NIOSH Center for Workers' Compensation Studies (CWCS)

Understand the uses and limitations of workers’ compensation systems for research and surveillance of work-related health conditions

Activities:

1. Inform NIOSH staff and public health partners on workers’ compensation systems and procedures. This includes training on administrative, institutional, and legal variations that affect claim filing and acceptance. Information may be provided through:
   • webinars
   • seminars
   • development of a workers’ compensation primer
   • study of successful state models and partnerships
   • meetings on identified areas of need such as loss prevention
   • insurance certification programs
2. Develop a broad understanding of the workers’ compensation insurance market by
   • documenting private insurers catering to specific industry sectors
   • developing collaborations with commercial workers’ compensation insurance carriers

Integrate key workers’ compensation data with electronic medical record systems

Activities:

1. Promote adoption of uniform coding standards and the recording of information useful for tracking in workers’ compensation record systems such as injury/illness nature, source, event, exposure, part of body, and detailed diagnoses (e.g. International Classification of Disease, ICD9-10), use of personal protective equipment, incident description, injured worker gender, hire date, occupation, age, and number of dependents.

   For example, there are already data elements for part of body, nature of injury, and cause of Injury, shared by both IAIABC for FROI/SROI, and WCIO for unit statistical reporting in a large number of states. Unit statistical data is the audited exposure, premium, and loss information for a workers’ compensation policy.

2. Encourage continued use of accepted health information technology standards to interface electronic workers’ compensation medical records and personal electronic health records with appropriate restrictions to protect the patient’s non-work-related medical information

   For example, there is already a strong use of standards in medical data. When NCCI developed their Medical Data Call, they relied on national medical coding standards already established, such as: HIPAA (Health Insurance Portability and Accountability Act), and Current Procedural Terminology (CPT) codes set by the American Medical Association (AMA).

Characterize occupational injury and illness risk, severity, and cost using workers’ compensation data across states, industries, size of employers, and occupations

Activities:

1. Characterize risks for occupational injuries and illnesses across risk classifications, industries and occupations by utilizing the workers’ compensation claims data, loss prevention records, and related program information. This includes identifying workers’ compensation data sets with sufficient data quality to characterize risk. Key resources may include:
   • first and subsequent reports of injury
   • transactional claims history
   • medical treatments and guidelines
   • administrative processes
   • litigation reports
   • benefit payments and lost-time duration
2. Link workers’ compensation data with group medical (non-workers’ compensation health insurance) and other data. This linkage is important to investigate occupational condition cost-shifting between workers’ compensation and group health plans.
3. Evaluate the relationships among workers’ compensation costs and other economic factors and those of other health and social insurance programs that result from occupational injuries, illnesses and fatalities
4. Conduct intervention research and activities to address identified occupational conditions or hazards

5. Continue to develop and test crosswalks between insurance industry and public health coding systems for industry and occupation [e.g. NCCI manual classes versus North American Industry Classification System (NAICS) and Standard Occupational Classification (SOC)], and for injury and illness nature, event or exposure, source, and part of body

   For example, the International Risk Management Institute (IRMI) has a crosswalk that cross references workers’ compensation class codes (NCCI and the independent bureaus) with NAICS and general liability class codes.

Identify employer, carrier, and state policies, programs and characteristics that significantly impact injury and illness rates and costs among workers

Activities:

1. Evaluate the factors (such as employer size, geographical location, etc.) associated with higher workers’ compensation claim frequency and severity within industries and states
2. Evaluate leading indicators associated with lower workers’ compensation claim frequency and severity to identify evidence-based safety and health programs, practices, and policies for:
   • management commitment
   • employee participation
   • management/labor health and safety committees
   • hazard identification and communication
   • hazard elimination and control through prevention through design, engineering, administrative, work practice, and personal protective equipment (PPE) approaches
   • program evaluation
   • early symptom reporting
   • return-to-work programs
   • job accommodation and light duty jobs
3. Evaluate the effects of individual state mandates and policies for workers’ compensation programs on occupational injuries and illnesses including:
   • health and safety program requirements
   • large/ small deductible policies
   • experience rating, retrospective rating, and schedule rating
   • group and individual discounts
   • safety grants (to support engineering controls and other prevention activities at insured employers)
   • owner and contractor controlled policies
   • loss prevention services
4. Encourage development of best practices for case-management and return-to-work programs
   • Partner with insurers and states to develop a research framework agenda for predictors of disability duration and evaluate the effectiveness of return-to-work programs
   • Encourage insurers and employers to analyze their data and use findings to develop best practices for primary, secondary, and tertiary injury and disability prevention
   • Encourage examination of underreporting of claims by employees and employers
5. Evaluate the effect of contingent worker arrangements (part-time, temporary, or contract workers) and professional employer organizations on the frequency and severity of employer workers’ compensation rates