![isory in nature and informational in content. It is not a new stan
dard or
regulation and does not create any new legal obligations or alter
existing obligations created by OSHA standards or regulations
or the
Occupational Safety and Health Act of 1970 (OSH Act). Pursua
nt to the OSH Act, employers must comply with safety and healt
h standards and
regulations issued and enforced either by OSHA or by an OSHA
‐approved state plan. In addition, the OSH Act’s General Duty
Clause, Section
5(a)(1), requires employers to provide their workers with a wor
kplace free from recognized hazards likely to cause death or ser
ious physical
harm. Implementation of an incident investigation program in ac
cordance with this guide can aid employers in their efforts to pr
ovide a safe
workplace.
Incident[Accident]Investigations:AGuideforEmployers
December 2015 1
WHYINVESTIGATE?
Incidentinvestigations
helpemployers:
illnesses
commitmenttohealth
andsafety](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-54-320.jpg)
![A systems approach always looks beyond the immediate causes
of the incident. If a worker suffers an
amputation on a table saw, the investigator would ask questions
such as:
the machine adequately guarded? If not, why not?
Was the guard damaged or non‐functional? If so, why hadn’t it
been fixed?
the guard design get in the way of the work?
Had the employee been trained properly in the procedures to do
the job safely?
In a systems approach, investigations do not focus primarily on
the behaviors of the workers closest to
the incidents, but on the factors [program deficiencies] that pro
mpted such behaviors. The goal is to
change the conditions under which people work by eliminating
or reducing the factors that create
unsafe conditions. This is typically done by implementing adequ
ate barriers and safeguards against the
factors that cause unsafe conditions or actions.
Root causes often involve multiple deficiencies in the safety an
d health management programs. These](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-63-320.jpg)
![step approach to conduct a successful incident investigation. Inc
luded
is a set of appendices that can serve as tools for employers to us
e when conducting investigations. They
are:
A: Incident Investigation Form –
previously introduced; will be used to walk the
employer through the four incident investigation steps
B: Incident Investigator’s Kit –
lists the equipment recommended to have ready at all
times to be prepared to conduct the investigation
C: Tips for Video/Photo Documentation
D: Sketch the Scene Techniques
E: Collect Information Checklist
Appendix F: Sample Questions for Identifying Incident Root Ca
uses – Sample questions to ask in
a systems approach process
The four‐step systems approach in this guide is supported by
the Incident Investigation Form [Appendix A] and other tools.
This approach will assist employers through the incident
investigation and help to ensure the implementation of
corrective measures based on the findings.](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-71-320.jpg)
![The steps are:
1.
PRESERVE/DOCUMENT THE SCENE [see Appendices A, B,
C
and D]
2. COLLECT INFORMATION [see Appendix E]
3. DETERMINE THE ROOT CAUSES –
All the ‘Whys’ the incident occurred [see Appendix F]
4. IMPLEMENT CORRECTIVE ACTIONS –
Prevent Future Incidents
Safety First
Before investigating, all emergency response needs must be com
pleted and the incident site must be
safe and secure for entry and investigation.
IncidentInvestigations:AGuideforEmployers
December 2015 7
With an effective safety and health management program in plac
e, all the involved parties are aware of
the roles they play during the investigation. This helps the trans](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-72-320.jpg)
![Appendix A: Incident Investigation Form [applicable sections pi
ctured at all steps]
B: Incident Investigator’s Kit
C: Tips for Video/Photo Documentation
D: Sketch the Scene Techniques
IncidentInvestigations:AGuideforEmployers
December 2015 8
Step2.COLLECTINFORMATION
Incident information is collected through interviews, document
reviews and other means. Appendix E
provides a checklist to use to help ensure all information pertine
nt to the incident is collected.
In addition to interviews, investigators may find other sources o
f useful information. These include:
manuals
guidance documents
policies and records
schedules, records and logs
records (including communication to employees)
and follow‐up reports](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-74-320.jpg)
![Thank you for your commitment to the safety and health of the
American workforce!
Incident[Accident]Investigations:AGuideforEmployers
December 2015 12
RESOURCES
OSHA Training Institute Education Centers: http://www.osha.go
v/otiec
The OSHA Training Institute (OTI) Education Centers are a nati
onal
network of non‐profit organizations authorized by OSHA to deli
ver
occupational safety and health training to public and private sec
tor
workers, supervisors and employers on behalf of OSHA. Releva
nt
courses are:
#7500 Introduction to Safety and Health Management
Description: This course covers the effective implementation of
a company’s safety and health
management system. The course addresses the four core elemen](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-84-320.jpg)
![ts of an effective safety and health
management system and those central issues that are critical to
each element’s proper management.
This course is an interactive training session focusing on class d
iscussion and workshops. Upon course
completion students will have the ability to evaluate, develop, a
nd implement an effective safety and
health management system for their company. Minimum studen
t contact hours: 5.5
OSHA #7505 Introduction to Incident [Accident] Investigation
Description: This course covers an introduction to basic inciden
t investigation procedures and describes
analysis techniques. Course topics include reasons for conducti
ng incident investigations, employer
responsibilities related to workplace incident investigations, an
d a four‐step incident investigation
procedure. The target audience is the employer, manager, empl
oyee or employee representative who is
involved in conducting incident and/or near‐miss or close call in
vestigations. Upon course completion
students will have the basic skills necessary to conduct an effect
ive incident investigation at the
workplace. Minimum student contact hours: 7.5](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-85-320.jpg)
![paper
Straight‐edge ruler (Can be used as a scale reference in photos)
investigation forms
stakes, warning tape
marking cones
Personal protective equipment: Gloves, hat, eyewear, ear plugs,
face mask, etc.
glass
visibility plastic tapes to mark off area
aid kit
gloves
Sampling [holding] containers with seals (Various types: bags, j
ars, containers, etc.)
tags
of tape: Scotch, masking, duct
ruler](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-97-320.jpg)
![1. Identify key benefits of conducting accident investigations.
2. Describe the accident investigation process.
2.1 Explain the differences in accident categories.
Reading Assignment
Chapter 1:
What is an Accident?
Chapter 2:
An Accident Happens: What Do You Do? How Long Do You Do
It?
Access the resource below, and read pp. 1-5:
Occupational Safety and Health Administration. (2015).
Incident [accident] investigations: A guide for
employers. Retrieved from
https://www.osha.gov/dte/IncInvGuide4Empl_Dec2015.pdf
In order to access the resource below, you must first log into
the myWaldorf Student Portal and access the
Business Source Complete database within the Waldorf Online
Library. To reduce the amount of results you
receive, it is recommended to search for the article by title and
author.
Boraiko, C., Beardsley, T., & Wright, E. (2008). Accident
investigations. Professional Safety, 53(9), 26-29.
Unit Lesson
The goal of any safety and health program is to prevent injuries,
illnesses, and property damage. When one](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-108-320.jpg)
![Telephone: 1–800–CDC-INFO (1–800–232–4636)
TTY: 1-888-232-6348
Email: [email protected]
Or visit the NIOSH Web site at www.cdc.gov/niosh
For a monthly update on news at NIOSH, subscribe to NIOSH
eNews by visiting
www.cdc.gov/niosh/eNews.
DHHS (NIOSH) Publication No. 2014–110
January 2014
Workers’ Compensation Insurance: A Primer for Public Health
iiiWorkers’ Compensation Insurance: A Primer for Public
Health
Foreword
Occupational safety and health research and surveillance are
essential for the prevention and
control of injuries, illnesses and hazards that arise from the
workplace. Research and surveil-
lance can fill gaps in knowledge about where hazards exist and
what interventions are effective at
preventing workplace injuries, illnesses and fatalities.
Workers’ compensation insurance records
are a resource used for these primary prevention purposes. In
addition, workers’ compensation
records may be used for early detection of health outcomes in
populations of workers which is
part of secondary prevention. They may also be used to help
identify effective medical treatment
which is part of tertiary prevention.](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-117-320.jpg)
![Presentations in the first workshop described
differences among state laws, proper interpreta-
tion of common industry terms, proprietary
interests in insurance data, public release of
internal analyses, methods for linking workers’
compensation records with other health and
employment records, and independent analysis
of claims data by health scientists, economists and
government agencies [NIOSH 2010; Utterback
et al. 2012]. One of the principal messages
from the first workshop was that even though
workers’ compensation records are primarily
designed and used by the insurance industry to
administer claims, public health investigators are
interested in them for prevention and control of
occupational injuries and illnesses. The interested
parties have different perspectives on the value
and potential uses of workers’ compensation
data. Relationships would need to build trust and
respect for the various stakeholder perspectives
to foster collaboration.
The second workshop included discussions of six
draft white papers along with 35 platform and
poster presentations on research with workers’
compensation data [NIOSH 2013a]. Although
much progress is being made in understand-
ing the merits of workers’ compensation data
resources, significant limitations exist. For
example, these data appear to constitute an
incomplete record of occupational injuries and
illnesses at the state level.
While standards for col-
lecting and compiling the](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-125-320.jpg)
![held and proceedings are available.
Workers’ Compensation Insurance: A Primer for Public
Health2
(5) claims and other workers’ compensation insur-
ance information on medical treatments, costs
and disability status; (6) limitations of current
industry data standards; (7) loss prevention
programs; and (8) public health research, sur-
veillance and regulations. A glossary of workers’
compensation terms begins on page 35 and a
guide for prospective research and surveillance
projects follows on page 41.
2. Background
The economic and social burden of occupational
injuries and illnesses can only be roughly esti-
mated [Leigh and Marcin 2012; Leigh 2011].
Uncertainties are due to many factors including:
(1) workers receive only a portion of regular wages
through workers’ compensation; (2) occupational
illnesses are frequently not compensated; (3)
medical treatment costs for many occupational
injuries are paid by other insurance; (4) insurance
data are fragmented; and (5) data are protected
for proprietary and personal
identification purposes.
No central repository for
workers’ compensation
claims information exists
in the U.S.
The National Academy of](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-127-320.jpg)
![Social Insurance (NASI),
a non-governmental organization, produces
an annual report on workers’ compensation
insurance. The most recent version, Workers’
Compensation Benefits, Coverage, and Costs,
2010, states that workers’ compensation insurance
covered more than 124 million U.S. workers at a
total estimated cost to employers of $71 billion in
2010 [Sengupta et al. 2012]. Total insured medical
payments to providers and insured cash benefits
to workers were estimated at $28.1 billion and
$29.5 billion, respectively.
Most workers’ compensation insurance car-
riers are private entities except for exclusive
state insurance funds in North Dakota, Ohio,
Washington and Wyoming. Also, twenty states
offer state-sponsored nonprofit competitive
insurance companies or state licensed mutual
insurance plans, some to only selected portions
Workers’ compensation data are
likely to be more complete for acute
injuries and more representative of
population risks than occupational
illness data.
of the market such as those employers that are
unable to obtain insurance coverage in the vol-
untary market. There are typically dozens if not
hundreds of private carriers in each state. Large
employers in the U.S. are often self-insured under
rules established by the states.
Workers’ Compensation Records
Workers’ compensation insurance, in various](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-128-320.jpg)
![forms, covers in excess of 90% of the U.S. wage
and salary workers [Sengupta et al. 2012]. Ideally,
each workplace injury or illness requiring medical
care covered by workers’ compensation would
result in a record being created for the claim.
The primary purpose for the record is to ensure
proper payment to injured or ill workers and to
the medical providers. Yet the record may contain
useful information for public health purposes
on the nature of the injury or disorder, the part-
of-body, the event or exposure, industry sector,
occupation, and the worker’s ability to continue
working or disability status. Descriptive contents
may provide additional
information on materials
related to the event such as
biological, chemical, ergo-
nomic or physical hazards.
Medical records for workers’
compensation cases can
provide further information
about the extent and severity of the injury plus
information about the injured workers such as
gender, age, race/ethnicity, and other chronic
health conditions that may exacerbate an injury.
Workers’ compensation medical records also
identify disabilities that result from the occupa-
tional injuries or illnesses and billing records can
contain information on treatments and costs for
the medical portion of the claims.
Insurance carriers and self-insured entities are
required to provide state government agencies](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-129-320.jpg)
![and to provide employers
with information needed to
protect their workforce.
Limitations on Records
Utility
For public health research and surveillance pur-
poses, workers’ compensation data are likely to be
more representative of population risks for acute
injuries than they are for occupational illnesses.
Some investigators have used limited workers’
compensation data to estimate the frequency,
magnitude, severity, and cost of compensated
injuries and to examine trends over time. Several
papers at the 2012 workshop described deficien-
cies in workers’ compensation records for injury
and illness surveillance purposes, even for more
severe injuries such as amputations, fractures and
concussions [NIOSH 2013a].
C ombining workers’ compensation data
from a number of jurisdictions is a major
technical challenge. Each state legislature and
the District of Columbia establish workers’
compensation requirements2 with significant
variations. For example, states vary in the cov-
erage of compensable cumulative injuries such
as carpal tunnel syndrome, levels of payments
for partial and total disability, both temporary
and permanent, and the minimum number
of days away from work to qualify for wage-
replacement compensation. In many states,
employers with small numbers of employees,
temporary employees and other groups, such](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-131-320.jpg)
![related to estimating or recommending insur-
ance premium rates for establishments within
industries. Only one private insurance entity, The
Liberty Mutual Research Institute for Safety, has
published extensive peer-review articles related to
injury and illness prevention based on workers’
compensation records [Courtney 2010].
E v e n w h e n c o n d u c t -
ing analyses of workers’
compensation data from
a single state, there are
c h ar a c t e r i s t i c s of t h e
workers’ compensation
data that limit its utility.
Multiple researchers have reported limitations
on the utilization of workers’ compensation for
occupational injury and illness research and
surveillance. Azaroff, et al. [2002] described
a number of filters that limit the reporting and
filing of cases and the subsequent development
of a medical record or workers’ compensation
claim following a workplace injury or illness.
Several investigators have reported much less
than full participation in workers’ compensation
for occupational injuries and illnesses with up to
half or more of the compensable claims going
unreported [Biddle et al. 1998; Rosenman et
al. 2000; Fan et al. 2006; Scherzer et al. 2008;
Lipscomb et al. 2009].
Leigh [2012] estimated that only 21% of the total
economic burden of occupational injuries and
illnesses was paid by workers’ compensation
insurance carriers. Others describe the diffi-
culty in estimating the portion of the burden](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-134-320.jpg)
![that is shifted to other social and health insur-
ance programs [Boden et al. 2001] such as when
workers with occupational injuries and illnesses
Each state has its own set of rules
about which employers are required
to obtain workers’ compensation
insurance.
file disability claims with the Social Security
Administration [O’Leary et al. 2012].
3. Brief History of Workers’
Compensation in the US
Following European examples from the 19th
century, states in the U.S. began to develop
workers’ compensation
laws in the early 1900’s to
address the increasing risks
of occupational injuries and
illnesses associated with the
industrial revolution. Initial
laws in several states were
declared unconstitutional
but, in 1911, Wisconsin became the first state
to establish a workers’ compensation system
that withstood constitutional challenges in the
courts. By 1920, most states and territories3 had
followed suit. Mississippi was the last state to
adopt a workers’ compensation law in 1948.4
These laws provide partial benefits to affected
workers and protect employers from tort suits for
occupational injuries and illnesses in nearly all
cases. This “grand bargain” circumvents lengthy,](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-135-320.jpg)
![Some states exclude corporate officers in limited
liability corporations without other employees.
Other states have specific workers’ compensation
rules for industry sectors such as mining and
construction. The employment relationships of
employers with employees versus contractors are
clearly defined in many states.5
Since the enactment of Texas workers’ compensa-
tion legislation in 1913, employers in that state
have been allowed to voluntarily participate in
workers’ compensation insurance coverage. Those
employers who choose to opt out of coverage
are not protected from tort suits by the injured
or ill workers, or by surviving family members
in case of fatalities. Any medical expenses are
the responsibility of the injured or ill workers.
No payments are required for the workers’ lost
earnings for the duration of their recovery period
or for permanent disabilities. More recently,
Oklahoma legislation that was enacted in May
2013 allows employers to opt out of workers’
compensation insurance. In this state, employers
who opt out are required to have an internal
compensation program for occupational injuries
and illnesses that is consistent with Employee
Retirement Income Security Act (ERISA)
[Oklahoma Insurance Department 2013].
Basis for Insurance Premiums
Throughout the history of workers’ compensation
in the U.S., premiums for insurance policies have
been determined by a set of factors related to
employer risks, primarily the mix of occupational
classes they employ. Employers are assigned to
work classifications6 according to state-sanctioned](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-138-320.jpg)
![rating bureau guidelines. In general, employers
in classifications with greater injury and illness
risks and loss costs have higher “manual rates.”
For example, a roofing contractor generally has a
higher manual rate than a bank. Recommended
or specified manual rates must be approved by
the state regulators in most cases. Additionally,
those employers which qualify for experience
rating and that have a history of greater injury
and illness claims and costs within the risk classes
are charged even higher premiums through the
application of an experience modification factor.
Those employers with fewer claims and lower loss
costs benefit from lower premiums.
5For greater details on workers’ compensation trends and
individual state requirements, readers
are directed to the annual NASI report [Sengupta et al. 2012]
and the annual report produced by
the U.S. Chambers of Commerce [U.S. Chamber of Commerce
2012].
6The classifications do not directly correspond to Standard
Industry Classification (SIC) or NAICS
codes or occupational classification systems, such as the
Standard Occupation Classes (SOC).
Workers’ Compensation Insurance: A Primer for Public
Health6
Motivations for Prevention
From the beginning of workers’ compensa-
tion insurance laws in the U.S., the experience
modification factor was intended to encour-](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-139-320.jpg)
![age employers to invest in safety. A history of
elevated claims frequencies and costs results in
higher insurance premiums for the employer.
Adoption of effective safety strategies reduces
occupational injuries and illnesses which should
decrease future premiums. Additionally, many
states have enacted legislation that requires carri-
ers to provide premium discounts for the presence
of employer-based leading indicators such as
safety and health programs
which meet specific criteria.
Moreover, most carriers
provide loss prevention ser-
vices to client employers in
order to limit escalation of
claims costs and insurance
premiums. Some states, for
example Texas, Missouri
and Arkansas, mandate that insurance carriers
provide loss prevention services to clients and
many specify that the services shall be provided
at no additional cost beyond the annual premium.
Recent Changes in the Industry and Market
The workers’ compensation insurance market
is dynamic. Both the nature of work and work-
force are changing. In recent years, the mix of
industries and technologies in the U.S. have
changed and the workforce is aging [Restrepo
and Shuford 2011] and increasingly non-English
speaking [Hakimzadeh and Cohn 2007] and obese
[Ostbye et al. 2007; Trogden
et al. 2007; Schmid et al.
2012]. In the past couple
of decades, there have been
substantial changes in state](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-140-320.jpg)
![laws that affect workers’
comp ens ation p olicies
and procedures. Workers’
compensation insurance
requirements on issues such as managed care
organizations, limited physician choice, voca-
tional rehabilitation, minimum standards of care,
and restrictions on treatment options have been
enacted in many states. Meanwhile, medical costs
for claims have escalated [Shuford et al. 2009]
and litigation of claims is common in many states
[Willborn et al. 2012].
Changes in the relationships between employees
and employers have created needs for newer
workers’ compensation insurance policy types.
For example, contingent work arrangements
through temporary employment agencies and
professional employer organizations (PEO) are
becoming more common [Smith et al. 2010].
These emergent work arrangements can compli-
cate coverage and incentives for injury prevention.
PEOs primarily have provided human resource
and management services to
client employers although
they increasingly employ
workers in other industries.
PEOs result in co-employ-
ment by the host agency and
the client employer. Newer
workers’ compensation
policy arrangements have
been developed for PEOs and similar employment](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-141-320.jpg)
![leasing organizations [Shuford 2013] since a single
host agency may employ workers at different times
in industries with various risk classifications.
In contrast, workers who are employees of a
temporary agency are covered under the workers’
compensation policy for that agency, not that of
the client employer. Independent contractors,
which are defined in the workers’ compensa-
tion statutes in many states, are not covered by
the policy of the contracting employer, e.g. the
general contractor at a construction site. Also,
independent contractors
which are self-employed
persons are qualified for
workers’ compensation
insurance in some, but not
all, states. Each of these
arrangements can blur the
responsibility for provision
of workers’ compensation
coverage and has resulted in a lack of coverage
for some workers.
Insurance Industry Resources
Many organizations produce information
that is used by various parts of the workers’
New types of workers’ compensation
insurance policies have been devel-
oped to cover the recent changes in
the relationships between employees
and employers.](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-142-320.jpg)
![The relationship between claims
frequencies and costs and the
employers’ premium is intended to
encourage investments to reduce the
risk of injuries and illnesses.
Workers’ Compensation Insurance: A Primer for Public Health
7Workers’ Compensation Insurance: A Primer for Public
Health
compensation insurance industry. The U.S.
Department of Labor formerly compiled reports
on benefits and costs and annual summaries of
changes in state workers’ compensation require-
ments. They also employed regional experts
on workers’ compensation. The federal efforts
have shifted and some of the products have been
replaced by private or nonprofit entities such as
NASI and a number of others. For example, a
biannual report that compares the average cost
of workers’ compensation insurance per $100
of employer payroll among states is published
by the State of Oregon [Oregon Department of
Consumer and Business Services 2012]. The roles
and contributions of a number of these insurance
organizations appears later in this document.
Effectiveness of State Laws
The comparative impact of the various state
requirements has been a source of debate over
the entire history of workers’ compensation in
the U.S. Federalization
of the programs has been
suggested from time to](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-143-320.jpg)
![time. The Occupational
Safety and Health Act in
1970 created the National
C om m i s s i on on St ate
Workers’ Compensation
Laws which, after public
meetings and comment period, proposed Federal
minimum standards for state programs if the
states did not substantially improve their laws.
Related Congressional actions failed to pass. The
Commission did develop a set of recommenda-
tions for the state programs.7 Changes in state
requirements subsequent to those recommenda-
tions have been periodically reviewed which
indicate partial adoption by each of the states.8
According to national surveillance data, the fre-
quency and rate of occupational injuries have
declined over the past several decades [Sengupta
et al. 2012; U.S. Bureau of Labor Statistics 2012].
In 2010, employer costs for workers’ compensa-
tion benefits as a proportion of payroll were at
the lowest level in 30 years [Sengupta et al. 2012].
There has also been a general trend across the
states to limit compensation for disabled workers
[Spieler and Burton 2012]. Whether the surveil-
lance trends are due to reduced injuries, increases
in underreporting, or other factors is the subject
of ongoing research.
4. Workers’ Compensation
Insurance Benefits
Payments for workers’ compensation claims can
be for employee medical treatment, loss of wages](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-144-320.jpg)
![provide permanent partial coverage for disfigurement
of the face or other body parts.
The extent of permanent partial disability is deter-
mined by the degree of impairment at the point of
“maximal medical improvement” in order to settle
the case. Impairment is usually determined according
to medical references such as the American Medical
Association Guides to the
Evaluation of Permanent
Impairment [Cocchiarella
and Anderson 2001].
Permanent total disability
indemnity payments are
made to those workers who can no longer be
employed in any capacity. Depending on the state,
these payments may continue until retirement
age, for the life of the individual, or until disability
payments are received from another source such
as the Social Security Administration.
In some cases, the portions of the disability that are
attributed to work and non-work conditions can
factor in the amount of the disability payment. For
example, in some jurisdictions, a worker who is
disabled as a result of occupational exposures to a
respiratory hazard may have their benefits reduced
if a non-occupational exposure, such as smoking, is
demonstrated to have contributed to the impairment.
Death benefits are paid to survivors of the worker
who was killed on the job. The level of benefits usually
varies with the number of dependents. Although
generally a function of the average weekly wage,](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-151-320.jpg)
![claims for loss trends. A potential drawback
with “factor-adjusted” methods is that their
values are usually higher than the actual values
of the individual claim (since the mean is always
higher than the mode and median in claim cost
distributions) [Wurzelbacher et al. 2013]. Some
carriers use yet other cost valuation methods.
5. Workers’ Compensation
Insurance Providers
The workers’ compensation insurance industry
is complex with total per annum expenditures
in excess of $70 billion [Sengupta et al. 2012].
The primary types of groups in the industry
include insurance carriers, state regulatory
agencies, third-party administrators and
numerous trade organizations. Insurance
providers may be privately-held corpora-
tions, mutual corporations (owned by the
policy holders), and state or Federal agen-
cies. All states except North Dakota permit
self-insurance for qualified employers [U.S.
Chamber of Commerce 2012].
Insurance Providers and Policies
The insurance providers are regulated by indi-
vidual state requirements. Even nationwide
insurance carriers must follow the require-
ments in each of the states where they offer
coverage. In most states, private insurance
carriers compete in the regulated voluntary
market. Twenty states offer alternatives to
the private insurers in the form of non-profit
state-sponsored insurance programs. In addi-
tion, state funds are the exclusive providers](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-154-320.jpg)
![market usually serves newer employers without
sufficient years of experience in workers’ com-
pensation, employers with poor claims experience
Workers’ Compensation Insurance: A Primer for Public
Health12
or employers in high-risk industries unable to
obtain a policy to underwrite their potential losses.
However, the residual market in some states may
include employers that voluntarily participate when
there are economic or services advantages. All 24
state-sponsored insurance
programs provide coverage
for their residual markets. A
few of the state-sponsored
government insurance pro-
grams provide insurance
coverage only to the residual
market. Some states require
the private insurance compa-
nies in their markets to write
proportionate coverage for the residual market
employers in the form of assigned-risk pools. The
Burton primer on workers’ compensation pro-
vides additional details on the residual market and
assigned-risk pools [Burton 2004].
6. State Workers’ Compensation
Agencies
Each state has an agency that provides administrative
services for workers’ compensation, has adjudicatory
responsibilities in cases of disputes, and/or develops](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-156-320.jpg)
![of proposed legal changes,
or consider other aspects of
policy options. Many states,
e.g. Florida [Florida Division
of Workers’ Compensation
2011], develop annual
reports for their agen-
cies that reveal the number of cases in various
categories such as indemnity, medical-only and
disallowed claims as well as the number of claims
All states workers’ compensation
agencies require that some portion
of the claims records be reported.
HIPPA Privac y Rule exempts
workers’ compensation medical
information from its disclosure
restrictions. (See footnote 1)
Workers’ Compensation Insurance: A Primer for Public Health
13Workers’ Compensation Insurance: A Primer for Public
Health
that are contested by the employer or the insurance
provider. The reports may also describe recent
changes to the requirements and the status of
claims that are open and those that are closed.
Other data may be pre-
sented on the average cost
of claims for various injury
and illness types as well as
the distribution of claims](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-159-320.jpg)
![or to combine as a self-insured entity. Membership
in a group is usually restricted to similar industries.
Other insurance arrangements include carve-outs,
which are labor/management agreements,10 and
captives, i.e. an insurance company that is wholly-
owned by a single employer or a group of employers
and provides insurance to the owners’ businesses.
Risk Retention
Workers’ compensation insurance policies deter-
mine the amount of risk the employer retains for
workplace injuries and illnesses. Risk retention may
increase employer interest in reducing potential
losses through safety and health prevention since
they could be responsible for payments on some
claims. In order of increasing risk retention by the
employer are the following insurance or policy
types: guaranteed cost, dividend, retrospective
rating, deductible, and self-insurance [Thamann
and Reitz 2000]. For example, with a guaranteed
cost policy, the loss to the employer in a given policy
year can never be more than the policy premium.
On the other hand, with large deductible policies,
the employer is self-insured up to an amount of the
deductible yet obtains an insurance policy for excess
coverage purchased from a provider. The deduct-
ible amounts may be per claim and/or aggregate
and range from a few thousands of dollars to $1
million or more. Nonetheless, the carrier of the
excess coverage is, according to the state regula-
tors, responsible for the entire claim amount. The
carrier then obtains reimbursement from the client
employer through an agreed mechanism.
Self-insurance is a form of insurance that is generally](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-170-320.jpg)
![widely used in the U.S. is
the Unit Statistical Report
that is provided by insurers to NCCI and other
workers compensation data collection organiza-
tions. These reports are initially valued at 18
months after policy effective dates and include
premium and loss information on a state basis.
Open claims are valued and reported annually
for up to 10 years to track loss development.13, 14
Limitations of Record Information
It is important to mention, once again, that the
primary purpose for the injury and billing records
is the timely payment of the
injured or ill workers and their
medical providers. Therefore,
information in these records
that is used for these purposes
is likely to be more robust
than other fields in the record
systems. For example, diag-
nostic and treatment codes
are more likely to be accurate and complete than
information on occupation and employment status,
particularly for medical only claims. An estimated
80% of all claims are medical only [Sengupta et al.
2012]. The statutory days away from work time
limits for “medical only” versus “lost time” claims
vary significantly from one state to another (Table 2).
13set of slides that explain unit reporting is available at
http://www.ncci.com/documents/DRW-
2008-Unit-Data-Reporting.pdf](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-178-320.jpg)
![offer loss prevention16 services to help policyhold-
ers manage these risks. They also assess risks that
exist at establishments for which they contem-
plate underwriting new policies. For current
policyholders, the primary purposes for the loss
prevention services are to reduce the frequency
and severity of workers’ compensation claims
and to improve the health
and safety program of the
client. Policyholders with
higher premiums are more
likely to receive routine loss
prevention services from
carriers than those with
smaller premiums [Morin
et al. 2013].
The provided services, which frequently are
viewed as marketing tools to retain existing
clients, may range from delivering relevant safety
In general, loss prevention programs
identify and describe risks at
policyholders’ establishments and
make recommendations for their
abatement.
and health pamphlets and brochures to full risk
characterizations that include recommendations
for remediation with follow up inspections. Most
small employers would not receive site visits
unless their claims experience indicated a need
for intervention.
Mandated Prevention Programs
All states have enacted legislation and developed](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-183-320.jpg)
![related rules and regulations to reduce occupa-
tional injury and illness risks. The strategies
employed by the states vary extensively and may
include employer safety and health program
requirements and incentives, insurance carrier
loss prevention activities, registries of authorized
occupational health and safety practitioners,
and employer or organizational grants for risk
mitigation and worker training (Table 3).17 These
inducements are often limited to those employ-
ers with greater than a minimum number of
employees, minimum qualifying premiums,
elevated experience modification factors, or
that appear on lists of high hazard industries.
Twelve states require workers’ compensation
insurance carriers to provide loss prevention
services to many employers at no additional cost
(Table 3). Requirement for these services is often
limited to those policyholders with greater than
a minimum number of employees, such as 25,
or with premiums above
minimum thresholds such
as $25,000.
C a r r i e r - b a s e d L o s s
Prevention Programs
Most large workers’ com-
pensation insurance carriers
invest portions of their revenues in loss prevention
programs [Dembe 1995; Nave and Veltri 2004;
Ryan 2013] although the amounts or percent-
ages are not readily available. According to one
16Note that “loss control” and “loss prevention” are terms that](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-184-320.jpg)
![are often used interchangeably. In con-
trast, the term “loss reduction” is typically used to refer to the
management of costs and disability once
an injury or illness has occurred through programs such as case
management and return-to-work.
17States that do not appear in Table 3 list of prevention
requirements or incentives are Alaska,
Arizona, Georgia, Idaho, Indiana, Iowa, Kentucky, Maryland,
Michigan, New Jersey, South
Carolina, Vermont, Virginia and West Virginia
Workers’ Compensation Insurance: A Primer for Public Health
23Workers’ Compensation Insurance: A Primer for Public
Health
recent report, 13% of large workers’ compensation
insurance clients, on average, receive loss control
visits in a given year although that value varies
widely by industry group (e.g. Manufacturing
= 32%, Construction = 16%, Agriculture = 4%)
[Ryan 2013]. For the most part, loss prevention
programs collect information on hazards and
other determinants of risks from employers either
prior to the issuance of a policy, i.e. risk selection
for underwriting, or as a means of providing
services to existing clients. Depending on the
size of the premium, loss prevention services may
include conduct of site visits which frequently
include walk-through inspections of facilities,
interviews with employees, supervisors and
managers, as well as reviews of the employer’s
safety and health program elements. The report
for the initial survey is shared with the carrier’s](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-185-320.jpg)
![underwriting staff as well
as a broker that may be
involved in the transaction.
These risk selection reports
are considered privileged
information and often only
selected portions of the
reports are shared with the client [Morin et al.
2013].
For new and existing clients, key elements of loss
prevention reports, such as a description of the
hazards identified and recommendations for their
abatement, may be provided to the employer. The
loss prevention staff may also communicate the
need for improvements (such as specific training
or documentation) to the employer’s health and
safety programs. They may also provide specific
services such as training employees, supervisors
and managers and make training materials and
model program elements available. Industrial
hygiene and ergonomic surveys are included
as needed. Afterwards, the loss prevention
program may track progress through follow-up
communications with the employer. The loss
prevention professional may assist the employer
in the completion of a safety grant application if
they are available.
Loss prevention records are not standardized
except perhaps within insurance providers. The
availability of mobile technology applications
for loss prevention programs is increasing and
may provide additional opportunities for data
standards developments on hazards and employer](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-186-320.jpg)
![ename=LMGroup/Views/LMG&ft=2&fid=1138356633468&ln=e
n
Workers’ Compensation Insurance: A Primer for Public Health
25Workers’ Compensation Insurance: A Primer for Public
Health
14. Public Health Research and
Surveillance18
Public health is “the science and art of preventing
disease, prolonging life and promoting health
through the organized efforts and informed
choices of society, organizations, public
and private, communities and individuals”
[Winslow 1920]. Fundamentally, public health
relies on surveillance programs to describe
the distribution of disease and injury, detect
new and emerging diseases and disorders,
target intervention activities to prevent their
incidence, and monitor the effectiveness of
those interventions. Workers’ compensation
records may be used for public health research
and surveillance activities. The terms “research”
and “surveillance” have specific meaning in
Federal public health activities which are briefly
discussed here.
Research
Federal regulations state
that “research means a
systematic investigation,
i n c l u d i n g r e s e a r c h
development, testing and
evaluation, designed to](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-192-320.jpg)
![de velop or cont r ibute
to generalizable knowledge” [45 Code of
Regulations (CFR) 46.102(d)]. Investigators
performing public health research or surveillance
activities have the responsibility to ensure that
the research is conducted in a manner consistent
with legal and ethical requirements. All research
involving human participants that is conducted
or supported by the U.S. Department of Health
and Human Services (DHHS) must comply with
DHHS Policy for Protection of Human Research
Subjects [45 CFR part 46]. Investigators should
consult with their local institutional review board
for assistance with development of research
or surveillance projects to insure that human
subjects are appropriately protected.
Federal regulations state that
“research means a systematic
investigation, including research
development, testing and evaluation,
designed to develop or contribute to
generalizable knowledge” (45 CFR
46.102(d)).
Surveillance
Public health surveillance is the systematic,
ongoing collection, management, analysis,
and interpretation of data followed by the
dissemination of these data to public health
programs to stimulate public health action
[Thacker et al. 2012]. Surveillance systems
can be used to monitor infectious and non-
infectious diseases as well as injuries and deaths.
Surveillance data can be primary in that they](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-193-320.jpg)
![are collected for a specific public health purpose
or they may be secondary in that the data were
collected for other purposes yet they can be useful
for tracking injuries, illnesses and deaths that
occur in a defined population.
Occupational health surveillance is the tracking
of workplace injuries, illnesses, hazards, and
exposures. In the U. S., because there are no
periodic national surveys of worker health,
o c c u p a t i o n a l h e a l t h
s u r v e i l l a n c e r e m a i n s
fragmented with substantial
data gaps. However, the
available surveillance data
are used to guide efforts
to improve worker safety
and health and to monitor
trends and progress over
time [NIOSH 2013b]. Data
and information derived from surveillance can
be used to:
(1) guide immediate action for important cases;
(2) measure the burden of an injury, disease,
or other health-related event or exposure,
including changes in related factors;
(3) identify populations at risk, including new
or emerging health concerns;
(4) guide the planning, implementation, and
evaluation of programs to prevent and control
injuries, disease, or adverse exposures;
(5) evaluate policies and practices;
(6) detect changes in health practices and the](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-194-320.jpg)
![more hazardous industries or
leading events for claims across all industries. Claims
information has been used to establish priorities
for loss prevention and other intervention actions
[Silverstein et al. 2002; Bonauto et al. 2006; Anderson
et al. 2013]. Yet other investigators have determined
that workers’ compensation claims data are currently
inadequate to characterize occupational injuries and
illnesses in particular [Rosenman et al. 2000; Azaroff
et al. 2002; Utterback et al. 2012].
Formerly, workers’ compensation claims information
from a large number of states was collected by BLS
for the Supplementary Data System (SDS), a non-
representative sample of occupational injuries and
illnesses. SDS contained discrepancies due to the
quality of data retrieved from states and the variability
of state laws on which injuries and illnesses were
reported [National Research Council 1987]. The
system was discontinued in the late 1980’s when the
Survey of Occupational Injuries and Illnesses (SOII)
along with the Census of Fatal Occupational Injuries
(CFOI) were being developed.
Estimating Rates
Rates of occupational injuries and illnesses require
estimates of at-risk populations (a “denominator”).
The denominator commonly used in the workers’
compensation industry is dollars of payroll. In
public health, preferred denominators for rates are
numbers of people or, in the case of occupational
studies, full-time equivalent (FTE) workers. Data
sets used to estimate the numbers of workers
within industries and/or occupations may be
obtained from population household surveys such](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-196-320.jpg)
![Workers’ Compensation Insurance: A Primer for Public
Health28
data from the workers’ compensation insurance
records. Effective searching of unstructured text
fields has also improved [Lehto et al. 2009; Patel
et al. 2012; Bertke et al. 2013].
Although systematic data analysis within a carrier’s
operations contributes to risk management goals
and client service, the information is not readily
available to public health organizations. When
made available, practitioners and researchers
have used claims data for epidemiologic studies,
to identify hazards, assess the effectiveness of
controls, assign priorities for limited resources,
and evaluate intervention programs.
Additional infor mation on e valuations
of workplace safety and health programs,
hazard monitoring and hazard exposure
data, and observations of worksites are types
of loss prevention information that could be
standardized and made more useful for research
and surveillance purposes. Over the past century
and more, carrier-based and state agency workers’
compensation programs have used data to identify
and evaluate risks for specific hazards across
industry sectors.
When systematically available, workers’
compensation data has been used extensively
for occupational safety and health research and](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-202-320.jpg)
![surveillance [NIOSH 2010; Utterback et al. 2012;
NIOSH 2013a] and they have supplemented the
surveillance information available from other
occupational resources.23 This primer provides
background information for those interested
in utilizing workers’ compensation data for
prevention purposes.
23Descriptions of many data sources used for occupational
surveillance may be accessed at http://
wwwn.cdc.gov/niosh-survapps/Gateway/DataSources.aspx.
Workers’ Compensation Insurance: A Primer for Public Health
29Workers’ Compensation Insurance: A Primer for Public
Health
References
American Association of State Compensation Insurance Funds
[2007]. State Funds: Their Role
in Workers’ Compensation,
[http://www.aascif.org/public/1.1.1_history.htm] Accessed on
November 8, 2013.
Anderson NJ, Bonauto DK, Adams D [2013]. Prioritizing
Industries for Occupational Injury and
Illness Prevention and Research, Washington State Workers’
Compensation Claims Data, 2002-
2010. Washington State Department of Labor and Industries
Technical Report Number 64-1-2013
[http://www.lni.wa.gov/Safety/Research/Files/bd_3F.pdf ].
Accessed on November 8, 2013.
Azaroff LS, Levenstein C, Wegman DH [2002]. Occupational](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-203-320.jpg)
![injury and illness surveillance:
Conceptual filters explain underreporting. Am J Pub Health
92:1421-1429.
Bertke SJ, Meyers AR, Wurzelbacher SJ, Bell J, Lampl ML,
Robins D [2012]. Development and
evaluation of a Naïve Bayesian model for coding causation of
workers’ compensation claims. J
Safety Res 43(5-6):327-32.
Biddle J, Roberts K, Rosenman KD, Welch EM [1998]. What
percentage of workers with work-
related illnesses receive workers’ compensation benefits? J
Occup Environ Med 40:325-331.
Boden LI, Biddle EA, Spieler EA [2001]. Social and economic
impacts of workplace illness and
injury: Current and future directions for research. Am J Ind Med
40:398-402.
Boden L, Ozonoff A [2008]. Capture-recapture estimates of
nonfatal workplace injuries and
illnesses. Annals Epidem 18:500-506.
Bonauto DK, Silverstein BA, Adams D, Foley M [2006].
Prioritizing industries for occupational
injury and illness prevention and research. J Occup Environ
Med 48:840-851.
Burton JF [2004]. A primer on workers’ compensation,
Workers’ Compensation Policy Review.
Nov/Dec 2004 [http://workerscompresources.com/wp-
content/uploads/2012/11/ND04A.pdf ].
Accessed November 7, 2013.
California Labor Code, Sections 6314.1, 6354 and 6355](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-204-320.jpg)
![[http://www.dir.ca.gov/doshpol/P&PC-19.
html]. Accessed on November 7, 2013
CDC [2010]. Distinguishing public health research and public
health nonresearch, CDC-
SA-2010-02, July 29, 2010
[http://www.cdc.gov/od/science/integrity/docs/cdc-policy-
distinguishing-public-health-research-nonresearch.pdf ].
Accessed November 7, 2013.
Cocchiarella L, Anderson GBJ, eds. [2001] Guides to the
Evaluation of Permanent Impairment.
5th ed. Chicago, Ill: American Medical Association.
Courtney TK [2010]. Workers’ compensation data utilization in
injury prevention research at the
Liberty Mutual Research Institute for Safety. In: Proceedings of
Use of Workers’ Compensation
Data for Occupational Injury and Illness Prevention. Utterback
DF, Schnorr TM eds. Cincinnati,
OH. National Institute for Occupational Safety and Health;
DHHS (NIOSH) Pub No. 2010-152.
pp. 49-53.
http://www.aascif.org/public/1.1.1_history.htm
http://www.ncbi.nlm.nih.gov/pubmed/23206504
http://www.ncbi.nlm.nih.gov/pubmed/23206504
http://onlinelibrary.wiley.com/doi/10.1002/ajim.10013/abstract
http://onlinelibrary.wiley.com/doi/10.1002/ajim.10013/abstract
http://workerscompresources.com/wp-
content/uploads/2012/11/ND04A.pdf
http://www.dir.ca.gov/doshpol/P&PC-19.html
http://www.dir.ca.gov/doshpol/P&PC-19.html
http://www.cdc.gov/od/science/integrity/docs/cdc-policy-
distinguishing-public-health-research-nonresearch.pdf
http://www.cdc.gov/od/science/integrity/docs/cdc-policy-](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-205-320.jpg)
![distinguishing-public-health-research-nonresearch.pdf
Workers’ Compensation Insurance: A Primer for Public
Health30
Dembe AE [1995]. Alternative approaches for incorporating
safety into state workers’
compensation reform legislation. J Insurance Regulation
13:445-450.
Department of Health and Human Services, Health Information
Privacy, [2003] Disclosures for
Workers’ Compensation Purposes 45 C.F.R. Sect. 164.512(l)
[http://www.hhs.gov/ocr/privacy/
hipaa/understanding/coveredentities/workerscomp.html].
Accessed on November 12, 2013.
Department of Health and Human Services [2013]. Workers’
compensation settlements and
payments [http://www.medicare.gov/supplement-other-
insurance/how-medicare-works-with-
other-insurance/who-pays-first/workers-comp-payments.html].
Accessed on November 12, 2013
Environmental Protection Agency [2013]. Worker Protection
Standard for Agricultural
Pesticides. [http://www.epa.gov/agriculture/twor.html].
Accessed on November 12, 2013.
Fan ZJ, Bonauto DK, Foley MP, Silverstein BA [2006].
Underreporting of work-related injury or
illness to workers’ compensation: individual and industry
factors. J Occup Environ Med 48:914-
922.](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-206-320.jpg)
![Fishback PV [2013]. Workers’ Compensation. EH.net,
[http://eh.net/encyclopedia/workers-
compensation/]. Accessed on November 12, 2013
Florida Division of Workers’ Compensation [2012]. 2011
Division of Workers’ Compensation
Annual Report. [http://www.myfloridacfo.com/wc/pdf/DWC-
Annual-Report-2011.pdf ].
Accessed May 10, 2013
Guyton GP [1999]. A Brief History of Workers’ Compensation.
Iowa Orthop J. 19: 106–110.
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1888620/].
Accessed on November 12, 2013.
Hakimzadeh S, Cohn D [2007]. English usage among Hispanics
in the United States, Pew
Research Hispanic Center; Nov 29, 2007.
[http://www.pewhispanic.org/2007/11/29/iv-workplace-
and-home/]. Accessed on November 7, 2013.
Hunt HA [2003-2004]. Benefit adequacy in state workers’
compensation programs. Social
Security Bulletin. 65(4):24-30.
International Association of Industrial Accident Boards and
Commissions [2004]. A
History of the IAIABC, 90th Annual Convention Edition
http://www.iaiabc.org/files/
Resources/2006HistoryofIAIABC.pdf. Accessed May 12, 2013
International Association of Industrial Accident Boards and
Commissions [2013]. EDI
Implementation Guides.
[http://www.iaiabc.org/i4a/pages/index.cfm?pageid=3339].
Accessed](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-207-320.jpg)
![on November 12, 2013.
Kiselica D, Sibson B, Green-McKenzie J [2004] Workers’
compensation: a historical review and
description of a legal and social insurance system. Clin Occup
Environ Med. May;4(2):v, 237-47.
Lehto M, Marucci-Wellman H, Corns H [2009]. Bayesian
methods: A useful tool for classifying
injury narratives into cause groups. Inj Prev Aug;15(4):259-65.
http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredent
ities/workerscomp.html
http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredent
ities/workerscomp.html
http://www.medicare.gov/supplement-other-insurance/how-
medicare-works-with-other-insurance/who-pays-first/workers-
comp-payments.html
http://www.medicare.gov/supplement-other-insurance/how-
medicare-works-with-other-insurance/who-pays-first/workers-
comp-payments.html
http://www.epa.gov/agriculture/twor.html
http://eh.net/encyclopedia/workers-compensation/
http://eh.net/encyclopedia/workers-compensation/
http://eh.net/encyclopedia/workers-compensation/
http://www.myfloridacfo.com/wc/pdf/DWC-Annual-Report-
2011.pdf
http://www.ncbi.nlm.nih.gov/pubmed/?term=Guyton
GP%5Bauth%5D
http://www.pewhispanic.org/2007/11/29/iv-workplace-and-
home/
http://www.pewhispanic.org/2007/11/29/iv-workplace-and-
home/
http://www.iaiabc.org/files/Resources/2006HistoryofIAIABC.pd
f
http://www.iaiabc.org/files/Resources/2006HistoryofIAIABC.pd](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-208-320.jpg)
![f
http://www.iaiabc.org/i4a/pages/index.cfm?pageid=3339
http://www.ncbi.nlm.nih.gov/pubmed?term=Kiselica
D%5BAuthor%5D&cauthor=true&cauthor_uid=15182746
http://www.ncbi.nlm.nih.gov/pubmed?term=Sibson
B%5BAuthor%5D&cauthor=true&cauthor_uid=15182746
http://www.ncbi.nlm.nih.gov/pubmed?term=Green-McKenzie
J%5BAuthor%5D&cauthor=true&cauthor_uid=15182746
http://www.ncbi.nlm.nih.gov/pubmed/15182746
http://www.ncbi.nlm.nih.gov/pubmed/19652000
http://www.ncbi.nlm.nih.gov/pubmed/19652000
Workers’ Compensation Insurance: A Primer for Public Health
31Workers’ Compensation Insurance: A Primer for Public
Health
Leigh JP [2011]. Economic burden of occupational injury and
illness in the United States.
Milbank Q 89:728-72.
Leigh JP, Marcin JP [2012]. Workers’ compensation benefits
and shifting costs for occupational
injury and illness. J Occup Environ Med 54:445-450.
Lipscomb HJ, Dement JM, Silverstein BA, Cameron W, Glazner
JE [2009]. Who is paying the
bills? Health care costs for musculoskeletal back disorders,
Washington State carpenters, 1989 –
2003. J Occup Environ Med 51:1185-1192.
Mine Health and Safety Administration [2013]. Title 30 CFR
Mineral Resources Parts 1 through
199. [http://www.msha.gov/30CFR/CFRINTRO.HTM].
Accessed November 12, 2013.](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-209-320.jpg)
![Missouri Department of Labor and Industrial Relations [2012].
Report of Injury. [http://labor.
mo.gov/DWC/Forms/WC-1-EDI-AI.pdf ]. Accessed November
12, 2013.
Morin JF, Utterback DF, Shor G, Welsh L, Bogyo TJ,
Wurzelbacher SJ [2013]. Workers’
compensation loss prevention information and interventions.
Submitted for publication.
National Commission on State Workmen’s Compensation Laws
[1972]. The Report of the
National Commission on State Workmen’s Compensation Laws.
Washington DC: Government
Printing Office.
[http://www.workerscompresources.com/National_Commission_
Report/
national_commission_report.htm]. Accessed on November 12,
2013.
National Research Council [1987]. Counting injuries and
illnesses in the workplace: Proposals for
a better system. Pollack ES and Keimig DG eds. National
Academy Press; Washington DC.
Nave M, Veltri A [2004]. Effect of loss control services on
reported injury incidents. J Safety Res
35:39-46.
NIOSH [2013a]. Proceedings of Use of Workers’ Compensation
Data for Occupational Safety
and Health, Utterback DF, Schnorr TM eds. Cincinnati, OH;
National Institute for Occupational
Safety and Health; DHHS (NIOSH) Pub No. 2013-147.
NIOSH [2013b]. Topic Page: Surveillance Program.](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-210-320.jpg)
![[http://www.cdc.gov/niosh/programs/surv/].
Accessed November 7, 2013.
NIOSH [2010]. Proceedings of Use of Workers’ Compensation
Data for Occupational Injury
and Illness Prevention. Utterback DF, Schnorr TM eds.
Cincinnati, OH. National Institute for
Occupational Safety and Health; DHHS (NIOSH) Pub No. 2010-
152.
Occupational Safety and Health Administration [2013]. OSHA
Law & Regulations. [http://www.
osha.gov/law-regs.html]. Accessed November 12, 2013.
Oklahoma Insurance Department [2013]. Self-Funded Health
Care Plans/Self-Insured Employers.
[https://www.ok.gov/oid/Consumers/Insurance_Basics/ERISA_I
nformation.html]. Accessed
November 7, 2013.
http://apps.webofknowledge.com/full_record.do?product=UA&s
earch_mode=GeneralSearch&qid=1&SID=4C65GpA1hlaF9eIjfA
5&page=1&doc=1
http://apps.webofknowledge.com/full_record.do?product=UA&s
earch_mode=GeneralSearch&qid=1&SID=4C65GpA1hlaF9eIjfA
5&page=1&doc=1
http://www.msha.gov/30CFR/CFRINTRO.HTM
http://labor.mo.gov/DWC/Forms/WC-1-EDI-AI.pdf
http://labor.mo.gov/DWC/Forms/WC-1-EDI-AI.pdf
http://www.workerscompresources.com/National_Commission_
Report/national_commission_report.htm
http://www.workerscompresources.com/National_Commission_
Report/national_commission_report.htm
http://www.cdc.gov/niosh/programs/surv/
http://www.osha.gov/law-regs.html
http://www.osha.gov/law-regs.html](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-211-320.jpg)
![https://www.ok.gov/oid/Consumers/Insurance_Basics/ERISA_In
formation.html
Workers’ Compensation Insurance: A Primer for Public
Health32
Oleinick A, Zaidman B [2004]. Methodologic issues in the use
of workers’ compensation database
for the study of work injuries with day away from work. I.
Sensitivity of case ascertainment. Am J
Ind Med 45:260-274.
Oregon [2013]. 2012 Oregon Workers’ Compensation Premium
Rate Ranking Summary. [http://
actprod.cbs.state.or.us/iportal/report_catalog.html]. Accessed
on November 7, 2013
O’Leary P, Boden LI, Seabury SA, Ozonoff A, Scherer E
[2012]. Workplace injuries and the take-
up of Social Security disability benefits. Social Security
Bulletin 72(3):1-17.
Ostbye T, Dement JM, Krause KM [2007]. Obesity and workers’
compensation: Results from the
Duke Health and Safety Surveillance System. Arch Intern Med
167:766-73.
Patel MD, Rose KM, Owens CR, Bang H, Kaufman JS [2012].
Performance of automated and
manual coding systems for occupational data: A case study of
historical records. Am J Ind Med
55(3):228-31.
Restrepo T, Shuford H [2011]. Workers’ compensation and the
aging workforce. National Council](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-212-320.jpg)
![on Compensation Insurance, Boca Raton, FL.
[https://www.ncci.com/documents/2011_Aging_
Workforce_Research_Brief.pdf ]. Accessed on November 7,
2013.
Rosenman KD, Gardiner JC, Wang J, Biddle J, Hogan A, Reilly
MJ, Roberts K, Welch E [2000].
Why most workers with occupational repetitive trauma do not
file for workers’ compensation. J
Occup Environ Med 42:25-34.
Ryan M [2013]. Risk management and loss control industry
trends. Presented at: E&S 2013
Loss Control Executive Forum, March 5, 2013
[http://www.iso.com/Conferences/Loss-Control-
Forum/Home.html?blogclick%20E&S%20Forum%20link].
Accessed on November 7, 2013.
Scherzer T, Wolfe N [2008]. Barriers to workers’ compensation
and medical care for injured
personal assistance services workers. Home Health Care Serv Q
27:37-58.
Schmid F, Laws C, Montero M [2012]. Indemnity benefit
duration and obesity. National Council
on Compensation Insurance, Boca Raton, FL.
[https://www.ncci.com/documents/Obesity-2012.
pdf ]. Accessed on November 7, 2013.
Sengupta I, Reno V, Burton JF, Baldwin M [2012]. Workers’
Compensation: Benefits, Coverage,
and Costs, 2010, National Academy of Social Insurance,
Washington DC.
Shuford H [2013]. The role of professional employer
organizations in workers compensation:](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-213-320.jpg)
![Evidence of workplace safety and reporting. In: Proceedings of
Use of Workers’ Compensation
Data for Occupational Safety and Health Workshop. Utterback
DF, Schnorr TM eds. NIOSH Pub.
No. 2013-147. pp. 51 – 56.
Shuford H, Restrepo T, Beaven N, Leigh JP [2009]. Trends in
components of medical spending
within workers’ compensation: Results from 37 states
combined. J Occup Environ Med 51:232-238.
Silverstein BA, Viikari-Juntura E, Kalat J [2002]. Use of a
prevention index to identify injuries at
high risk for work-related musculoskeletal disorders of the
neck, back and upper extremity in
Washington State. Am J Ind Med 41:149-169.
http://actprod.cbs.state.or.us/iportal/report_catalog.html
http://actprod.cbs.state.or.us/iportal/report_catalog.html
http://www.ncbi.nlm.nih.gov/pubmed/17452538
http://www.ncbi.nlm.nih.gov/pubmed/17452538
http://www.ncbi.nlm.nih.gov/pubmed/22420026
http://www.ncbi.nlm.nih.gov/pubmed/22420026
https://www.ncci.com/documents/2011_Aging_Workforce_Rese
arch_Brief.pdf
https://www.ncci.com/documents/2011_Aging_Workforce_Rese
arch_Brief.pdf
http://www.iso.com/Conferences/Loss-Control-
Forum/Home.html?blogclick E&S Forum link
http://www.iso.com/Conferences/Loss-Control-
Forum/Home.html?blogclick E&S Forum link
https://www.ncci.com/documents/Obesity-2012.pdf
https://www.ncci.com/documents/Obesity-2012.pdf
Workers’ Compensation Insurance: A Primer for Public Health](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-214-320.jpg)
![33Workers’ Compensation Insurance: A Primer for Public
Health
Smith CK, Silverstein BA, Bonauto DK, Adams D, Fan ZJ
[2010]. Temporary workers in
Washington State. Am J Ind Med 53: 135-145.
Spieler E [1994]. Perpetuating risk? Workers’ compensation and
the persistence of occupational
injuries, 31 Houston Law Rev. 119-264. Excerpts reprinted in
Employment Law (Rothstein M,
Leibman L, eds. ); 1995 Workers’ Compensation Yearbook
(Burton, JF Jr. ed. 1994).
Spieler EA, Burton JF [2012]. The lack of correspondence
between work-related disability and
receipt of workers’ compensation benefits. Am J Ind Med
55:487-505.
Spielholz P, Cullen J, Smith C, Howard N, Silverstein BA,
Bonauto DK [2008]. Assessment of
perceived injury risks and priorities among truck drivers and
trucking companies in Washington
State. J Safety Res 39:569-576.
Thacker SB, Qualters JR, Lee LM [2012]. Public health
surveillance in the United States:
Evolution and challenges. MMWR (Suppl) 61(03):3-9.
Thamann D, Reitz D [2000]. Workers’ Compensation Guide,
Interpretation and Analysis, The
National Underwriter Company, Cincinnati, OH.
Trogdon JG, Finkelstein EA, Hylands T, Dellea PS, Kamal-Bahl
SJ [2008]. Indirect costs of
obesity: A review of the current literature. Obes Rev 9(5):489-](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-215-320.jpg)
![500.
U.S. Bureau of Labor Statistics [2012]. News Release: Nonfatal
occupational injuries and illnesses
requiring days away from work, 2011. Washington DC.
November 8, 2012. [http://www.bls.gov/
news.release/osh2.nr0.htm]. Accessed on June 11, 2013
U.S. Chambers of Commerce [2012]. 2011 Analysis of Workers’
Compensation Laws. Washington
DC. (Updated annually in July of subsequent year)
Utterback DF, Schnorr TM, Silverstein BA, Spieler EA, Leamon
TB, Amick BC [2012].
Occupational health and safety surveillance and research using
workers’ compensation data. J
Occup Environ Med 54:171-176.
Washington State Department of Labor and Industries [2012].
Division of Occupational Safety
and Health, Directive 2.10: Programmed inspection and visit
activities, January 5, 2012. [http://
www.lni.wa.gov/Safety/Rules/Policies/PDFs/WRD210.pdf ].
Accessed on November 7, 2013.
Willborn SL, Schwab SJ, Burton JF, Lester GLL [2012].
Employment Law: Cases and Materials.
LexisNexis, New Providence, NJ.. p. 881.
Winslow, Charles-Edward Amory [1920]. The untilled fields of
public health. Science 51(1306):
23–33.
Wurzelbacher SJ, Meyers AR, Bertke SJ, Lampl M, Robins DR,
Bushnell PT, Tarawneh A,
Childress D, Turnes J [2013]. Comparison of cost valuation](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-216-320.jpg)
![Workers’ Compensation Insurance: A Primer for Public Health
Delivering on the Nation’s promise:
safety and health at work for all people
through research and prevention
To receive documents or other information about occupational
safety and health
topics, contact NIOSH
Telephone: 1-800-CDC-INFO (1-800-232-4636)
TTY: 1-888-232-6348
email: [email protected]
or visit the NIOSH website http://www.cdc.gov/niosh/
For a monthly update on news at NIOSH, subscribe to NIOSH
eNews by visiting
http://www.cdc.gov/niosh/eNews.
DHHS (NIOSH) Publication No. 2014–110
January 2014
Department of Health and Human Services
Centers for Disease Control and Prevention
National Institute for Occupational Safety and Health
DisclaimerOrdering
InformationForewordAcknowledgementsAcronyms and
AbbreviationsTable of Contents1. Introduction2. Background3.
Brief History of Workers’ Compensation in the US4. Workers’
Compensation Insurance Benefits5. Workers’ Compensation
Insurance Providers6. State Workers’ Compensation Agencies7.](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-230-320.jpg)
![campaign through e‐mail ([email protected]). Their website
contains fall prevention information
and materials, and allows stakeholders to share their own
campaign success stories. Print
campaign materials are available through OSHA
(www.osha.gov/stopfalls). Other resources,
including research findings, training aides and videos, are
available on the three official
campaign websites: www.osha.gov/stopfalls/,
www.cdc.gov/niosh/construction/stopfalls.html,
and www.stopconstructionfalls.com. OSHA’s campaign website,
www.osha.gov/stopfalls/ is
now available in both English and Spanish.3 With simple
language, clear illustrations, and easy‐
to‐follow instructions, our campaign materials include posters,
factsheets, safety videos,
stickers, and public service announcements, spot‐the‐hazards
cards.
The campaign was a re‐launched on Workers Memorial Day on
April 28, 2013 with new
products for active dissemination, including a “Local Partners
Manual” for persons or
organizations at the local, state or regional levels who wish to
start their own local campaigns.](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-247-320.jpg)
![mailto:[email protected]
http:http://www.stopconstructionfalls.com](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-250-320.jpg)
![aign websites hosted by NIOSH, OSHA and
CPWR received over half a
million page views in 2012.
visits) to its
www.cdc.gov/niosh/construction/stopfalls.html. Five of the ‘top
ten’ tweets from
[email protected] were centered on construction falls.
by National Construction
Center CPWR had 900,215 page views (96,892 unique visits).
The campaign also
generated 503 email inquiries and 62 campaign partners.
for the campaign by a NORA
Construction Sector Council member at Washington University
School of Medicine in St.
Louis. The Facebook page has 315 ‘likes,’ and has reached 14
states in the U.S. and 44
countries worldwide.](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-255-320.jpg)
![The website was developed and launched by Dr. Lipscomb and
her carpenter colleagues. The
site is funded by the National Construction Center.
The NIOSH Office of Construction Safety and Health conducted
an informal evaluation of the
Nail Gun Safety: A Guide for Construction Contractors by
reaching out to nine stakeholders to
get feedback on the Guide, stories about its impact, or other
ideas on dissemination. From what
we have heard, the Guide has been a real help to the industry.
Members the Associated
General Contractors of America (AGC), an important
stakeholder and member of the NORA
Construction Sector Council, expressed their pleasure with the
document. In fact, one
contractor called it “the best document he has ever received
from the [federal] government,”
and he said that he has made it required reading for all of his
staff. The findings from this
evaluation are included in Appendix II.
NIOSH CSH, Accomplishments, 2009‐2013, Page 9 of 27
http:www.nailgunfacts.org](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-265-320.jpg)
![(DSR) designed, developed, and patented (U.S. Patent No.
7,509,702, issued on March 29,
2009) a multi‐functional guardrail system that can be used on
numerous residential and
commercial‐industrial work sites. This research is being led by
Dr. Thomas Bobick5 and supports
NORA Construction Sector ‘Ready for Impact” Strategic Goal
#1 to “Reduce Construction
Worker fatalities and serious injuries caused by falls to a lower
level.” This guardrail system is
capable of providing protection to personnel who must work
near (1) unguarded roof surfaces,
(2) unguarded skylights, (3) unguarded roof and floor holes, and
(4) on stairs that have not yet
had handrails installed. The easy‐to‐install fall‐prevention
system was designed to meet all
OSHA safety requirements for guardrails. Through extensive
testing in NIOSH labs, the final
design will support more than twice the OSHA 200‐pound
top‐rail strength requirement for a
worker falling against it. It can be used on commercial,
industrial, and residential flat roofs, as
well as being adjustable to 7 different residential roof slopes
(from 6‐in‐12 [27°] to 24‐in‐12](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-278-320.jpg)
![[63°]). In addition, four other variations were developed for
installation on flat and vertical
surfaces that are unprotected, including staircases before the
handrails are installed.
Impact: The impact of using the NIOSH guardrail system is an
adaptable fall‐prevention system
that is readily available to improve safety conditions for
residential and commercial
construction workers. The safety intervention can be installed to
protect workers in situations
where fall protection is not normally used. From September
2011 to October 2012, a field
evaluation was conducted by the West Virginia University
Safety and Health (WVUS&H)
Extension Office. One local WV residential contractor was
evaluated during this time.6 The
contractor used the system on a variety of homes to meet the
requirements of the OSHA fall‐
protection standards. Through a contract with NIOSH, the
WVUS&H Extension Office provided
training in the use of the fall‐prevention system, using
installation instructions developed by the
project team. The owners of the contracting firm commented
that they normally do not use](https://image.slidesharecdn.com/introductiontooshadirectorateoftrainingandeducati-221018140150-bd848b0c/85/Introduction-to-OSHA-Directorate-of-Training-and-Educati-docx-279-320.jpg)
Introduction to OSHA Directorate of Training and Educati.docx
- 1. Introduction to OSHA Directorate of Training and Education OSHA Training Institute Lesson Overview Purpose: information about OSHA Topics: 1. Why is OSHA important to you? 2. What rights do you have under OSHA? 3. What responsibilities does your employer have under OSHA? 4. What are OSHA standards? 5. How are OSHA inspections conducted? 6. Where can you go for help? 2 Topic 1: Why is OSHA Important to You? 405 workers were killed on the
- 2. job in 2013 (3.2 per 100,000 full- time equivalent workers) die every day were killed from work-related injuries in 2013 ous workplace injuries and illnesses were reported by private industry employers in 2012 3 OSHA Makes a Difference • Worker deaths in America are down–on average, from about 38 worker deaths a day in 1970 to 12 a day in 2013. • Worker injuries and illnesses are down–from 10.9 incidents per 100 workers in 1972 to 3.0 per
- 3. 100 in 2012. Occupational Safety and Health Administration, an agency of the U.S. Department of Labor is to improve worker safety and health protection 4 the OSH Act formally came into being on April 28, 1971 History of OSHA OSHA’s Mission mission of OSHA is to assure safe and healthful working conditions for working men and women by setting and enforcing
- 4. standards and by providing training, outreach, education and assistance. mission are: ◦ Developing job safety and health standards and enforcing them through worksite inspections ◦ Providing training programs to increase knowledge about occupational safety and health 5 Topic 2: What Rights Do You Have Under OSHA? ve the right to: ◦ A safe and healthful workplace ◦ Know about hazardous chemicals ◦ Report injury to employer ◦ Complain or request hazard correction from employer ◦ Training ◦ Hazard exposure and medical records ◦ File a complaint with OSHA ◦ Participate in an OSHA inspection ◦ Be free from retaliation for exercising safety and health rights 6 Worker Rights
- 5. Handout #1: OSHA Poster work? 7 ection is Law: The Occupational Safety and Health Act of 1970 (OSH Act) right to a safe and healthful workplace workplaces that are free of known dangers that could harm their employees to participate in activities to ensure their protection from job hazards 8 Your Right to…
- 6. written, complete hazard communication program that includes information on: physical and health hazards of the chemicals and how workers can protect themselves 9 Your Right to… The Hazard Communication Standard (HCS) requires chemical manufacturers, distributors, or importers to provide Safety Data Sheets (SDSs) (formerly known as Material Safety Data Sheets or MSDSs) to communicate the hazards of hazardous chemical products. As of June 1, 2015, the HCS will require new SDSs to be in a uniform format.
- 7. requires most employers with more than 10 workers to keep a log of injuries and illnesses report an injury* and review current log view the annually posted summary of the injuries and illnesses (OSHA 300A) Your Right to… 10 *It is against the OSHA law to retaliate or discriminate against a worker for reporting an injury or illness concerns in the workplace to their employers without fear of discharge or discrimination
- 8. concerns to their employer or OSHA about unsafe or unhealthful conditions in the workplace Your Right to… 11 training from employers on a variety of health and safety hazards and standards that employers must follow 12 Your Right to… ng covers topics such as, chemical hazards, equipment hazards, noise, confined spaces, fall hazards in construction, personal protective equipment, along with a variety of other subjects workers can understand
- 9. physical agents are: ◦ Metals and dusts, such as, lead, cadmium, and silica ◦ Biological agents, such as bacteria, viruses, and fungi ◦ Physical stress, such as noise, heat, cold, vibration, repetitive motion, and ionizing and non-ionizing radiation Your Right to… 13 complaint with OSHA if they believe a violation of a safety or health standard, or an imminent danger situation, exists in the workplace not be revealed to the employer have the right to find out OSHA’s action on the complaint and request a review if an inspection is not made Your Right to…
- 10. Note: Often the best and fastest way to get a hazard corrected is to notify your supervisor or employer. 14 OSHA inspector e inspector privately injuries, illnesses or near misses that resulted from those hazards and describe any concern you have about a safety or health issue results, abatement measures and may object to dates set for violation to be corrected
- 11. Your Right to… 15 retaliation for exercising safety and health rights health on the job without fear of punishment the OSH Act feel they have been punished for exercising their safety and health rights Your Right to… 16 e a workplace free from recognized hazards and comply with OSHA standards standards and provide workers access to their exposure and medical records
- 12. their rights under the Act (Section 11(c)) 17 Employer Responsibilities (cont.) 18 REPORTING AND RECORDING CHECKLIST Employers must: -related hospitalization, amputation, or loss of an eye ry or illness to the employer Topic 4:
- 13. What are OSHA Standards? OSHA standards are: methods employers must use to protect employees from hazards workers from a wide range of hazards 19 Four Groups of OSHA Standards General Industry* Construction Maritime Agriculture *General Industry is the set that applies to the largest number of workers and worksites Where there are no specific standards, employers must comply with the General Duty Clause of the OSH Act.
- 14. OSHA Standards (cont.) These standards also: substances, or noise that workers can be exposed to and equipment and keep records of workplace injuries and illnesses 20 Most Frequently Cited OSHA Standards 21 OSHA’s website provides information regarding the most frequently cited standards Click: Frequently Cited OSHA Standards to view current data establishment,” select ALL or one of the options listed Federal or, from the dropdown
- 15. menu, a specific state groups, or enter a valid 2 to 6 digit code for a specific Industry from the NAICS Manual ults for: All sizes of establishments, in Federal jurisdiction, with a Construction NAICS code of “23” Common Most Frequently Cited Standards: Fall Protection; Hazard Communication; Scaffolding; Respiratory Protection; Electrical; Powered Industrial Trucks; Ladders http://www.osha.gov/pls/imis/citedstandard.html safety and health officers (CSHOs) to conduct workplace inspections at reasonable times notice, except in rare circumstances (e.g. Imminent Danger) an OSHA inspection in advance can receive fines and a jail term 22
- 16. Different Types of OSHA Inspections talizations complaints/referrals — Local Emphasis Program (LEP), National Emphasis Program (NEP), particular hazards or industries -up Inspections 23 23 VIOLATION TYPE PENALTY WILLFUL A v io la tio n th a t th e e m p lo y e r in te n tio n a lly a n d k n o w in g ly c o m m its o r a v io la tio n th a t th e e m p lo y e r c o m m its w ith p la in in d iffe re n c e to th e la w . O S H A m a y p ro p o s e p e n a ltie s o f u p to $ 7 0 ,0 0 0 fo r e a c h w illfu l v io la tio n , w ith a m in im u m p e n a lty o f $ 5 ,0 0 0 fo r e a c h w illfu l v io la tio n .
- 17. SERIOUS A v io la tio n w h e re th e re is s u b s ta n tia l p ro b a b ility th a t d e a th o r s e rio u s p h y s ic a l h a rm c o u ld re s u lt a n d th a t th e e m p lo y e r k n e w , o r s h o u ld h a v e k n o w n , o f th e h a za rd . T h e re is a m a n d a to ry p e n a lty fo r s e rio u s v io la tio n s w h ic h m a y b e u p to $ 7 ,0 0 0 . OTHER-THAN-SERIOUS A v io la tio n th a t h a s a d ire c t re la tio n s h ip to s a fe ty a n d h e a lth , b u t p ro b a b ly w o u ld n o t c a u s e d e a th o r s e rio u s p h y s ic a l h a rm . O S H A m a y p ro p o s e a p e n a lty o f u p to $ 7 ,0 0 0 fo r e a c h o th e r-th a n -s e rio u s v io la tio n . REPEATED A v io la tio n th a t is th e s a m e o r s im ila r to a p re v io u s v io la tio n . O S H A m a y p ro p o s e p e n a ltie s o f u p to $ 7 0 ,0 0 0 fo r e a c h re p e a te d v io la tio n . 24 conduct an inspection at your workplace
- 18. HA violations? 25 26 -workers and union representatives tion on chemicals training materials 27
- 19. OSHA offices (you can call or write) istance Specialists in the area offices Health (NIOSH) – OSHA’s sister agency ocal, community-based resources 28 http://www.osha.gov/ How to Raise a Concern Handout #7: Identifying Safety and Health Problems in the Workplace workplace hazards ered safety and/or health problems in the workplace/site 29
- 20. website ◦ Workers can file a complaint ◦ A worker representative can file a complaint local regional or area offices to discuss your concerns – be specific and include appropriate details 30 Handout #8a: General Industry discusses the industry-specific scenario would be important to include in their complaint ◦ What was included in the complaint? ◦ What was added to the complaint?
- 21. 31 Handout #8b: Construction discusses the industry-specific scenario would be important to include in their complaint ◦ What was included in the complaint? ◦ What was added to the complaint? 32 Handout #8c: Maritime Industry discusses the industry-specific scenario would be important to include in their complaint ◦ What was included in the complaint?
- 22. ◦ What was added to the complaint? 33 sources inside the workplace that will help you find information on safety and health issues? workplace that will help you find information on safety and health issues? 34 This lesson covered: importance of OSHA, including the history of safety and health regulation leading to the creation of OSHA and OSHA’s mission; esources, including how to file a complaint.
- 23. 35 Thank You! Introduction to�OSHALesson OverviewTopic 1:�Why is OSHA Important to You?History of OSHAOSHA’s MissionTopic 2:�What Rights Do You Have Under OSHA?Worker RightsSlide Number 8Slide Number 9Slide Number 10Slide Number 11Slide Number 12Slide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17Employer Responsibilities (cont.)Topic 4:�What are OSHA Standards?OSHA Standards (cont.)Most Frequently Cited OSHA StandardsSlide Number 22Different Types of OSHA InspectionsSlide Number 24Questions for ReviewSlide Number 26Slide Number 27Slide Number 28How to Raise a ConcernSlide Number 30Group Activity: Filing a ComplaintGroup Activity: Filing a ComplaintGroup Activity: Filing a ComplaintQuestions for ReviewSlide Number 35Slide Number 36 Unit Assessment QUESTION 1 What steps must an organization take before an accident occurs to ensure it is prepared to conduct an effective accident investigation? Your response must be at least 200 words in length. QUESTION 2
- 24. Explain the four levels of accidents, providing an example of each. How are the categories different from each other? Your response must be at least 200 words in length. QUESTION 3 Why is it important to include near misses in the accident investigation process? Your response must be at least 75 words in length. QUESTION 4 How do accident investigations help an organization avoid spending money in the future? Your response must be at least 75 words in length. QUESTION 5 Describe two characteristics of an effective accident investigation process that you feel are particularly important. Briefly explain your choices. Your response must be at least 75 words in length. QUESTION 6
- 25. In addition to identifying accident causal factors, what other benefits does an effective accident investigation process provide to a safety and health program? Your response must be at least 75 words in length. CHAPTER2 - ..• An Accident Happens What D o You Do? How Long D o You Do It? These two questions are major issues of accident investigation that must be addressed and answered. Answering the first is simple: p1,;ovide emergency response, protect the employees involved from further harm, and try to determine what happened so that measures can be taken to prevent its happening again. Answering the second question is more difficult. Some companies commit a specific amount of time to an accident investigation-a day, two weeks, or a month, for example-depending on the severity of the accident. In a perfect world, there is no time limit-an accident investigator investigates an accident until he or she is reasonably certain of what happened and why. This book answers the first question-it tells
- 26. you what to do-and it provides ways to decrease the amount of time it takes to do it. Accident investigations are a dreadful part of a safety professional's job. Accident outcomes may include injuries, fatalities, and property or equipment damage. It is sometimes difficult to "get over" the outcome of an accident, especially if there is a fatality or an employee is hospitalized because of it. However, accident investigations are a necessary and critical part of the 9 Part I: Introduction to the Accident Sequence 10 occupational safety process. A thorough acciden~ investigation can be of ~eat benefit to your organization, not only by preventmg ~e same type of accident from happening again, but also by finding syste~c problems that ~ould cause more severe accidents in the future. The main purpose of an accident investigation is to find the causes (what happened) and _fix the problems to prevent the accident from recurring. "Accidents do not )USt happen, but are caused" (Marshall 2000, 29).
- 27. Goals of Accident Investigation Determine the Accident Sequence without Placing Blame An accident investigation determines the accident sequence and finds the causal factors of an accident. Its purpose is not to find fault or assign blame. How do you keep from finding fault when an individual disregards a major safety policy? The answer is to be fair and consistent with your policy. If there is no accountability for violating a safety policy or disregarding the safety program, then the safety program will eventually fail. The main issue is to find out why the individual violated the safety policy. The accident investigator must determine why the safety program allowed the individual to disregard the rule and why supervisors did not enforce the rule. While these types of situations are rare, it is imperative for companies to correct problems with their safety programs to keep accidents from happening (Sorrell 1998). Recommend Corrective Actions Accident investigations determine corrective actions so that future accidents are prevented and the overall safety program is improved.
- 28. Update the Overall Safety Program By identifying hazards from th k 1 1 h e wor er level up to the management systerns eve , t e safety progr b . am can e updated and improved. An accident is afl opporturuty to find and fix problems wi·th th £ e sa ety program. Chapter 2: An Accident Happens Accident Reporting Thorough Reporting Is Necessary Accidents cannot be investigated if they are not properly reported. All accidents, including fatalities, injuries, and property damage, as well as potential accidents (near misses), should be reported. Formal company policy and employee training must spell out how to properly and consistently report accidents, near misses, and property damage (Vincoli 1994). Individuals must have no fear of repercussions for informing the company or the safety department of an accident or near miss. If people fear punishment or repercussion (accusation of fault or blame) for accidents, they are less likely to report them (Speir 1998). It is crucial to a company's safety program and to the
- 29. prevention of future accidents that all accidents and near misses be reported so that all of the problems in the safety program can be found. Incentive Programs Must Reward Reporting Incentive programs have been developed to reward safe behaviors. Unfortunately, many of them do not actually reward safe behavior but instead inhibit the reporting of accidents and near misses because employees fear losing their incentives. Such incentives do not improve safety programs. Reporting accidents and near misses, finding causal factors, and determining corrective actions, however, will improve them. Reporting accidents and near misses should be rewarded, and incentive programs should be designed to reward the reporting of all accidents and near misses. Documentation versus Investigation When accidents occur, it is not just meant to document the occurrence. The purpose of an accident investigation is to ask questions, interview, analyze, probe, and discover what happened. It is not just to take witness statements and document what happened. Many companies' accident investigation forms and record-keeping forms are just a documentation tool. The purpose is to use these forms and tools to investigate and determine the
- 30. causal factors and prevent these instances from occurring. 11 Part I: Introduction to the Accident Sequence 12 Why Do We Need Accident Investigations? To Avoid Spending Money on Accidents in the Future Accidents are a major expense for companies. According to the 2011 edition of I,gury Facts, in 2009 the total cost of unintentional injuries at work Was $168.9 billion dollars (National Safety Council 2011). This monetary figure does not reflect the cost of human pain and suffering as a result of accidents. In 2009, 3,582 fatal occupational injuries occurred and 5.1 million injuries were reported (National Safety Council 2011). Bird and Germain compare the costs of an accident to an iceberg-like an iceberg, most of the costs of an accident are not obvious and are not seen. For every dollar of medical and insurance costs an injury or illness incurs, the uninsured costs are $5 to $50 and miscellaneous costs are $1 to $3. The uninsured costs include damage to equipment, tools,
- 31. and products; production delays; and legal expenses. The miscellaneous costs include accident investigation expenses, hiring replacement workers, and loss of business (Bird and Germain 1985). As expensive as an accident may be, the resulting investigation can ultimately save money by helping to prevent future accidents and update safety programs. Future savings will be found in identifying systemic problems in the safety program and correcting them. Near misses are excellent opportunities to prevent costly accidents and identify and deal with systemic problems in the safety program. Accident costs come directly from a company's bottom line. While saving money is a great motivator for improving safety procedures, a bigger motivator is avoiding the pain and suffering accidents produce. The field of occupational safety is very dynamic, with theories and concepts that change over cirn_e. However, most people would agree that "the ultimate goal of all efforts 1~ . safety engineering should be to reduce accidents and harmful exposures (.Marshall 2000, 6). To Prevent Future Accidents A 'd . . . d . 1·ured, n acc1 ent 1nvest1gat1on cannot do
- 32. anything for the person alrea Y U1 . . the machine already damaged, or the product already destroyed. Its value is JJl Chapter 2: An Accident Happens preventing future accidents. Although investigations are performed reactively, they allow companies to be proactive in improving their safety programs. To Comply with the Law and Detennine the Total Cost of an Accident Accident investigations must also be performed to complete workers' compensation claims, to comply with legal requirements and Occupational Safety and Health Administration (OSHA) regulations, and to determine the total costs of accidents. Decisions to Be Made Before an Investigation Begins Determine the Level of Investigation Companies define levels of accidents and levels of accident investigations to help answer questions about how an investigation will be conducted- such as how much detail the investigation should uncover and how long the investigation should take. In general, the more serious an accident is, the more
- 33. detailed the investigation will be and the longer it will take. The philosophy of this book is that whether an accident is minor or catastrophic, the investigation process still follows the same steps---develop the accident sequence, analyze it, determine causal factors, and recommend corrective actions. The levels of accidents and types of accident investigations are listed in Exhibit 2.1. Decide Who Will Investigate Once the accident level and the depth of investigation are determined, your company must decide whether to use an individual or a team to do the investigation. Many people from throughout your organization may be able to perform adequate accident investigations. The key is to choose the person (or persons) who is in the best position to discover what really happened and determine how to prevent it from happening again. Foremen and supervisors are excellent choices if they are able to look beyond their departments to 13 Part I: Introduction to the Accident Sequence 14 Exhibit 2.1
- 34. CATEGORIZATION OF ACCIOENTS LEVELS OF ACCIDENTS TYPES OF ACCIDENT INVESTIGATIONS 1. Near miss Near misses can range from potentially minor to potentially catastrophic accidents. At the least, document the near miss on a form, determine its causes, and recommend corrective actions. 2. Minor injury or first-aid case 3. Major injury or recordable injury 4. Catastrophic injury (fatality, many injured, or major property damage) Investigate, interview injured employee, determine causes, and recommend corrective actions. Document on a form. Investigate, interview the injured employee and witnesses, use analytical techniques, determine causes, and recommend corrective actions. Write a short report. Team investigation. Interview injured, eyewitnesses, and other employees; use analytical techniques; determine causes; and recommend corrective actions. Write a full report explaining the analytical techniques used.
- 35. · • c gernent, system1c causes-problems with the overall system of sa1ety mana d · shoul They usually understand the workers' jobs and the roles supervisors play. Safety professionals can do investigations, but usually they do;; fully understand all of the workers' job functions, so they must spen~ .is 1 · · b d · fessionai earruog JO uttes and sequences. A more useful role for safety pro . aJs · ·din · . fession is prov1 g assistance to accident investigators, since safety pro (11 . d t syste are trame to uncover and analyze systemic causes and managernen causes. The Team Approach . cioD For large or comple "d th "d , ... vestlgi1 x acci ents, e team approach to acc1 ent ,,, . Jess seems loo-ical beca · . d th n with . i:,· use more 10format1on must be analyze a ,vbO senous accidents Th al . . }eade! · e usu team approach is to appoint a team tbe oversee~ and manages the investigation. The number of individuals o:)•ect team will vary dep din -ny s1.1 en g on the accident's complexity. NortnaJ.L '
- 36. Chapter 2: An Accident Happens matter experts will be used to lend expertise about the complex issues that will be uncovered in the accident investigation. In order for a team investigation to work effectively, the team leader must assign each subject matter expert to work in his or her area of expertise. Having the subject matter experts work separately on the overall investigation rather than concentrating on their own areas is a waste of time. Each subject matter expert should have a separate area to focus on, such as a technical or engineering issue, training, management systems, supervision, emergency response, etc. The team leader coordinates all of the efforts and ensures that all of the subject matter experts are working toward a common goal- finding out what happened and how to prevent it. Decide How Much Time Will Be Allotted to the Investigation Deciding how much time the investigators will be given to perform the investigation and document the findings is a difficult decision. Many companies allot a set amount of time based on the level of the accident and the type of investigation to be performed. Ideally, the company should allow
- 37. enough time to find out what happened and determine how to prevent it from recurring. In most cases, a first-aid case or an OSHA-recordable case will take a few days, while a major injury, fatality, or other complex accident may take anywhere from a couple of days to a month. Investigations of catastrophes with multiple fatalities and involving complex systems (plant explosions, plane crashes, etc.) usually take from a month to several years. The time needed to perform investigations at any level depends on the amount of data collected, the number of interviews, the number of people helping with the investigation, the analytical methods used, the complexity of the systems involved, and the length of the final report or form. Determine Whether Additional Resources Will Be Needed For the most part, this book discusses nonproprietary investigation techniques that do not require extra expenses. However, in many investigations, consultants (subject matter experts, medical doctors, lawyers) or special 15 Part I: Introduction to the Accident Sequence 16
- 38. equipment (testing equipment, external testing, laboratory work, computer software) may be needed. Coordinating these resources will extend the tune needed to perform an investigation. Summary The basic requirement for a successful accident investigation program is a formal accident-reporting policy with proper and consistent reporting of all accidents and near misses from employees who do not fear repercussions. In the past, most accident investigations began with the question ''Who did it?" In a mod~m investigation, the accident investigator must concentrate on causal factors and corrective actions and not place blame. Accident investigations should be conducted by a qualified individual or team. The purpose of the investigation is to find the causal factors of the accident and determine the corrective actions to prevent recurrence of the accident as well as to find systemic causes and thus prevent other types of accidents in the future. Accident investigations are a necessary part of the occupational safety process. Although proactive accident prevention and loss control strategies are the main purpose of a safety program, accidents will occur. The company
- 39. and the accident investigator must learn from each accident and revise the safety program as needed. Part I INTRODUCTION TO THE ACCIDENT SEQUENCE Accidents do not just happen-they are caused, and the key to accident investigation is to find the causes. The first step in finding the cause of an accident is to examine the sequence of events that led up to it. Discovering this sequence is the goal of many of the analytical techniques discussed later in the book. This part of the book includes many theories that have been developed to determine how accidents occur. Many have been and continue to be used, and many others have been disproven. This book will mention many theories, but will focus on those that are based on the accident sequence. The objective of this book is to present an analytical approach to accident investigations-gathering evidence, using analytical techniques and ~e analytical process to determine the accident sequence, and using this Info .
- 40. rmatton to discover the causes and to recommend changes to prevent future accidents. Ob· Jectives for Part I: • Dnderstand that accidents have a sequence of events and be able to deter · thi mine · s sequence. • Be familiar with several accident causation theories and know how each applies to the accident sequence. Part I: Introduction to the Accident Sequence 2 • Be aware that most accidents have multiple causes. • Be able to break down accidents and use an analytical approach to investigate them. CHAPTER1 What is An Accident? Nobody wants to answer the phone and hear the words, "There's been an accident." But what is an accident? There are many different
- 41. ways in which that term is to describe something that should not have occurred. A child would say, "It was an accident. I didn't mean to break that window with my ball." However, in the realm of investigations, an accident is an occurrence in a sequence of events that produces unintended injury, death, or property damage. Definition of Terms Accident There are many definitions for accident. Most books agree that an accident is an undesired event that causes injury or property damage (Bird and Germain 1985). Many companies use the term incident rather than accident because accident implies human error, whereas, according to the National Safety Council, "an incident is an unintentional event that may cause personal harm or other damage" (National Safety Council 2009, viii). The definition of accident that best captures the analytical approach to accident investigation is: "Th at occurrence in the sequence of events that produces unintended injury, 3 Part I: Introduction to the Accident Sequence
- 42. 4 death, or property damage" (National Safety Council 2009, viii). Accidents are sequences of events. There are normal (positive) sequences where there is no accident and accident sequences, also called negative sequences. An accident is a result of a negative sequence of events. These definitions and others are listed in Exhibit 1.1. Near Miss The difference between an accident and a near miss is usually luck or chance. A near miss is an occurrence in a sequence of events that had the potential to produce injury, death, or property damage but did not. Near misses can and should be investigated the same way accidents are. Accident Investigation An accident investigation is a structured process that attempts to uncover the sequence of events that produced or had the potential to produce injury, death, or property damage so that causal factors can be determined and corrective actions can be taken. Any occurrence that has a sequence of events can be investigated by analytical techniques-first-aid cases, OSHA-recordable injuries or illnesses, fatalities, property
- 43. damage, or near misses. The steps in an accident investigation are: analyzing the facts, developing an accident sequence, finding the causes, and recommending corrective action. The next definitions have to do with the accident itself. Safety professionals use various terms for the basic terminology of the profession (Sorrell 1998); this book simplifies the definitions. Causal Factors The causes of the accident are called the causal factors. A causal factor is an event or circumstance that produced an accident. Other books may use the term root cause to mean something similar. Causal factors can be at the basic (worker or equipment) level, the intermediate (supervisory) level, and the upper management level. The causal factors of an accident answer the question, ''What happened?" After causal factors are determined through an Chapter 1: What is An Accident? analytical process, con-ective actions are developed to prevent similar types of accidents.
- 44. Corrective Actions Corrective actions are the actions taken to prevent recurrence of the accident. Causal factors link to corrective actions to address all levels of causes and accountability ( see Exhibit 1.1, Definitions). Exhibit 1.1 DEFINITIONS Accident-The occurrence in a sequence of events that produces unintended injury, death, or property damage. Incident-An unintentional event that may cause personal harm or other damage. Near Miss-An occurrence in a sequence of events that had the potential to produce injury, death, or property damage but did not. Accident Investigation-A structured process of uncovering the sequence of events that produced or had the potential to produce injury, death, or property damage to determine the causal factors and corrective actions. Causal Factors-Events and circumstances that produced the accident. Causal factors incorporate "root causes," "basic causes," "immediate causes," lower level causes, upper level causes, and management causes. When discovering causal factors, it is important to analyze all causes at all levels.
- 45. Corrective Actions-The actions taken to prevent recurrence of the accident. Corrective actions are the "fixes" to prevent future accidents. These fixes should be performed at the appropriate level. Accidents versus Incidents There has been much debate from safety professionals on the relevance of the terms accident and incident. Many companies use the term incident to lessen the impact of human error or fault in the meaning. Many companies and even governmental agencies have switched to the term incident and thus perform 5 Part I: Introduction to the Accident Sequence 6 incident investigations. Other companies use the concept of an incident as more of property or equipment damage. There is not much use in trying to contemplate the differences, and just embrace whichever one works for your company or industry. The same accident investigation processes and analytical techniques can
- 46. be used no matter what term is used to describe the unintended injury, death, or property damage. Near Misses How do near misses fit into the accident investigation process? A near miss is an occurrence in a sequence of events that had the potential to produce injury, death, or property damage but did not. In aeronautical terms, when airplanes almost collide or fly too close to each other, then it is a near miss or you could say a near hit-they nearly hit each other. In these instances you want a far hit. The concept of a near miss is widely confused among employees and these instances usually do not get properly reported. The best concept that can be used to describe a near miss is when someone sees you do something and says, ''You were lucky," or '"( ou dodged a bullet on that occasion. That almost got you that time." These are all instances that resulted in a near miss. What is the difference in an accident and a near miss? Again, sometimes the only difference in a near miss and an accident is a matter of inches or seconds and luck or chance. If the blade was one inch to the left, then it would have been a fatality. According to the definitions, the only difference between these
- 47. two terms is the severity that one was hurt, or damage was done. The moSt important issue is to determine the potential of injury, death, or property damage for these instances. The biggest problem with near misses is the procedure for how these near misses are reported. If near misses are not reported, then they cannot be investigated; thus, the potential for an accident still exists. These near misses are extremely important to understand and ensure that all employees understand the importance of prompt reporting of these instances. Near misses usually fall into the categories that will eventually ruro into an accident. How companies handle and react to near misses is the keY to preventing these hazards and issues before they become accidents. Praise Chapter 1: What is An Accident? and recognition for reporting near misses, instead of fault- finding accusations, will start a trend in more reporting of near misses, thus making near misses a proactive management tool to ensure a sincere message of trying to fix problems and prevent accidents (Clark 2010). Property Damage and Equipment Damage Accidents
- 48. Property damage and equipment damage accidents are also sometimes as confusing as near misses and also often unreported. One of the issues with this type of accident is the monetary damage. Similar to near misses, how much monetary damage is enough to prompt a response or reporting? A broken hand tool might not get reported; however, a vehicle crash might get reported. These are also based on potential, in that even though there was no injury or death, there was still loss, but there was potential for injury as well. Just take a look at forklifts in plants: how many do you see that are all scratched and dented? I wonder how many of those were reported. Small versus Big Accidents Many professionals get bogged down by the issue of big accidents versus small accidents. All accidents, no matter how big or small, can and should be investigated. It starts with a hazard or a hazardous situation. The bigger the hazard or hazardous situation or act/ omission, then the more likelihood of loss. There are instances where a near-miss accident had more potential than an injury accident; however, through chance and luck it was just a small accident or a near miss. That near miss must be investigated, causal factors
- 49. found, and corrective actions taken to prevent a much bigger accident and loss the next time, if conditions remained the same. Just because the accident was a small one this time, if conditions and acts are not corrected, then a big accident will come later. Near misses, property damage, and injury accidents can all be investigated. Risk and Accidents There has been much debate over these terms over the years. There is risk in everything we do. Risk is the amount of probability of occurrence and severity of occurrence that is inherent in everything we do. There are also hazards 7 Part I: Introduction to the Accident Sequence 8 that increase the amount of risk in our everyday life. Zero accidents is a goal that every company and every person should strive to meet. While most companies strive to reduce hazards and hazardous situations and reduce the amount of risk, there are risky situations that arise every day at the workplace.
- 50. Summary There are many types of accidents, near misses, and even property damage events that need to be investigated. The type of accident makes no difference. First aid injuries or fatalities and catastrophes are basically all the same. The theories apply to both the small accident and the large accident and even near misses. There is a sequence of events for all, and while some are more complicated than others, they are basically the same. Many of the near misses are categorized as a near miss because of luck more than safety controls. No matter what size of the accident (even near misses), they all have causal factors that caused the accident. They key to accident investigation is to identify the causal factors and correct them to prevent accident recurrence. REVIEW QUESTIONS I 1. What is an accident? 2. Why should near misses b~ investigated? 3. What is the difference in an accident, near miss, and property damage accident? , 4. What are causal fac;tors?
- 51. 1 Preserve/ Document Scene 2 Collect Information 3 Determine Root Causes 4 Implement Corrective Actions United States Department of Labor Occupational Safety and Health Administration December 2015 i TABLE OF CONTENTS
- 52. PURPOSE OF THE GUIDE – WHY INVESTIGATE? ........................................................... .................................... 1 PRINCIPLES OF INCIDENT INVESTIGATIONS ..................... ................................................................................ 1 The Language of Incident Investigations .................................. ................................................................ 1 Investigate All Incidents, Including “Close Calls” .................... .................................................................. 2 Investigate Programs, Not Behaviors ....................................... ................................................................. 3 Focus on the Root Causes, Not Blame or Fault ......................... ................................................................ 4 ESTABLISH AN INCIDENT INVESTIGATION PROGRAM ..... .................................................................................... 4 CONDUCT INCIDENT INVESTIGATIONS – A FOUR‐STEP SYSTEMS APPROACH .................................. ........................ 6 Step 1. Preserve/Document the Scene ....................................... .............................................................. 7 Step 2. COLLECT INFORMATION ......................................... ............................................................................. 8 Step 3. DETERMINE ROOT CAUSES ..................................... ............................................................................. 9
- 53. Step 4. IMPLEMENT CORRECTIVE ACTIONS ....................... .............................................................................. 10 RESOURCES ......................................................................... .................................................................. 12 REFERENCES ........................................................................ .................................................................. 14 APPENDIX A: INCIDENT INVESTIGATION FORM ............... ..................................................................................... A‐1 APPENDIX B: INCIDENT INVESTIGATOR’S KIT ................. ...................................................................................... B‐1 APPENDIX C: TIPS FOR VIDEO/PHOTO DOCUMENTATION ...................................................................................... C‐1 APPENDIX D: SKETCH THE SCENE TECHNIQUES .............. ..................................................................................... D‐1 APPENDIX E: COLLECT INFORMATION CHECKLIST .......... ....................................................................................... E‐1 APPENDIX F: SAMPLE QUESTIONS FOR IDENTIFYING INC IDENT ROOT CAUSES .......................................................... . F‐1 DISCLAIMER: This guide was developed by OSHA's Directorate of Training an d Education and is intended to assist employers, workers, and ot hers as they strive to improve workplace health and safety. This guide is adv
- 54. isory in nature and informational in content. It is not a new stan dard or regulation and does not create any new legal obligations or alter existing obligations created by OSHA standards or regulations or the Occupational Safety and Health Act of 1970 (OSH Act). Pursua nt to the OSH Act, employers must comply with safety and healt h standards and regulations issued and enforced either by OSHA or by an OSHA ‐approved state plan. In addition, the OSH Act’s General Duty Clause, Section 5(a)(1), requires employers to provide their workers with a wor kplace free from recognized hazards likely to cause death or ser ious physical harm. Implementation of an incident investigation program in ac cordance with this guide can aid employers in their efforts to pr ovide a safe workplace. Incident[Accident]Investigations:AGuideforEmployers December 2015 1 WHYINVESTIGATE? Incidentinvestigations helpemployers: illnesses commitmenttohealth andsafety
- 55. workplacemorale Your company experienced an incident that resulted (or almost r esulted) in a worker injury or illness…Now what? As a responsible employer, you need to react quickly to the inci dent with a prescribed investigation procedure for finding the root causes and impleme nting corrective actions. Quick and planned actions demonstrate your company’s commit ment to the safety and health of your workers, and your willingness to improve your sa fety and health management program to prevent future incidents. PURPOSEOFTHEGUIDE–WHYINVESTIGATE? The purpose of this Incident Investigation Guide is to provide e mployers a systems approach to help them identify and control the underlying or root causes of all in cidents in order to prevent their recurrence. The Bureau of Labor Statistics reports that more than a dozen
- 56. workers died every day in American workplaces in 2013, and ne arly 4 million Americans suffered a serious workplace injury. And ten s of thousands are sickened or die from diseases resulting from their chronic exposures to toxic substances or stressful workplace conditions. These events cause much suffering and great financ ial loss to workers and their families, and also result in significant costs to employers and to society as a whole. Many more “near misse s” or “close calls” also happen; these are incidents that could have ca used serious injury or illness but did not, often by sheer luck. Practic ally all of these harmful incidents and close calls are preventable. All incidents – regardless of size or impact – need to be investigated. The process helps employers look beyond what happened to discover why it happened. This allows employers to identify and correct shortcomings in their safety and health management programs.
- 57. OSHA created this Guide to help employers conduct workplace incident investigations using a four‐step systems approach. This process is supported by an Incident Inve stigation Form, found in Appendix A, which employers can use to be sure all details of the incident in vestigation are covered. Additional tools to assist with the investigation process are found in Appendices B through F. PRINCIPLESOFINCIDENTINVESTIGATIONS TheLanguageofIncidentInvestigations Employers will notice this Guide uses the term “incident”, not “ accident”, to describe a workplace event. This is because the word “accident” has come to be considered a s a random event that “oh, well, it just IncidentInvestigations:AGuideforEmployers December 2015 2 happened” and could not have been prevented. However, the va st majority of harmful workplace events do not “just happen.” On the contrary, most harmful wor kplace incidents are wholly preventable.
- 58. In short, the basic principle is that incidents do not have to occu r; they can be prevented by addressing the shortcomings in the programs that manage health and safety in the workplace. The following are the key terms that are used throughout this gu ide: Incident: A work‐related event in which an injury or ill‐health ( regardless of severity) or fatality occurred, or could have occurred. Root Causes: The underlying reasons why unsafe conditions exi st or if a procedure or safety rule was not followed in a workplace. Root causes generally reflect management, design, planning, organizational or operational failings (e.g., a damaged guard ha d not been repaired; failure to use the guard was routinely overlooked by supervisors to ensure the speed of production). Close Call: An incident that could have caused serious injury o r illness but did not; also called a “near miss.” Investigating a worksite incident— a fatality, injury, illness, or close call—
- 59. provides employers and workers the opportunity to identify hazards in their operations a nd shortcomings in their safety and health programs. Most importantly, it enables employers and wo rkers to identify and implement the corrective actions necessary to prevent future incidents. Incident investigations that focus on identifying and correcting root causes, not on finding fault or blame, also improve workplace morale and increase productivity , by demonstrating an employer’s commitment to a safe and healthful workplace. InvestigateAllIncidents,Including“CloseCalls” OSHA strongly encourages employers to investigate all workpla ce incidents—both those that cause harm and the “close calls” that could have caused harm under sl ightly different circumstances. Investigations are incident‐prevention tools and should be an int egral part of an occupational safety and health management program in a workplace. Such a program is a structured way to identify and control the hazards in a workplace, and should emphasize continual imp rovement in health and safety
- 60. performance. When done correctly, an effective incident investi gation uncovers the root causes of the incident or ‘close call’ that were the underlying factors. Most i mportant, investigations can prevent future incidents if appropriate actions are taken to correct the ro ot causes discovered by the investigation. Effective incident investigations are the right thing to do, not o nly because they help employers prevent future incidents, but because they help employers to identify ha zards in their workplaces and shortcomings in their safety and health management programs. Investigations also save employers money, because incidents are far more costly than most people r ealize. The National Safety Council estimates that, on the average, preventing a workplace injury ca n save $39,000, and preventing a fatality more than $1.4 million, not to mention the suffering of t he workers and their families. The more obvious financial costs are those related to workers' compensati on claims, but these are only the direct IncidentInvestigations:AGuideforEmployers
- 61. December 2015 3 “One central principle…is the need to consider the organizational factors that create the preconditions for errors as well as the immediate causes.” ‐Sidney Dekker (2006) costs of incidents. The indirect costs are less obvious, but very commonly greater, and include lost production, schedule delays, increased administrative time (for emergency response, investigations, claim processing and others), lower morale, training of new or t emporary personnel, increased absenteeism, and damaged customer relations and corporate rep utation. InvestigatePrograms,NotBehaviors As stated previously, incident investigations that follow a syste ms approach are based on the principle that the root causes of an incident can be traced back to failures
- 62. of the programs that manage safety and health in the workplace. This approach is fundamentally dif ferent from a behavioral safety approach, which incorrectly assumes that the majority of workpl ace incidents are simply the result of “human error” or “behavioral” failures. Under a systems approa ch, one would not conclude that carelessness or failure to follow a procedure alone was the caus e of an incident. To do so fails to discover the underlying or root causes of the incident, and there fore fails to identify the systemic changes and measures needed to prevent future incidents. When a shortcoming is identified, it is important to ask why it existed and why it was not previously a ddressed. For example: a procedure or safety rule was not followed, why was the procedure or rule not followed? production pressures play a role, and, if so, why were production pressures permitted to jeopardize safety? the procedure out‐of‐date or safety training inadequate? If so, why had the problem not been previously identified, or, if it had been identified, why had it not been addressed?
- 63. A systems approach always looks beyond the immediate causes of the incident. If a worker suffers an amputation on a table saw, the investigator would ask questions such as: the machine adequately guarded? If not, why not? Was the guard damaged or non‐functional? If so, why hadn’t it been fixed? the guard design get in the way of the work? Had the employee been trained properly in the procedures to do the job safely? In a systems approach, investigations do not focus primarily on the behaviors of the workers closest to the incidents, but on the factors [program deficiencies] that pro mpted such behaviors. The goal is to change the conditions under which people work by eliminating or reducing the factors that create unsafe conditions. This is typically done by implementing adequ ate barriers and safeguards against the factors that cause unsafe conditions or actions. Root causes often involve multiple deficiencies in the safety an d health management programs. These
- 64. deficiencies may exist, for example, in areas such as workplace design, cultural and organizational factors, equipment maintenance and other technical matters, ope rating systems and procedures, IncidentInvestigations:AGuideforEmployers December 2015 4 staffing, supervision, training, and others. Eliminating the imm ediate causes is like cutting weeds, while eliminating the root causes is equivalent to pulling out the roots so that the weed cannot grow back. FocusontheRootCauses,NotBlameorFault A successful incident investigation must always focus on discov ering the root causes. If an investigation is focused on finding fault, it will always stop short of discovering the root causes. It is essential to discover and correct all the factors contributing to an incident, which nearly always involve equipment, procedural, training, and othe r safety
- 65. and health program deficiencies. Addressing underlying or root causes is necessary to truly under stand why an incident occurred, to develop truly effective corrective a ctions, and to minimize or eliminate serious consequences from similar future incidents. Moreover, if an investigation is understood to be a search for “s omeone to blame,” both management and labor will be reluctant to participate in an open and forthrig ht manner. Workers will be afraid of retaliation and management will be concerned about recognizing system flaws because of potential legal and financial liabilities. Investigationsthatfocusonidentifyingandcorrectingthereal underlyingcausesnotonlypreventfutureincidents,butcanalso improveworkplacemoraleandproductivity,bydemonstratingan employer’scommitmenttoasafeandhealthfulworkplace. ESTABLISHANINCIDENTINVESTIGATIONPROGRAM When a serious incident occurs in the workplace, everyone will be busy dealing with the emergency at hand. Therefore, it is important t o be
- 66. prepared to investigate incidents before they occur. An incident investigation program should include a clearly stated, easy‐to‐fo llow written plan to include guidelines for: and when management is to be notified of the incident OSHA, which must comply with reporting requirements that are: o All work‐related fatalities within 8 hours o All work‐related inpatient hospitalizations, all amputations, and all losses of an eye within 24 hours Who is authorized to notify outside agencies (i.e., fire, police, etc.) Who will conduct investigations and what training they should h ave received Timetables for completing the investigation and developing/imp lementing recommendations will receive investigation recommendations EffectiveIncident InvestigationPrograms: writtenprocedures
- 67. trainedonincident investigationandcompany procedures betweenworkers,worker representatives,and management cause(s),noton establishingfault cause(s) correctiveactionsbasedon investigationfindings programreviewtoidentify andcorrectprogram deficienciesandidentify incidenttrends Eliminating the immediate causes is like cutting weeds, while eliminating the root causes is equivalent to pulling out the roots so that the weed cannot grow back.
- 68. IncidentInvestigations:AGuideforEmployers December 2015 5 will be responsible for implementing corrective actions Although a supervisor sometimes conducts incident investigatio ns, to be most effective investigations should be conducted by a team in which managers and employee s work together, since each brings different knowledge, understanding, and perspectives to an inve stigation. Working together will also encourage all parties to “own” the conclusions and recommenda tions and to jointly ensure that corrective actions are implemented in a timely manner. Where the incident involves a temporary worker provided by a s taffing agency, both the staffing agency and the host employer should conduct an incident investigation. Where the incident involves a multi‐ employer worksite, the incident investigation should be shared with each employer at the worksite. It is a fundamental principal that temporary workers are entitled to t he same protections under the OSH Act
- 69. as all other covered workers. Therefore, if a temporary worker i s injured and the host employer knows about it, the staffing agency should be informed promptly, so th e staffing agency knows about the hazards facing its workers. Equally, if a staffing agency learns o f an injury, it should inform the host employer promptly so that future injuries might be prevented, a nd the case is recorded appropriately. Both the host employer and staffing agency should track and wh ere possible, investigate the cause of workplace injuries. As we now know, investigations are to focus on identifying root causes, not establishing fault. Employers can reinforce a systems approach by stressing it in their written program as well as their investigation procedures. Identifying and correcting root causes should alway s be the key objective. IncidentInvestigations:AGuideforEmployers December 2015 6 “Human error is not the
- 70. conclusion of an investigation. It is the starting point.” ‐Sidney Dekker (2006) “Errors are seen as consequences rather than causes” ‐James Reason (2000) CONDUCTINCIDENTINVESTIGATIONS– AFOUR‐STEPSYSTEMSAPPROACH One of the biggest challenges facing the investigators is to determine what is relevant to what happened, how it happened, and especially why it happened. This involves conducting a syst ems approach incident investigation that focuses on the root causes of the incident to really help prevent them from happening agai n. This section of the guide assists the employer to implement a fo ur‐
- 71. step approach to conduct a successful incident investigation. Inc luded is a set of appendices that can serve as tools for employers to us e when conducting investigations. They are: A: Incident Investigation Form – previously introduced; will be used to walk the employer through the four incident investigation steps B: Incident Investigator’s Kit – lists the equipment recommended to have ready at all times to be prepared to conduct the investigation C: Tips for Video/Photo Documentation D: Sketch the Scene Techniques E: Collect Information Checklist Appendix F: Sample Questions for Identifying Incident Root Ca uses – Sample questions to ask in a systems approach process The four‐step systems approach in this guide is supported by the Incident Investigation Form [Appendix A] and other tools. This approach will assist employers through the incident investigation and help to ensure the implementation of corrective measures based on the findings.
- 72. The steps are: 1. PRESERVE/DOCUMENT THE SCENE [see Appendices A, B, C and D] 2. COLLECT INFORMATION [see Appendix E] 3. DETERMINE THE ROOT CAUSES – All the ‘Whys’ the incident occurred [see Appendix F] 4. IMPLEMENT CORRECTIVE ACTIONS – Prevent Future Incidents Safety First Before investigating, all emergency response needs must be com pleted and the incident site must be safe and secure for entry and investigation. IncidentInvestigations:AGuideforEmployers December 2015 7 With an effective safety and health management program in plac e, all the involved parties are aware of the roles they play during the investigation. This helps the trans
- 73. ition from emergency response and site safety to preserving the scene and documenting the incident. Now is the time an employer’s incident investigation program’s written plan goes into effect and the incident investigation begins. Step1.Preserve/DocumenttheScene Preserve the Scene: Preserve the scene to prevent material evidence from being rem oved or altered; investigators can use cones, tape, and/or guards. Document the Scene: Document the incident facts such as the date of the investigatio n and who is investigating. Essential to documenting the scene is capturing the injured employee’s name , injury description, whether they are temporary or permanent, and the date and location of the incide nt. Investigators can also document the scene by video recording, photogaphing and sketching. Tools provided to help with Step 1 are:
- 74. Appendix A: Incident Investigation Form [applicable sections pi ctured at all steps] B: Incident Investigator’s Kit C: Tips for Video/Photo Documentation D: Sketch the Scene Techniques IncidentInvestigations:AGuideforEmployers December 2015 8 Step2.COLLECTINFORMATION Incident information is collected through interviews, document reviews and other means. Appendix E provides a checklist to use to help ensure all information pertine nt to the incident is collected. In addition to interviews, investigators may find other sources o f useful information. These include: manuals guidance documents policies and records schedules, records and logs records (including communication to employees) and follow‐up reports
- 75. policies and records corrective action recommendations Interviews can often yield detailed, useful information about an incident. Since memories fade, interviews must be conducted as promptly as possible: preferably as soon as things have settled down a bit and the site is both secure and safe. The sooner a witness is interviewed, the more accurate and candid his/her statement will be. An incident investigation always involves interviewing and possibly re‐interviewing some of the same or new witnesses as more information becomes available, up to and including the highest levels of management. Carefully question witnesses to solicit as much inf ormation as possible related to the incident. Since some questions will need to be designed around the interv iewee, each interview will be a unique experience. When interviewing injured workers and witnesses it
- 76. is crucial to reduce their possible fear and anxiety, and to develop a good rapport. When conducting in terviews, investigators should: Conduct the interview in the language of the employee/intervie wee; use a translator if needed Clearly state that the purpose of the investigation and interview is fact‐finding, not fault‐finding Emphasize that the goal is to learn how to prevent future incide nts by discovering the root causes of what occurred Establish a climate of cooperation, and avoid anything that may be perceived as intimidating or in search of someone to blame for the incident Let employee know that they can have an employee representati ve (e.g., labor representative), if available/appropriate Ask the individuals to recount their version of what happened interrupt the interviewee IncidentInvestigations:AGuideforEmployers December 2015 9
- 77. Take notes and/or record the responses; interviewee must give p ermission prior to being recorded Have blank paper and or sketch available for interviewee to use for reference clarifying questions to fill in missing information Reflect back to the interviewees the factual information obtaine d; correct any inconsistencies Ask the individuals what they think could have prevented the in cident, focusing on the conditions and events preceding the injury Step3.DETERMINEROOTCAUSES The root causes of an incident are exactly what the term implies: The underlying reasons why the incident occurred in a workplace. Root causes generally reflect management, design, planning, organizational and/or operational failings (e.g., employees were not trained adequately; a damaged guard had not been repaired).
- 78. Determining the root cause is the result of persistently asking “ why” Determining the root cause is the most effective way to ensure t he incident does not happen again Finding the root causes goes beyond the obvious proximate or i mmediate factors; it is a deeper evaluation of the incident. This requires persistent “digging”, ty pically by asking “Why” repeatedly. Conclusions such as “worker was careless” or “employee did no t follow safety procedures” don’t get at the root causes of the incident. To avoid these incomplete and m isleading conclusions in the investigative process, investigators need to continue to ask “wh y?” as in, “Why did the employee not follow safety procedures?” If the answer is “the employee was i n a hurry to complete the task and the safety procedures slowed down the work”, than ask “Why was t he employee in a hurry?” The more and deeper “why?” questions asked, the more contributing factors ar e discovered and the closer the investigator gets to the root causes. If a procedure or safety rule was not followed, why was the
- 79. procedure or rule not followed? Did production pressures play a role, and, if so, why were production pressures permitted to jeopardize safety? Was the procedure out ‐of‐date or safety training inadequate? If so, why had the problem not been previously identified, or, if it had been identified, why had it not been addressed? It cannot be stressed enough that a successful incident investiga tion must always focus on discovering the root causes. Investigations are not effective if they are focus ed on finding fault or blame. If an investigation is focused on finding fault, it will always stop sho rt of discovering the root causes, because it will stop at the initial incident without discovering their unde rlying causes. The main goal must always be to understand how and why the existing barriers against the h azards failed or proved insufficient, not to find someone to blame. IncidentInvestigations:AGuideforEmployers December 2015 10
- 80. The questions listed below are examples of inquiries that an inv estigator may pursue to identify contributing factors that, in turn, can lead to root causes: If a procedure or safety rule was not followed, why was the proc edure or rule not followed? Was the procedure out of date or safety training inadequate? W as there anything encouraging deviation from job procedures such as incentives or speed of co mpletion? If so, why had the problem not been identified or addressed before? Was the machinery or equipment damaged or fail to operate pro perly? If so, why? Was a hazardous condition a contributing factor? If so, why was it present? (e.g., defects in equipment/tools/materials, unsafe condition previously identifie d but not corrected, inadequate equipment inspections, incorrect equipment used or provided, improper substitute equipment used, poor design or quality of work environment or equipment) Was the location of equipment/materials/worker(s) a contributin g factor? If so, why? (e.g., employee not supposed to be there, insufficient workspace, “err
- 81. or‐prone” procedures or workspace design) Was lack of personal protective equipment (PPE) or emergency equipment a contributing factor? If so why? (e.g., PPE incorrectly specified for job/task, i nadequate PPE, PPE not used at all or used incorrectly, emergency equipment not specified, avai lable, properly used, or did not function as intended) Was a management program defect a contributing factor? If so, why? (e.g., a culture of improvisation to sustain production goals, failure of supervisor to detect or report hazardous condition or deviation from job procedure, supervisor accountab ility not understood, supervisor or worker inadequately trained, failures to initiate corrective act ions recommended earlier) Additional examples of questions to ask to get to the root causes are listed in Appendix F. Step4.IMPLEMENTCORRECTIVEACTIONS The investigation is not complete until corrective actions are im plemented that address the root causes
- 82. of the incident. Implementation should entail program level improvements and should be supported by senior management. Note that corrective actions may be of limited preventive value if they do not address the root causes of the incident. Throughout the workplace, the findings and how they are presented will shape perceptions and subsequent corrective actions. Superficial conclusions such as "Bob should have used common sense," and weak corrective actions such as “Employee s must remember to wear PPE”, are unlikely to improve the safety culture or to prevent future incid ents. IncidentInvestigations:AGuideforEmployers December 2015 11 In planning corrective actions and how best to implement them, employers may find that some root
- 83. causes will take time and perseverance to fix. Persisting in impl ementing substantive corrective actions, however, will not only reduce the risk of future incidents but als o improve the company’s safety, morale and its bottom line. Specific corrective actions address root causes directly; howeve r, some corrective actions can be general, across‐the‐board improvements to the workplace safety environment. Sample global corrective actions to consider are: Strengthening/developing a written comprehensive safety and he alth management program Revising safety policies to clearly establish responsibility and a ccountability Revising purchasing and/or contracting policies to include safet y considerations Changing safety inspection process to include line employees al ong with management representatives Implementing a systems approach will help ensure all incident i nvestigations are successful.
- 84. Thank you for your commitment to the safety and health of the American workforce! Incident[Accident]Investigations:AGuideforEmployers December 2015 12 RESOURCES OSHA Training Institute Education Centers: http://www.osha.go v/otiec The OSHA Training Institute (OTI) Education Centers are a nati onal network of non‐profit organizations authorized by OSHA to deli ver occupational safety and health training to public and private sec tor workers, supervisors and employers on behalf of OSHA. Releva nt courses are: #7500 Introduction to Safety and Health Management Description: This course covers the effective implementation of a company’s safety and health management system. The course addresses the four core elemen
- 85. ts of an effective safety and health management system and those central issues that are critical to each element’s proper management. This course is an interactive training session focusing on class d iscussion and workshops. Upon course completion students will have the ability to evaluate, develop, a nd implement an effective safety and health management system for their company. Minimum studen t contact hours: 5.5 OSHA #7505 Introduction to Incident [Accident] Investigation Description: This course covers an introduction to basic inciden t investigation procedures and describes analysis techniques. Course topics include reasons for conducti ng incident investigations, employer responsibilities related to workplace incident investigations, an d a four‐step incident investigation procedure. The target audience is the employer, manager, empl oyee or employee representative who is involved in conducting incident and/or near‐miss or close call in vestigations. Upon course completion students will have the basic skills necessary to conduct an effect ive incident investigation at the workplace. Minimum student contact hours: 7.5
- 86. OSHA Website: www.osha.gov Incident Investigation Webpage http://www.osha.gov/dcsp/products/topics/incidentinvesti gation/index.html Injury and Illness Prevention Programs Webpage http://www.osha.gov/dsg/topics/safetyhealth/index.html This webpage provides information relevant to Injury and Illnes s Prevention Programs in the workplace. To learn more about Injury and Illness Prevention Pr ograms, refer to: http://www.osha.gov/Publications/OSHA3665.pdf and http://www.osha.gov/dsg/topics/safetyhealth/OSHAwhite‐paper‐ january2012sm.pdf IncidentInvestigations:AGuideforEmployers December 2015 13 OSHA’s "$afety Pays" program
- 87. online tool can help employers assess the impact of occupational injuries and illnesses on their profitability. To learn more about OSHA’s "$afety Pays" program, visit http://www.osha.gov/dcsp/smallbusiness/safetypays/ Other: UK Health and Safety Executive Investigating Accidents and Incidents: A Workbook for employe rs, unions, safety representatives, and safety professionals. 2004. http://www.hse.gov.uk/pubns/hs g245.pdf IncidentInvestigations:AGuideforEmployers December 2015 14 REFERENCES Center for Chemical Process Safety publication, Guidelines for Preventing Human Error in Process Safety, Center for Chemical Process Safety (CCPS), 19 94. Conklin, T., Pre‐Accident Investigations: An Introduction to Or
- 88. ganizational Safety, Ashgate Publishing Company; 1 edition (September 28, 2012), ISBN‐10: 1409447820, ISBN‐13: 978‐ 1409447825 Dekker, S., The Field Guide to Understanding Human Error, As hgate Publishing Company; 1 edition (June 30, 2006), English, ISBN‐10: 0754648265; ISBN‐ 13: 978‐0754648260 National Safety Council, http://www.nsc.org/pages/home.aspx Reason, J., Human error: models and management, BMJ 2000;3 20:768 IncidentInvestigations:AGuideforEmployers A‐1 APPENDIXA:INCIDENTINVESTIGATIONFORM Form Section Systems Approach Section A: Information Step 1 Company Name: ______________________________________ _ Date: ____________ Investigator (or) Team Name (s) and Titles: Name Title
- 89. _________________________________ _____________________________________ _________________________________ _____________________________________ _________________________________ _____________________________________ _________________________________ _____________________________________ Section B: Incident Description/Injury Information Step 1 and Step 2 1) Name and Age of Injured Employee: _______________________________________________ Employee’s first language: ______________________________ __________________________ Employees Job Title: ___________________________________ __________________________ Job at time of injury: _____________________________________________________ _______ Type of employment: Full‐time Temporary Seasonal Other: ________ Length of time with Company:
- 90. ____________________________________________________ Length in current position at the time of the incident: _________________________________ Description and severity of injury: _________________________________________________ 2) Date and time of incident: _____________________________________________________ __ 3) Location of Incident: __________________________________ __________________________ NOTE: Items 4, 5, and 6 are used for both Step 1 and Step 2 4) Detailed description of incident: Include relevant events leadin g up to, during, and after the incident. (It is preferred that the information is provided by the injured employee.) _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________
- 91. _____________________________ _____________________________________________________ _____________________________ Use additional pages if needed IncidentInvestigations:AGuideforEmployers A‐2 5) Description of incident from eye witnesses, including relevant e vents leading up to, during and after the incident. Include names of persons interviewed, job titl es and date/time of interviews. _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________
- 92. _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ Use additional pages if needed 6) Description of incident from additional employees with knowled ge, including relevant events leading up to, during and after the incident. Include names of pe rsons interviewed, job titles and date/time of interviews. _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________
- 93. _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ Use additional pages if needed IncidentInvestigations:AGuideforEmployers A‐3 Section C: Identify the Root Causes: What Caused or Allowed t he Incident to Happen? Step 3 The Root Causes are the underlying reasons the incident occurre
- 94. d, and are the factors that need to be addressed to prevent future incidents. If safety procedures w ere not being followed, why were they not being followed? If a machine was faulty or a safety de vice failed, why did it fail? It is common to find factors that contributed to the incident in severa l of these areas: equipment/machinery, tools, procedures, training or lack of trai ning, and work environment. If these factors are identified, you must determine why these facto rs were not addressed before the incident. _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________
- 95. _____________________________________________________ _____________________________ Use additional pages if needed Section D: Recommended Corrective Actions to Prevent Future Incidents Step 4 _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ Use additional pages if needed Section E: Corrective Actions Taken/ Root Causes Addressed Step 4 _____________________________________________________ _____________________________ _____________________________________________________ _____________________________
- 96. _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ _____________________________________________________ _____________________________ Use additional pages if needed IncidentInvestigations:AGuideforEmployers B‐1 APPENDIXB:INCIDENTINVESTIGATOR’SKIT Sample list of items to use to conduct the investigation: Batteries (for phones, cameras, equipment, etc.) / Audio recorder devices in various sizes rod and writing pad pencils, markers
- 97. paper Straight‐edge ruler (Can be used as a scale reference in photos) investigation forms stakes, warning tape marking cones Personal protective equipment: Gloves, hat, eyewear, ear plugs, face mask, etc. glass visibility plastic tapes to mark off area aid kit gloves Sampling [holding] containers with seals (Various types: bags, j ars, containers, etc.) tags of tape: Scotch, masking, duct ruler
- 98. stick (yellow/black) (yellow/white) IncidentInvestigations:AGuideforEmployers C‐1 APPENDIXC:TIPSFORVIDEO/PHOTODOCUMENTATION Note: Interviewees must be aware that they are being video reco rded and/or photographed. It is recommended that investigators obtain permission from the in terviewee prior to the interview. Tips for Video Documentation: Video the scene as soon as possible; doing this early on will pic k up details that may later add valuable information to the investigation slowly 360 degrees left and right to establish location
- 99. Narrate what is being taped, and describe objects, size, directio n, location, etc. If vehicles were involved, record direction of travel, going and coming Tips for Photograph Documentation: make notes about the photos taken Start by taking distance shots first then move in to take closer p hotos of the scene Take photos at different angles (from above, 360 degrees of sce ne, left, right, rear) to show the relationship of objects and minute and/or transient d etails such as ends of broken rope, defective tools, drugs, wet areas, or containers Take panoramic photos to help present the entire scene, top to b ottom ‐ side to side Take notes on each photo; these should be included in the incide nt investigation file with the photos Identify and document the photo type, date/time/location taken, subject, weather conditions, measurements, etc.
- 100. Place an item of known dimensions in the photo to add a frame of reference and scale (e.g., a penny, a pack of cards) the person taking the photo Indicate the locations where photos were taken on sketches (See Appendix D) IncidentInvestigations:AGuideforEmployers D‐1 APPENDIXD:SKETCHTHESCENETECHNIQUES 1. Make sketches large; at least 8” x 10” and clear, be sure to print legibly 2. Include “Incident Details” (i.e., time, date, injured, location, co nditions, etc.) 3. Include measurements (i.e. distances, heights, lengths, etc.) and use permanent points (e.g., telephone pole, building) to clearly present the measurements 4. Indicate directions – N= North; E= East; W= West; S= South 5. Make notes on sketch to provide additional information such as the photo location and/or
- 101. where people were at the time of the incident Note: The sketch can be used during interviews to help intervie wees identify their location before, during or after the incident IncidentInvestigations:AGuideforEmployers E‐1 APPENDIXE:COLLECTINFORMATIONCHECKLIST Investigators should be sure their investigation answers the foll owing questions: WHO? WHERE? was injured? saw the incident? was working with the employee? had instructed/assigned the employee? else was involved? else can help prevent recurrence? did the incident occur? was the employee at the time? was the supervisor at the time? were fellow workers at the time? were other people who were involved at the time? were witnesses when incident occurred?
- 102. WHAT? WHY? was the incident? was the injury? was the employee doing? had the employee been told to do? tools was the employee using? machine was involved? operation was the employee performing? instructions had the employee been given? specific precautions were necessary? specific precautions was the employee given? protective equipment should have been used? protective equipment was the employee using? had other persons done that contributed to the incident? problem or questions did the employee encounter? did the employee or witnesses do when the incident occurred? extenuating circumstances were involved? did the employee or witnesses see? will be done to prevent recurrence? safety rules were violated? new rules are needed? was the employee injured? and what did the employee do?
- 103. and what did the other person do? wasn’t protective equipment used? weren’t specific instructions given to the employee? was the employee in the position? was the employee using the tools or machine? didn’t the employee check with the supervisor when the employee noted things weren’t as they should be? did the employee continue working under the circumstances? wasn’t the supervisor there at the time? WHEN? HOW? did the incident occur? did the employee start on that job? was the employee assigned on the job? were the hazards pointed out to the employee? was the employee’s supervisor last check on job progress? did the employee first sense something was wrong? did the employee get injured? could the employee have avoided it? could fellow workers have avoided it? could supervisor have prevented it ‐ could it
- 104. be prevented? IncidentInvestigations:AGuideforEmployers F‐1 APPENDIXF:SAMPLEQUESTIONSFORIDENTIFYINGINCIDE NTROOTCAUSES QUESTIONS 1. Did a written or well‐established procedure exist for employees to follow? 2. Did job procedures or standards properly identify the potential h azards of job performance? 3. Were there any hazardous environmental conditions that may ha ve contributed to the incident? 4. Were the hazardous environmental conditions in the work area r ecognized by employees or supervisors? 5. Were any actions taken by employees, supervisors, or both to el iminate or control environmental hazards? 6. Were employees trained to deal with any hazardous environment al conditions that could arise?
- 105. 7. Was sufficient space provided to accomplish the job task? 8. Was there adequate lighting to properly perform all the assigned tasks associated with the job? 9. Were employees familiar with job procedures? 10. Was there any deviation from the established job procedures? 11. Were the proper equipment and tools available and being used f or the job? 12. Did any mental or physical conditions prevent the employee(s) f rom properly performing their jobs? 13. Were there any tasks in the job considered more demanding or d ifficult than usual (e.g., strenuous activities, excessive concentration required, etc.)? 14. Was there anything different or unusual from normal operations ? (e.g., different parts, new or different chemicals used, recent adjustments/maintenance/cleani ng on equipment) 15. Was the proper personal protective equipment specified for the j ob or task? 16. Were employees trained in the proper use of any personal protec tive equipment? 17. Did the employees use the prescribed personal protective equip ment? 18. Was personal protective equipment damaged or not properly fun
- 106. ctioning? 19. Were employees trained and familiar with the proper emergency procedures, including the use of any special emergency equipment and was it available? 20. Was there any indication of misuse or abuse of equipment and/o r materials at the incident site? 21. Is there any history of equipment failure, were all safety alerts a nd safeguards operational and was the equipment functioning properly? 22. If applicable, are all employee certification and training records current and up‐to‐date? 23. Was there any shortage of personnel on the day of the incident? 24. Did supervisors detect, anticipate, or report an unsafe or hazard ous condition? 25. Did supervisors recognize deviations from the normal job proce dure? 26. Did supervisors and employees participate in job review session s, especially for those jobs performed on an infrequent basis? 27. Were supervisors made aware of their responsibilities for the sa fety of their work areas and
- 107. employees? 28. Were supervisors properly trained in the principles of incident p revention? 29. Was there any history of personnel problems or any conflicts wi th or between supervisors and employees or between employees themselves? 30. Did supervisors conduct regular safety meetings with their empl oyees? 31. Were the topics discussed and actions taken during the safety m eetings recorded in the minutes? 32. Were the proper resources (i.e., equipment, tools, materials, etc. ) required to perform the job or task readily available and in proper condition? 33. Did supervisors ensure employees were trained and proficient b efore assigning them to their jobs? 1 Course Learning Outcomes for Unit I Upon completion of this unit, students should be able to:
- 108. 1. Identify key benefits of conducting accident investigations. 2. Describe the accident investigation process. 2.1 Explain the differences in accident categories. Reading Assignment Chapter 1: What is an Accident? Chapter 2: An Accident Happens: What Do You Do? How Long Do You Do It? Access the resource below, and read pp. 1-5: Occupational Safety and Health Administration. (2015). Incident [accident] investigations: A guide for employers. Retrieved from https://www.osha.gov/dte/IncInvGuide4Empl_Dec2015.pdf In order to access the resource below, you must first log into the myWaldorf Student Portal and access the Business Source Complete database within the Waldorf Online Library. To reduce the amount of results you receive, it is recommended to search for the article by title and author. Boraiko, C., Beardsley, T., & Wright, E. (2008). Accident investigations. Professional Safety, 53(9), 26-29. Unit Lesson The goal of any safety and health program is to prevent injuries, illnesses, and property damage. When one
- 109. of these unwanted events happens, it is no surprise that it may be seen as a failure of the safety program, the safety manager, or the organization itself. After all, accidents are preventable, right? Think about that for a moment—do you believe that all accidents are preventable? Was there a time in your life where you tripped over your own feet for no apparent reason and stumbled or fell? What could you have done to prevent this from happening? Could you even foresee it happening? Is the solution to pay attention to where/how you are walking? How would you do that? The reality is that you probably shrugged your shoulders and said, “Well, that was a dumb thing to do,” and, most likely, you moved on without making any changes to the way you walked. The reality is that something caused you to stumble and fall; you just cannot identify it (or you do not want to take the time to identify it). While it is likely true that all accidents are preventable, finding and correcting the causes is not easy. Some might even say that accidents are inevitable. We know that we cannot reduce risk to zero, so there is always a probability, however small, that an accident will happen. Before we continue, perhaps we should look deeper into what we mean by an accident. A simple definition of accident would be an unplanned series of events that result in injury, illness, or property damage (Oakley, 2012). Note that the definition does not indicate how serious the injury, illness, or property damage would be but, rather, includes everything from minor bumps and bruises to fatalities. It includes one dollar’s worth of property damage to millions of dollars’ worth of damage. The key to the definition is the word “unplanned.” We could also use the words unexpected, undesired, or unwanted. Some organizations use terms like mishap or
- 110. UNIT I STUDY GUIDE Introduction to Accident Investigation https://www.osha.gov/dte/IncInvGuide4Empl_Dec2015.pdf 2 UNIT x STUDY GUIDE Title incident rather than accident, citing that the word accident implies that nothing can be done to correct the problem—hence the saying, “it was just an accident.” Different terms are sometimes used to differentiate injuries from property damage or to discern serious injuries from minor injuries. For consistency in this course, we will be using the term “accident” for all of these unwanted events, regardless of severity. Every accident provides an opportunity to identify conditions, processes, or practices that, if corrected, would aid our overall accident prevention efforts. A well-designed accident investigation process ensures that causes are identified without bias or blame, and effective measures to eliminate or control the causes are identified and implemented. Most safety practitioners divide accidents into categories based on severity. A typical list in order of decreasing severity might resemble the following (Oakley, 2012):
- 111. Accidents of lower severity are often considered precursors to accidents of greater severity, so there is a prevention benefit to investigating all accidents. The severity can be used to determine the depth of the investigation and who will conduct it. You probably would not want to expend the same resources investigating a near miss as you would a fatality, but you also would not want to completely ignore the near miss. The effectiveness of any accident investigation depends on the knowledge and experience of the investigator. Workplace accidents are, statistically speaking, a rare event, considering the millions of man hours worked every year. Many safety professionals will never have the opportunity (or misfortune) to investigate a fatality. This is a good thing, of course, but it creates a dilemma—how does one acquire the necessary knowledge and experience? Certainly, this course will help, but it does not provide a cookbook or checklist solution. Each accident scenario is different and can be approached from many different angles. An organization’s safety culture, or lack of safety culture, may also affect how accidents are investigated. For some organizations, a team approach to investigation may work best, especially for serious accidents. Supervisors
- 112. are often tasked with conducting investigations of accidents that happen within their work crews, but this approach has some drawbacks. If accidents are rare events at the organizational level, they are even rarer at the worksite level, so supervisors will get fewer opportunities to improve their skills. In addition, causal factors may lead back to the supervisor, so there could be a significant bias in how the investigation is conducted. Accident investigation is a reactive process that happens only after an adverse event, but that does not mean the process cannot be planned in advance. Having a pre-accident plan that defines roles and responsibilities in the accident investigation process will reduce the time needed to conduct the investigation and increase the overall effectiveness. The plan should include the following: ts are to be investigated, ocess. Each individual with responsibilities in the accident investigation process should have a copy of the plan. The first action to take when notified of an accident should be to
- 113. refer to the plan. The U.S. Department of the Interior’s Bureau of Land Management has an excellent example of a pre-accident plan at the following link: BLM Pre-Accident Plan. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=w eb&cd=5&cad=rja&uact=8&ved=0CD0QFjAEahUKEwje9MWo weXHAhUTNYgKHV6FD00&url=http://www.ntc.blm.gov/krc/u ploads/330/Pre- accident%20plan.doc&usg=AFQjCNGxgieXo0lY4NVenC6NQD dbf3Np9Q&sig2=ql0gJIxK-8Kh 3 UNIT x STUDY GUIDE Title In the next unit, we will examine various theories of accident causation that can be used in the investigation process. In subsequent units, will we outline the investigation process and use some real-world scenarios to which the theories can be applied. Reference Oakley, J. S. (2012). Accident investigation techniques: Basic theories, analytical methods, and applications (2nd ed.). Des Plaines, IL: American Society of Safety Engineers. Suggested Reading Access the Washington State Department of Labor and Industries at the link below, and download the PowerPoint presentation on Accident Investigation Basics. This
- 114. presentation will provide more information on what an accident is, why they should be investigated, and how they should be investigated. Washington State Department of Labor & Industries. (2009). Accident investigation basics. Retrieved from http://www.lni.wa.gov/SAFETY/TRAININGPREVENTION/ON LINE/courseinfo.asp?P_ID=145 Reading this article will provide more insight into how accident investigations can be used as part of an overall accident prevention program. In order to access the resource below, you must first log into the myWaldorf Student Portal and access the Business Source Complete database within the Waldorf Online Library. To reduce the amount of results you receive, it is recommended to search for the article by title and author. Cook, N. (2013). Accident investigation. Rospa Occupational Safety & Health Journal, 43(11), 13-18. The United Kingdom’s Health and Safety Executive workbook on accident investigation is a good resource to learn more about how investigations are handled outside of the United States: Health and Safety Executive. (2004). Investigating accidents and incidents. Retrieved from http://www.hse.gov.uk/pubns/hsg245.pdf Learning Activities (Non-Graded) After you complete your reading assignment from the course textbook, answer the review questions on pages
- 115. 8 and 16. Answer the questions as completely as you can, using concepts and other information learned in Chapters 1 and 2 of the textbook. Think about what you learned that might apply to your organization and how it might help you make your organization more safety conscious. The purpose of this activity is to help you study and learn the concepts taught in this unit. This is a non- graded activity, so you will not submit it. If you experience difficulty in mastering any of the concepts, contact your instructor for additional information and guidance. Workers’ Compensation Insurance: A Primer for Public Health Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health Workers’ Compensation Insurance: A Primer for Public Health Workers’ Compensation Insurance: A Primer for Public Health David F. Utterback, Alysha R. Meyers,
- 116. Steven J. Wurzelbacher Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health January 2014 Workers’ Compensation Insurance: A Primer for Public Healthii This document is in the public domain and may be freely copied or reprinted. Disclaimer Mention of any company or product does not constitute endorsement by the National Institute for Occupational Safety and Health (NIOSH). In addition, citations to Web sites external to NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or their programs or products. Furthermore, NIOSH is not responsible for the content of these Web sites. All Web addresses referenced in this document were accessible as of the publication date. Ordering Information To receive documents or other information about occupational safety and health topics, contact NIOSH:
- 117. Telephone: 1–800–CDC-INFO (1–800–232–4636) TTY: 1-888-232-6348 Email: [email protected] Or visit the NIOSH Web site at www.cdc.gov/niosh For a monthly update on news at NIOSH, subscribe to NIOSH eNews by visiting www.cdc.gov/niosh/eNews. DHHS (NIOSH) Publication No. 2014–110 January 2014 Workers’ Compensation Insurance: A Primer for Public Health iiiWorkers’ Compensation Insurance: A Primer for Public Health Foreword Occupational safety and health research and surveillance are essential for the prevention and control of injuries, illnesses and hazards that arise from the workplace. Research and surveil- lance can fill gaps in knowledge about where hazards exist and what interventions are effective at preventing workplace injuries, illnesses and fatalities. Workers’ compensation insurance records are a resource used for these primary prevention purposes. In addition, workers’ compensation records may be used for early detection of health outcomes in populations of workers which is part of secondary prevention. They may also be used to help identify effective medical treatment which is part of tertiary prevention.
- 118. Workers’ compensation insurance covers nearly all workers in the U.S. and provides those who are injured or become ill as a result of work with medical treatment, a portion of lost wages, and a lump sum for some permanent impairments. Nonetheless, there are limitations to conducting studies that rely on workers’ compensation records since not all injuries and illnesses result in claims being filed. Furthermore, the data that are collected are not readily combined if obtained from multiple sources since requirements vary substantially among the states. The National Institute for Occupational Safety and Health (NIOSH) joined with a number of public and private sector co-sponsors to convene two workshops on the use of workers’ com- pensation data for occupational safety and health. Creation of this document was suggested at the second workshop as a means to describe elements of the workers’ compensation insurance programs in the U.S. and the potential to utilize the records for public health purposes. Public health agencies, the workers’ compensation industry, trade associations and the state-level programs share interests in utilizing these data to protect workers from occupational injuries and illnesses. To help facilitate these goals, NIOSH has created a Center for Workers’ Compensation Studies. Further information on the center may be obtained at http://www.cdc.gov/niosh/topics/ workerComp/CWCS/. John Howard, M.D. Director
- 119. National Institute for Occupational Safety and Health Centers for Disease Control and Prevention http://www.cdc.gov/niosh/topics/workerComp/CWCS/ http://www.cdc.gov/niosh/topics/workerComp/CWCS/ Workers’ Compensation Insurance: A Primer for Public Healthiv Acknowledgements We thank the participants at the Use of Workers’ Compensation Data for Occupational Safety and Health Workshop that was held in Washington, DC in June 2012 for suggesting that a docu- ment like this primer be developed. Many of those participants and other stakeholders provided essential input on the scope and contents of this primer. We also thank the internal and external reviewers for their valuable comments. Acronyms and Abbreviations AASCIF – American Association of State Compensation Insurance Funds ACORD – Association for Cooperative Operations Research and Development ACS – American Community Survey AIA – American Insurance Association CBP – County Business Patterns CDC – Centers for Disease Control and Prevention CES – Current Employment Statistics CFOI – Census of Fatal Occupational Injuries CFR – Code of Federal Regulations CPS – Current Population Survey
- 120. DHHS – Department of Health and Human Services EDI – Electronic Data Interchange FEIN – Federal Employer Identification Number FROI – First Report of Injury FTE – Full-time Equivalent HIPAA – Health Insurance Portability and Accountability Act IAIABC – International Association of Industrial Accident Boards and Commissions ICD – International Classification of Disease IRS – Internal Revenue Service MSHA – Mine Safety and Health Administration NAICS – North American Industry Classification System NASI – National Academy of Social Insurance NAIC – National Association of Insurance Commissioners NCOIL – National Conference of Insurance Legislators NCCI – National Council on Compensation Insurance NIOSH – National Institute for Occupational Safety and Health OES – Occupational Employment Statistics OIICS – Occupational Injury and Illness Classification System OSHA – Occupational Safety and Health Administration PCIAA – Property and Casualty Insurers Association of America PEO – Professional Employment Organizations QCEW – Quarterly Census of Employment and Wages SDS – Supplementary Data System SIC – Standard Industrial Classification System SOC – Standard Occupational Classification System SOII – Survey of Occupational Injuries and Illnesses TPA – Third-party Administrator WCIO – Workers’ Compensation Insurance Organizations WCRI – Workers’ Compensation Research Institute Workers’ Compensation Insurance: A Primer for Public Health vWorkers’ Compensation Insurance: A Primer for Public
- 121. Health Table of Contents Foreword ............................................................................................... ....................................................... iii Acknowledgements ............................................................................................... ..................................... iv Acronyms and Abbreviations ........................................................................................ ....... ................... iv 1. Introduction ............................................................................................... ............................................. 1 2. Background ............................................................................................... .............................................. 2 3. Brief History of Workers’ Compensation in the U.S. .......................................................................... 4 4. Workers’ Compensation Insurance Benefits ........................................................................................ 7 5. Workers’ Compensation Insurance Providers ................................................................................... 11 6. State Workers’ Compensation Agencies .............................................................................................1 2
- 122. 7. Third-Party Administrators ............................................................................................... ..................13 8. Types of Policies ............................................................................................... .....................................13 9. Policy Premiums ............................................................................................... .....................................18 10 Workers’ Compensation Records ............................................................................................... ........19 11. Standardized Codes and Systems in Workers’ Compensation ......................................................21 12. Loss Prevention ............................................................................................... ...................................22 13. Workers’ Compensation Associations .............................................................................................. 23 14. Public Health Research and Surveillance .........................................................................................25 15. Public Health Regulations ............................................................................................... ...................26 16. Breaking through Barriers ........................................................................................... ....
- 123. ..................27 References ............................................................................................... ....................................................29 Tables Table 1 ............................................................................................... ............................................................8 Table 2 ............................................................................................... ..........................................................14 Table 3 ............................................................................................... ..........................................................16 Appendices Appendix A: Workers’ Compensation Primer Glossary .....................................................................35 Appendix B: Preparing for Engagement ............................................................................................... .41 Workers’ Compensation Insurance: A Primer for Public Health Workers’ Compensation Insurance: A Primer for Public Health 1Workers’ Compensation Insurance: A Primer for Public Health
- 124. 1. Introduction The purpose of this document is to help public health researchers and practitioners, particu- larly those in occupational safety and health, to broaden their understanding of workers’ compensation insurance, relevant aspects of the insurance industry records, and the potential uses of that information for public health pur- poses. Workers’ compensation insurance has been established in all states to provide income protection, medical treatment, and rehabilita- tion for employees who are injured or become ill as a result of work. Workers’ compensation claims and medical treatment records along with other information resources have been used to conduct occupational safety and health research and surveillance and to identify intervention needs. Several government agencies and private organizations sponsored two workshops in September 2009 and June 2012 on the use of workers’ compensation data for occupational safety and health purposes. The workshops featured discussions of opportunities for collabo- ration in the analysis of workers’ compensation data in order to help reduce the risks of occupa- tional injuries and illnesses. Participants included representatives from private insurance carriers, insurance associations, self-insured corporations, academic institutions and government agencies.
- 125. Presentations in the first workshop described differences among state laws, proper interpreta- tion of common industry terms, proprietary interests in insurance data, public release of internal analyses, methods for linking workers’ compensation records with other health and employment records, and independent analysis of claims data by health scientists, economists and government agencies [NIOSH 2010; Utterback et al. 2012]. One of the principal messages from the first workshop was that even though workers’ compensation records are primarily designed and used by the insurance industry to administer claims, public health investigators are interested in them for prevention and control of occupational injuries and illnesses. The interested parties have different perspectives on the value and potential uses of workers’ compensation data. Relationships would need to build trust and respect for the various stakeholder perspectives to foster collaboration. The second workshop included discussions of six draft white papers along with 35 platform and poster presentations on research with workers’ compensation data [NIOSH 2013a]. Although much progress is being made in understand- ing the merits of workers’ compensation data resources, significant limitations exist. For example, these data appear to constitute an incomplete record of occupational injuries and illnesses at the state level. While standards for col- lecting and compiling the
- 126. data exist, they are not uni- versally used. Some fields on the record forms are often blank or incomplete and essential information for public health purposes, such as occupation, race, ethnicity, and duration of employment, may not be recorded. Multiple parties add data to the records at various stages as claims work their ways through the employees, employers, medical facilities, third-party administrators and state agencies. Nonetheless, important public health research can be conducted with available data as long as the limitations and their effects on generalizability are considered. At the end of the second workshop, some com- mented that the public health and the insurance communities may have different interpretations of terms in common usage and overcoming that barrier might be facilitated by a summary of the workers’ compensation industry and a crosswalk of terminology used by each group. A team began work on this document as a result. Following the background and brief history of the workers’ compensation programs in the U.S., this primer describes: (1) benefits and premiums; (2) the relationship between premiums and safety incentives; (3) roles of insurers, state agencies and third party administrators; (4) types of policies; Two workshops on the use of workers’ compensation data for public health purposes have been
- 127. held and proceedings are available. Workers’ Compensation Insurance: A Primer for Public Health2 (5) claims and other workers’ compensation insur- ance information on medical treatments, costs and disability status; (6) limitations of current industry data standards; (7) loss prevention programs; and (8) public health research, sur- veillance and regulations. A glossary of workers’ compensation terms begins on page 35 and a guide for prospective research and surveillance projects follows on page 41. 2. Background The economic and social burden of occupational injuries and illnesses can only be roughly esti- mated [Leigh and Marcin 2012; Leigh 2011]. Uncertainties are due to many factors including: (1) workers receive only a portion of regular wages through workers’ compensation; (2) occupational illnesses are frequently not compensated; (3) medical treatment costs for many occupational injuries are paid by other insurance; (4) insurance data are fragmented; and (5) data are protected for proprietary and personal identification purposes. No central repository for workers’ compensation claims information exists in the U.S. The National Academy of
- 128. Social Insurance (NASI), a non-governmental organization, produces an annual report on workers’ compensation insurance. The most recent version, Workers’ Compensation Benefits, Coverage, and Costs, 2010, states that workers’ compensation insurance covered more than 124 million U.S. workers at a total estimated cost to employers of $71 billion in 2010 [Sengupta et al. 2012]. Total insured medical payments to providers and insured cash benefits to workers were estimated at $28.1 billion and $29.5 billion, respectively. Most workers’ compensation insurance car- riers are private entities except for exclusive state insurance funds in North Dakota, Ohio, Washington and Wyoming. Also, twenty states offer state-sponsored nonprofit competitive insurance companies or state licensed mutual insurance plans, some to only selected portions Workers’ compensation data are likely to be more complete for acute injuries and more representative of population risks than occupational illness data. of the market such as those employers that are unable to obtain insurance coverage in the vol- untary market. There are typically dozens if not hundreds of private carriers in each state. Large employers in the U.S. are often self-insured under rules established by the states. Workers’ Compensation Records Workers’ compensation insurance, in various
- 129. forms, covers in excess of 90% of the U.S. wage and salary workers [Sengupta et al. 2012]. Ideally, each workplace injury or illness requiring medical care covered by workers’ compensation would result in a record being created for the claim. The primary purpose for the record is to ensure proper payment to injured or ill workers and to the medical providers. Yet the record may contain useful information for public health purposes on the nature of the injury or disorder, the part- of-body, the event or exposure, industry sector, occupation, and the worker’s ability to continue working or disability status. Descriptive contents may provide additional information on materials related to the event such as biological, chemical, ergo- nomic or physical hazards. Medical records for workers’ compensation cases can provide further information about the extent and severity of the injury plus information about the injured workers such as gender, age, race/ethnicity, and other chronic health conditions that may exacerbate an injury. Workers’ compensation medical records also identify disabilities that result from the occupa- tional injuries or illnesses and billing records can contain information on treatments and costs for the medical portion of the claims. Insurance carriers and self-insured entities are required to provide state government agencies
- 130. with claims information that is used for admin- istrative requirements such as oversight and to conduct hearings for adjudication of disputes. The level of detail and quality of information vary among the data providers. Nonetheless, in each state, a government agency has longitudinal data that may be suitable for public health research and Workers’ Compensation Insurance: A Primer for Public Health 3Workers’ Compensation Insurance: A Primer for Public Health surveillance purposes. It is noteworthy that the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule exempts workers’ compensation medical information from its disclosure restrictions.1 If information from multiple sources or jurisdic- tions could be combined, workers’ compensation insurance records would permit better analysis and tracking of occupational injuries and some diseases. In public health, use of these tracking systems is called surveillance. (See box for a defi- nition.) Health scientists, economists, and others use large surveillance data sets for informative analyses of trends in incidence and costs, identification of health hazards associated with new technologies, evaluation of injury and illness preven- tion program effectiveness,
- 131. and to provide employers with information needed to protect their workforce. Limitations on Records Utility For public health research and surveillance pur- poses, workers’ compensation data are likely to be more representative of population risks for acute injuries than they are for occupational illnesses. Some investigators have used limited workers’ compensation data to estimate the frequency, magnitude, severity, and cost of compensated injuries and to examine trends over time. Several papers at the 2012 workshop described deficien- cies in workers’ compensation records for injury and illness surveillance purposes, even for more severe injuries such as amputations, fractures and concussions [NIOSH 2013a]. C ombining workers’ compensation data from a number of jurisdictions is a major technical challenge. Each state legislature and the District of Columbia establish workers’ compensation requirements2 with significant variations. For example, states vary in the cov- erage of compensable cumulative injuries such as carpal tunnel syndrome, levels of payments for partial and total disability, both temporary and permanent, and the minimum number of days away from work to qualify for wage- replacement compensation. In many states, employers with small numbers of employees, temporary employees and other groups, such
- 132. as farm employees, are excluded from coverage requirements. Certain groups of workers such as railroad, longshore, many maritime and all Federal employees are covered by rules established at the national level. Special compensation funds have been established at the Federal level for atomic weapons workers and for those disabled by black lung disease. Another factor that makes it difficult to combine data from multiple sources is the lack of national data standards. For example, although some nationally standardized data coding systems are available, such as Occupational Injury and Illnesses Classification System (OIICS), and North American Industry Classification System (NAICS), they are not universally used across the states. In fact, workers’ compensation rate- making bodies like the National Council on Compensation Insurance (NCCI) and several state rating bureaus use coding systems that pre-date OIICS and NAICS systems. These coding systems are discussed in subsequent chapters. The U.S. Centers for Disease Control and Prevention (CDC) defines public health surveillance as the “ongoing systematic collection,
- 133. analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practices, closely i n t e g r a t e d w i t h t h e t i m e l y dissemination of these data to those who need to know.” 1More on the exclusion of workers’ compensation medical records from the HIPAA Privacy Rule can be found at http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredent ities/workerscomp.html 2This document uses “requirements” as a substitute term for legislation, statutes, rules and regula- tions since the sources for the legal obligations vary among the states. http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredent ities/workerscomp.html Workers’ Compensation Insurance: A Primer for Public Health4 Furthermore, access to workers’ compensation data can be difficult to obtain. Insurance carriers are usually private businesses that manage very large data sets in integrated, proprietary systems. These data are generally not shared with external groups. Some insurance organizations like NCCI routinely collect standardized data from insurance carriers in many states but their contracts protect the proprietary interests of the contributing carriers and restrict data uses to issues directly
- 134. related to estimating or recommending insur- ance premium rates for establishments within industries. Only one private insurance entity, The Liberty Mutual Research Institute for Safety, has published extensive peer-review articles related to injury and illness prevention based on workers’ compensation records [Courtney 2010]. E v e n w h e n c o n d u c t - ing analyses of workers’ compensation data from a single state, there are c h ar a c t e r i s t i c s of t h e workers’ compensation data that limit its utility. Multiple researchers have reported limitations on the utilization of workers’ compensation for occupational injury and illness research and surveillance. Azaroff, et al. [2002] described a number of filters that limit the reporting and filing of cases and the subsequent development of a medical record or workers’ compensation claim following a workplace injury or illness. Several investigators have reported much less than full participation in workers’ compensation for occupational injuries and illnesses with up to half or more of the compensable claims going unreported [Biddle et al. 1998; Rosenman et al. 2000; Fan et al. 2006; Scherzer et al. 2008; Lipscomb et al. 2009]. Leigh [2012] estimated that only 21% of the total economic burden of occupational injuries and illnesses was paid by workers’ compensation insurance carriers. Others describe the diffi- culty in estimating the portion of the burden
- 135. that is shifted to other social and health insur- ance programs [Boden et al. 2001] such as when workers with occupational injuries and illnesses Each state has its own set of rules about which employers are required to obtain workers’ compensation insurance. file disability claims with the Social Security Administration [O’Leary et al. 2012]. 3. Brief History of Workers’ Compensation in the US Following European examples from the 19th century, states in the U.S. began to develop workers’ compensation laws in the early 1900’s to address the increasing risks of occupational injuries and illnesses associated with the industrial revolution. Initial laws in several states were declared unconstitutional but, in 1911, Wisconsin became the first state to establish a workers’ compensation system that withstood constitutional challenges in the courts. By 1920, most states and territories3 had followed suit. Mississippi was the last state to adopt a workers’ compensation law in 1948.4 These laws provide partial benefits to affected workers and protect employers from tort suits for occupational injuries and illnesses in nearly all cases. This “grand bargain” circumvents lengthy,
- 136. expensive trials where the burden of proof was on the employee and removed a source of financial uncertainty for the employer. Since the beginning of workers’ compensation programs in the U.S., nearly all employers have 3References to state workers’ compensation laws in this document should be read to include the territories of Guam and the Virgin Islands plus the District of Columbia, all of which have sepa- rate statutes and regulations. 4For greater details on the history and development of workers’ compensation laws in Europe and the U.S., readers are directed to http://www.iaiabc.org/files/Resources/2006HistoryofIAIABC. pdf, http://eh.net/encyclopedia/workers-compensation/, http://www.ncbi.nlm.nih.gov/pmc/ articles/PMC1888620/, or http://www.aascif.org/public/1.1.1_history.htm http://www.iaiabc.org/files/Resources/2006HistoryofIAIABC.pd f http://www.iaiabc.org/files/Resources/2006HistoryofIAIABC.pd f http://eh.net/encyclopedia/workers-compensation/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1888620/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1888620/ http://www.aascif.org/public/1.1.1_history.htm Workers’ Compensation Insurance: A Primer for Public Health 5Workers’ Compensation Insurance: A Primer for Public Health
- 137. been required to have insurance to cover pay- ments for: (1) medical costs resulting from occupational injuries and some occupational illnesses suffered by workers; and (2) partial replacement of injured or ill workers’ lost wages, also known as indemnity. Death benefits are paid to survivors for occupational fatalities. These benefits are paid only for claims where workers were injured or became ill due to conditions that “arise out of and in the course of employment,” with restrictions that vary substantially among the 50 states due to legislation and case law. In return for this coverage, employers are granted immunity from employee law suits (tort litiga- tion) for nearly all occupational injuries and illnesses. Thus workers’ compensation insurance is structured to be the sole employee remedy for restitution subsequent to occupational injuries and illnesses. Some exceptions exist for willful injuries and gross negligence. Mandatory Coverage Each state has its own set of requirements about which employers are compelled to obtain workers’ compensation insurance. Varying factors are generally the industry sector of the employer, the minimum number of employees, length of employment, and, in some cases, the familial relationship of the employee with the employer. The minimum number of employees requiring provision of workers’ compensation coverage varies between one and five across the states. Some states exclude agricultural employers with less than a specified number of employees. Some states exclude self-employed workers while other states provide an option for their coverage.
- 138. Some states exclude corporate officers in limited liability corporations without other employees. Other states have specific workers’ compensation rules for industry sectors such as mining and construction. The employment relationships of employers with employees versus contractors are clearly defined in many states.5 Since the enactment of Texas workers’ compensa- tion legislation in 1913, employers in that state have been allowed to voluntarily participate in workers’ compensation insurance coverage. Those employers who choose to opt out of coverage are not protected from tort suits by the injured or ill workers, or by surviving family members in case of fatalities. Any medical expenses are the responsibility of the injured or ill workers. No payments are required for the workers’ lost earnings for the duration of their recovery period or for permanent disabilities. More recently, Oklahoma legislation that was enacted in May 2013 allows employers to opt out of workers’ compensation insurance. In this state, employers who opt out are required to have an internal compensation program for occupational injuries and illnesses that is consistent with Employee Retirement Income Security Act (ERISA) [Oklahoma Insurance Department 2013]. Basis for Insurance Premiums Throughout the history of workers’ compensation in the U.S., premiums for insurance policies have been determined by a set of factors related to employer risks, primarily the mix of occupational classes they employ. Employers are assigned to work classifications6 according to state-sanctioned
- 139. rating bureau guidelines. In general, employers in classifications with greater injury and illness risks and loss costs have higher “manual rates.” For example, a roofing contractor generally has a higher manual rate than a bank. Recommended or specified manual rates must be approved by the state regulators in most cases. Additionally, those employers which qualify for experience rating and that have a history of greater injury and illness claims and costs within the risk classes are charged even higher premiums through the application of an experience modification factor. Those employers with fewer claims and lower loss costs benefit from lower premiums. 5For greater details on workers’ compensation trends and individual state requirements, readers are directed to the annual NASI report [Sengupta et al. 2012] and the annual report produced by the U.S. Chambers of Commerce [U.S. Chamber of Commerce 2012]. 6The classifications do not directly correspond to Standard Industry Classification (SIC) or NAICS codes or occupational classification systems, such as the Standard Occupation Classes (SOC). Workers’ Compensation Insurance: A Primer for Public Health6 Motivations for Prevention From the beginning of workers’ compensa- tion insurance laws in the U.S., the experience modification factor was intended to encour-
- 140. age employers to invest in safety. A history of elevated claims frequencies and costs results in higher insurance premiums for the employer. Adoption of effective safety strategies reduces occupational injuries and illnesses which should decrease future premiums. Additionally, many states have enacted legislation that requires carri- ers to provide premium discounts for the presence of employer-based leading indicators such as safety and health programs which meet specific criteria. Moreover, most carriers provide loss prevention ser- vices to client employers in order to limit escalation of claims costs and insurance premiums. Some states, for example Texas, Missouri and Arkansas, mandate that insurance carriers provide loss prevention services to clients and many specify that the services shall be provided at no additional cost beyond the annual premium. Recent Changes in the Industry and Market The workers’ compensation insurance market is dynamic. Both the nature of work and work- force are changing. In recent years, the mix of industries and technologies in the U.S. have changed and the workforce is aging [Restrepo and Shuford 2011] and increasingly non-English speaking [Hakimzadeh and Cohn 2007] and obese [Ostbye et al. 2007; Trogden et al. 2007; Schmid et al. 2012]. In the past couple of decades, there have been substantial changes in state
- 141. laws that affect workers’ comp ens ation p olicies and procedures. Workers’ compensation insurance requirements on issues such as managed care organizations, limited physician choice, voca- tional rehabilitation, minimum standards of care, and restrictions on treatment options have been enacted in many states. Meanwhile, medical costs for claims have escalated [Shuford et al. 2009] and litigation of claims is common in many states [Willborn et al. 2012]. Changes in the relationships between employees and employers have created needs for newer workers’ compensation insurance policy types. For example, contingent work arrangements through temporary employment agencies and professional employer organizations (PEO) are becoming more common [Smith et al. 2010]. These emergent work arrangements can compli- cate coverage and incentives for injury prevention. PEOs primarily have provided human resource and management services to client employers although they increasingly employ workers in other industries. PEOs result in co-employ- ment by the host agency and the client employer. Newer workers’ compensation policy arrangements have been developed for PEOs and similar employment
- 142. leasing organizations [Shuford 2013] since a single host agency may employ workers at different times in industries with various risk classifications. In contrast, workers who are employees of a temporary agency are covered under the workers’ compensation policy for that agency, not that of the client employer. Independent contractors, which are defined in the workers’ compensa- tion statutes in many states, are not covered by the policy of the contracting employer, e.g. the general contractor at a construction site. Also, independent contractors which are self-employed persons are qualified for workers’ compensation insurance in some, but not all, states. Each of these arrangements can blur the responsibility for provision of workers’ compensation coverage and has resulted in a lack of coverage for some workers. Insurance Industry Resources Many organizations produce information that is used by various parts of the workers’ New types of workers’ compensation insurance policies have been devel- oped to cover the recent changes in the relationships between employees and employers.
- 143. The relationship between claims frequencies and costs and the employers’ premium is intended to encourage investments to reduce the risk of injuries and illnesses. Workers’ Compensation Insurance: A Primer for Public Health 7Workers’ Compensation Insurance: A Primer for Public Health compensation insurance industry. The U.S. Department of Labor formerly compiled reports on benefits and costs and annual summaries of changes in state workers’ compensation require- ments. They also employed regional experts on workers’ compensation. The federal efforts have shifted and some of the products have been replaced by private or nonprofit entities such as NASI and a number of others. For example, a biannual report that compares the average cost of workers’ compensation insurance per $100 of employer payroll among states is published by the State of Oregon [Oregon Department of Consumer and Business Services 2012]. The roles and contributions of a number of these insurance organizations appears later in this document. Effectiveness of State Laws The comparative impact of the various state requirements has been a source of debate over the entire history of workers’ compensation in the U.S. Federalization of the programs has been suggested from time to
- 144. time. The Occupational Safety and Health Act in 1970 created the National C om m i s s i on on St ate Workers’ Compensation Laws which, after public meetings and comment period, proposed Federal minimum standards for state programs if the states did not substantially improve their laws. Related Congressional actions failed to pass. The Commission did develop a set of recommenda- tions for the state programs.7 Changes in state requirements subsequent to those recommenda- tions have been periodically reviewed which indicate partial adoption by each of the states.8 According to national surveillance data, the fre- quency and rate of occupational injuries have declined over the past several decades [Sengupta et al. 2012; U.S. Bureau of Labor Statistics 2012]. In 2010, employer costs for workers’ compensa- tion benefits as a proportion of payroll were at the lowest level in 30 years [Sengupta et al. 2012]. There has also been a general trend across the states to limit compensation for disabled workers [Spieler and Burton 2012]. Whether the surveil- lance trends are due to reduced injuries, increases in underreporting, or other factors is the subject of ongoing research. 4. Workers’ Compensation Insurance Benefits Payments for workers’ compensation claims can be for employee medical treatment, loss of wages
- 145. (indemnity), vocational rehabilitation, perma- nent disability, and death. The rules for the level of payment vary tremendously among the states with a few exceptions. First, all medical expenses are the responsibility of the insurance provider without co-payment by the claim- ant but may be subject to legislated time limits and to medical fee schedules. These covered costs include the initial treatment and subsequent treatments plus physical therapy or vocational rehabilitations. Second, indemnity payments to the worker who misses work for greater than the minimum waiting period are provided tax-free. Third, most states provide wage replacement payments for the initial waiting period after lost work time exceeds a number of days that is set by the individual states (Table 1). For example, if the initial waiting period for indem- nity payments is five calendar days, payments for that initial period would be made once the lost work time on that claim exceeds a separate minimum period such as 21 calendar days. This latter minimum time period is called the retroactive period. 7http://www.workerscompresources.com/National_Commission_ Report/national_commis- sion_report.htm 8http://www.ncbi.nlm.nih.gov/pubmed/15182746, http://www.ssa.gov/policy/docs/ssb/v65n4/v65n4p24.pdf
- 146. http://www.workerscompresources. com/, National_Commission_Report/National_Commission/1- 2004/Jan2004_nat_com.htm Payments for workers’ compensa- tion claims cover employee medical treatment, loss of wages, vocational rehabilitation, permanent disability and death. http://www.workerscompresources.com/National_Commission_ Report/national_commission_report.htm http://www.workerscompresources.com/National_Commission_ Report/national_commission_report.htm http://www.ssa.gov/policy/docs/ssb/v65n4/v65n4p24.pdf http://www.workerscompresources.com/ http://www.ssa.gov/policy/docs/ssb/v65n4/v65n4p24.pdf http://www.workerscompresources.com/ Workers’ Compensation Insurance: A Primer for Public Health8 Table 1. Waiting period for claimant to receive wage replacement benefits and the retroactive period which, if exceeded, results in payment for the waiting period State Waiting Period (days) 1 Retroactive (days) 2 AL 3 21 AK 3 28 AR 7 14 AZ 7 14 CA 3 14 CO 3 14
- 147. CT 3 14 DE 3 7 DC 3 14 FL 7 21 GA 7 21 HI 3 ID 5 14 IL 3 14 IN 7 21 IA 3 14 KS 7 21 KY 7 14 LA 7 42 ME 7 14 MD 3 14 MA 5 21 MI 7 14 MN 3 10 MS 5 14 MO 3 14 MT 4 NE 7 42 NV 5 6 NH 3 14 NJ 7 7 NM 7 28 NY 7 14 NC 7 21 Workers’ Compensation Insurance: A Primer for Public Health 9Workers’ Compensation Insurance: A Primer for Public Health Table 1. Waiting period for claimant to receive wage
- 148. replacement benefits and the retroactive period which, if exceeded, results in payment for the waiting period State Waiting Period (days) 1 Retroactive (days) 2 AL 3 21 AK 3 28 AR 7 14 AZ 7 14 CA 3 14 CO 3 14 CT 3 14 DE 3 7 DC 3 14 FL 7 21 GA 7 21 HI 3 ID 5 14 IL 3 14 IN 7 21 IA 3 14 KS 7 21 KY 7 14 LA 7 42 ME 7 14 MD 3 14 MA 5 21 MI 7 14 MN 3 10 MS 5 14 MO 3 14 MT 4 NE 7 42 NV 5 6 NH 3 14
- 149. NJ 7 7 NM 7 28 NY 7 14 NC 7 21 Table 1. Waiting period for claimant to receive wage replacement benefits and the retroactive period which, if exceeded, results in payment for the waiting period (continued) ND 5 5 OH 7 14 OK 3 OR 3 14 PA 7 14 RI 3 SC 7 14 SD 7 7 TN 7 14 TX 7 14 UT 3 14 VT 3 10 VA 7 21 WA 3 14 WV 3 7 WI 3 7 WY 3 9 1The minimum number of days away from work to qualify for indemnity payments, also known as the waiting period. 2If away from work for a number of days in excess of the retroactive period, claimant qualifies for indemnity payment for the waiting period.
- 150. Source: 2011 Chambers of Commerce Workers’ Compensation Laws, Chart IX, (see caveats pp. 78 – 79 in reference) Workers’ Compensation Insurance: A Primer for Public Health10 Temporary Disabilities Temporary and permanent disability benefits can be in the form of partial or total benefits. Temporary partial benefits would be merited when workers are away from work beyond the specified minimum period but able to return to work in a limited capacity that would partially affect their income. Temporary total disability benefits occur when the worker is unable to be employed in any capacity for a period of time that exceeds the specified waiting period. Many states have set time limits on temporary total disability indemnity payments such as 104 weeks. These benefits may convert to temporary partial benefits if the worker is able to return to work part- time for limited periods or if able to complete work in another position at a lower pay rate. Permanent Disabilities Permanent partial disability payments are awarded for workers who may no longer return to work with sufficient capacity to perform their prior duties or if they lose part or all of the function of a specific body part due to a work-related amputation or other disability. The loss of a body part or function is often compensated based on a fee schedule such that a set multiplier of the average wage is paid either as a lump sum or over a period of time. Many states also
- 151. provide permanent partial coverage for disfigurement of the face or other body parts. The extent of permanent partial disability is deter- mined by the degree of impairment at the point of “maximal medical improvement” in order to settle the case. Impairment is usually determined according to medical references such as the American Medical Association Guides to the Evaluation of Permanent Impairment [Cocchiarella and Anderson 2001]. Permanent total disability indemnity payments are made to those workers who can no longer be employed in any capacity. Depending on the state, these payments may continue until retirement age, for the life of the individual, or until disability payments are received from another source such as the Social Security Administration. In some cases, the portions of the disability that are attributed to work and non-work conditions can factor in the amount of the disability payment. For example, in some jurisdictions, a worker who is disabled as a result of occupational exposures to a respiratory hazard may have their benefits reduced if a non-occupational exposure, such as smoking, is demonstrated to have contributed to the impairment. Death benefits are paid to survivors of the worker who was killed on the job. The level of benefits usually varies with the number of dependents. Although generally a function of the average weekly wage,
- 152. death benefits are often limited by a minimum and maximum amount but may last for the lifetime of the surviving spouse or until dependent children attain 18 years of age or older in certain cases. Settlement of Claims Lump sum settlements, also known as negotiated settlements or compromise and release agreements, in lieu of limited periodic payments, have been increasing for disabilities covered by workers’ com- pensation insurance. These agreements are reached between the disabled employee, the employer and the insurance provider. In some states, settlements may cover only indemnity portions of a claim, with future medical benefits provided, while others allow payouts for future medical care (including Medicare set-asides,9 if appropriate). Often times, the settlements must be approved by a state workers’ compensation authority. Claim Costs and Reserves Claims that are not settled through mutual agree- ment remain open until all payments for medical treat- ments, rehabilitation and indemnity have been completed and the worker returns to work, reaches the maximum indemnity period or retirement age or dies. As a result, the cost of a claim can continue to grow. Future 9Medicaid set-asides for occupational injuries and illnesses are explained at http://www.medicare. gov/supplement-other-insurance/how-medicare-works-with- other-insurance/who-pays-first/
- 153. workers-comp-payments.html. Future obligations on a claim are handled in the form of reserves that are established for open ended claims. Workers’ Compensation Insurance: A Primer for Public Health 11Workers’ Compensation Insurance: A Primer for Public Health obligations on a claim are handled in the form of reserves that are established for open ended claims and are dependent on the nature of the injury and the likelihood of the rehabilitation of the worker. Reserves typically represent estimates of the most likely future cost of the claim, which approximates the mode of the distribution of claims of that type, rather than the mean. With the open-ended nature of longer duration claims, insurance carriers often value (estimate cost of ) the claims based on the payments made to date, the payments plus reserves, or the pay- ments plus reserves as of a certain period of time, such as 30 months after the date of injury. Claims can also be valued using “factor-adjusted” methods that calculate costs by applying actu- arial loss development factors that attempt to estimate the ultimate payout amounts for the claims. For the “factor-adjusted” method, reserves therefore represent the mean future cost of claims of the same type. This method is applied to groups of claims and is used by insurance underwriters for analyzing aggregated
- 154. claims for loss trends. A potential drawback with “factor-adjusted” methods is that their values are usually higher than the actual values of the individual claim (since the mean is always higher than the mode and median in claim cost distributions) [Wurzelbacher et al. 2013]. Some carriers use yet other cost valuation methods. 5. Workers’ Compensation Insurance Providers The workers’ compensation insurance industry is complex with total per annum expenditures in excess of $70 billion [Sengupta et al. 2012]. The primary types of groups in the industry include insurance carriers, state regulatory agencies, third-party administrators and numerous trade organizations. Insurance providers may be privately-held corpora- tions, mutual corporations (owned by the policy holders), and state or Federal agen- cies. All states except North Dakota permit self-insurance for qualified employers [U.S. Chamber of Commerce 2012]. Insurance Providers and Policies The insurance providers are regulated by indi- vidual state requirements. Even nationwide insurance carriers must follow the require- ments in each of the states where they offer coverage. In most states, private insurance carriers compete in the regulated voluntary market. Twenty states offer alternatives to the private insurers in the form of non-profit state-sponsored insurance programs. In addi- tion, state funds are the exclusive providers
- 155. of workers’ compensation insurance in four states – North Dakota, Ohio, Washington and Wyoming. Insurance providers employ a range of special- ists such as actuaries, adjusters, underwriters, claims administrators and loss control con- sultants (see glossary). Brokers directly market insurance policies to employers and they may offer policies from a single insurance carrier or multiple competing carriers. Many private insurance providers specialize in spe- cific industry sectors in which they are most familiar with risks. Large national carriers offer insurance across diverse sectors but may still focus on certain industries. Many private insurance providers also offer other lines of coverage beyond workers’ compensation, such as property and liability. Insurance providers typically issue annual policies. An employer may opt to change insurance carrier on the anniversary of the policy except in states with exclusive funds. Annual policies add to the competitiveness of the market yet they reduce the investment commitment of a carrier to client employers. For example, carriers are not likely to invest in cost reduction strategies such as safety equipment if the recovery of the investment would take several years to materialize. Residual Market The residual market customarily consists of those employers that are unable to obtain insurance coverage in the voluntary market. The residual
- 156. market usually serves newer employers without sufficient years of experience in workers’ com- pensation, employers with poor claims experience Workers’ Compensation Insurance: A Primer for Public Health12 or employers in high-risk industries unable to obtain a policy to underwrite their potential losses. However, the residual market in some states may include employers that voluntarily participate when there are economic or services advantages. All 24 state-sponsored insurance programs provide coverage for their residual markets. A few of the state-sponsored government insurance pro- grams provide insurance coverage only to the residual market. Some states require the private insurance compa- nies in their markets to write proportionate coverage for the residual market employers in the form of assigned-risk pools. The Burton primer on workers’ compensation pro- vides additional details on the residual market and assigned-risk pools [Burton 2004]. 6. State Workers’ Compensation Agencies Each state has an agency that provides administrative services for workers’ compensation, has adjudicatory responsibilities in cases of disputes, and/or develops
- 157. regulations and rules for the workers’ compensa- tion system consistent with the intent of legislative mandates. Portions of the agencies may operate as commissions, bureaus, or departments. They may be affiliated with other levels of government in the states such as labor, industry, insurance or commerce. Collection of Records All states require that some portion of the workers’ c o m p e n s a t i o n c l a i m s records be reported to the agency by employers (Table 2). In some cases only indemnity claims are reported yet in others all claims (including medical only claims) are reported. More and more states have developed automatic Web (internet)-based or telemetric reporting systems that use standard forms and require the use of standardized codes The residual market usually serves newer employers without sufficient experience in workers’ compensa- tion, employers with poor claims experience, or employers in high-risk industries unable to obtain a policy to underwrite their potential losses. for fields in the forms. For example, the Workers’ Compensation Insurance Organization (WCIO) part-of-body, nature of injury or illness, and cause of incident codes are used in nearly all jurisdictions.
- 158. State agencies may be restricted by requirements in the portions of the workers’ comp ens at ion re cords which may be released to the public. In some states, those restrictions can extend to other in-state agencies as well. It bears repeating that HIPAA Privacy Rule exempts workers’ compen- sation medical information from its disclosure restrictions. Other Roles of State Agencies Many state agencies oversee special funds that provide benefits to injured or ill workers whose employer failed to obtain the legally required coverage. Most states also offer second injury funds which reimburse employers for certain claims paid to workers with pre-existing injuries. A few state agencies, e.g. Ohio and Washington, provide safety grants to offset some portion of an employer’s expenses for installation of safety equipment. Grants in other states, e.g. Massachusetts and Oregon, are made to support development of injury prevention training pro- grams (Table 3). A few states have research c o m p o n e n t s i n t h e i r workers’ compensation agencies. These components may track expenditures, evaluate the implications
- 159. of proposed legal changes, or consider other aspects of policy options. Many states, e.g. Florida [Florida Division of Workers’ Compensation 2011], develop annual reports for their agen- cies that reveal the number of cases in various categories such as indemnity, medical-only and disallowed claims as well as the number of claims All states workers’ compensation agencies require that some portion of the claims records be reported. HIPPA Privac y Rule exempts workers’ compensation medical information from its disclosure restrictions. (See footnote 1) Workers’ Compensation Insurance: A Primer for Public Health 13Workers’ Compensation Insurance: A Primer for Public Health that are contested by the employer or the insurance provider. The reports may also describe recent changes to the requirements and the status of claims that are open and those that are closed. Other data may be pre- sented on the average cost of claims for various injury and illness types as well as the distribution of claims
- 160. across industry segments. Web (Internet) Services Most state agencies provide diverse services and extensive information via Web sites. Available services include injury, illness and death claim forms for employees and employers and the means to report suspected fraud. Proof of insurance cover- age by individual employers may be obtained in some states through their Web sites. The Web site information may describe the rights and responsi- bilities of employees, employers, insurance carriers, medical providers, and the state agency according to requirements in the state. Many states provide plain- language guides for employees and employers that explain claims processing and appeals. Ombudsmen in some states may be contacted through the Web sites to assist claimants. Most state agencies also use Web sites to promote safe and healthful working conditions and to provide information on safety and health program aids that can be readily used by employers. Other infor- mation on participation in various programs associated with premium discounts or penalties is offered as well. Lists of insurance providers as well as consultants and third party administrators are available on many state sites. Training on the workers’ com- pensation requirements is often made available through the Web sites. Links to state statutes and regulations are common.
- 161. 7. Third-Party Administrators Third-party administrators (TPA) are insurance organizations other than the brokers, providers, associations and the state agencies. TPAs provide a wide range of services. They often complete the actual claims forms and may be the direct payer of benefits to workers and to medical providers. They can be the intermediary that reports the claim information to the respective state agency and they provide analytical reports to their clients. Self- insured businesses often employ TPAs for a diverse range of claim and insurance services. TPAs may complete and otherwise process claim forms for the employer, pool or group including an initial determination of compensability. Complete risk management information systems are offered by some TPAs. In addition, they can provide services such as medical case management, medical bill review, and programs for the injured employee to return- to-work. Some TPAs provide investigation, subrogation and legal services to their clients. Pharmacy benefit management and Medicare set- aside services are some of the later additions to the TPA offerings. Yet others may provide loss pre- vention services and health and safety training for
- 162. employees and employers. TPAs may also provide clients with their required Occupational Safety and Health Administration (OSHA) logs for recordable injuries and illnesses. 8. Types of Policies Workers’ compensation insurance policies vary in many ways. The most straightforward policies cover the claims costs due to a worker injury or illness experienced by a single employer at a single business establishment, i.e. location. Some employers have multiple establishments for a single policy and the risk classification for the individual establishments may be differ- ent, e.g. a manufacturer that also has a retail outlet. Yet other policies may cover workers at multiple establishments that change over time Third-party administrators (TPA) are insurance organizations other than the brokers, providers, associations and the state agencies. Increasing risk retention by the employer is accommodated by the following insurance or policy types: guaranteed cost, dividend, retrospective rating, deductible, and self-insurance.
- 163. Workers’ Compensation Insurance: A Primer for Public Health14 Table 2. Required employer reporting of injuries, illnesses and deaths to State Workers’ Compensation Bureaus. State Medical Treatment beyond 1st Aid Provided1 Indemnity Only (Min. No. Days)2,3 AL Y(3) AK Y AR Y AZ Y CA Y(1) CO Y(3) CT Y(1) DE Y DC Y FL Y GA Y(7) HI Y ID Y Y(1)4 IL Y(3) IN Y(1) IA Y(3) KS Y(1) KY Y(1) LA Y(7)
- 164. ME Y(1) MD Y(3) MA Y(5) MI Y(7) MN Y(3) MS Y(5) MO Y MT Y NE Y NV Y NH Y NJ Y NM Y NY Y(1) NC Y(1) ND Y Workers’ Compensation Insurance: A Primer for Public Health 15Workers’ Compensation Insurance: A Primer for Public Health Table 2. Required employer reporting of injuries, illnesses and deaths to State Workers’ Compensation Bureaus (continued). OH Y(7) OK Y OR Y(3) PA Y(1) RI Y Y(3) 4 SC >$500 Y(1) 4 SD Y Y(7) 4
- 165. TN Y TX Y(1) UT Y VT Y Y(1) 4 VA Y WA Y(1) WV Y WI Y(3) WY Y 1If Y, employers are required to report all claims that result in medical treatment beyond first aid to the workers’ compensation bureau. (In SC, all claims with >$500 in medical expenses must be reported.) 2Employers are required to report all claims for occupational injuries and illnesses for workers missing work for a period of time in excess of these values. 3All deaths due to occupational injuries or illnesses must also be reported in all states. 4Additional reporting required for disabilities in excess of the number of days indicated. Source: 2011 Chambers of Commerce Workers’ Compensation Laws, Chart IX, (see caveats pp. 78 – 79 in reference) Workers’ Compensation Insurance: A Primer for Public Health16
- 166. Table 3. States with statutes, rules and/or regulations about employer-based occupational safety and health program elements plus states with approved state OSHA Plans or consultation programs only, 2011 State OS&H Regulations States Requirements Employer Written Safety and Health Program CA1, HI2, LA3, MN4, NE, NV5, NH5, NC6,WA Employer/Employee Safety and Health Committee AL7, CA4, CT8, MN9, MT10, NE, NV11, NH10, NC12, OR13, TN14, WA5 Insurer to Provide Loss Prevention Services AR, CA, KS, MS, MO, MT, NM, OR, PA, RI, SD, TX On-Site Inspection by Loss Prevention Services AR15, CA16, DE17, NM18, NY19, RI20, TX21 Incentives Premium Reduction for Safety Program Elements
- 167. CO, DE22, FL, HI, ME, NH, NM, NY, ND, OH, OK, PA, SD23, UT24, WI, WY25 Employer Penalty for Violation of Rule at Time of Injury CA, IL, MA, MO, NC, WI Safety Grant MA26, MN, NY, ND, OH, OR26,UT, WA Registry of S&H Practitioners HI, LA, MO State OSHA Plan AK, AZ, CA, CT27, HI, IL27, IN, IA, KY, MD, MI, MN, NV, NJ27, NM, NY27, NC, OR, SC, TN, UT, VT, VA, WA, WY State Consultation Program Only AL, AR, CO, DE, FL, GA, ID, KS, LA, ME, MA, MS, MO, MT, NE, NH, ND, OH, OK, PA, RI, SD, TX, WV, WI Information in this table was obtained from Web sites of state legislatures and agencies. Due to the difficulty in locating statutes, rules, regulations and relevant case law, some information may have been omitted from the table. Further information may be obtained from the primary author. 1Reduced documentation requirements if <10 employees; <20 employees and not on high hazard list and experience modification is <1.1; or < 20 employees and on designated low-hazard list.
- 168. 2If >24 employees 3If > 15 employees 4For high hazard industries on list 5If >10 employees Workers’ Compensation Insurance: A Primer for Public Health 17Workers’ Compensation Insurance: A Primer for Public Health 6If experience modification factor is >1.5 7Upon written request of an employee 8If >25 employees or injury and illness rate greater than average for industry 9If > 25 employees or if in top 10% within industry lost-days rate or if top 25% of pure premium for all classes 10If >5 employees 11If >25 employees 12If >10 employees and experience modification factor >1.5 13Routine safety meetings also allowed 14If experience modification factor is >1.2 15Or other appropriate services if premium > $25,000, or if > $5,000 and loss ratio > 100%, or if loss ratio > 150% 16For targeted high hazard employers 17Fee is charged and employer required to participate in Workplace Safety Program discount 18If premium > $5,000, self-inspection is allowed 19If payroll > $800,000 and experience modification factor >1.2 20If premium > $25,000 and requested by employer 21If premium > $25,000 and loss ratio >1.0, or if premium >
- 169. $5,000 and loss ratio > 2.5 22If premium > $3,161 23Unspecified penalty for establishments where deficiency has not been corrected at time of subsequent safety review 24If experience modification factor >1.0 or if 3-year loss ratio > 100% and if “work place safety program” not adopted after request from the insurer then 5% premium surcharge is allowed 25Based on reduced loss ratio attainment 26Grants available for training only 27Public sector employees only are covered by the state plan along with consultation program for most private businesses Workers’ Compensation Insurance: A Primer for Public Health18 such as one for a company in the residential construction industry. If employees of the business routinely travel to other states, provisions that cover losses in the other states may be added to policies. If the business has employ- ees located in multiple states, multiple policies are typically required. With workers’ compensation records alone, it may be difficult to associate an injury or illness with an establishment when the policy covers multiple establishments. In many states, employers are allowed to form groups or pools to obtain insurance in the voluntary markets
- 170. or to combine as a self-insured entity. Membership in a group is usually restricted to similar industries. Other insurance arrangements include carve-outs, which are labor/management agreements,10 and captives, i.e. an insurance company that is wholly- owned by a single employer or a group of employers and provides insurance to the owners’ businesses. Risk Retention Workers’ compensation insurance policies deter- mine the amount of risk the employer retains for workplace injuries and illnesses. Risk retention may increase employer interest in reducing potential losses through safety and health prevention since they could be responsible for payments on some claims. In order of increasing risk retention by the employer are the following insurance or policy types: guaranteed cost, dividend, retrospective rating, deductible, and self-insurance [Thamann and Reitz 2000]. For example, with a guaranteed cost policy, the loss to the employer in a given policy year can never be more than the policy premium. On the other hand, with large deductible policies, the employer is self-insured up to an amount of the deductible yet obtains an insurance policy for excess coverage purchased from a provider. The deduct- ible amounts may be per claim and/or aggregate and range from a few thousands of dollars to $1 million or more. Nonetheless, the carrier of the excess coverage is, according to the state regula- tors, responsible for the entire claim amount. The carrier then obtains reimbursement from the client employer through an agreed mechanism. Self-insurance is a form of insurance that is generally
- 171. limited to larger employers which demonstrate to their state workers’ compensation regulating agency that they have the financial resources to make the equivalent of indemnity, medical and death benefit payments to their employees who suffer occupa- tional injuries and illnesses. Qualifications for self-insurance vary among the states. For example, some require surety bonds. In Ohio, an exclusive state program, self-insurance is permitted only for those employers with a minimum of 500 employees. Other Policies As mentioned earlier, state-sponsored programs also provide insurance coverage for workers whose employer failed to obtain the required insurance policy. Most states also provide special coverage for second injuries which reduces the financial disincentives of employing a worker with an existing disability. 9. Policy Premiums Premiums for workers’ compensation insurance policies are determined by the risk classification of the insured employer, the size of the payroll, and in many cases, on the employer’s past claims experience. “Manual rates” or “base rates” are set for each of the industry risk classes by actuarial organizations like NCCI and are expressed as the cost of insurance per $100 in payroll. The manual rate is then adjusted using an experience modification factor for those employers who are sufficiently large to be rated based on their claims history. The premium setting process and related terms are more fully explained in other sources such as A Primer on Workers’ Compensation by John F. Burton, Jr.11
- 172. 10“Carve out” has different meanings across the insurance industry. The definition used for workers’ compensation insurance carve outs in California may be found at http://www.dir. ca.gov/dwc/carveout.html. 11 Burton’s Workers’ Compensation Resource provides access to a wide range of relevant materials. http://workerscompresources.com/wp- content/uploads/2012/11/ND04A.pdf http://www.dir.ca.gov/dwc/carveout.html http://www.dir.ca.gov/dwc/carveout.html http://workerscompresources.com/wp- content/uploads/2012/11/ND04A.pdf Workers’ Compensation Insurance: A Primer for Public Health 19Workers’ Compensation Insurance: A Primer for Public Health Experience Modification Factor In general, an employer’s history of increasing numbers of claims and costs leads to higher expe- rience ratings and higher overall premiums. The experience modification factor is usually affected more by the frequency of claims from the policy holder than by the total cost, although these rules vary among the states. The loss ratio is one of the factors used to calculate premiums and it is equal to the total costs for losses divided by total premiums paid. The loss ratio may be calculated for a single client, a risk class
- 173. or for the insurance industry as a whole. Other Premium Adjustments The premium may be further altered by discounts that are awarded for multiple reasons. For example, discounts may encourage certain activities such as an employer’s participation in a safety council, having joint labor management health and safety committees, or having documented safety and health programs. Some provide premium discounts for firms with drug and alcohol programs. Many mutual insurance companies provide divi- dends that effectively reduce the premiums. 10. Workers’ Compensation Records Workers’ compensation claims records contain information that may be used to determine the frequency of injuries and illnesses plus indicators of morbidity severity such as medical treatments, their costs, hospitalizations, days away from work, types and percentages of disabilities, and reha- bilitation. As mandated by the individual state laws, parts of workers’ compensation records and record systems may be completed by employees, employers, medical providers, insurance carriers, third-party administrators, and the state agencies. Premiums for workers’ compensation insurance policies are dependent on
- 174. the risk classification of the employer, the size of the payroll, and in many cases, on the establishment’s past claims experience. Not only can workers’ compensation records be used to determine the frequency of injuries and illnesses, but also disability status, medical treatments, their costs, hospitaliza- tions, days away from work, and rehabilitation. The most common types of records are the claims forms for injury and illness and these are required in all states. Yet other potentially useful records may be collected and retained by the carrier. These additional records may describe employer safety and health programs, work-site inspections and other loss prevention activities. Records may also exist on the current insurance status of individual employers, carrier enrollments to conduct business in the state, registrations of con- sultants and third-party administrators, adjudi- cations and appeals, and self-insurance applica- tions, among others. Access to these records may be restricted by the applicable laws in each
- 175. state. Individual investigators need to verify all legal restrictions in each state of interest. Standard Records The most common claims record is the first report of injury (FROI) form. The form col- lects some demographic i n f o r m at i o n o n t h e injured or ill employee, disability status, and contact information for the employer, insurance carrier, and medical pro- vider. Many states use the standard FROI developed through the Electronic Data Interchange (EDI) by the International Association of Industrial Accident Boards and Commissions (IAIABC). An example of the EDI form and instructions can be accessed at the Missouri Department of Labor and Industrial Relations Web site.12 Three versions of this form are now in use across the participating states. Forms used by yet other states contain similar information but the range of forms is too broad to list each one of them. 12One example of an EDI FROI can be found at http://labor.mo.gov/DWC/Forms/WC-1-EDI-AI.pdf. http://labor.mo.gov/DWC/Forms/WC-1-EDI-AI.pdf Workers’ Compensation Insurance: A Primer for Public
- 176. Health20 The EDI forms include sections on employee wage, gender, date of birth and date of hire, occupation, employment status, and number of dependents. The event fields include date, time of day, date employer was notified and date dis- ability began, type of injury and affected body part, and descriptive information on the equipment involved, worker activities, work process, sequence of events, and check boxes for use of personal protective equip- ment. Dates for return to work or for deaths are also listed on the form. The medical treatment provider is also identified and their address is listed along with a checklist for the level of treatment (from none to hospitalization), and future lost work time antici- pated. Many of the fields on the FROI use standard codes which are described below in section 11. Subsequent reports of injury (SROI) for each claim may be completed at the time treatment is provided by a health care practitioner, when a benefit type is changed (e.g. from temporar y total to per- manent total disability), or when the claimant returns to work or dies. Thus, a series of reports may be available for each claim. A computerized record is generally used to combine the information
- 177. from the claims record series. Billing forms from treatment providers are another set of records that provide important information. These forms list the treatment costs and may include information on diagno- sis and treatments (such as Current Procedural The initiator of workers’ compen- sation claims has a major role in ensuring that all fields in the FROI form are accurately completed. The initiator may be the employer, injured employee, insurance broker, TPA, or a treating physician depend- ing on the state. Information in the workers’ com- pensation records that is used for payment of workers and medical providers is likely to be more accu- rate and complete than other fields in the record systems. Terminology codes) which may differ from the FROI and SROI. The differences may result from additional medical testing or from aggravation of an existing condition such as an infection. Any changes in diagnosis should be recorded in the injury claim record system. Another record system
- 178. widely used in the U.S. is the Unit Statistical Report that is provided by insurers to NCCI and other workers compensation data collection organiza- tions. These reports are initially valued at 18 months after policy effective dates and include premium and loss information on a state basis. Open claims are valued and reported annually for up to 10 years to track loss development.13, 14 Limitations of Record Information It is important to mention, once again, that the primary purpose for the injury and billing records is the timely payment of the injured or ill workers and their medical providers. Therefore, information in these records that is used for these purposes is likely to be more robust than other fields in the record systems. For example, diag- nostic and treatment codes are more likely to be accurate and complete than information on occupation and employment status, particularly for medical only claims. An estimated 80% of all claims are medical only [Sengupta et al. 2012]. The statutory days away from work time limits for “medical only” versus “lost time” claims vary significantly from one state to another (Table 2). 13set of slides that explain unit reporting is available at http://www.ncci.com/documents/DRW- 2008-Unit-Data-Reporting.pdf
- 179. 14NCCI’s Statistical Plan for Workers Compensation and Employers Liability is applicable in Alaska, Alabama, Arizona, Arkansas, Colorado, Connecticut, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, Virginia and West Virginia. http://www.ncci.com/documents/DRW-2008-Unit-Data- Reporting.pdf http://www.ncci.com/documents/DRW-2008-Unit-Data- Reporting.pdf Workers’ Compensation Insurance: A Primer for Public Health 21Workers’ Compensation Insurance: A Primer for Public Health The information in many claim records evolves over time and delays in availability are to be expected. Statutes of limitation are common for workers filing claims for an occupational injury or illness and often extend to 2 years in many states. Employers are required to report claims information to state agen- cies within specified periods that vary among states – usually less than 15 days (Table 2). Employers and insurers are also required to maintain claims records for time periods that vary among the states. Records maintenance is one of the primary services provided to employers by TPAs. Many of the terms used in the workers’ compensa-
- 180. tion industry have specific meanings. For example, the term “claim,” itself is subject to confusion as it is applied to the notification of the supervisor, notification of the insurer at the time of injury, the “first report” for the state workers’ compensation agency, or a request for arbitration on the part of the worker. Some of these terms are defined in the glossary (p. 35). For any set of electronic data, it is important to obtain the applicable data dictionary that specifically defines each data element and each code used. An historical dictionary may be essential for longitudinal data. Additional limitations on claims information are described in the Background section of this document. Disallowed and Zero-Cost Claims Claims can be disallowed by insurance carriers or contested by the employer. The basis for denial is usually related to the degree of disability or the requirement that the injury or illness “arise out of and in the course of employment.” Disallowed claims may be appealed to administrative or judicial bodies depending on the state and may result in litigation which follows established procedures in each jurisdiction. Zero-cost claims may also occur but these are not the same as disallowed claims. The claim may have been initiated yet the injury or illness did not result in medical treatment or in lost work time. At least one state, Ohio, allows employers to pay the initial treatment and/or indemnity cost up to specified limits. If the claim is paid by the employer and remains within those limits, the claims records would indicate zero costs to
- 181. the agency. 11. Standardized Codes and Systems in Workers’ Compensation Numerous standardized data coding systems are utilized for workers’ compensation claims infor- mation. Some of these were specifically developed and adopted within the workers’ compensation industry while other coding systems such as NAICS and International Classification of Disease (ICD) were developed for other purposes. Standard Systems There have been and are many attempts to stan- dardize data for workers’ compensation records. For example, WCIO led a collaborative effort to standardize codes for the part-of-body, nature of injury, and cause of event that are used across the workers’ compensation insurance industry including NCCI, IAIABC and the Association for Cooperative Operations Research and Development (ACORD) but not in all jurisdictions. NCCI coding systems for industry risk classifications and a number of other factors are used in about 40 jurisdictions. IAIABC in collaboration with a number of states developed standardized forms that utilize several different data coding structures. The standards and codes have changed over time and different release versions have been adopted by states.15 U.S. government coding systems are used extensively such as OIICS from the Bureau of Labor Statistics (BLS) and Federal Employer Identification Number (FEIN) from the Internal Revenue Service (IRS). The Standard Occupational Classification (SOC) and Standard
- 182. Industry Classification (SIC) also continue to be used in some states. Several states, e.g. California and New York, have developed their own codes for certain classes of workers’ compensation information. Crosswalks may be available for some of the 15http://www.iaiabc.org/i4a/pages/index.cfm?pageid=3339 Workers’ Compensation Insurance: A Primer for Public Health22 coding systems. Unfortunately, the comparisons are often uncertain. For example, it is not always possible to identify unique ICD codes for the NCCI injury classification codes and the OIICS nature of injury codes do not correspond one- to-one with WCIO recommended codes. Portions of the individual records may be completed by parties unfamiliar with various coding systems which may lead to errors. For example, many employers may not know the codes for the nature of injury although online guides are available in many jurisdictions. Multi-source documents may be more prone to errors and omissions. 12. Loss Prevention Many insurance carriers have loss prevention programs to identify and describe the particular risks that exist at policyholders’ establishments, make recommendations for their abatement, and
- 183. offer loss prevention16 services to help policyhold- ers manage these risks. They also assess risks that exist at establishments for which they contem- plate underwriting new policies. For current policyholders, the primary purposes for the loss prevention services are to reduce the frequency and severity of workers’ compensation claims and to improve the health and safety program of the client. Policyholders with higher premiums are more likely to receive routine loss prevention services from carriers than those with smaller premiums [Morin et al. 2013]. The provided services, which frequently are viewed as marketing tools to retain existing clients, may range from delivering relevant safety In general, loss prevention programs identify and describe risks at policyholders’ establishments and make recommendations for their abatement. and health pamphlets and brochures to full risk characterizations that include recommendations for remediation with follow up inspections. Most small employers would not receive site visits unless their claims experience indicated a need for intervention. Mandated Prevention Programs All states have enacted legislation and developed
- 184. related rules and regulations to reduce occupa- tional injury and illness risks. The strategies employed by the states vary extensively and may include employer safety and health program requirements and incentives, insurance carrier loss prevention activities, registries of authorized occupational health and safety practitioners, and employer or organizational grants for risk mitigation and worker training (Table 3).17 These inducements are often limited to those employ- ers with greater than a minimum number of employees, minimum qualifying premiums, elevated experience modification factors, or that appear on lists of high hazard industries. Twelve states require workers’ compensation insurance carriers to provide loss prevention services to many employers at no additional cost (Table 3). Requirement for these services is often limited to those policyholders with greater than a minimum number of employees, such as 25, or with premiums above minimum thresholds such as $25,000. C a r r i e r - b a s e d L o s s Prevention Programs Most large workers’ com- pensation insurance carriers invest portions of their revenues in loss prevention programs [Dembe 1995; Nave and Veltri 2004; Ryan 2013] although the amounts or percent- ages are not readily available. According to one 16Note that “loss control” and “loss prevention” are terms that
- 185. are often used interchangeably. In con- trast, the term “loss reduction” is typically used to refer to the management of costs and disability once an injury or illness has occurred through programs such as case management and return-to-work. 17States that do not appear in Table 3 list of prevention requirements or incentives are Alaska, Arizona, Georgia, Idaho, Indiana, Iowa, Kentucky, Maryland, Michigan, New Jersey, South Carolina, Vermont, Virginia and West Virginia Workers’ Compensation Insurance: A Primer for Public Health 23Workers’ Compensation Insurance: A Primer for Public Health recent report, 13% of large workers’ compensation insurance clients, on average, receive loss control visits in a given year although that value varies widely by industry group (e.g. Manufacturing = 32%, Construction = 16%, Agriculture = 4%) [Ryan 2013]. For the most part, loss prevention programs collect information on hazards and other determinants of risks from employers either prior to the issuance of a policy, i.e. risk selection for underwriting, or as a means of providing services to existing clients. Depending on the size of the premium, loss prevention services may include conduct of site visits which frequently include walk-through inspections of facilities, interviews with employees, supervisors and managers, as well as reviews of the employer’s safety and health program elements. The report for the initial survey is shared with the carrier’s
- 186. underwriting staff as well as a broker that may be involved in the transaction. These risk selection reports are considered privileged information and often only selected portions of the reports are shared with the client [Morin et al. 2013]. For new and existing clients, key elements of loss prevention reports, such as a description of the hazards identified and recommendations for their abatement, may be provided to the employer. The loss prevention staff may also communicate the need for improvements (such as specific training or documentation) to the employer’s health and safety programs. They may also provide specific services such as training employees, supervisors and managers and make training materials and model program elements available. Industrial hygiene and ergonomic surveys are included as needed. Afterwards, the loss prevention program may track progress through follow-up communications with the employer. The loss prevention professional may assist the employer in the completion of a safety grant application if they are available. Loss prevention records are not standardized except perhaps within insurance providers. The availability of mobile technology applications for loss prevention programs is increasing and may provide additional opportunities for data standards developments on hazards and employer
- 187. health and safety program elements. 13. Workers’ Compensation Associations and Organizations The workers’ compensation insurance industry is supported by a large number of professional and trade associations and other organizations that operate at the international, national, state and even local levels. Some are membership organiza- tions that provide professional services such as annual meetings, education and training. Some are research organizations that complete work under contracts. Others are affiliations of state and provincial agency represen- tatives. Only a few of the longest-standing organi- zations will be mentioned here. Two of the oldest workers’ compensation insur- ance industry associations are NCCI and IAIABC. These organizations date from the earliest state workers’ compensation programs in the U.S. According to their Web site, NCCI “is the largest provider of workers’ compensation and employee injury data and statistics in the nation.” NCCI receives proprietary claims information from insurance carriers in their member states in the form of a Unit Statistical Data report which guides setting of manual rates for their client jurisdic- tions. To support the reporting system, NCCI in conjunction with WCIO has developed a number
- 188. of standard coding schemes for nature of injury, event causation, and part-of-body. In addition, NCCI standard codes for industry, occupation and other factors are used by the nearly 40 affiliate jurisdictions. NCCI also conducts research and other analyses across a range of issues in the workers’ compensation insurance industry. Many of their reports may be accessed at https://www. ncci.com/nccimain/pages/default.aspx. The workers’ compensation insurance industry is supported by many professional and trade associations that provide a range of services. https://www.ncci.com/nccimain/pages/default.aspx https://www.ncci.com/nccimain/pages/default.aspx Workers’ Compensation Insurance: A Primer for Public Health24 The IAIABC mission statement is “to improve the efficiency and effectiveness of workers’ compensation systems throughout the world.” Among its published strategic principles are: “provide a forum for regulators, stakeholders and experts to share information and discuss issues and solutions; assist jurisdictions in identifying opportunities for reducing costs and improving the delivery of benefits; and develop, analyze, and promulgate standards and uniform practices.” IAIABC has published a number of important insurance industry documents and it sponsors and supports the EDI. Much of their information
- 189. may be accessed at http://www.iaiabc.org/i4a/ pages/index.cfm?pageid=3277. Other workers’ compensation organizations include WCRI whose mission statement is: “to be a catalyst for significant improvements in workers’ compensation systems, providing the public with objective, credible, high-quality research on important public policy issues.” The institute is an independent and not-for-profit organization providing peer-reviewed, objective information about workers’ compensation systems. Most of their documents are available to members only but some useful information may be found at http://www.wcrinet.org/about.html. According to the NASI Web site, the academy is a nonprofit, nonpartisan and non-governmental organization led by the nation’s experts on social insurance. It evaluates programs and data to develop solutions to challenges on social insurance and economic security. NASI supports research and publishes documents on social insurance topics and produces an annual report on workers’ compensa- tion programs in the U.S. that may be obtained free of charge at http://www.nasi.org/about. WCIO “is a voluntary association of statutorily authorized or licensed rating, advisory, or data service organizations that collect workers com- pensation insurance information in one or more states.” Members of the WCIO are managers of boards and agencies within the jurisdictions. Its forum supports development of electronic data transmission standards for insurers and rating/ advisory organizations. Additional information
- 190. about WCIO and its range of products can be found at https://www.wcio.org/Document%20 Library/AboutPage.aspx. ACORD is an international organization that facilitates the development of open consensus data standards and standard forms for many segments of the insurance industry, and works with its members and partner organizations to drive implementation of those standards. Their information may be found at http://www.acord. org/Pages/default.aspx. A couple of other organizations that are widely recognized in the insurance industry include: John F. Burton Jr.’s Workers’ Compensation Resource which provides access to data, research, and other information pertaining to workers’ compensation in the United States and other countries when possible. The resource offers open access to many publications such as the 1972 Report of the National Commission on State Workmen’s Compensation Laws. The extensive workers’ compensation information may be found at http://workerscompresources.com/. Dr. Burton also hosts an annual meeting for discussion of current workers’ compensation research. The Liberty Mutual Research Institute for Safety (LMRIS) is a research organization funded by a private insurance company. For over 60 years, the institute has conducted scientifically rigor- ous, peer-reviewed research to improve worker safety and health. They conduct laboratory and field studies and publish records-based
- 191. research using workers’ compensation data col- lected by Liberty Mutual Insurance. Extensive information on LMRIS can be found at http:// w w w. l i b e r t y mutu a l g roup. c om / om app s / ContentServer?pagename=LMGroup/Views/ LMG&ft=2&fid=1138356633468&ln=en Other organizations that serve the workers’ compensation insurance industry include the American Association of State Compensation Insurance Funds (AASCIF), American Insurance Association (AIA), National Association of Insurance Commissioners (NAIC), National Conference of Insurance Legislators (NCOIL), and Property and Casualty Insurers Association of America (PCIAA). http://www.iaiabc.org/i4a/pages/index.cfm?pageid=3277 http://www.iaiabc.org/i4a/pages/index.cfm?pageid=3277 http://www.wcrinet.org/about.html http://www.nasi.org/about https://www.wcio.org/Document%20Library/AboutPage.aspx https://www.wcio.org/Document%20Library/AboutPage.aspx http://www.acord.org/Pages/default.aspx http://www.acord.org/Pages/default.aspx http://workerscompresources.com/ http://www.libertymutualgroup.com/omapps/ContentServer?pag ename=LMGroup/Views/LMG&ft=2&fid=1138356633468&ln=e n http://www.libertymutualgroup.com/omapps/ContentServer?pag ename=LMGroup/Views/LMG&ft=2&fid=1138356633468&ln=e n http://www.libertymutualgroup.com/omapps/ContentServer?pag ename=LMGroup/Views/LMG&ft=2&fid=1138356633468&ln=e n http://www.libertymutualgroup.com/omapps/ContentServer?pag
- 192. ename=LMGroup/Views/LMG&ft=2&fid=1138356633468&ln=e n Workers’ Compensation Insurance: A Primer for Public Health 25Workers’ Compensation Insurance: A Primer for Public Health 14. Public Health Research and Surveillance18 Public health is “the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals” [Winslow 1920]. Fundamentally, public health relies on surveillance programs to describe the distribution of disease and injury, detect new and emerging diseases and disorders, target intervention activities to prevent their incidence, and monitor the effectiveness of those interventions. Workers’ compensation records may be used for public health research and surveillance activities. The terms “research” and “surveillance” have specific meaning in Federal public health activities which are briefly discussed here. Research Federal regulations state that “research means a systematic investigation, i n c l u d i n g r e s e a r c h development, testing and evaluation, designed to
- 193. de velop or cont r ibute to generalizable knowledge” [45 Code of Regulations (CFR) 46.102(d)]. Investigators performing public health research or surveillance activities have the responsibility to ensure that the research is conducted in a manner consistent with legal and ethical requirements. All research involving human participants that is conducted or supported by the U.S. Department of Health and Human Services (DHHS) must comply with DHHS Policy for Protection of Human Research Subjects [45 CFR part 46]. Investigators should consult with their local institutional review board for assistance with development of research or surveillance projects to insure that human subjects are appropriately protected. Federal regulations state that “research means a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge” (45 CFR 46.102(d)). Surveillance Public health surveillance is the systematic, ongoing collection, management, analysis, and interpretation of data followed by the dissemination of these data to public health programs to stimulate public health action [Thacker et al. 2012]. Surveillance systems can be used to monitor infectious and non- infectious diseases as well as injuries and deaths. Surveillance data can be primary in that they
- 194. are collected for a specific public health purpose or they may be secondary in that the data were collected for other purposes yet they can be useful for tracking injuries, illnesses and deaths that occur in a defined population. Occupational health surveillance is the tracking of workplace injuries, illnesses, hazards, and exposures. In the U. S., because there are no periodic national surveys of worker health, o c c u p a t i o n a l h e a l t h s u r v e i l l a n c e r e m a i n s fragmented with substantial data gaps. However, the available surveillance data are used to guide efforts to improve worker safety and health and to monitor trends and progress over time [NIOSH 2013b]. Data and information derived from surveillance can be used to: (1) guide immediate action for important cases; (2) measure the burden of an injury, disease, or other health-related event or exposure, including changes in related factors; (3) identify populations at risk, including new or emerging health concerns; (4) guide the planning, implementation, and evaluation of programs to prevent and control injuries, disease, or adverse exposures; (5) evaluate policies and practices; (6) detect changes in health practices and the
- 195. effects of the changes; (7) prioritize the allocation of health resources; 18For a thorough explanation of public health research and non- research as defined by CDC, please see http://www.cdc.gov/od/science/integrity/docs/cdc-policy- distinguishing-public-health- research-nonresearch.pdf . http://www.cdc.gov/od/science/integrity/docs/cdc-policy- distinguishing-public-health-research-nonresearch.pdf http://www.cdc.gov/od/science/integrity/docs/cdc-policy- distinguishing-public-health-research-nonresearch.pdf Workers’ Compensation Insurance: A Primer for Public Health26 Estimations of the populations at risk that are needed for rate calculations are likely to require information from record sets other than workers’ compensation. (8) describe the clinical course of disease; and (9) provide a basis for epidemiologic research. Workers’ compensation records, most commonly administrative claims data, are used for occupational surveillance. In some states, for example California (California Labor Code) and Washington (Department of Labor and Industries), workers’ compensation claims information is used to identify
- 196. more hazardous industries or leading events for claims across all industries. Claims information has been used to establish priorities for loss prevention and other intervention actions [Silverstein et al. 2002; Bonauto et al. 2006; Anderson et al. 2013]. Yet other investigators have determined that workers’ compensation claims data are currently inadequate to characterize occupational injuries and illnesses in particular [Rosenman et al. 2000; Azaroff et al. 2002; Utterback et al. 2012]. Formerly, workers’ compensation claims information from a large number of states was collected by BLS for the Supplementary Data System (SDS), a non- representative sample of occupational injuries and illnesses. SDS contained discrepancies due to the quality of data retrieved from states and the variability of state laws on which injuries and illnesses were reported [National Research Council 1987]. The system was discontinued in the late 1980’s when the Survey of Occupational Injuries and Illnesses (SOII) along with the Census of Fatal Occupational Injuries (CFOI) were being developed. Estimating Rates Rates of occupational injuries and illnesses require estimates of at-risk populations (a “denominator”). The denominator commonly used in the workers’ compensation industry is dollars of payroll. In public health, preferred denominators for rates are numbers of people or, in the case of occupational studies, full-time equivalent (FTE) workers. Data sets used to estimate the numbers of workers within industries and/or occupations may be obtained from population household surveys such
- 197. as the Current Population Survey (CPS) or the American Community Survey (ACS), or from employer establishment survey programs such as Occupational Employment Statistics (OES), Current Employment Statistics (CES), or County Business Patterns (CBP). All of these data sources have broad coverage but exclude some types of workers. The Quarterly Census of Employment and Wages (QCEW), which is nearly comprehensive and collected by states for unemployment insurance purposes does report the number of workers by establishments although it does not distinguish between full-time and part-time workers. The QCEW data may be adjusted to estimate FTEs with hours per industry data from the surveys listed above. In any case, the scope, exclusions, and restrictions on survey and state level data should be carefully examined and understood. 15. Public Health Regulations Many Federal, state and local government regulations have been developed to address public health concerns. It is beyond the scope of this document to describe the myriad public health concerns that are regulated. Instead, we limit this description to those authorities where workers’ compensation data may be useful. The Occupational Safety and Health Administration (OSHA) and the Mine Safety and
- 198. Health Administration (MSHA) are two Federal agencies with regulatory mandates to protect the health and safety of workers in the U.S. OSHA and MSHA regulations are available through their respective Web sites and elsewhere.19, 20 Additionally, the US Environmental Protection Agency regulates pesticide hazards for agricultural workers.21 State and local health departments are 19http://www.osha.gov/law-regs.html 20http://www.msha.gov/30CFR/CFRINTRO.HTM 21http://www.epa.gov/agriculture/twor.html http://www.osha.gov/law-regs.html http://www.msha.gov/30CFR/CFRINTRO.HTM http://www.epa.gov/agriculture/twor.html Workers’ Compensation Insurance: A Primer for Public Health 27Workers’ Compensation Insurance: A Primer for Public Health Regulations are perceived by many as essential to the protection of public health. Individuals may not have the knowledge or resources that are required to make deci- sions about personal exposure to potentially hazardous materials including chemical, ergonomic, physical and biological agents. charged with protecting the health of all residents in their jurisdictions, and some health departments
- 199. are active in workplace he a lt h and s afe t y and t r a ck i ng o c c up at i ona l illnesses and injuries. In fiscal year 2013, NIOSH provided funds to help s u p p o r t o c c u p at i o n a l health and safety surveillance programs in twenty-three states.22 Regulations are perceived by many as essential to the protection of public health. Individuals may not have the knowledge or resources that are required to make decisions about personal exposure to potentially hazardous materials including chemical, ergonomic, physical and biological agents. In the occupational arena, regulations are established by OSHA and MSHA to limit potential hazards through the use of interventions such as exposure limits, machine guarding, fall protection, trenching standards, medical screening and many more. Regulations pertaining to workers’ compensation are established by the individual jurisdictions including the states, territories, and the District of Columbia, and the Federal government for its own employees. The states frequently require all employers including those self-insured for workers’ compensation to provide health and s a f e t y p r o g r a m s f o r t h e i r e s t a b l i s h m e n t s . These requirements vary substantially across the jurisdictions and many are
- 200. augmented by occupational s a f e t y a n d h e a l t h requirements in departmen s of labor or similar agencies. Carrier-based loss prevention programs t recognition and control of hazards for which regulations apply. In addition to the insurance claims and medical information, records for these mandated activities may be useful for occupational safety and health research and surveillance. 16. Breaking through Barriers Despite its limitations, research organizations, state-based surveillance programs, and workers’ compensation agencies and associations have used claims data for research and surveillance purposes. Collaborations have been mostly within states due to problems with combining data from multiple jurisdictions. Additional collaborations would create further opportunities to use workers’ compensation records and related information to prevent occupational injuries, illnesses and fatalities. Overcoming some of the limitations would
- 201. be possible with more systematic collection and analysis of workers’ compensation data across industries and occupations. Further standardization of data elements and coding schemes such as universal adoption of ICD medical codes and ICD-E external cause of injury codes would be beneficial. Development of additional computer-based record systems would provide g re at e r o p p or t u n it i e s for m ore i n for m at i ve d a t a c o l l e c t i o n a n d interpretation. Advances in auto-coding of data by computer systems, which rely on standard codes, would reduce the number of errors and missing often assist employers in the 22The NIOSH funded surveillance programs in 2013 exist in the following states: California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Oregon, Texas, Washington, and Wisconsin. In some states, for example California and Washington, the workers’ compensation claims information is used to identify more hazardous industries or leading events for claims across all industries.
- 202. Workers’ Compensation Insurance: A Primer for Public Health28 data from the workers’ compensation insurance records. Effective searching of unstructured text fields has also improved [Lehto et al. 2009; Patel et al. 2012; Bertke et al. 2013]. Although systematic data analysis within a carrier’s operations contributes to risk management goals and client service, the information is not readily available to public health organizations. When made available, practitioners and researchers have used claims data for epidemiologic studies, to identify hazards, assess the effectiveness of controls, assign priorities for limited resources, and evaluate intervention programs. Additional infor mation on e valuations of workplace safety and health programs, hazard monitoring and hazard exposure data, and observations of worksites are types of loss prevention information that could be standardized and made more useful for research and surveillance purposes. Over the past century and more, carrier-based and state agency workers’ compensation programs have used data to identify and evaluate risks for specific hazards across industry sectors. When systematically available, workers’ compensation data has been used extensively for occupational safety and health research and
- 203. surveillance [NIOSH 2010; Utterback et al. 2012; NIOSH 2013a] and they have supplemented the surveillance information available from other occupational resources.23 This primer provides background information for those interested in utilizing workers’ compensation data for prevention purposes. 23Descriptions of many data sources used for occupational surveillance may be accessed at http:// wwwn.cdc.gov/niosh-survapps/Gateway/DataSources.aspx. Workers’ Compensation Insurance: A Primer for Public Health 29Workers’ Compensation Insurance: A Primer for Public Health References American Association of State Compensation Insurance Funds [2007]. State Funds: Their Role in Workers’ Compensation, [http://www.aascif.org/public/1.1.1_history.htm] Accessed on November 8, 2013. Anderson NJ, Bonauto DK, Adams D [2013]. Prioritizing Industries for Occupational Injury and Illness Prevention and Research, Washington State Workers’ Compensation Claims Data, 2002- 2010. Washington State Department of Labor and Industries Technical Report Number 64-1-2013 [http://www.lni.wa.gov/Safety/Research/Files/bd_3F.pdf ]. Accessed on November 8, 2013. Azaroff LS, Levenstein C, Wegman DH [2002]. Occupational
- 204. injury and illness surveillance: Conceptual filters explain underreporting. Am J Pub Health 92:1421-1429. Bertke SJ, Meyers AR, Wurzelbacher SJ, Bell J, Lampl ML, Robins D [2012]. Development and evaluation of a Naïve Bayesian model for coding causation of workers’ compensation claims. J Safety Res 43(5-6):327-32. Biddle J, Roberts K, Rosenman KD, Welch EM [1998]. What percentage of workers with work- related illnesses receive workers’ compensation benefits? J Occup Environ Med 40:325-331. Boden LI, Biddle EA, Spieler EA [2001]. Social and economic impacts of workplace illness and injury: Current and future directions for research. Am J Ind Med 40:398-402. Boden L, Ozonoff A [2008]. Capture-recapture estimates of nonfatal workplace injuries and illnesses. Annals Epidem 18:500-506. Bonauto DK, Silverstein BA, Adams D, Foley M [2006]. Prioritizing industries for occupational injury and illness prevention and research. J Occup Environ Med 48:840-851. Burton JF [2004]. A primer on workers’ compensation, Workers’ Compensation Policy Review. Nov/Dec 2004 [http://workerscompresources.com/wp- content/uploads/2012/11/ND04A.pdf ]. Accessed November 7, 2013. California Labor Code, Sections 6314.1, 6354 and 6355
- 205. [http://www.dir.ca.gov/doshpol/P&PC-19. html]. Accessed on November 7, 2013 CDC [2010]. Distinguishing public health research and public health nonresearch, CDC- SA-2010-02, July 29, 2010 [http://www.cdc.gov/od/science/integrity/docs/cdc-policy- distinguishing-public-health-research-nonresearch.pdf ]. Accessed November 7, 2013. Cocchiarella L, Anderson GBJ, eds. [2001] Guides to the Evaluation of Permanent Impairment. 5th ed. Chicago, Ill: American Medical Association. Courtney TK [2010]. Workers’ compensation data utilization in injury prevention research at the Liberty Mutual Research Institute for Safety. In: Proceedings of Use of Workers’ Compensation Data for Occupational Injury and Illness Prevention. Utterback DF, Schnorr TM eds. Cincinnati, OH. National Institute for Occupational Safety and Health; DHHS (NIOSH) Pub No. 2010-152. pp. 49-53. http://www.aascif.org/public/1.1.1_history.htm http://www.ncbi.nlm.nih.gov/pubmed/23206504 http://www.ncbi.nlm.nih.gov/pubmed/23206504 http://onlinelibrary.wiley.com/doi/10.1002/ajim.10013/abstract http://onlinelibrary.wiley.com/doi/10.1002/ajim.10013/abstract http://workerscompresources.com/wp- content/uploads/2012/11/ND04A.pdf http://www.dir.ca.gov/doshpol/P&PC-19.html http://www.dir.ca.gov/doshpol/P&PC-19.html http://www.cdc.gov/od/science/integrity/docs/cdc-policy- distinguishing-public-health-research-nonresearch.pdf http://www.cdc.gov/od/science/integrity/docs/cdc-policy-
- 206. distinguishing-public-health-research-nonresearch.pdf Workers’ Compensation Insurance: A Primer for Public Health30 Dembe AE [1995]. Alternative approaches for incorporating safety into state workers’ compensation reform legislation. J Insurance Regulation 13:445-450. Department of Health and Human Services, Health Information Privacy, [2003] Disclosures for Workers’ Compensation Purposes 45 C.F.R. Sect. 164.512(l) [http://www.hhs.gov/ocr/privacy/ hipaa/understanding/coveredentities/workerscomp.html]. Accessed on November 12, 2013. Department of Health and Human Services [2013]. Workers’ compensation settlements and payments [http://www.medicare.gov/supplement-other- insurance/how-medicare-works-with- other-insurance/who-pays-first/workers-comp-payments.html]. Accessed on November 12, 2013 Environmental Protection Agency [2013]. Worker Protection Standard for Agricultural Pesticides. [http://www.epa.gov/agriculture/twor.html]. Accessed on November 12, 2013. Fan ZJ, Bonauto DK, Foley MP, Silverstein BA [2006]. Underreporting of work-related injury or illness to workers’ compensation: individual and industry factors. J Occup Environ Med 48:914- 922.
- 207. Fishback PV [2013]. Workers’ Compensation. EH.net, [http://eh.net/encyclopedia/workers- compensation/]. Accessed on November 12, 2013 Florida Division of Workers’ Compensation [2012]. 2011 Division of Workers’ Compensation Annual Report. [http://www.myfloridacfo.com/wc/pdf/DWC- Annual-Report-2011.pdf ]. Accessed May 10, 2013 Guyton GP [1999]. A Brief History of Workers’ Compensation. Iowa Orthop J. 19: 106–110. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1888620/]. Accessed on November 12, 2013. Hakimzadeh S, Cohn D [2007]. English usage among Hispanics in the United States, Pew Research Hispanic Center; Nov 29, 2007. [http://www.pewhispanic.org/2007/11/29/iv-workplace- and-home/]. Accessed on November 7, 2013. Hunt HA [2003-2004]. Benefit adequacy in state workers’ compensation programs. Social Security Bulletin. 65(4):24-30. International Association of Industrial Accident Boards and Commissions [2004]. A History of the IAIABC, 90th Annual Convention Edition http://www.iaiabc.org/files/ Resources/2006HistoryofIAIABC.pdf. Accessed May 12, 2013 International Association of Industrial Accident Boards and Commissions [2013]. EDI Implementation Guides. [http://www.iaiabc.org/i4a/pages/index.cfm?pageid=3339]. Accessed
- 208. on November 12, 2013. Kiselica D, Sibson B, Green-McKenzie J [2004] Workers’ compensation: a historical review and description of a legal and social insurance system. Clin Occup Environ Med. May;4(2):v, 237-47. Lehto M, Marucci-Wellman H, Corns H [2009]. Bayesian methods: A useful tool for classifying injury narratives into cause groups. Inj Prev Aug;15(4):259-65. http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredent ities/workerscomp.html http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredent ities/workerscomp.html http://www.medicare.gov/supplement-other-insurance/how- medicare-works-with-other-insurance/who-pays-first/workers- comp-payments.html http://www.medicare.gov/supplement-other-insurance/how- medicare-works-with-other-insurance/who-pays-first/workers- comp-payments.html http://www.epa.gov/agriculture/twor.html http://eh.net/encyclopedia/workers-compensation/ http://eh.net/encyclopedia/workers-compensation/ http://eh.net/encyclopedia/workers-compensation/ http://www.myfloridacfo.com/wc/pdf/DWC-Annual-Report- 2011.pdf http://www.ncbi.nlm.nih.gov/pubmed/?term=Guyton GP%5Bauth%5D http://www.pewhispanic.org/2007/11/29/iv-workplace-and- home/ http://www.pewhispanic.org/2007/11/29/iv-workplace-and- home/ http://www.iaiabc.org/files/Resources/2006HistoryofIAIABC.pd f http://www.iaiabc.org/files/Resources/2006HistoryofIAIABC.pd
- 209. f http://www.iaiabc.org/i4a/pages/index.cfm?pageid=3339 http://www.ncbi.nlm.nih.gov/pubmed?term=Kiselica D%5BAuthor%5D&cauthor=true&cauthor_uid=15182746 http://www.ncbi.nlm.nih.gov/pubmed?term=Sibson B%5BAuthor%5D&cauthor=true&cauthor_uid=15182746 http://www.ncbi.nlm.nih.gov/pubmed?term=Green-McKenzie J%5BAuthor%5D&cauthor=true&cauthor_uid=15182746 http://www.ncbi.nlm.nih.gov/pubmed/15182746 http://www.ncbi.nlm.nih.gov/pubmed/19652000 http://www.ncbi.nlm.nih.gov/pubmed/19652000 Workers’ Compensation Insurance: A Primer for Public Health 31Workers’ Compensation Insurance: A Primer for Public Health Leigh JP [2011]. Economic burden of occupational injury and illness in the United States. Milbank Q 89:728-72. Leigh JP, Marcin JP [2012]. Workers’ compensation benefits and shifting costs for occupational injury and illness. J Occup Environ Med 54:445-450. Lipscomb HJ, Dement JM, Silverstein BA, Cameron W, Glazner JE [2009]. Who is paying the bills? Health care costs for musculoskeletal back disorders, Washington State carpenters, 1989 – 2003. J Occup Environ Med 51:1185-1192. Mine Health and Safety Administration [2013]. Title 30 CFR Mineral Resources Parts 1 through 199. [http://www.msha.gov/30CFR/CFRINTRO.HTM]. Accessed November 12, 2013.
- 210. Missouri Department of Labor and Industrial Relations [2012]. Report of Injury. [http://labor. mo.gov/DWC/Forms/WC-1-EDI-AI.pdf ]. Accessed November 12, 2013. Morin JF, Utterback DF, Shor G, Welsh L, Bogyo TJ, Wurzelbacher SJ [2013]. Workers’ compensation loss prevention information and interventions. Submitted for publication. National Commission on State Workmen’s Compensation Laws [1972]. The Report of the National Commission on State Workmen’s Compensation Laws. Washington DC: Government Printing Office. [http://www.workerscompresources.com/National_Commission_ Report/ national_commission_report.htm]. Accessed on November 12, 2013. National Research Council [1987]. Counting injuries and illnesses in the workplace: Proposals for a better system. Pollack ES and Keimig DG eds. National Academy Press; Washington DC. Nave M, Veltri A [2004]. Effect of loss control services on reported injury incidents. J Safety Res 35:39-46. NIOSH [2013a]. Proceedings of Use of Workers’ Compensation Data for Occupational Safety and Health, Utterback DF, Schnorr TM eds. Cincinnati, OH; National Institute for Occupational Safety and Health; DHHS (NIOSH) Pub No. 2013-147. NIOSH [2013b]. Topic Page: Surveillance Program.
- 211. [http://www.cdc.gov/niosh/programs/surv/]. Accessed November 7, 2013. NIOSH [2010]. Proceedings of Use of Workers’ Compensation Data for Occupational Injury and Illness Prevention. Utterback DF, Schnorr TM eds. Cincinnati, OH. National Institute for Occupational Safety and Health; DHHS (NIOSH) Pub No. 2010- 152. Occupational Safety and Health Administration [2013]. OSHA Law & Regulations. [http://www. osha.gov/law-regs.html]. Accessed November 12, 2013. Oklahoma Insurance Department [2013]. Self-Funded Health Care Plans/Self-Insured Employers. [https://www.ok.gov/oid/Consumers/Insurance_Basics/ERISA_I nformation.html]. Accessed November 7, 2013. http://apps.webofknowledge.com/full_record.do?product=UA&s earch_mode=GeneralSearch&qid=1&SID=4C65GpA1hlaF9eIjfA 5&page=1&doc=1 http://apps.webofknowledge.com/full_record.do?product=UA&s earch_mode=GeneralSearch&qid=1&SID=4C65GpA1hlaF9eIjfA 5&page=1&doc=1 http://www.msha.gov/30CFR/CFRINTRO.HTM http://labor.mo.gov/DWC/Forms/WC-1-EDI-AI.pdf http://labor.mo.gov/DWC/Forms/WC-1-EDI-AI.pdf http://www.workerscompresources.com/National_Commission_ Report/national_commission_report.htm http://www.workerscompresources.com/National_Commission_ Report/national_commission_report.htm http://www.cdc.gov/niosh/programs/surv/ http://www.osha.gov/law-regs.html http://www.osha.gov/law-regs.html
- 212. https://www.ok.gov/oid/Consumers/Insurance_Basics/ERISA_In formation.html Workers’ Compensation Insurance: A Primer for Public Health32 Oleinick A, Zaidman B [2004]. Methodologic issues in the use of workers’ compensation database for the study of work injuries with day away from work. I. Sensitivity of case ascertainment. Am J Ind Med 45:260-274. Oregon [2013]. 2012 Oregon Workers’ Compensation Premium Rate Ranking Summary. [http:// actprod.cbs.state.or.us/iportal/report_catalog.html]. Accessed on November 7, 2013 O’Leary P, Boden LI, Seabury SA, Ozonoff A, Scherer E [2012]. Workplace injuries and the take- up of Social Security disability benefits. Social Security Bulletin 72(3):1-17. Ostbye T, Dement JM, Krause KM [2007]. Obesity and workers’ compensation: Results from the Duke Health and Safety Surveillance System. Arch Intern Med 167:766-73. Patel MD, Rose KM, Owens CR, Bang H, Kaufman JS [2012]. Performance of automated and manual coding systems for occupational data: A case study of historical records. Am J Ind Med 55(3):228-31. Restrepo T, Shuford H [2011]. Workers’ compensation and the aging workforce. National Council
- 213. on Compensation Insurance, Boca Raton, FL. [https://www.ncci.com/documents/2011_Aging_ Workforce_Research_Brief.pdf ]. Accessed on November 7, 2013. Rosenman KD, Gardiner JC, Wang J, Biddle J, Hogan A, Reilly MJ, Roberts K, Welch E [2000]. Why most workers with occupational repetitive trauma do not file for workers’ compensation. J Occup Environ Med 42:25-34. Ryan M [2013]. Risk management and loss control industry trends. Presented at: E&S 2013 Loss Control Executive Forum, March 5, 2013 [http://www.iso.com/Conferences/Loss-Control- Forum/Home.html?blogclick%20E&S%20Forum%20link]. Accessed on November 7, 2013. Scherzer T, Wolfe N [2008]. Barriers to workers’ compensation and medical care for injured personal assistance services workers. Home Health Care Serv Q 27:37-58. Schmid F, Laws C, Montero M [2012]. Indemnity benefit duration and obesity. National Council on Compensation Insurance, Boca Raton, FL. [https://www.ncci.com/documents/Obesity-2012. pdf ]. Accessed on November 7, 2013. Sengupta I, Reno V, Burton JF, Baldwin M [2012]. Workers’ Compensation: Benefits, Coverage, and Costs, 2010, National Academy of Social Insurance, Washington DC. Shuford H [2013]. The role of professional employer organizations in workers compensation:
- 214. Evidence of workplace safety and reporting. In: Proceedings of Use of Workers’ Compensation Data for Occupational Safety and Health Workshop. Utterback DF, Schnorr TM eds. NIOSH Pub. No. 2013-147. pp. 51 – 56. Shuford H, Restrepo T, Beaven N, Leigh JP [2009]. Trends in components of medical spending within workers’ compensation: Results from 37 states combined. J Occup Environ Med 51:232-238. Silverstein BA, Viikari-Juntura E, Kalat J [2002]. Use of a prevention index to identify injuries at high risk for work-related musculoskeletal disorders of the neck, back and upper extremity in Washington State. Am J Ind Med 41:149-169. http://actprod.cbs.state.or.us/iportal/report_catalog.html http://actprod.cbs.state.or.us/iportal/report_catalog.html http://www.ncbi.nlm.nih.gov/pubmed/17452538 http://www.ncbi.nlm.nih.gov/pubmed/17452538 http://www.ncbi.nlm.nih.gov/pubmed/22420026 http://www.ncbi.nlm.nih.gov/pubmed/22420026 https://www.ncci.com/documents/2011_Aging_Workforce_Rese arch_Brief.pdf https://www.ncci.com/documents/2011_Aging_Workforce_Rese arch_Brief.pdf http://www.iso.com/Conferences/Loss-Control- Forum/Home.html?blogclick E&S Forum link http://www.iso.com/Conferences/Loss-Control- Forum/Home.html?blogclick E&S Forum link https://www.ncci.com/documents/Obesity-2012.pdf https://www.ncci.com/documents/Obesity-2012.pdf Workers’ Compensation Insurance: A Primer for Public Health
- 215. 33Workers’ Compensation Insurance: A Primer for Public Health Smith CK, Silverstein BA, Bonauto DK, Adams D, Fan ZJ [2010]. Temporary workers in Washington State. Am J Ind Med 53: 135-145. Spieler E [1994]. Perpetuating risk? Workers’ compensation and the persistence of occupational injuries, 31 Houston Law Rev. 119-264. Excerpts reprinted in Employment Law (Rothstein M, Leibman L, eds. ); 1995 Workers’ Compensation Yearbook (Burton, JF Jr. ed. 1994). Spieler EA, Burton JF [2012]. The lack of correspondence between work-related disability and receipt of workers’ compensation benefits. Am J Ind Med 55:487-505. Spielholz P, Cullen J, Smith C, Howard N, Silverstein BA, Bonauto DK [2008]. Assessment of perceived injury risks and priorities among truck drivers and trucking companies in Washington State. J Safety Res 39:569-576. Thacker SB, Qualters JR, Lee LM [2012]. Public health surveillance in the United States: Evolution and challenges. MMWR (Suppl) 61(03):3-9. Thamann D, Reitz D [2000]. Workers’ Compensation Guide, Interpretation and Analysis, The National Underwriter Company, Cincinnati, OH. Trogdon JG, Finkelstein EA, Hylands T, Dellea PS, Kamal-Bahl SJ [2008]. Indirect costs of obesity: A review of the current literature. Obes Rev 9(5):489-
- 216. 500. U.S. Bureau of Labor Statistics [2012]. News Release: Nonfatal occupational injuries and illnesses requiring days away from work, 2011. Washington DC. November 8, 2012. [http://www.bls.gov/ news.release/osh2.nr0.htm]. Accessed on June 11, 2013 U.S. Chambers of Commerce [2012]. 2011 Analysis of Workers’ Compensation Laws. Washington DC. (Updated annually in July of subsequent year) Utterback DF, Schnorr TM, Silverstein BA, Spieler EA, Leamon TB, Amick BC [2012]. Occupational health and safety surveillance and research using workers’ compensation data. J Occup Environ Med 54:171-176. Washington State Department of Labor and Industries [2012]. Division of Occupational Safety and Health, Directive 2.10: Programmed inspection and visit activities, January 5, 2012. [http:// www.lni.wa.gov/Safety/Rules/Policies/PDFs/WRD210.pdf ]. Accessed on November 7, 2013. Willborn SL, Schwab SJ, Burton JF, Lester GLL [2012]. Employment Law: Cases and Materials. LexisNexis, New Providence, NJ.. p. 881. Winslow, Charles-Edward Amory [1920]. The untilled fields of public health. Science 51(1306): 23–33. Wurzelbacher SJ, Meyers AR, Bertke SJ, Lampl M, Robins DR, Bushnell PT, Tarawneh A, Childress D, Turnes J [2013]. Comparison of cost valuation
- 217. methods for workers compensation. In: Proceedings of Use of Workers’ Compensation Data for Occupational Safety and Health Workshop. Utterback DF, Schnorr TM eds. NIOSH Pub. No. 2013-147. pp.147-151. http://www.ncbi.nlm.nih.gov/pubmed/18331420 http://www.ncbi.nlm.nih.gov/pubmed/18331420 http://www.lni.wa.gov/Safety/Rules/Policies/PDFs/WRD210.pdf http://www.lni.wa.gov/Safety/Rules/Policies/PDFs/WRD210.pdf http://www.sciencemag.org/cgi/pmidlookup?view=long&pmid= 17838891 Workers’ Compensation Insurance: A Primer for Public Health Workers’ Compensation Insurance: A Primer for Public Health 35Workers’ Compensation Insurance: A Primer for Public Health Appendix A: Workers’ Compensation Primer Glossary and Other Industry Terms actuary – one who calculates insurance premiums, reserves and dividends adjuster – see claims adjuster appeal – right of an individual who received an adverse decision to seek review by a higher authority assigned risk – an insured entity that would normally be rejected by commercial insurance carriers
- 218. in the voluntary market but is designated for coverage by state law audit – examination and verification of employer records on payroll basic premium – portion of a standard retrospective insurance premium that covers administrative costs, fees and commissions broker – business that sells insurance coverage to employers; may represent a number of insurance carriers captive – insurance provider for a single business organization that is owned by that organization carrier – organization acting as an insurer carve-outs – labor/management agreements for insurance coverage of occupational injuries and illnesses (has various other meanings in the insurance industry as a whole) case manager – insurer representative that oversees medical treatments for injury or illness claims claim – application for insurance benefits due to occupational injury or illness claim disallowance – insurer rejection of a claim for medical treatment or indemnity costs claimant – person making a demand for payment of benefits claims adjuster – insurer representative who investigates claims
- 219. for authenticity and settlements claims initiator – person who completes the initial claim form for compensation deductible – a type of workers’ compensation insurance policy for which the initial loss to some specified limit is not reimbursed by insurance payment, i.e. the risk is retained by employer Workers’ Compensation Insurance: A Primer for Public Health36 disability – condition that curtails a person’s ability to carry on normal pursuits dividend plan – a type of workers’ compensation insurance policy for which the insured may receive funds back (a dividend) if losses are less than anticipated doctor’s first report – initial claimant evaluation by physician which is required in some states Electronic Data Interchange – developed several standard claim data reporting forms and was fostered by the IAIABC exclusive funds – state-sponsored workers’ compensation insurance in jurisdictions where private insurance is not allowed exclusive remedy – in workers’ compensation, the only recourse for worker injuries and illnesses
- 220. experience modification factor – multiplier adjustment to employer’s premium based on prior claims history in comparison with the average experience of the risk class, may be greater than or less than unity first report of injury – initial form completed by claims initiator with detailed information on the claimant, employer, nature of injury, event description, and anticipated medical treatment needs groups – similar industry employers that combine to share risks and insurance coverage; also may be employees that are covered under single insurance policy, e.g. group health insurance guaranteed cost – a type of workers’ compensation insurance policy where the premium is the only cost to the employer impairment – alteration of an individual’s health status; a deviation from normal in a body part or organ system and its functioning (Cocchiarella and Anderson 2001) incurred losses – paid plus reserved claim costs, including medical and indemnity; experience modification ratings are based on incurred costs indemnity payments – compensation for lost work time claim paid to covered injured or ill workers to partially replace lost wages independent medical examiner – registered medical practitioners who provide impartial medical assessments
- 221. loss control – see loss prevention loss development factor – prediction of future payments on open claims loss prevention – actions to limit risk through hazard recognition and abatement and safety and health program evaluation; also known as loss control Workers’ Compensation Insurance: A Primer for Public Health 37Workers’ Compensation Insurance: A Primer for Public Health loss ratio – insured losses divided by premiums earned in a given period loss reduction – activities to limit financial losses and disability after a claim is filed for an injury or illness; also known as medical or disability management loss runs – employer-based information on prior claims experience lost work days – accrual of time away from work due to an occupational injury or illness managed care – enrolled medical services that focuses on care utilization and costs manual rate – published rates, established by rating bureaus, for insured groups based on average costs for the group
- 222. medical only claim – workers’ compensation claim for medical treatment expenses and does not include lost work days meeting the minimum lost time requirement for indemnity payments medical review board – state sanctioned group of medical practitioners that provides independent medical expertise on appropriate treatments, disability determination, and other science-based criteria Medicare set-aside – allocation in a claim settlement to pay future medical expenses that would have been paid by Medicare monopolistic funds – see exclusive funds mutual insurance company – organization that issues insurance policies and is owned by its policyholders net premium – total insurance premium after adjustments for experience modification and discounts pools – multiple meanings but usually a collection of groups that share insurance coverage professional employer organization (PEO) – firm that hires a client company’s employees, becoming the policy holder of record for workers’ compensation; this arrangement results in co-employment pure premium – portion of manual rate that covers anticipated losses and loss adjustment expenses rating bureau – state sanctioned private group that establishes permitted manual rates for insurance
- 223. premiums reciprocal group – association of employer entities that mutually share risks of economic losses re-insurance – insurance purchased by an insurance carrier to limit risks Workers’ Compensation Insurance: A Primer for Public Health38 reserve funds – accounting liability for the current value of future expected costs on a claim residual market – portion of employers unable to obtain insurance coverage in the voluntary market retrospective rating – a type of workers’ compensation insurance policy where the premium is based on the actual insured losses during the policy term return-to-work – program to assist injured workers regain employment after a claim has been filed risk group – see groups risk retention – portion of possible future liability that is not covered by an insurance policy scheduled benefit – pre-determined amount of payment for specified loss such as an amputation Second Injury Fund – insurance provided for previously disabled workers
- 224. self-insured – a type of workers’ compensation insurance policy where the employer is responsible for its own losses associated with required risk coverage single payer – for health insurance, a single entity, generally a government agency, is responsible for all insured costs state funds – state government offered mandatory insurance; may be exclusive (monopolistic) in a few states or competitive in yet other states subrogation – recovery of claim expenses from another responsible party Supplemental Data System – survey of workers’ compensation claims information by Bureau of Labor Statistics in the 1970’s and 1980’s prior to the Survey of Occupational Injuries and Illnesses and the Census of Fatal Occupational Injuries surety bond – financially backed guarantee to reimburse third party losses surveillance – ongoing systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practices, closely integrated with the timely dissemination of these data to those who need to know third-party administrator – insurance businesses that provide services to employers, brokers, insurers, and groups related to workers’ compensation claims underwriter – one who selects risks to be solicited or rates the
- 225. acceptability of risks underwriting – to be responsible for financial losses in accordance with an insurance policy Workers’ Compensation Insurance: A Primer for Public Health 39Workers’ Compensation Insurance: A Primer for Public Health uninsured employer fund – state funds to cover losses when employer has failed to obtain required insurance Unit Statistical Report – information on workers’ compensation loss experiences reported to a rating agency value – estimates of current or future liability costs on a claim voluntary market – competitive market for workers’ compensation insurance that exists in all but the 4 exclusive fund states Workers’ Compensation Insurance: A Primer for Public Health Workers’ Compensation Insurance: A Primer for Public Health 41Workers’ Compensation Insurance: A Primer for Public Health Appendix B: Preparing for Engagement
- 226. In preparation for contacting the workers’ compensation data custodian, one should consider several issues and evaluate some available resources. For example, one should visit the Web site for the workers’ compensation program in the state to evaluate the available information such as annual reports and reporting forms. In addition, the Web sites have links to applicable statutes and regulations with explanatory guides for injured workers and their employers. Researchers and public health practitioners may also want to think about the issues below prior to approaching potential collaborating organizations who are workers’ compensation data custodians. If the state workers’ compensation Web sites does not provide specific information on their requirements, these issues may be addressed in direct communications with a knowledgeable agency official. Study Background Questions What are the proposed project concept and time commitments? Might provide examples from other jurisdictions ● Surveillance – ongoing analysis of longitudinal data ● Etiologic research – may be time limited relationship but usually longitudinal data What data sources may be needed for the project? ● Public agencies – do they have a research unit or other organization with shared interest/ mission? ● Private – if restricted, can they share de-identified data, are
- 227. they comprehensive? Are there specific legal restrictions on data availability from state agencies? Can data be examined or explored prior to collaboration commitment? What are the possible mutual benefits for the collaborating organizations? ● Examine their existing products ● Review examples from other jurisdictions (e.g. Florida Annual Report) ● Reinforce experience with confidential handling of personal and other sensitive information ● Think about realistic needs for future information, assistance and review How are data stored and what formats are used? ● Electronic: on line or downloaded (CD, DVD, hard drives, encryption?) ● Hard copy ● Incomplete data and historical gaps in data ● Denominator (population) data available for rate estimation (unemployment insurance agencies)? Which, if any, standardized data coding systems and which versions are used (e.g. WCIO, OIICS, NCCI, NAICS, ICD E-codes)? Is a data dictionary available? Are narrative fields part of the records that may require data mining? What are the proposed agreements for clearance of articles,
- 228. reports and other products? Workers’ Compensation Insurance: A Primer for Public Health42 Other State Coverage Questions If the state publishes an annual report, what kind of information is captured in the report? What exclusion criteria are used to decide which employers need to provide workers’ compensa- tion coverage for workers? For example ● Minimum employer size* ● Industry sector (e.g. agriculture)* ● Familial relationship of the employee with the employer* ● Self-employed workers* ● Corporate officers* Are separate rules written for industries such as agriculture, construction or mining? Does the state offer workers’ compensation insurance plans? If yes, for which employers? Which employers, if any, are allowed to self-insure in the state?* Does NCCI or another rating bureau collect standardized data from insurance carriers in the state? Does the state require private insurance companies to write
- 229. coverage for residual market employers? Are employers in the state allowed to form groups or pools to obtain insurance in the voluntary markets? Are employers in the state allowed to combine to create a self- insured entity? Are carve-out arrangements permitted in the state? What automatic, Web-based or telemetric reporting systems are used in the state? Who can file a first report of injury? What requirements exist related to managed care organizations in the state?* What requirements govern the choice of treating physicians in the state?* What requirements exist related to vocational rehabilitation in the state?* What requirements restrict treatment options in the state?* Has the state imposed any time or cost limits on compensation for disabled workers? If yes, what are they?* *Answers to these questions can be found in the annual “Analysis of Workers’ Compensation Laws” produced by U.S. Chambers of Commerce
- 230. Workers’ Compensation Insurance: A Primer for Public Health Delivering on the Nation’s promise: safety and health at work for all people through research and prevention To receive documents or other information about occupational safety and health topics, contact NIOSH Telephone: 1-800-CDC-INFO (1-800-232-4636) TTY: 1-888-232-6348 email: [email protected] or visit the NIOSH website http://www.cdc.gov/niosh/ For a monthly update on news at NIOSH, subscribe to NIOSH eNews by visiting http://www.cdc.gov/niosh/eNews. DHHS (NIOSH) Publication No. 2014–110 January 2014 Department of Health and Human Services Centers for Disease Control and Prevention National Institute for Occupational Safety and Health DisclaimerOrdering InformationForewordAcknowledgementsAcronyms and AbbreviationsTable of Contents1. Introduction2. Background3. Brief History of Workers’ Compensation in the US4. Workers’ Compensation Insurance Benefits5. Workers’ Compensation Insurance Providers6. State Workers’ Compensation Agencies7.
- 231. Third-Party Administrators8. Types of Policies9. Policy Premiums10. Workers’ Compensation Records11. Standardized Codes and Systems in Workers’ Compensation12. Loss Prevention13. Workers’ Compensation Associations and Organizations14. Public Health Research and Surveillance15. Public Health Regulations16. Breaking through BarriersReferencesAppendix A: Workers’ Compensation Primer Glossary and Other Industry TermsAppendix B: Preparing for Engagement
- 232. NIOSH’s Office of Construction Safety and Health: Accomplishments in our First Four Years BACKGROUND Creation and function of CSH Since its inception in December 2009, the Office of Construction Safety and Health (CSH) has adhered to it mission in providing Institute‐wide senior scientific and administrative leadership for construction research and related activities. CSH ensures that research elements from the National Construction Center are fully integrated and included in all designs and plans for construction research and its implementation. Together the CSH Director and Deputy Director formulate the strategic vision and goals, develop proposals; guide the direction of the National Occupational Research Agenda (NORA) Construction Sector Council; and implement research plans that ensure that the construction research program is
- 233. responsive to comments and contributions from emerging research, the National Construction Center, stakeholders, external reviewers, and the NIOSH Director. CSH actively develops partnerships within NIOSH and among its external stakeholders, and coordinates construction research and related activities among NIOSH divisions, labs and other offices. It extends this coordination within and among the NIOSH‐funded National Construction Center 1 and other extramural construction researchers, with the Directorate of Construction in the Occupational Safety and Health Administration (OSHA), with OSHA's public Advisory Committee on Construction Safety and Health (ACCSH), the OSHA Construction Alliance, and with several trade associations. Establishing the Construction Program Manager and Coordinator positions as dedicated full‐ time personnel within NIOSH through CSH has improved the Institute’s ability to align 1
- 234. CPWR—The Center for Construction Research and Training has successfully applied to serve as the National Construction Center since 1994. NIOSH CSH, Accomplishments, 2009‐2013, Page 1 of 27
- 235. construction resources with the its national priorities. It has improved coordination among the NIOSH divisions and laboratories that are conducting research in construction, and has improved, as well, the coordination between those divisions and the National Construction Center. Much of this is accomplished through regular meetings with DLO representatives on the Construction Steering Committee, as well as with direct meetings with construction researchers and DLO management. Furthermore, this interaction has improved and enhanced the integration of research conducted by extramural researchers supported through the NIOSH Office of Extramural Programs. The personnel decision has led also to better management of the work of the NORA Construction Sector Council.
- 236. Stewardship of NORA Construction Sector Council The NORA Construction Sector Council was the first council to develop a national research agenda in October 2008 (http://www.cdc.gov/niosh/nora/comment/agendas/construction/ ). This was the first national effort to create an occupational safety and health research agenda for the construction industry. Efforts are still underway to address the goal of answering the question: “What information do we need to be more effective in preventing injuries and illnesses in construction?” A description of research needs and information gaps was one important basis for the agenda. The other basis was “research to practice” (r2p); specifically, a description of how research findings could be used by construction stakeholders to bring about needed changes in the industry. The NORA Construction Sector Council seeks to promote the most important research, understand the most effective intervention strategies, and learn how to implement those strategies to achieve sustained improvements in workplace practice.
- 237. Developing the National Construction Agenda provided a vehicle by which construction industry stakeholders could describe the most relevant issues, gaps, and safety and health needs in the industry. The resulting agenda consists of 15 research strategic goals designed to address ten top problems in construction safety and health. These included seven “outcome” goals related to important sources of injury or illness, and eight “contributing factor” goals related to important influences that impact prevention and control measures throughout the industry. In a recent analysis conducted by the NIOSH Office of Extramural Programs, the Construction Sector had more strategic goals that were being addressed by both extramural and intramural researchers when compared to the other sectors. The Construction Sector currently has 12 out of its 13 active goals that are being addressed by either extramural or intramural researchers. Beginning in 2010, the Manager and Coordinator of the NORA Construction Sector Council oversaw the selection of two of the 15 goals for priority activity. All 15 goals are important and
- 238. relevant; however, making significant accomplishments in all areas within the decade is daunting given budgetary realities and other considerations. The selected goals were Goal 1 (Reduce Construction Worker fatalities and serious injuries caused by falls to a lower level), for NIOSH CSH, Accomplishments, 2009‐2013, Page 2 of 27 http://www.cdc.gov/niosh/nora/comment/agendas/construction
- 239. which a falls prevention campaign is an intermediate goal; and Goal 13 Increase the use of “prevention through design (PtD)” approaches to prevent or reduce safety and health hazards in construction, for which green jobs in construction is a component. The selection has allowed the Council to better harness its energies and work collectively to make significant progress and bring research accomplishments to the industry. The Manager and Coordinator oversaw a mid‐decade review by the Sector Council of all 15 goals to determine progress toward meeting the goals. The review began in 2011, the half‐way point in the decade‐long NORA effort. CSH and the NORA Construction Sector Council undertook a review of efforts to date, which provided an
- 240. opportunity to take stock of overall developments; look at NORA projects and partnerships underway; examine the impact of the economic recession on construction generally, and on safety and health developments in construction; and to provide additional strategic direction and fine‐tuning. The report of the mid‐decade review is available upon request. Progress on each goal was assessed, and goals were categorized into: Exploratory ‐ important issue but still defining problems and solutions Developmental – some solutions are available but they are not ready for impact Ready for Impact – sufficient solutions are available and we know what contractors need to do for impact in the industry Six goals fall into the ‘Ready for Impact’ category. The Construction Sector Council reviewed the performance measures and roadmaps for each Ready for Impact strategic goal, and prepared a mid‐decade report with the progress of each of these goals. NORA Goals
- 241. Ready for Impact 6 Falls (1); Struck by (3); Silica (5); Culture (8); Disparities (12); PtD (13) Developmental 7 Electrocution (2): Noise (4) Welding Fumes (6) MSD (7) S&H Management (9) Training (11) Surveillance (14) Exploratory 2 Industry Organization (10) Engage the Media (15) This categorization has proven effective in moving forward, assessing progress, and, more importantly, assessing impact among the 15 second decade NORA goals in construction. NIOSH CSH, Accomplishments, 2009‐2013, Page 3 of 27
- 242. ACCOMPLISHMENTS – Office of Construction Safety and Health I. Construction Falls Prevention Campaign In 2011, the rate of fatal injuries in construction was the second highest of any U.S. industry. Within the industry, falls at construction
- 243. sites are the leading cause of death, accounting for 35% of deaths among private sector construction workers (not including government or self‐employed workers) in 2011; most of these deaths were attributed to falls from roofs, scaffolds, and ladders. Deaths and injuries from falls represent a major, persistent, yet preventable public health problem. Under the auspices of the NORA Construction Sector Council, a campaign, national in scope, to prevent falls among construction workers was conceived, developed and led to address one of the NORA ‘Ready for Impact’ goals “Reduce Construction Worker fatalities and serious injuries caused by falls to a lower level“ (Strategic Goal #1). The Sector Council identified the campaign as one of two goals on which to focus. A National Construction Campaign Coordinating Committee was formed with the charge to: (1) Explore how various campaigns have been used to advance safety and health goals; (2) Gather basic information needed to identify and address
- 244. fundamental questions on planning and implementation of a construction fatality campaign; and (3)Prepare options for discussion by the full NORA Construction Sector Council. The goal of the campaign, in part, was to develop a national campaign aimed at construction contractors, onsite supervisors, and workers to address and reduce falls, fall‐related injuries, and fall‐related fatalities among construction workers. The scientific underpinnings of the campaign were prepared during 2010‐2011 by Sector Council members working in groups, along with staff in CSH, the NIOSH Communication and Research Translation Office (CRTO),2 the National Construction Center and OSHA. The latter two are represented on the Council, and played key roles in developing the campaign. The National Construction Center hired a social marketing firm to prepare an environmental scan of construction fall prevention campaigns in the United States and abroad. CSH hired the same social marketing firm to prepare a social marketing plan. Because the campaign relies heavily on completed research, it is a major r2p endeavor.
- 245. The National Construction Center then hired the same social marketing expert to conduct focus groups to test messages that could be used in a campaign. The campaign theme and messages were determined by NIOSH, OSHA and the National Construction Center. The national construction falls prevention campaign (also described as Safety Pays, Falls Cost) is a remarkable accomplishment among NIOSH, OSHA and the NORA Construction Sector Council. 2 CRTO changed organizationally to become the Office of Communications (OC) in September 2014. NIOSH CSH, Accomplishments, 2009‐2013, Page 4 of 27
- 246. The campaign kickoff was hosted by U.S. Department of Labor Secretary Hilda Solis on Workers Memorial Day on April 26, 2012. The National Construction Center hosts the non‐government principal web presence supporting the campaign (http://www.stopconstructionfalls.com) and responds to inquiries about the
- 247. campaign through e‐mail ([email protected]). Their website contains fall prevention information and materials, and allows stakeholders to share their own campaign success stories. Print campaign materials are available through OSHA (www.osha.gov/stopfalls). Other resources, including research findings, training aides and videos, are available on the three official campaign websites: www.osha.gov/stopfalls/, www.cdc.gov/niosh/construction/stopfalls.html, and www.stopconstructionfalls.com. OSHA’s campaign website, www.osha.gov/stopfalls/ is now available in both English and Spanish.3 With simple language, clear illustrations, and easy‐ to‐follow instructions, our campaign materials include posters, factsheets, safety videos, stickers, and public service announcements, spot‐the‐hazards cards. The campaign was a re‐launched on Workers Memorial Day on April 28, 2013 with new products for active dissemination, including a “Local Partners Manual” for persons or organizations at the local, state or regional levels who wish to start their own local campaigns.
- 248. The National Association of Counties, for example, mentioned the campaign in their April 2013 newsletter (http://www.naco.org/newsroom/countynews/Current%20Issue/4 ‐8‐ 2013/Pages/OSHA‐launches‐safety‐campaign‐to‐prevent‐falls.as px). Having the information about the campaign posted for city and county officials across the country, has been expected to assist dissemination, especially at permit and registration offices where construction contractors frequent. Several local areas have made the campaign a priority, and have created innovative ways to disseminate campaign messages. Boston, Massachusetts and Montgomery County, Maryland, for example, have worked with the public transportation systems to post some of the campaign posters on busses, metro‐rail trains and highway digital billboards. State agencies have been encouraged to support the campaign, and several have spearheaded their state’s efforts in collaboration with NIOSH’s Fatality Assessment and Control Evaluation (FACE) program.
- 249. The momentum of this extremely well‐received campaign has been such NIOSH, OSHA and the National Construction Center agreed to add a third year (2014). The focus of the campaign in Year 3 was expanded to all types of construction, and no longer focused only on residential construction. In support of Year 3, NIOSH announced the campaign in CDC’s Morbidity and Mortality Weekly Report (MMWR) (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6316a7.htm? s_cid=mm6316a7_e). Also, a video, “A construction framer talks about protecting his crew from falls” 3 Campaign fact sheets are available on the OSHA website in English, Spanish, Polish, Portuguese and Russian. NIOSH CSH, Accomplishments, 2009‐2013, Page 5 of 27 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6316a7.htm? s_cid=mm6316a7_e http://www.naco.org/newsroom/countynews/Current%20Issue/4- 8 www.osha.gov/stopfalls http:www.stopconstructionfalls.com www.cdc.gov/niosh/construction/stopfalls.html www.osha.gov/stopfalls www.osha.gov/stopfalls
- 251. (http://www.youtube.com/watch?v=MFthzInDdLQ&feature=you tu.be) was posted to the NIOSH website in May 2014. The footage was taken on a visit to residential construction sites in Phoenix, Arizona to which NIOSH was invited by a LeBlanc Building Company., Inc. based on their practice of requiring all of their workers to use fall protection when working at height. A national Construction Safety Stand‐Down (June 2‐6, 2014) was also added in Year 3. The stand‐ down was conceived as a voluntary event for employers to talk directly to employees about hazards, protective methods, and the company’s safety policies, goals and expectations. CPWR created an easy, cost‐free, day‐by‐day list of suggested activities that could be tailored to individual jobsites, and posted these to www.stopconstructionfalls.com. Impact: The research to support the strategic planning and execution of the national construction falls prevention campaign was awarded the 2012
- 252. Thoth Award in the category of Research/Evaluation from the Public Relations Society of America. The three campaign websites (NIOSH, OSHA and CPWR) received over half a million page views in 2012. Campaign partners and stakeholders also spread the campaign’s message to thousands of employers (the primary target audience) and construction workers through blast e‐mails, radio and television broadcasts, webinars, publications, trainings and outreach events. The National Construction Center designed an evaluation plan for the campaign. The evaluation of the campaign’s first year served three key purposes: (1) assess audience response to the campaign messages and materials (focus groups); (2) document campaign reach (metrics); and (3) examine partnership quality. The evaluation was conducted among small residential construction contractors, owners, supervisors, and foremen to assess exposure to campaign messages and materials at the four‐month point from the campaign launch. Conducted in August 2012 in the Washington, DC metropolitan area, the
- 253. evaluation findings suggested that the campaign did not have a high level of awareness among contractors four months after the campaign was first launched. Some summary recommendations informed by the focus group results are included in Appendix I. Subsequent campaign efforts were aimed to improve dissemination to the primary target audience. To examine partnership quality, eight pre‐selected campaign partners (representing a range of unions, academia, business and government) were surveyed to assess the success of campaign partnerships in implementing the first year of the campaign. The summary conclusions from this component of the evaluation are listed in Appendix I. Some metrics of interest are visits to websites designed to support the construction falls prevention campaign. www.stopconstructionfalls.com in the first year of the campaign. NIOSH CSH, Accomplishments, 2009‐2013, Page 6 of 27 http:www.stopconstructionfalls.com
- 255. aign websites hosted by NIOSH, OSHA and CPWR received over half a million page views in 2012. visits) to its www.cdc.gov/niosh/construction/stopfalls.html. Five of the ‘top ten’ tweets from [email protected] were centered on construction falls. by National Construction Center CPWR had 900,215 page views (96,892 unique visits). The campaign also generated 503 email inquiries and 62 campaign partners. for the campaign by a NORA Construction Sector Council member at Washington University School of Medicine in St. Louis. The Facebook page has 315 ‘likes,’ and has reached 14 states in the U.S. and 44 countries worldwide.
- 256. that 4,399 certificates were obtained online; that 729,032 workers were engaged through the stand‐downs; and that there were 186,324 page views on the web page that OSHA developed for the stand‐down (there were more than 282,770 views for campaign and stand‐down pages together for during 03/17/14 to 06/11/14). The stand‐down page will be available through mid‐July, so data collection will continue. For Year 3 of the campaign and the stand‐down, we observed more and broader engagement by contractors of all sizes. Safway (http://www.safwaygroup.com/) is the largest provider of construction access equipment (e.g., scaffolds) in North America. Safway became a partner with the construction falls prevention campaign in 2014 (http://www.safway.com/Press/newsDetail.asp?id=104). They invested approximately $100,000 to adapt existing and develop new company‐specific campaign materials (e.g., mailers, promotional items) for their staff, trainees, and business partners. All U.S. Air Force Ground Safety forces based in the United
- 257. States and abroad participated in the campaign (year 3) and the stand‐down, including through their training activities, audits, internal newspaper articles, internal television network, posters, and briefings at the Air Force Ground Safety Commander's calls. All 2,000 Air Force Ground safety professionals were required to focus on fall protection awareness during the entire week of the stand‐down, with an expectation that the 650,000 Ground Safety staff at every at Air Force base would be reached. The construction falls prevention campaign will continue distributing information and providing outreach. This includes a partnership with two Latino groups facilitates distributing the Spanish version of the falls prevention campaign materials. NIOSH CSH, Accomplishments, 2009‐2013, Page 7 of 27 http://www.safway.com/Press/newsDetail.asp?id=104 http:http://www.safwaygroup.com http:www.stopconstructionfalls.com www.cdc.gov/niosh/construction/stopfalls.html
- 259. II. Nail Gun Safety Dr. Hester Lipscomb at Duke University identified key risk factors associated with nail gun use through a decade of NIOSH‐funded research,4 and demonstrated the effectiveness of trigger and training interventions. Such interventions, however, have not been adopted by nail gun manufacturers or users. There were no OSHA regulations, furthermore, that explicitly address nail guns. In response to these practice gaps, the issue was brought before OSHA’s Advisory Committee for Construction Safety and Health (ACCSH), and a work group was formed to examine the issue in more detail. CSH worked with the work group co‐chairs to arrange for presentations by Dr. Lipscomb so that she could share study findings. ACCSH eventually passed a motion unanimously asking OSHA to develop guidance and/or regulations. In addition, the NORA Construction Sector Council’s Strategic Goal #3 (related to “struck by” incidents) addresses preventing these
- 260. injuries by developing guidance.1 NIOSH took the lead role in working with OSHA to create co‐branded guidance for contractors to address this goal. The NIOSH‐OSHA co‐branded document, Nail Gun Safety: A Guide for Construction Contractors (http://www.cdc.gov/niosh/docs/2011‐202/) was published in September of 2011. The Spanish language version was published in October 2012. The publication provides the latest information on how nail gun injuries occur; descriptions of worksite nail gun incidents; specific training recommendations; and practical advice that contractors can use to prevent nail gun injuries. NIOSH and CPWR‐funded research, identifying both the problem and effective interventions, was used substantially in the publication. Expertise in both research and communication was used to customize content for the target audience. For example, the Guide used sidebar sections to provide both key research findings (“You should know”) and actual cases (“Worksite story”) to
- 261. help convey key messages. A dissemination plan was designed cooperatively by the National Construction Center, OSHA Directorate of Construction, and CRTO and CSH in NIOSH. Using some of the information in the Nail Gun Safety: A Guide for Construction Contractors in June 2013, NIOSH released an innovative new publication, Straight Talk About Nail Gun Safety (http://www.cdc.gov/niosh/docs/2013‐149/), which is also available in Spanish. The publication was designed and developed by James Albers while he was with the Division of Applied Research and Technology, and uses a comic format to illustrate the potential risks of traumatic injury using nail guns, and how these risks can be reduced. Real‐life examples from 4 Through its responsibilities as the National Construction Center, CPWR hosts a research consortium of which Dr. Lipscomb is a member. NIOSH CSH, Accomplishments, 2009‐2013, Page 8 of 27 http://www.cdc.gov/niosh/docs/2013-149 http://www.cdc.gov/niosh/docs/2011-202
- 263. residential building construction are used to explain nail gun traumatic injury risks related to the two different nail gun triggering systems and a variety of residential framing nailing tasks. The information in this publication is based on focus group discussions with residential building subcontractors, safety specialists and workers; NIOSH supported research; and Nail Gun Safety: A Guide for Construction Contractors. As a safety awareness publication, Straight Talk About Nail Gun Safety provides potential and new nail gun users with basic information to help them recognize potentially unsafe conditions and nail gun features that increase the risk of traumatic nail gun injury. The publication can be used in conjunction with safety training required by OSHA, or to reinforce previous nail gun safety training. Impact: By design, most requests for the Nail Gun Safety: A Guide for Construction Contractors publication were routed through OSHA and NIOSH websites, respectively.
- 264. version of the Nail Gun Safety: A Guide for Construction Contractors received 14,578 page views (10,606 visits) to the NIOSH website while the Spanish version of the Guide received 1173 page views (874 visits). The English version of Straight Talk About Nail Gun Safety received 9,542 page views (6,867 visits) to the NIOSH website, while the Spanish version of the comic received 1,007 page views (724 visits). website containing information about the Guide. OSHA printed 50,000 copies of the Guide initially in September 2011, and has almost exhausted a second printing of 50,000. partnered to present a nail gun safety webinar under the auspices of the American Society of Safety Engineers (ASSE). As part of the diffusion plan, a dedicated nail gun safety website (www.nailgunfacts.org) was launched in October 2011 to provide additional videos, worker testimonials, and news reports about nail gun injuries, training resources, and research information to construction audiences.
- 265. The website was developed and launched by Dr. Lipscomb and her carpenter colleagues. The site is funded by the National Construction Center. The NIOSH Office of Construction Safety and Health conducted an informal evaluation of the Nail Gun Safety: A Guide for Construction Contractors by reaching out to nine stakeholders to get feedback on the Guide, stories about its impact, or other ideas on dissemination. From what we have heard, the Guide has been a real help to the industry. Members the Associated General Contractors of America (AGC), an important stakeholder and member of the NORA Construction Sector Council, expressed their pleasure with the document. In fact, one contractor called it “the best document he has ever received from the [federal] government,” and he said that he has made it required reading for all of his staff. The findings from this evaluation are included in Appendix II. NIOSH CSH, Accomplishments, 2009‐2013, Page 9 of 27 http:www.nailgunfacts.org
- 267. III. Green Jobs in Construction Integrating Safety and Health into Green Construction: One of the six “Ready for Impact” goals of the NORA Construction Sector Council relates to green construction (Goal 13.0: Increase the use of “prevention through design” approaches to prevent or reduce safety and health hazards in construction). Under the auspices of the NORA Construction Sector Council, an ad hoc work group was formed with the charge go: (1) Explore strategies and tactics that are or can be used to integrate safety and health into green building and construction initiatives in the United States; (2) Review the draft NIOSH White Paper, “NIOSH Perspectives on Sustainable Buildings: GREEN …AND SAFE,” and draft recommendations and other suggestions for action among construction safety and health stakeholders, including members of the NORA Construction Sector Council; (3) Explore other relevant green construction issues, not covered in the NIOSH white paper, that might be appropriate for discussion and action among
- 268. construction safety and health stakeholders; and (4) Prepare options for discussion by the full NORA Construction Sector Council. NIOSH’s Prevention through Design (PtD) national initiative addresses design‐related occupational injuries and illnesses by encouraging the elimination of hazards and minimizing risks to workers across all industry sectors and settings. CSH has used PtD principals that examine the potential for hazards throughout the life cycle of work premises, tools, equipment, machinery, substances, and worker processes. This includes their construction, manufacture, use, maintenance, and ultimate disposal or reuse. PtD has been the linchpin of NIOSH’s efforts to integrate occupational safety and health into green and sustainable construction. Together, the NIOSH Construction and PtD programs collaborate on efforts to increase the use of design interventions to address safety and health hazards early in the pre‐design and design processes in the construction sector. As part of the PtD initiative, CSH and its construction stakeholders
- 269. developed a framework to create awareness, provide guidance, and address occupational safety and health issues associated with green jobs and sustainability efforts. CSH has taken a number of key steps to advance this issue, articulating the case for why green construction represents an opportunity to promote worker safety and health as a fundamental dimension of true sustainability. For example, CSH staff assisted in writing the entry to NIOSH’s Science Blog, “Going Green: Safe and Healthy Jobs” (http://blogs.cdc.gov/niosh‐science‐blog/2010/01/green‐2/) was published in January 2010 following the NIOSH “Making Green Jobs Safe” Workshop held in December 2009. At the Workshop, 170 representatives from the occupational safety and health and environmental communities within industry, labor, academia, government agencies, and nongovernment organizations met to consider how to emphasize that green jobs should be NIOSH CSH, Accomplishments, 2009‐2013, Page 10 of 27 http://blogs.cdc.gov/niosh-science-blog/2010/01/green-2
- 270. safe and healthy for workers. Several NORA Construction Sector Council members participated
- 271. in the Workshop, and found the discussions in the construction track to be very stimulating. In addition, armed with its white paper, NIOSH formally approached the USGBC in February 2011 about the merits of integrating occupational safety and health generally, and PtD specifically, into its Leadership in Energy and Environmental Design (LEED) rating system. NIOSH, with colleagues from the NORA Construction Sector Council, prepared a ”credit‐by‐ credit” review of the 2009 LEED credits, and identified six credits that could be enhanced by inserting additional language to the credit to address safety and health. Additional reference material was also developed. NIOSH shared these materials with USGBC in 2011 and continues to work with them on strategies to incorporate safety and health into now LEED version 4. The USGBC is working with NIOSH to outline other modes by which the USGBC stakeholders can become knowledgeable about the merits of integrating occupational safety and health into other LEED credits (e.g., June 26, 2012 seminar on integrating occupational safety and health
- 272. into LEED by Christine Branche and Matt Gillen to USGBC headquarters staff in Washington, DC). In January 2013, CSH participated in the USGBC’s Summit on Green Buildings and Human Health. The Summit was very successful, and USGBC is open to including worker issues into their initiatives. At USGBC’s invitation, NIOSH authored a blog that appears on their website. This blog on “Green Building and Human Health” was co‐posted on the NIOSH Science blog in June 2013. In April 2013, CSH presented at the Good Jobs, Green Jobs Conference delivering a presentation using a “Life Cycle Safety” approach to ensure that green buildings are safe buildings. In June 2013, CSH presented at the Associated General Contractors of America (AGC) Environmental Conference delivering a presentation on integrating safety and health into green buildings and rating systems. Also in June 2013, CSH presented at the American Society of Safety Engineers (ASSE), Professional Development Conference delivering a presentation on integrating safety and health into green construction. In November 2013, the CSH
- 273. presented at the USGBC National Conference (Greenbuild) on the topic of life cycle safety and its role in social equity issues. NIOSH CSH, Accomplishments, 2009‐2013, Page 11 of 27
- 274. NIOSH is working with Virginia Tech on designing a “safe roof design guide” to serve as stand‐ alone guidance material in the LEED version 4 Reference Guide or as input for several LEED credits that relate to roofs and skylights. The safe roof design concepts presented in this guide are aimed at owners, developers, and designers; they are to be used in the design phases. There are specific design suggestions specific to roofs and tools and processes that designers can use. NIOSH worked with Virginia Tech to develop a pilot credit (“Safe Roof Plan”) and is discussing its potential use with USGBC. On the state and local levels, the California Fatality Assessment and Control Evaluation (FACE) program responded to a rash of deaths among construction workers installing solar panels by producing a video and fact sheets about risks and preventive measures. These include using fall
- 275. protection systems and ensuring that lifts are available to hoist solar panels to the roof, so that workers aren’t trying to manually carry panels up ladders. One of their digital stories, “Preventing Falls Through Skylights,” won the 2012 APHA Digital Technology Award Contest. Two of the co‐workers of the roofing supervisor who died tragically after he fell through a skylight decided to be part of this digital story. They highlight the events that led up to his death and explain what could have been done to prevent it. The moving video will be used by roofers and others in trainings to prevent similar fatalities from occurring. This video was promoted as a part of the 2013 Workers Memorial Day events commemorating workers who gave their lives for their work and highlight efforts to prevent workplace deaths. CSH views this as an important initiative that will take time to deliver results. CSH has established a working relationship with the USGBC and expects this to provide insights and perspectives on how best to move ahead. This effort faces many challenges such as the lack of architect, designer or owner involvement in safety. The USGBC
- 276. itself is in the process of rethinking its approach to several issues now that LEED version 4 has been released and users are commenting on it. Because the USGBC’s LEED is the most widely used rating system in green construction, it makes our discussions with USGBC prodigious. NIOSH has made progress in working with the USGBC and others to integrate worker health and safety into green building design; more information can be found on our Prevention through Design site. NIOSH CSH, Accomplishments, 2009‐2013, Page 12 of 27
- 277. ASSISTANCE WITH DISSEMINATION IV. Residential Construction Safety Guard Rail System Driven by the prevalence of fatalities and severe injuries caused by workers falling through roof and floor openings, and existing skylights, NIOSH worked with residential carpenters to develop a multi‐functional guardrail system that could be used in numerous work situations to prevent workers from falling to lower levels. Researchers within NIOSH’s Division of Safety Research
- 278. (DSR) designed, developed, and patented (U.S. Patent No. 7,509,702, issued on March 29, 2009) a multi‐functional guardrail system that can be used on numerous residential and commercial‐industrial work sites. This research is being led by Dr. Thomas Bobick5 and supports NORA Construction Sector ‘Ready for Impact” Strategic Goal #1 to “Reduce Construction Worker fatalities and serious injuries caused by falls to a lower level.” This guardrail system is capable of providing protection to personnel who must work near (1) unguarded roof surfaces, (2) unguarded skylights, (3) unguarded roof and floor holes, and (4) on stairs that have not yet had handrails installed. The easy‐to‐install fall‐prevention system was designed to meet all OSHA safety requirements for guardrails. Through extensive testing in NIOSH labs, the final design will support more than twice the OSHA 200‐pound top‐rail strength requirement for a worker falling against it. It can be used on commercial, industrial, and residential flat roofs, as well as being adjustable to 7 different residential roof slopes (from 6‐in‐12 [27°] to 24‐in‐12
- 279. [63°]). In addition, four other variations were developed for installation on flat and vertical surfaces that are unprotected, including staircases before the handrails are installed. Impact: The impact of using the NIOSH guardrail system is an adaptable fall‐prevention system that is readily available to improve safety conditions for residential and commercial construction workers. The safety intervention can be installed to protect workers in situations where fall protection is not normally used. From September 2011 to October 2012, a field evaluation was conducted by the West Virginia University Safety and Health (WVUS&H) Extension Office. One local WV residential contractor was evaluated during this time.6 The contractor used the system on a variety of homes to meet the requirements of the OSHA fall‐ protection standards. Through a contract with NIOSH, the WVUS&H Extension Office provided training in the use of the fall‐prevention system, using installation instructions developed by the project team. The owners of the contracting firm commented that they normally do not use
- 280. guardrails during residential construction; however, after the training session, all crew 5 Dr. Bobick was chosen in 2013 as CDC’s Civilian Engineer of the Year. 6 During the field study, the contractor used the guardrail system, both externally on the roof and internally on stairs and for internal edge protection. NIOSH CSH, Accomplishments, 2009‐2013, Page 13 of 27
- 281. members felt very positive about using the system,7 and the contractor plans to continue using the system in their home as well as a commercial business. Verbal feedback from workers and management indicate high acceptance of this system. V. Ladder Application Falls from ladders are an important source of preventable construction injuries. Misjudging the ladder angle is an important risk factor for a fall. If the ladder is set too steeply, it is more likely
- 282. to fall back or slide away during use, and if it is set too shallow then the bottom can slide out. Researchers within NIOSH’s Division of Safety Research (DSR) designed and developed the first NIOSH construction related application (app). This research is being led by Dr. Peter Simeonov and supports NORA Construction Sector ‘Ready for Impact” Strategic Goal #1 to “Reduce Construction Worker fatalities and serious injuries caused by falls to a lower level.” The NIOSH Ladder Safety phone app is designed to improve extension ladder safety and has an angle of inclination indicator making it easy to set an extension ladder at the proper angle of 75.5 degrees. This free and popular app became available in June 2013 through the NIOSH website (http://www.cdc.gov/niosh/topics/falls/), the Apple App‐store (https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewSof tware?id=658633912&mt=8), and the Android Market (https://play.google.com/store/apps/details?id=gov.cdc.niosh.dsr .laddersafety). The science that led to the development of the app received awards in 2014 from both NIOSH and the
- 283. Department of Health and Human Services. The app’s inclination indicator allows most cell phones to provide both a visual and an audible signal when the ladder angle is correctly set. NIOSH’s Division of Safety Research tested and patented the concept of the app’s inclination indicator. They compared existing ladder positioning methods and found that the indicator improved both the accuracy and efficiency for ladder positioning. The Ladder Safety app also includes other handy information about ladder safety, i.e., ladder selection, inspection, accessorizing, and use. The science and research behind the development of the ladder safety app can be found at http://www.cdc.gov/niosh/topics/falls/. A Spanish language version of the Ladder Safety app has also been released. 7 Training included a hands‐on practice installing the system on three typical construction situations (sloped, horizontal, and vertical orientations). NIOSH CSH, Accomplishments, 2009‐2013, Page 14 of 27
- 285. VI. Safety Solution s – Home Building Booklet Home building is physically demanding work and manual material handling may be the most difficult part of the job. These activities increase the risk of painful strains and sprains and more serious soft tissue injuries. NIOSH’s Division of Applied Research & Technology designed and developed Simple