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A recent study to be published in the Journal of Occupational and Environmental Medicine [See Schwatka, Natalie V., Ph.D., et al., “Reoccurring Injury, Chronic Health Conditions, and Behavior Health: Gender Differences in the Causes of Workers’ Compensation Claims” JOEM, December 8, 2017, DOI: 10.1097/JOM.0000000000001301], suggests that while having incurred a prior workers’ compensation (“WC”) claim increases the odds that the worker—whether male or female—will file a subsequent claim, there are other factors associated with the filing of subsequent claims that are more closely linked to the worker’s gender. For example, among working women, the combination of a past claim and certain behavioral risk factors (e.g., depression, poor sleep habits, and headache) increases the likelihood of a future claim, yet not so in men. The researchers caution, however, that some of the gender difference may be due to the fact that men are less prone to admit they suffer from those same behavioral risk factors.
The researchers examined data during a four and one-half year period (May 1, 2010 - December 31, 2014), related to 16,926 Colorado workers who had completed a baseline health risk assessment (HRA) as part of a health risk management program offered to companies by their WC insurer, Pinnacle Assurance (“Pinnacle”). Pinnacle insures some 55,000 Colorado employers—more than 60 percent of the employers in the state.
Generally speaking, the HRA included questions about chronic health conditions and job demands. The questions were gleaned from questionnaires that had been earlier created by the World Health Organization. The HRA contained 29 questions about various health conditions, including, but not limited to depression, anxiety, fatigue, hypertension, diabetes, obesity, high cholesterol, arthritis, coronary issues, and cancer. The researchers also tracked the relevant workers’ work task difficulty, as well as other variables, such as pay scheme, employment type (full or part-time), educational status, etc.
The researchers were attempting to build on prior research that indicate the pathways to work injury may be quite different among men and women. Those within the workers’ compensation community have long noted, for example, that national injury and fatality data show that men are much more likely to be injured or killed at work than women. Occupational injury experts have typically explained most of the difference by the fact that men usually face greater occupational hazards than women. For example, women are disproportionately underrepresented in construction and other hazardous industries.
Acknowledging that a roofer and a teacher faced different risks of injury, the researchers nevertheless sought to:
The researchers noted that, regardless of gender, a higher proportion of workers with past claims also experienced a future claim, compared with those workers who had no prior claim. Indeed, for both men and women, having a past claim was the most predictive factor in determining the likelihood of a future claim.
Beyond that factor, however, the important relevant data began to diverge for men and women. For example, in the case of women:
Among male workers, the results were different. The researchers observed that, in general, health conditions and work task were not associated with likelihood of a future claim for men. Alternatively, those men that combined a past claim with either a metabolic health condition or a chronic digestive condition actually filed fewer subsequent claims.
The researchers noted one finding that appears, at least at first blush, to be counter-intuitive. For both men and women, workers with a past claim and certain chronic medical conditions—e.g., hypertension, diabetes, obesity, and or high cholesterol—were associated with a lower probability of filing a future claim.
Noting their own and other research, the authors offered several possible answers for this finding. For one thing, workers with chronic health conditions may have more difficulty recovering from their work-related injuries than those who are healthier in general. With a slower and more difficult recovery, those with chronic health conditions may, therefore, be more likely to be provided with modified duty or they may simply be out of the workplace altogether and, therefore, not exposed to any work-related risks. The reduced number of subsequent claims may also be associated with a fear of job loss and the associated concern about the loss of health insurance.
The researchers observed a strong association between headache, depression, and poor behavioral health and the filing of subsequent claims by women. They noted that, in general, women are more likely than men to have such psychosocially-related health conditions. Some argue that this isn’t so much the case, but rather that women are more likely than men to report such conditions. The researchers also posited that post-injury, women may experience more fatigue or stress from managing home life than men. They may also have more difficulty with unfavorable interactions within the WC system.
The researchers acknowledged a number of limitations in their study. Noting that the HRA data was self-reported, they indicated this could cause biases in the data and analyses. They further observed that only businesses that had enrolled in Pinnacol’s health risk management study were within the dataset. Businesses that were already concerned about promoting worker health and well-being might be over-represented in the study. The researchers indicated there could be employer level factors that affected the occurrence of claims that were not captured within the study.
As borne out in other studies, the researchers allow that following a work-related injury, employers should first attend to the hazards and exposures that are causally connected to that injury. That advice aligns itself with common sense. Dangerous conditions, left unchecked, will only lead to additional injuries by other workers.
The study tends to show, however, that the future claims prevention (or at least reduction) doesn’t end when the specific safety factor is addressed. Other factors associated with the individual worker’s overall health condition are quite predictive of future claims. Moreover, employers desiring to reduce subsequent injury claims may need to use different strategies when it comes to their female employees.
The study doesn’t address several important issues. For example, while reducing the number of subsequent injuries and claims is an important issue, it would be even better to reduce the number of initial injuries and claims. There are a number of important barriers that prevent employers from learning about many important risk factors. For example, within this study, the employee health risk assessments were voluntary and post-employment. Yet, in the employment world, pre-employment physical exams and health questionnaires are governed by relatively strict ADA rules and regulations. It may be increasingly difficult to determine if a worker—male or female—suffers from depression.
The study associates fatigue and lack of sleep with increased subsequent claims filings among women with prior injuries. How intrusive can an employer be in assessing these risks? “Did you sleep well last night?” According to the study, it’s an important issue, but is it the employer’s business? Except in those few states that utilize strong apportionment rules [see Larson’s Workers’ Compensation Law, § 90.01, et seq.], the employer takes the employee largely as it finds him or her. He may be from Mars; she’s likely from Venus.
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