Rousmaniere: Has the Burden of Disabilities for Workers Changed?

Monday, April 7, 2014 | 0

The Bureau of Labor Statistic's reported rates of work fatalities and work injuries continue their long-term decline.  The National Council on Compensation Insurance has been reporting decline in lost time claim frequency for years. The trends as report by both sources over the past decade or two have averaged roughly 3% to 5% per year. The NCCI in a month and by BLS in the Fall will issue 2013 figures that in all likelihood extend this streak.

It's time to step back and ask, has the burden of work disabilities really dropped so much?  There are no simple answers to this question. But it is very important to ask.

Indeed, we need at much as ever to understand if and how the burden of disabilities for workers may be evolving.  The very mission of workers compensation is lessening the burden of disability on households and employers.  Federal, state and local governments have been issuing a seemingly endless number of laws (such as ADA, FMLA and paid sick leave) and regulations to ensure that individuals with disabilities (regardless of cause) have access to employment, the public square, and civic respect. 

Employer practices in managing workers with disabilities, again regardless of cause, have improved.  The Integrated Benefits Institute and the Disability Management Employers Coalition were founded and run strong educational programs on the idea that the burden of disability in the working age population is both greater than commonly perceived and can be greatly reduced for both worker and employer, if addressed intelligently without silo blinkers.   

Medical advances are part of the evolving story.  The Kessler Foundation, headquartered in West Orange, NJ, is interested in exploring how medical care for injuries has advanced.  Nancy D. Chiaravalloti, Ph.D. of the Foundation cites several reasons why recovery from traumatic brain injury be improving.  She writes, "in the trauma center, medical practices have improved. For example, there are new technologies such at brain oxygenation monitoring systems that help physicians monitor physiological aspects of the immediate post injury period. Rehab practices have improved. For example, there is a greater emphasis on evidenced based practice. There is also a greater awareness of what factors can impede rehabilitation - such as medication effects.  I feel strongly that recovery is going to continue to improve in the coming years."

But back to that trend data.  Some doubt the credibility of the BLS and NCCI figures.  Most provocatively J. Paul Leigh, a professor at the University of California, Davis, has for years used epidemiological methods to estimate vastly greater fatal occupational diseases than government or private industry sources.  Others charge that private industry is suppresses work injury incidence.  They have not made a strong argument that suppression has increased over time, which would be necessary if suppression is behind the rate declines.

Let's exclude occupational diseases and focus on injuries, in particular musculoskeletal plus traumatic catastrophes that are burns, spinal cord injuries, brain injuries, and multiple trauma.  Professor Leigh might argue that means staging Hamlet without the melancholy Dane. 

Besides frequency of injury and death, there is the matter of severity.  Have injuries changed in severity?

The word means various things.  Insurers use the word severity to refer to the dollar cost of the injury claim.   The medical profession has developed many grading systems to define the extent of deficit a patient experiences.  A patient's position on the scale over time, ideally towards a reduction in deficit.  

The typical work injury experience starts with an acute event (fall from a high level) or gradual process (upper extremity strain).  Increase in deficit followed by recovery back towards restoration of function.  The workplace has greatly improved its ability to bring a worker back without waiting for complete restoration of function. 

If the recovering worker is back at work, and if the employer finds the worker productive back at work, even at modified duty, then the burden of disability for both can be said to be less than were the worker at home and the employer paying indemnity benefits. 

The emerging picture is mixed among classes of workers or scenarios, suggesting an overall burden of disability score is likely pointless. Work injury risk appears to be lower. We don't know if the average functional deficit of work injuries at the outset has changed. A greater share of the employed workforce may have some degree of functional deficit for whatever cause.  The remaining cohort of injured workers not back at work may on average have high functional deficits than a decade or two ago.

Here is the Okie Effect at play. Will Rodgers opined that migration of Oklahoman households to California during the Dust Bowl caused the average IQ in each state to go up.

It's probably prudent to ask, not whether the burden has gone up or down, but if there are scenarios in which it is likely the burden has gone down. If we know these scenarios, we can then ask if they are more prevalent today than in the past. And we can ask about the future. That's for my next article.