Premium rates, work demands play role in whether injuries involve time loss

IWH study finds the distinction between lost-time and no-lost-time claims goes beyond injury severity

In many workers’ compensation systems, injury claims tend to fall into two categories: lost-time claims and no-lost-time claims. And the perception generally is that injuries resulting in time off work are more severe than no-lost-time injuries.

For example, one might expect all workers who twist and dislocate their knee after falling from a work platform to need time off work (i.e. lost-time claims), no matter where they are employed. One might also expect workers who superficially cut their fingers while unpacking boxes to be back at work the next day after getting some medical attention (i.e. no-lost-time claims), again no matter where they are employed.

But a new study by the Institute for Work & Health (IWH), based on data from Ontario’s Workplace Safety and Insurance Board (WSIB), finds that it’s more than just the type or nature of the injury that plays a role in whether an injury ends up being a lost-time or no-lost-time claim. Two workplace characteristics also seem to play a role: the physical demands of the job, and the workers’ compensation premium rate paid by the employer.

That is, in a group of workers who all suffer roughly the same severity of injury—e.g. who dislocate their knee after a fall from a platform—those whose jobs aren’t as physically demanding or whose employers pay high workers’ compensation premiums are more likely to be back at work the next day.

On one level, this could be a good news story, says Dr. Peter Smith, an IWH scientist and the lead author of the study. As he explains, premium rates in Ontario are “experience rated” in order to encourage injury prevention and early and safe work returns in the event of injury. This study suggests that premium rates are effective in terms of the second objective of getting people back to work, he says.

On another level, Smith points out we don’t know how workers are being brought back to work or what practices firms are using to minimize time loss. There are good ways, such as modified duties and work accommodation, says Smith. But there are also bad ways, such as claims management and claims suppression. Currently, we have no way of knowing what’s going on, and we really should.

Smith’s study, “The relationship between worker, occupational and workplace characteristics and whether an injury requires time off work: a matched case-control analysis in Ontario, Canada,” has been published online ahead of print in January 2015 by the American Journal of Industrial Medicine (doi:10.1002/ajim.22420).

Some workplace factors played a role

To conduct the study, Smith and his research team collected data on a random sample of about 7,000 WSIB no-lost-time claims. The team then matched each no-lost-time claim with up to four WSIB lost-time claims that were similar in terms of type of injury (with 43 categories to choose from), event leading to injury (from 17 choices), the part of the body injured (18 choices) and the year of injury. This allowed the researchers to look for differences in worker characteristics or workplace characteristics that might help explain why essentially the same type and severity of injury could result in either a no-lost-time or lost-time claim.

Notable, and sometimes surprising, differences and similarities were found between the two groups. Among them:

  • Physical workload mattered. This finding supports what one would expect, that it would be harder to work the day after an injury if the work is physically demanding.
  • Age and time on the job didn’t matter. Though one might expect that workers who are young or new to the job would be less likely to take time off work after an injury, there was no evidence of this in the findings.
  • Employer size didn’t matter. One might expect large employers to be more likely to report no-lost-time claims on the grounds that they are perhaps more able to accommodate injured workers. However, large employers were not more likely to report no-lost-time claims.
  • Premium rate mattered. The study compared claims from employers in the top third of rate groups with the highest premiums against those in the bottom third. Employers paying more in premium rates were less likely to have lost-time claims.

Given that workplaces with higher premium rates are usually those with higher hazards and injury rates, it’s surprising that injured workers in these firms were less likely to take time off in comparison with workers in firms that pay low premium rates, says Smith.

We don’t know why that would be the case. Is it due to a workplace culture or policies and practices that people are less likely to take time off after an injury? If practices, are they practices such as work accommodation or claims management and claims suppression?

Better data needed

One recommendation Smith makes after this study is for the WSIB and its counterparts elsewhere to rethink their approach of classifying claims as either no-lost-time or lost-time. If the distinctions between two types of claims are not as clear-cut as they once might have been, then the categories are not as useful in painting a picture of how well workplaces are performing in primary prevention, says Smith.

We should collect information that tell us whether no-lost-time claims are for relatively minor injuries, or injuries that require periods of modified or alternate duties, he adds.

Differentiating between these two types of no-lost-time claims will let us know if firms are preventing serious injuries from occurring, or just preventing absences following an injury.

Source: At Work, Issue 79, Winter 2015: Institute for Work & Health, Toronto

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