The Occupationally Injured Worker

8/6/2019 The Occupationally Injured Worker

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The Occupationally Injured Worker:Investigating The Decision To

Settle A Workers Compensation Claim

By

Andrew Nay, Ph.D., CRC, CDMSVocational Rehabilitation Consultant


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Statement of the Problem(s)

A distinct lack of foundational knowledge regarding thefactors that may influence the decision to settle a claim.

Disability is an evolving concept that is not universallydefined.

While most injured workers ultimately return to work, asignificant portion of this population will become displaced or

unemployed due to their occupational injury or illness.

Many of the current models of disability determination inworkers compensation are insufficient in accounting forvarious psychosocial factors that influence a workers decisionto ultimately settle their workers compensation claim.


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Theoretical Framework

Dembes Model

Illustrates the contextual factors associatedbetween various individuals, groups and socialinstitutions that contribute to the overallexperiences of the injured worker


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Purpose of the Study

To determine what factors or characteristics

influence an injured workers decision to settlehis or her workers compensation claim.

Guided by the research question:

What impact do various individual and contextual variableshave on the decision to settle a workers compensationclaim?


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Review of the Literature

While there appears to be no previous research that specifically

addresses the research question posed in this study, a review ofrelated literature on occupational injury outcomes was undertakento provide an increased understanding of workers experienceswithin workers compensation systems, specifically focusing on:

x Conceptualizing Occupational Disability

x

Expectation of Recoveryx Psychological and Psychosocial Characteristics of Disability

x Environmental and Social Considerations

x Outcome Studies Of Occupational Disability

x Injured Worker Perceptions and Experiences of Workers Compensation


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Conceptualizing Occupational

Disability

Disability is defined as, individual difficulty performingsocially expected activities such as work (Nagi 1969). Recognizes the importance of many interactions between the

environment and the impairment, illness or disability that cause orintensify disabilities.x Such as Workplace, Family and various Insurance System Characteristics

Closely supports Dembes (2001) comprehensive model

According to the Social Security Administration (2003), a 20year-old who is engaged in work has a 30% chance ofbecoming disabled before the age of retirement.


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Expectation of Recovery

May influence the time in which claim is settled

May be influenced by:

Motivation

Coping skills

Perceived value of work, relative to the associatedcosts and social impact of the injury(Shultz, 2003).


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Psychological and Psychosocial

Characteristics of Disability

Anxiety

For the injured worker, how will the injury impactwork-life?

Undetermined uncertainty about future.

Additional stress from the Workers

Compensation System. Lack of understanding.

Feelings of lack of control over case.


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Psychological and PsychosocialCharacteristics of Disability Depression

Ericksons stagesx Middle-aged adults, Generativity

Type of Injury (mild-moderate-severe)

Litigation of a Claim

x Extensive delays in rehabilitation service delivery,treatment, work absence and lost wages.


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Psychological and PsychosocialCharacteristics of Disability

Disability and chronic pain not only affects aninjured workers prospective work status, butimpacts their domestic and societal situation as

well.


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Outcome Studies Of Occupational

Disability

Settlement Probability(Thomason & Burton, 1993)

Pre-injury weekly wage and time away from work,positively influenced the amount of settlement.

Age found to be positively correlated with settlementamount implying that the older an individual is at thetime of injury, the higher the negotiated settlement.

Attorney involvement increases the amount of insureradjustment activity, increases the probability ofsettlement, although decreases overall settlement size


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Injured Worker Perceptions andExperiences of Workers Compensation

Workers generally report negative experiences within the

workers compensation system, a system that has beenperceived by many as uncaring, unfair and adversarial(Reid et al., 1994).

Reluctance to report occupational injuries and illnesses.

10.6% of workers with work related chronic upperextremity pain file a workers compensation claim fortheir condition (Morse et al., 1998)


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Method

This study utilizes a retrospective design to investigate thedecision-making process of injured workers in Michigan

who reported a work-related injury resulting in a claim forworkers compensation benefits during the 2007 calendaryear (window-in-time)

x Initial dataset Date of injury occurring in 2007 (N=42,708).x Eliminate Medical-only and no-time-lost claims (N=17,365).x Eliminate RTW w/o settlement, dropped claims, etc.x Retain Claims in which a settlement agreement had been executed

(N=1311)x Retain Claims that were continuing to pay wage-loss benefits (N= 1843)

were retained.

The final dataset consisted of a total sample size of 3,111 participants whohad either settled their claim or were continuing to receive wage-loss

benefits as of 1/1/10.


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Sample CriteriaAll participants shall meet the following criteria:

1) Reported a compensable work-related injury that occurred inthe calendar year of 2007,

2) Filed a Form BWC-100 (Basic Report of Injury) with the State ofMichigan for wage-loss benefits,

3) Was absent from the workplace due to the reported injury for aminimum of 7 days, and

4) Are continuing to receive wage-loss benefits, or have settled theirworkers compensation claim


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Data Analysis

Statistical Package for the Social Sciences (SPSS)version 15.0 Descriptive statistics (Table 2) Chi-square analysis (examination of

relationship) and Cramers V (strength ofdependency)

Pearsons Correlation analysis (multicolinearity) Primary statistical method of choice for this

study is binary logistic regression Hosmer-Lemeshow Test (measure variability)


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Log Regression Model

Logit (P (Settlement=1)) = ES +Ei (Individual

Characteristics)i+Ej (Contextual Characteristics)j + E,

Or more specifically:

x Logit (P (Settlement=1)) = FS +FAge +F2 Gender +

F3 Marital Status +F4 Number Of Dependents +F5Type Of Injury+F6 Part Of Body+ F7 Pre-Injury

Average Weekly Wage +F8 Timeliness of Wage LossBenefit +F9 Geographic Residence +F10 AttorneyInvolvement + E


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Summary of Findings

Four (4) of the predictor variables identified by thisresearcher have possible factors in influencing an

occupationally injured workers decision to settle his orher claim:

x Genderx Average weekly pre-injury wage,x Timeliness of wage-loss benefitx

Attorney involvement.

The model was successful predictor of settlement 78% ofthe time although could only account for approximately41% of the variance in claims resulting in settlement (chisquare = 7.62, p = .447).


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Summary of Findings (significant) Timeliness of wage-loss benefit

The longer the duration between the date of injury and initial wage loss payment,the less likely an individual is to settle their workers compensation claim.

Attorney Involvement

Most positive and significant predictor of claims resulting in settlement Individuals represented by attorneys are thirteen times more likely to settle their

workers compensation claim when accounting for all other variables in the model

Pre-injury Average Weekly Wage

Utilized to compare between high wage earners (more than $842/week) and lowwage earners (less than $497/week) on settlement outcome.

Low wage earners were more than two times likely to settle compared to high

wage earners. Gender

Female presence in this sample is not proportionate to their participation in thelabor force.

Findings may also be influenced by the nature of the work that femalestraditionally perform (administrative, office-oriented, or customer serviced based,rather than heavy manual labor).


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Non-significant Variables

x Marital Status

x Agex Body part of injury/Nature of injury

x Geographic Residence


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Summary of Findings

Significant vs. Non-significant Predictors Comparison of findings to related research, for example:

x The calculated odds ratio indicates that individuals who arerepresented by attorneys are essentially thirteen (13) timesmore likely to settle their workers compensation claim whenaccounting for all other variables in the model. This issomewhat consistent with Blackwell et al. (2003) where it wasfound that when injured workers did not retain an attorney,they were 1.74 times more likely to return to work than clientswho had an attorney.

x These findings are also consistent with Thomason & Burtons(1993) findings where those claims that had attorneysinvolvement were more likely to settle.


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Results Examples An individuals martial status was not statistically significant in predicting settlement

in the model (p = .380). When controlling for all other variables, the model indicatesthat individuals who are married do, however, have a slightly larger probability ofsettlement ( = .086), than those who are single at the time of injury.

When controlling for all variables in the model, those workers who reportedsustaining body systems injuries and illnesses ( = .062, p = .580) were 1.775 timesmore likely to settle their claim as compared to those with upper extremity injuries.

Compared with individuals with earnings of less than $497 per week, those earning

between $498 to $841 ( = -.272, p = .015), as well as those earning above $842 perweek ( = -.890, p < .001), indicate negative associations on settlement outcomewhen controlling for all other variables in the model.

Age was not predictive of settlement outcome and had a negligible effect on anindividuals decision to settle his or her workers compensation claim ( = .094, p =.391).


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Limitations of the Study The cause element has already occurred. Initial data based on self-reported information Missing data (case-wise procedure) Chi-square analysis may not fully control for other relevant

variables that are influencing the outcome Confidence level ( = .05) may influence the probability of a Type Ierror

Confounding effects that could not be accounted for in this study Generalizability concerns due to differing jurisdictions Changes in the measures of association of recoded variables

Multicollinearity characteristics could have an impact on significantfindings Limitations in the ability to concretely define some predictor

variables

There are also practical limitations, i.e., changing legislation, legal venues,

case law, etc.


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Implications (Practice)Management and Administration of WC Claims

Facilitate Settlement

Provides empirical evidence that there are significant,measurable variables that influence settlement outcome.

Reduce Indemnity

Provides the basis for additional research into developingbest-practices for minimizing indemnity, facilitatingsettlement, disability case management, and betterunderstanding complex disability claims.


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ImplicationsImplications for Future Research

x Help to develop best practices within workers compensation relativeto vocational rehabilitation and claims management, and help toensure fair and just treatment for injured workers.

x Future research across those States that have similar workerscompensation systems would also offer additional findings that would

be useful in policy development and program evaluation.

x Could also be used to supplement historical studies regardingindividuals perceptions of the workers compensation system anddetermine what individuals do after they settle their claim.

x Can contribute to similar research or serve to provide the foundation

for meta-analytic studies that can address positive and negative trendsamong workers compensation systems and settlement outcomes.

x Applied in conjunction with vocational rehabilitation outcome studies,researchers can better understand both the incentives anddisincentives associated with workers compensation and return towork, and its interaction with the likelihood of successful job

placement.


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Conclusion Overall, outcome studies regarding settlement serve to

improve our understanding of the occupationally injuredindividual, including their experiences and perceptions ofthe workers compensation system as a whole.

Hopefully, this study will help spark renewed interests inassessing present practices in workers compensation,contributing toward improving cost-containment strategiesfor employers and improve the quality of life of individualssuffering from occupational illness or disability.

Further research in this area can also help provideinformation that is useful in administering variousrehabilitation services to injured workers to help improve

post-injury outcomes.

The Occupationally Injured Worker

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