Workers Compensation and Occupational Safety and Health Challenges

Workers compensation is a state-level social insurance program that provides financial, medical, and rehabilitation benefits to workers who sustain job-related injuries or illnesses. Workers, employers, and other stakeholders involved in workers compensation administration have long voiced concerns about the extent to which workers compensation promotes occupational safety and health and the well-being of injured workers. Key topic areas include prevention of injury and disability, claim management processes, and occupational health and safety.   

Prevention of Injury and Disability-Organizational Safety

Safety culture is an organization's norms, beliefs, roles, attitudes, and practices concerned with minimizing exposure of employees to workplace hazards. The goal of a safety culture is to develop a norm in which employees are aware of the risks in their workplace and are continually on the lookout for hazards. A safety culture motivates and recognizes safe behavior by focusing on the attitudes and behaviors of the employees. It is a process—not a program; it takes time to develop and requires a collective effort to implement its many features. 

While several management practices have been cited as important components of safety programs, how much does each incrementally contribute to injury reduction?  A study examined the degree to which six management practices frequently included in safety programs (management commitment, rewards, communication and feedback, selection, training, and participation) contributed to a safe work environment for employees. While most participants implemented reactive practices (fixing problems once they have occurred), what differentiated the participants with low injury rates was that they also employed proactive measures to prevent accidents. 

The most effective step is in the front-end hiring and training of new personnel. The second most effective step is to ensure that the risk management, human resources or safety manager position has a management-level classification. This study also demonstrated that training alone is not adequate.

Claim Administration

System complexity is a drag on performance. Complexity, delays, and excessive disputes within workers compensation systems have been widely-criticized as a factor that raises system costs and that can harm injured workers by creating an adversarial relationship with employers or preventing timely receipt of needed medical care and rehabilitation services.

Employers felt that workers were harmed by poor coordination between different safety, wellness, and benefit programs within employers. Safety management, worker wellness, nonoccupational disability benefits, sick leave, and leave provided under the Family Medical Leave Act (FMLA) were all named as examples of processes that might have separate recordkeeping systems, preventing relevant information from feeding back into prevention efforts.

Employers who provide resources for management level personnel to navigate the three-headed monster, coordinate benefits and data are positioned to reduce injury rates, injured worker outcomes, and employee retention. 

Occupational Health Care

The fragmentation of healthcare delivery between workers compensation and other healthcare payers and providers is the most widely cited challenge to the health and well-being of injured workers. Employers report poor communication and the fragmentation of healthcare between occupational and nonoccupational health care providers harmed injured workers. Confusion about privacy and information sharing may amplify the consequences of care fragmentation between group health and workers compensation. While communications between physicians and claims administrators are still allowed with consent, providers may not communicate with employers about the ability to accommodate injured workers, which effectively disables the concept of prevention in occupational medicine.

Lack of medical management / population health / comorbidities issues and concerns by stakeholder groups raises concerns about the inability of workers compensation systems to address worker health and nonoccupational comorbidities before a claim is filed. This fragmentation of care is viewed as a major problem. Employers and health care providers pointed out that workers compensation medical care is distinguished sharply from other parts of the health care system by its explicit orientation toward return to work and functional improvement, so the failure to engage with occupational health providers before a workers compensation claim is filed is a missed opportunity.

Dedicated resources in occupational health differentiates employers with reduced incident rates, and overall employee health in the organization. In addition, addressing challenges is essential for integration of workers compensation and promotion of occupational safety health, and well-being of workers. 

It is important for senior living operators to understand the nuances of workers compensation and how it can impact their employees and operations. The AssuredPartners Senior Living team includes a nationwide network of in-house resources, including risk managers and data analysts with senior living experience who assist clients in optimizing their safety and health initiatives. To learn more, contact our team of senior living professionals.

 

References: 

Journal of Safety Research, Volume 33, Issue 2. 2020

Rand Corporate, Stakeholder Views on Policy and Research Priorities. How Can Workers Compensation Systems Promote Occupational Safety and Health? By Michael Dworsky, Nicholas Broten, 2018.

Podcast: Smartlinx and M3 Risk Management Services, LLC: A Look at Workers Compensation and LTC. 2018.