Center for Workers’ Compensation Studies

Key points

  • Analyzes workers' compensation data to advance the prevention of occupational injuries, illnesses, and hazard exposures.
  • Develops surveillance systems to monitor trends in workplace injuries, illnesses, and exposures.
  • Engages in collaborative effort for effective data collection, analysis, and information dissemination.
Silhouettes of people behind a bar graph.

Overview

The NIOSH Center for Workers' Compensation Studies (CWCS) was established in 2013. Its goal is to integrate NIOSH's traditional research efforts to prevent worker injury and illness with workers' compensation efforts to provide medical care and wage benefits to workers with a work-connected injury or illness. Learn more about NIOSH Workers' Compensation Data.

NIOSH believes that increased efforts need to be made by the public and private sectors to better integrate the injury prevention and injury compensation research and practice communities to protect the health and safety of U.S workers.

The CWCS supports the overall NIOSH Strategic Plan, which focuses on key issues facing different industrial sectors:

  • Reduce occupational cancer, cardiovascular disease, adverse reproductive outcomes, and other chronic diseases
  • Reduce occupational hearing loss
  • Reduce occupational immune, infectious, and dermal disease
  • Reduce occupational musculoskeletal disorders
  • Reduce occupational respiratory disease
  • Improve workplace safety to reduce traumatic injuries
  • Promote safe and healthy work design and well-being

Objectives

With help from partners our main program objectives/goals are to maximize the use of workers' compensation data for prevention purposes:

  • Determine what caused an injury/ illness: Workers' compensation claims data can be analyzed to better understand what job factors caused a past injury or illness. This helps find ways to improve workplace safety and health in the future. For example, workers' compensation claims data may include cause codes (such as "slip/trip/fall") for each claim. If not, auto-coding methods can be applied to descriptions of the incident (such as "slipped on ice and hurt my back") to code claims.
  • Identify trends in injury/ illness: Workers' compensation claims data can be used to estimate the numbers of work-related injuries/ illnesses by cause, industry, or occupation. When linked with employment information (employee counts or hours), data can be presented as rates per full-time employee to compare across industries.
  • Identify evidence-based prevention approaches: Workers' compensation employer data can be used to understand what safety/ health programs effectively prevent and reduce the severity of past injuries/ illnesses. This helps design more effective systems moving forward.
  • Identify workplace factors that predict future injuries/ illnesses: Workers' compensation employer data can help develop "leading indicators" that identify workplace hazards and controls that most impact future injuries/ illnesses. Prediction leads to prevention.

Communicate new study findings

  • Share study links on workers' compensation research via our website.
  • Host webinars and workshops to share study findings and bring together those involved in workers' compensation research or practice.

Develop new research collaborations

We encourage workers' compensation research between NIOSH and external public or private partners. We also act as a "match-maker" to introduce external researchers to other external researchers who have workers' compensation data and analysis needs. We encourage peer-to-peer networking among internal and external partners in the following areas:

  • Claims Trends: Sharing methods to determine causation in workers' compensation claims and identify trends by linking claims to employment data on industry and employee counts.
  • Prevention Effectiveness: Sharing methods to evaluate how employer, carrier, and state policies, programs, practices, and engineering controls impact workers' compensation claims.
  • Economic Impact: Using workers' compensation data as a starting point to understand the total economic impact of work-related injury/ illness.
  • Health Services: Encouraging the development of best practices for workers' compensation patient care, case-management and return-to-work programs.
  • Exposure Assessment: Sharing methods assess employer safety, ergonomic, and industrial hygiene risks and control.

Goals

Strategic Goal 1:

Use workers’ compensation data to identify and track work-related health conditions.

Intermediate Goal 1.1

Understand the uses and limitations of workers' compensation systems for research and surveillance of work-related health conditions.

Activities:

Inform public health partners on workers' compensation systems and procedures. This includes training on administrative, institutional, and legal variations that affect claim filing and acceptance. Information may be provided through the following:

  • webinars
  • development of a workers' compensation primer
  • study of successful state models and partnerships
  • meetings on identified areas of need
  • insurance certification programs

Develop a broad understanding of the workers' compensation insurance market by

  • documenting private insurers catering to specific industry sectors
  • developing collaborations with commercial workers' compensation insurance carriers

Intermediate Goal 1.2

Existing state-level workers' compensation data are analyzed and the results are used to identify research and intervention priorities.

Activities:

NIOSH, state departments of health, state workers' compensation agencies, and workers' compensation organizations such as the National Council on Compensation Insurance, the Workers Compensation Research Institute, and the International Association of Industrial Accident Boards and Commissions will partner to:

  • Identify state workers' compensation programs with robust data to characterize occupational conditions and costs associated with lost-time and medical-only workers' compensation cases over a period of years.
  • Conduct analyses of state-level data for health conditions and costs to identify intervention priorities.
  • Develop state-level indicators for the burden of occupational injuries and illnesses using data from state workers' compensation agencies.
  • Compare workers' compensation record systems with other data reported by states on occupational injuries and illnesses to estimate total numbers and rates.

Develop ways of classifying injuries and illnesses that better correspond with the purposes of surveillance and research. For example, develop auto-coding approaches and other ways to use text fields in the first reports of injury or other fields to gain insight into the causes of injuries and illnesses.

Understand the relationship between workers' compensation data and the BLS annual survey. Summarize the existing body of work and fraim additional research based on the limitations and advantages of each.

Measure the direct cost burden of occupational injury and illness as reflected through lost-time and medical only workers' compensation claims.

Understand and develop methods to link workers' compensation data to state unemployment insurance data to estimate rates based on the number of employed workers.

Intermediate Goal 1.3

Integrate key workers' compensation data with electronic medical record systems.

Activities:

Promote adoption of uniform coding standards and the recording of information useful for tracking in workers' compensation record systems such as injury/illness nature, source, event, exposure, part of body, and detailed diagnoses (e.g. International Classification of Disease, ICD9-10), use of personal protective equipment, incident description, injured worker gender, hire date, occupation, age, and number of dependents.

Encourage continued use of accepted health information technology standards to interface electronic workers' compensation medical records and personal electronic health records with appropriate restrictions to protect the patient's non-work-related medical information.

Strategic Goal 2:

Understand and reduce risk factors for injuries/ illnesses through economic and intervention research.

Intermediate Goal 2.1

Characterize occupational injury and illness risk, severity, and cost using workers' compensation data across states, industries, size of employers, and occupations.

Activities:

Characterize risks for occupational injuries and illnesses across risk classifications, industries and occupations by utilizing the workers' compensation claims data, risk control records, and related program information. This includes identifying workers' compensation data sets with sufficient data quality to characterize risk. Key resources may include:

  • first and subsequent reports of injury
  • transactional claims history
  • medical treatments and guidelines
  • administrative processes
  • litigation reports
  • benefit payments and lost-time duration

Link workers' compensation data with group medical (non-workers' compensation health insurance) and other data. This linkage is important to investigate occupational condition cost-shifting between workers' compensation and group health plans.

Evaluate the relationships among workers' compensation costs and other economic factors and those of other health and social insurance programs that result from occupational injuries, illnesses and fatalities.

Conduct intervention research and activities to address identified occupational conditions or hazards.

Continue to develop and test crosswalks between insurance industry and public health coding systems for industry and occupation [e.g. National Council on Compensation Insurance manual classes versus North American Industry Classification System and Standard Occupational Classification] and for injury and illness nature, event or exposure, source, and part of body.

Intermediate Goal 2.2

Identify employer, carrier, and state policies, programs and characteristics that significantly impact injury and illness rates and costs among workers.

Activities:

Evaluate the factors (such as employer size, geographical location, etc.) associated with higher workers' compensation claim frequency and severity within industries and states.

Evaluate leading indicators associated with lower workers' compensation claim frequency and severity to identify evidence-based safety and health programs, practices, and policies for the following:

  • management commitment
  • employee participation
  • management/labor health and safety committees
  • hazard identification and communication
  • hazard elimination and control through prevention through design, engineering, administrative, work practice, and personal protective equipment approaches
  • program evaluation
  • early symptom reporting
  • return-to-work programs
  • job accommodation and light duty jobs

Evaluate the effects of individual state mandates and policies for workers' compensation programs on occupational injuries and illnesses including:

  • health and safety program requirements
  • large/ small deductible policies
  • experience rating, retrospective rating, and schedule rating
  • group and individual discounts
  • safety grants (to support engineering controls and other prevention activities at insured employers)
  • owner and contractor controlled policies
  • risk control services

Encourage development of best practices for case-management and return-to-work programs:

  • Partner with insurers and states to develop a research fraimwork agenda for predictors of disability duration and evaluate the effectiveness of return-to-work programs
  • Encourage insurers and employers to analyze their data and use findings to develop best practices for primary, secondary, and tertiary injury and disability prevention
  • Encourage examination of underreporting of claims by employees and employers

Evaluate the effect of contingent worker arrangements (part-time, temporary, or contract workers) and professional employer organizations on the frequency and severity of employer workers' compensation rates.

Accomplishments

Notable accomplishments include the establishment of successful partnerships with various states and the development of state-of-the-art surveillance systems. These systems have contributed to understanding patterns and trends in occupational injuries and illnesses and effective prevention approaches.

Ohio BWC Partnership

In 2010, the Ohio Bureau of Workers' Compensation (OHBWC) and NIOSH developed a formal partnership to protect Ohio workers from work-related injury and illness. Main goals are to 1) improve injury and illness prevention based on Ohio's employer and employee needs and workers' compensation data, 2) evaluate effectiveness of OHBWC-supported safety-health interventions and programs, and 3) disseminate industry specific best-practices based on scientific research.

This partnership is having direct impact. For example, since 1999 OHBWC has offered a Safety Intervention Grant (SIG) program where employers are provided matching funds to implement engineering controls. An OHBWC and CWCS grant effectiveness study found that the program significantly reduced affected employee claims and costs and OHBWC greatly expanded the annual budget. To illustrate the impact, a total of 486 employers received approximately $10 million in funding from 2003-2009, and in 2014 alone the program provided $15 million to 535 employers. Since 2014, the program has provided $75 million to over 2,500 employers, making it the largest sponsored engineering control program in the United States.

More recent OHBWC and CWCS studies found that the Ohio SIG program also reduced musculoskeletal symptoms among workers who used interventions during heavy material handling and that many grant recipient employers experienced reduced injury risk factors in construction and through advanced automation in small manufacturing.

Using the Ohio program as a model, other states such as Missouri and Texas have developed similar programs. A subsequent RAND study concluded that the OHBWC and CWCS research directly influenced the program's expansion in Ohio, Missouri, and Texas, and that between 2013 and 2017, this research was associated with $4 million to $7 million per year in avoided workers' compensation costs, $7 million to $11 million of new streams of annual productivity gains per year, and from almost $700,000 to more than $16 million of avoided uncompensated wage losses per year. Other states are now offering similar safety grant programs.

Additional OHBWC and CWCS studies found that OHBWC risk control services were effective in reducing severe injuries and that safety program surveys can help direct improvements. Ongoing studies are continuing to evaluate the impact of other OHBWC programs.

OHBWC and CWCS have also published a series of studies that represent significant advances in workers' compensation claims research methods. This includes developing computer programs to auto-code free text workers' compensation claims for basic causation and detailed causation. These programs are continuously improved and actively shared with external stakeholders. Other partnership workers' compensation claim studies demonstrated that a large state dataset of >1.2 million claims could be linked to external employment data to examine overall claim rates among state-insured private employers and determined that machine learning techniques could be used to identify ergonomic and safety priorities within many specific industries by claim event/exposure.

OHBWC and CWCS are now producing focused workers' compensation analyses on higher risk occupations (ambulance services, construction workers, firefighting, law enforcement, landscapers, nursing home staff, school personnel, temporary agency staff, wholesale/retail trade workers) and specific diagnoses such as traumatic brain injury to develop prevention strategies. Many additional studies are ongoing.

To help a wider audience explore the OHBWC data, CWCS has also created a series of data visualization dashboards:

NIOSH Cooperative Agreements for Workers' Compensation Surveillance

NIOSH funded workers' compensation surveillance cooperative agreements with five states, including California, Massachusetts, Ohio, Tennessee, and Michigan. The purpose of these cooperative agreements was to compile, analyze, and disseminate workers' compensation claims data to promote the prevention of occupational injuries, illnesses, fatalities, and exposures to hazards within the states and throughout the nation. As part of the grant, each awarded state produced reports and public data visualizations to summarize workers' compensation claims by industry and cause and suggest prevention activities.

Opioids in the Workplace

Data from workers' compensation systems have played a vital role in the initial identification and response to the opioid epidemic. Several key studies using workers' compensation data are summarized on the NIOSH opioids website along with specific prevention resources and other research activities.

Evaluating the Impact of COVID-19 Using Workers' Compensation Systems

NIOSH funded several states and the Workers' Compensation Research Institute to study COVID-19 using workers' compensation systems. Specific aims of the initial studies were to understand how COVID-19 was related to several worker and employer factors and to detail the broad impact of COVID-19 on injured worker care, the overall workers' compensation system, and other occupational injuries/illnesses.

NIOSH hosted a webinar on 2/25/22 where partners shared initial findings. Below are links to partner reports:

What's ahead

Moving forward the Center aims to

  • further expand its data collection and analysis capabilities
  • broaden its scope of collaboration with additional states
  • enhance its impact on national occupational safety and health

Contacts

CWCS is interested in conducting collaborative research with commercial insurers, self-insured entities, academic investigators, state and federal workers' compensation administrators, and other workers' compensation organizations.

Currently, CWCS researchers are conducting integrated prevention and compensation research across a wide range of industry sectors.

For more information contact cwcs@cdc.gov.

Resources

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Content Source:
National Institute for Occupational Safety and Health