employer, was responsible for managing the claim, 2 claimants were aware that their claim was open for life, and 1 claimant was aware that claimants could change physicians. CONCLUSIONS Workers' Compensation programs were designed to expedite care and treatment while decreasing the adversarial environment for workplace injuries. Yet delays and confrontational events continue to be experienced by the injured worker. This often results in the impression that workplace injuries have worse outcomes for the same diagnosis. The lack of effective education with regard to the rights and responsibilities of the claimant may also lead to this poorer outcome. Given studies showing the benefits of patient education in preventing malpractice claims and improving health-care outcomes, it is suggested that improved patient education for the injured worker is warranted and may lead to improved outcomes with diminished adversarial events.

Workplace safety is an important determinant of workers’ welfare. Empirical evidence shows the workplace injury rate decreases during recessions. This paper uses detailed administrative Workers’ Co...

Background In patients with shoulder arthritis, workers’ compensation (WC) status presents unique challenges to the clinician because of the socioeconomic and psychosocial aspects attendant to patients covered on this type of insurance. Patients, surgeons, and these insurance programs would be informed by a better understanding of the factors that may impact the results of a shoulder arthroplasty as treatment for glenohumeral arthritis in this population. The objectives of this study were to determine: (1) the extent to which patient-reported outcomes are impacted by WC status in comparison to patients covered by other types of insurance, (2) which factors are predictive of a successful outcome of shoulder arthroplasty as defined by improvement exceeding the minimal clinically important difference (MCID), (3) the ability of WC patients to return to their presurgical occupation after arthroplasty. Methods This was a retrospective study of a longitudinally maintained institutional database of 677 patients who underwent primary anatomic shoulder arthroplasty with a minimum 2-year follow-up, 39 of whom had WC insurance. These patients were compared to a matched cohort of 78 patients without WC insurance. Primary outcome measures included SST scores, SANE scores, and need for revision surgery. Univariate and multivariate analyses were performed to determine preoperative characteristics associated with success as defined by improvement greater than the MCID of the SST. Results Success, defined as improvement beyond MCID, occurred in a significantly lower proportion of WC patients compared to non-WC patients (64% vs. 94%, P Conclusions The challenges in treating patients covered by WC are underscored by the high percentage of these patients that do not improve beyond the MCID and the high percentage of patients with physically-demanding jobs that are unable to return to their presurgical occupation. Those patients who report less disability with routine daily activities (ie, higher SF-36 role physical domain scores) may fare better with anatomic shoulder arthroplasty. Patients with physically-demanding jobs should be counseled that return to their previous occupation is unlikely. Level of Evidence Level III; Retrospective Cohort Comparative Study

BACKGROUND: Workers who suffered a workplace injury and submitted a claim with the compensation board in Ontario often faced economic and non-economic costs that provoked depressive feelings, family strain, financial strain, and feelings of diminished self-worth. OBJECTIVE: This qualitative descriptive study aimed to understand the perceived gaps and failures associated with the support systems (e.g., union, compensation and employer) that were in place to assist some male underground workers in Sudbury, Ontario, Canada, who had suffered a workplace injury and had a compensation claim. METHODS: Twelve in-depth, in-person, individual, semi-structured interviews were conducted and data were transcribed verbatim and anonymized at the time of transcription. Data analysis followed Braun and Clarke’s guidelines for thematic analysis. RESULTS: Themes that emerged include: unfair and inadequate recognition of an injury; limited communication with stakeholders involved with their claim, including claim adjudicators, challenges when returning to work, and compensation claim system barriers. CONCLUSIONS: Cooperation, collaboration, knowledge transfer, and decreased power imbalances could help to reduce the economic and non-economic strain felt by a worker with an injury. Additionally, a government-funded third-party advocate who knows the medical system, union contracts, the workers’ compensation system, and employer policies and practices could act on behalf of an injured worker.

Purpose Workers’ compensation claims consist of occupational injuries severe enough to meet a compensability threshold. Theoretically, systems with higher thresholds should have fewer claims but greater average severity. For research that relies on claims data, particularly cross-jurisdictional comparisons of compensation systems, this results in collider bias that can lead to spurious associations and confound analyses. In this study, I use real and simulated claims data to demonstrate collider bias and problems with methods used to account for it. Methods Using Australian claims data, I used a linear regression to test the association between claim rate and mean disability durations across Statistical Areas. Analyses were repeated with nesting by state/territory to account for variations in compensability thresholds across compensation systems. Both analyses are repeated on left-censored data. Simulated claims data are analysed with Cox survival analyses to illustrate how left-censoring can reverse effects.Results The claim rate within a Statistical Area was inversely associated with disability duration. However, this reversed when Statistical Areas were nested by state/territory. Left-censoring resulted in an attenuation of the unnested association to non-significance, while the nested association remained significantly positive. Cox regressions on simulated data showed left-censoring can also reverse effects. Conclusions Collider bias can seriously confound work disability research, particularly cross-jurisdictional comparisons. Work disability researchers must grapple with this challenge by using appropriate study designs and analytical approaches, and considering how collider bias affects interpretation of results.

Background: Step-downs are scheduled reductions in the rate of compensation paid to injured workers. Their primary purpose is to encourage return to work. Despite being widespread in Australia, we know of no evidence that they influence time spent off work. Using claims data from each Australian workers' compensation jurisdiction, we will examine whether step-downs affect the rate at which injured workers leave the compensation system. Methods: 1) Regression discontinuity Using the National Dataset for Compensation-based statistics, we will convert record-level claims data into benefit cessation rates, documenting the proportion of workers' compensation claims that remain in the system each day. Using a regression discontinuity (RD) design, we will test whether step-downs increased the benefit cessation rate within each jurisdiction. Analyses will be limited to claims lodged between July 2008 and June 2015 (allowing a minimum of two years of follow up; the data were last updated to June 2017). Where jurisdictions have changed either the step-down rate or initial rate of compensation, we will only include claims lodged after the latest implementation date to ensure consistency in exposure. We will also analyse Western Australia, which currently has no step-downs as a control. Claims with two weeks or fewer of compensated time loss will be excluded to account for employer excess in Victoria and South Australia, as will claims affected by the maximum wage replacement cap, which mitigate or preclude step-down effects. We will also conduct sensitivity analyses with a one-week delay as workers may not be aware of impending step-downs and only respond after receiving reduced compensation. RD analyses will be conducted in R using the rdd package. The package calculates optimal RD bandwidths (BW) using the Imbens-Kalyanaraman calculation, in addition to sensitivity analyses using half- and double-sized BWs. We have attached a proof of concept plot, based on analysis of the 13 week step-down in Victoria. We found no evidence of an effect: local average treatment effects (LATE): 0.44, p = .168 (half-BW: -0.20, p = .307; double-BW: 0.75, p = .173). 2) Meta-analyses We will conduct a meta-analysis of each RD model to derive a pooled effect estimate and determine the proportion of variance attributable to heterogeneity. If we find significant heterogeneity, we will look at several factors to determine those that affect step-down effects. We have identified the following possible factors to consider: timing of step-down, the magnitude of reduction (difference between pre- and post-step-down rate), and the pre step-down wage replacement rate. Meta-analyses will be conducted in R using the metafor package.

This project builds on an earlier study (1) in which we compared durations of compensated time loss across eight Australian workers' compensation jurisdictions. The purpose was to determine whether policy variations between the jurisdictions affected time off work. We found substantial significant differences between the groups, even with adjustment for a host of factors known to affect disability duration including demographics, socio-economic status, industry, occupation, and injury type. However, seven of the eight jurisdictions were state- or territory-based. There could still be regional differences (e.g., culture, unemployment rate) influencing time off work that were not accounted for in the analysis. In this study, we address this limitation by taking advantage of a unique aspect of the eighth jurisdiction, Commonwealth Comcare, which serves workers in government and interstate employers. Using similar methods - adjusted survival analysis - we will compare disability durations across multiple states from a single workers' compensation jurisdiction. Whatever differences remain should be attributable to regional variations unaccounted for by the factors included in the model and differences in workers' compensation policy. Note: we conducted an earlier version of this analysis. However, we later found issues with the Comcare data and delayed the project until these could be sorted. We have presented the earlier findings as proof-of-concept. 1. Collie A, Lane TJ, Hassani-Mahmooei B, Thompson J, McLeod C. Does time off work after injury vary by jurisdiction? A comparative study of eight Australian workers’ compensation systems. BMJ Open. 2016;6(5):e010910. doi:10.1136/bmjopen-2015-010910

A systematic scoping review of the evidence relating work disability with subsequent suicide or deliberate self-harm

This study investigates the effects of legislation in South Australia that overhauled the workers' compensation system. In this plan, we propose an analytical strategy to investigate whether it affected claiming or disrupted the claims process, and what effects if any it had on injured worker outcomes.

This study aimed to determine the association between maximum daily temperature and work-related injuries according to employment status in South Korea.Data on workers' compensation claims and daily maximum temperature between May 20 and September 10, 2017-2018, were collected and analyzed. The absolute temperature risk effect (ATR) was evaluated by comparing the risk effect at 2 temperatures (30°C vs 33°C) across all communities using 2-stage time-series analysis.The association between high temperatures and work-related injuries was statistically significant in the construction sector (ATR, 1.129; 95% confidence interval [CI], 1.010-1.261). In addition, the findings of this study also demonstrated a higher risk effect among nonpermanent workers (ATR, 1.109; 95% CI, 1.013-1.214) at 33°C versus 30°C when compared with permanent workers (ATR, 0.963; 95% CI, 0.891-1.041).This study found a significant association between high temperatures and work-related injuries among nonpermanent workers in South Korea.