Worker Compensation in Commercial Drivers Injury Prevention and Case Management Brian Harrison, M.D....

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Worker Compensation in Commercial DriversInjury Prevention and Case Management

Brian Harrison, M.D.April 2014Worker Comp (WC) in Commercial Drivers (CD)- ConceptsDOT Regulations reduce major WC Cases BUT:DOT Regulations may increase Lost Workdays in both major and minor casesEmployers can improve primary prevention of CD WC Cases through Safe work practices while performing non-driving dutyTruck driver wellnessSafe use of all medications (Rx and OTC)Case managers and adjusters should attend to all potential barriers to RTW in WC CasesUse Worker Rehab Program more liberally

23Commercial Driving Big Vehicles, Big Costs, Big RegulationsActive Interstate Truck and Bus Companies (2004) 662,392Between 2000 and 2010: truck and bus miles increased 20%; more carriers.Total Number of CDLs Issued 6-7 millionFMCSA certification examinations for commercial motor vehicle drivers: 3-4 million exams annually

Source: Motor Carrier Safety Progress Report (September, 2004)3Vehicles Involved in non-Fatal injury per 100 Million Vehicle Miles Traveled by Vehicle Type

Professionals Drive More Safely Than We DoThey Live in Regulation Nation!1939 First Regs: Interstate Commerce Commission Good physical & mental health, no addiction to narcotics, no excessive use of alcohol. 1954 - Exams first required 1970 DOT created 1999 - Ill bus driver liable for 22-death crash2000 FMCSA created2005 SAFE TEA LU: Chief Medical Officer, Medical Review Board, Medical Expert Panels; National Registry of Certified Medical Examiners proposed2006 Sleep Apnea: Joint Task Force Guidelines2014 National Registry of Certified Medical ExaminersTrained, Tested, Certified

Safe Accountable Flexible Efficient Transportation Equity Act6Medical Standards (Regulations)of the FMCSA13 standards directly related to medical requirements 4 standards are specific Medical examiner cannot interpret or alter Vision, Hearing, Epilepsy, Insulin use9 standards are general (likely to, which interferes, or satisfied by Skill Performance Evaluation or OKed by MD)Medical examiner decides if medical condition affects drivers ability to safely operate a CMV6Joint Task Force Guidelines

Joint Task Force Guidelines

Two or more of the following:

1. Body mass index >35 kg/m22.Neck circumference in men >17 and in women 16 3. Hypertension (new, uncontrolled, or unable to control with fewer than two medications)

An Observational Study ofCommercial Drivers at risk of OSA915Index Exams613 (67%)No unaddressed OSA risk302 (33%)At risk for OSA, BMI 3563 (21%)Lost to f/u239 (79%)Available for f/u at 3-9 mo.19 (7.5%)Out of service PSG (all positive)219 (92%)To weight loss option1 (0.5%)To bariatric surgery87 (40%)At BMI < 35 in 3-9 months49 (100%)Remained at BMI < 35132 (100%)Proceeded to PSG and treatment (if indicated)49 (56%)Seen for re-cert (10.6 mo average f/u)132 (60%)BMI still 35 at 3-9 monthsWhen given optionto lose weight:40% did, Average of33# !And kept it offFor 1 year!!!22nd Anniversary of DOT Drug Tests

The Omnibus Transportation Employee Testing Act became law on Oct. 28, 1991Seems like a long time ago: Packers went 4-12in 1991 with Coach Infante and QB Mike TomczakIllegal drug use among transportation workers has since dropped 50%Fatal accidents from alcohol use by truck and bus drivers has since dropped 23%

Packers went about 200-125 since then, Tomczak #18Crashology - The science of Driving SafelyLarge Truck Crash Causation StudyFMCSA 2007

120,000 large truck crashes occurred between April 2001 - December 2003Study Sample of 963 crashes involving1,123 large trucks with death or injury11Top 10 Critical Reasons (CR) for Truck Crashes(2 mechanical, 8 operator)Over loadedMaking illegal maneuver Inadequate surveillance Traveling too fast for conditions Inattention Following too close Misjudgment of gap or others speedStop required before crashExternal distraction Brake problems

Prescription and Over-the-Counter Medications Tool Kit DOT FTA 2003 now updated April 2011This Toolkit is a compilation of policies, procedures, forms, and training resources that represent the best practices being used throughout the U.S. by a variety of transit systems. . . the result of an extensive effort by the Federal Transit Administration (FTA) to compile a broad range of materials as examples and models.

12Top 10 Associated Factors (associated with CR)- Ranked By Frequency

Brake problems Traffic flow interruption (congestion, previous crash) Prescription drug use Traveling too fast for conditions Unfamiliarity with roadway Roadway problems Required to stop before crash (traffic control device, crosswalk) 8. Over-the-counter drug use9. Inadequate surveillance10. FatigueAnd, 5th most important byPreventable Fraction Drug involved in 17% of crashes. These increased risk by only 30%, but since so many drivers use them, they ranked 5th out of 20 factors, ahead of driver fatigue, inattention, tire problems, jackknifing, cargo shift, alcohol, and illegal drugs, in terms of preventable fraction


Safety and Ergonomics Have Caused Injury Rates to Decline in All Sectors The fatal injury and illness rate declined by almost one third 1994 - 2011 (Bureau of Labor Statistics). Safety and Ergonomics Have Caused Injury Rates to Decline in All Sectors

Non-fatal rates have fallenby almost 2/3rds

1994 - 2011

Trucking Cost ConundrumTrucking Industry has improved safety, cut illegal drug use and alcohol misuse, and followed the rulesCosts should have gone down, but havent, in:Health planWorker compTurnoverCompliance costsAccident Liability16Worker Comp ConundrumTrucking companies pay higher worker comp premiums every year, even as large truck crash rates continue to drop.

Non-life threatening injuries suffered during non-driving duties make costs climb, despite fewer major injuries from crashesTransportation: Highest rates of Lost Time(258, up from 251 in 2011)

258, up from 251 in 2011more than double the average for all occupations and a median of 13 days away from workBureau of Labor Statistics, U.S. Department of Labor, The Editor's Desk, Work injuries and illnesses requiring days away from work in 2011 on the Internet at (visited March 24, 2014).

18Worker Comp Medical $ Climb

As Has the Cost of All Benefits

Workers Comp Conundrum Root CausesIll health and health-risking behavior underlie this conundrum, not a lack of driving safety Individuals with multiple health risks are more likely to submit claims Workers Comp medical care and wage indemnity costs are higher in high risk claimants Organizations with higher prevalence of health risks have higher Workers Comp costsAnd Drivers must WORK more safely, not just DRIVE more safely!

The burden of chronic illness in an aging workforce is a culprit you can seize!

Ill health and high-risk behavior underlie this conundrum, not a lack of safety or of ergonomics Individuals with multiple health risks are more likely to submit claims Workers Comp medical care and wage indemnity costs are higher in high risk claimants Organizations with higher prevalence of health risks have higher Workers Comp costs

22Low Risk will Mean Low CostHigh Risk Will Mean High CostElevated Body Mass IndexLack of physical ActivityHigh StressHigh CholesterolHigh Blood PressureSmokingExcessive AlcoholImperfect Safety Belt UseEstablished Chronic Disease Recreational Drug UsePerceived ill-healthDissatisfaction with lifeDissatisfaction with workDepressed moodOverall Score:Low Risk (any 2 or fewer)Medium Risk (any 3 or 4)High Risk (any 5 or more)Low Risk Will Mean Low Cost

24Obesity and All Medical Costs77% higher average medical costs (obese vs. ideal)Treatment of obesity-related diseases accounted for 27% of the rise in inflation-adjusted per capita medical spending between 1987-2001

Thorp et al, The impact of obesity on rising medical spending Health Affairs 2004 supplement

26Obesity: Worker compensation claims are increased by obesity. There is a linear relationship between BMI and the rate of claims. Employees with BMI >40, compared to recommended-weight employees, had:twice as many worker comp claims 13 times more lost work days Especially claims involving the low back, lower extremity, wrist or hand. This includes sprains/strains/contusions, slip/falls, and lifting/exertion. The combination of obesity and high risk occupation was particularly detrimental (Ostbye, 2007).

27Obesity: 6 times higher medical costs for worker compensation care10 times higher worker comp and indemnity costs

Drive Down Trucker Trauma byReducing Injuries Away From the Wheel Personalized Care

Commercial Drivers Drive Safely, But Might Not Work SafelyCommercial driver safety improvements have cut large truck crashes to half of what they were 10 years ago, per million miles driven.High rates of strains, sprains, bruises, and other conditions classified as musculoskeletal disorders (MSDS).While lumping freight, climbing in and out of the cab, and managing the trailer.Get In And Out Safely!Classic 3 points of contact method.When a 220 pound trucker jumps from the height of the cab to the ground, they drive 1,637 pounds of force throughout their body.From the lowest step, a mere 16 inches from the ground, more than 300 pounds of force drives upward into the body.Mechanical lifts such as powered lift gates pa