The Economic Burden of Workplace Injuries

Nicole Matoushek, PT, MPH, CSHE, CE

ErgoRehab, Inc.

According to the Occupational Safety and Health Administration, every year workplace injuries, illnesses and deaths cost our nation $170 billion (1). There are direct costs and indirect costs associated with all workplace injuries. Direct costs are those payments made to the employee and medical care providers. Indirect costs refer to the costs associated with lost productivity, training, administrative time, reduced product quality, overhead costs, legal fees and increased insurance premiums. In 2001, the economic burden to our nation from over-exertion injuries or injuries caused by excessive pushing, pulling, lifting, holding or carrying resulted in $9.8 billion in direct costs, repetitive motion injuries totaled $2.3 billion in direct costs, and the indirect costs associated with these ergonomic injuries accounted for $39 billion (2).

There is a relationship between workplace safety and a company’s performance and profits. As workplace injuries increase, the injury claims increase and profits suffer. Company safety and ergonomic programs can reduce injuries and increase company bottom line profits. In fact, one study estimated that a good safety and health program can save $4 to $6 for every $1 invested (1). The direct results from these programs include: reduced workers’ compensation and medical costs, diminished absenteeism, lower employee turnover and training costs and higher productivity and employee morale.

Using Ergonomics in Injury Management
Ergonomics can be used in managing workplace injuries in order to control and contain injuries and the associated costs, therefore increasing the company profitability. The results of using ergonomics in injury management include; a prompt and safe return to work, cost savings and injury containment. By using ergonomics in injury management, injured workers will be able to safely and promptly return to productive work duties with a reduced chance for re-injury or injury progression. This in turn, reduces the indemnity costs associated with lost time injuries, increases employee performance and reduces direct medical costs related to treating subsequent injuries that may result from continued exposure to ergonomic risk factors.

The key to work-related injury management is a strong understanding of ergonomics and how work demands affect human performance and disease development. Core competencies in ergonomics, clinical management of work-related injuries and ergonomic risk control are essential to successful work-injury management.

Ergonomics
Ergonomics is the study of the interaction between the work, the workplace and the worker. Taken from the Latin words “Ergo” meaning “work” and “nomos” meaning the “study of”, Ergonomics literally means the “study of work”. However, today’s application of ergonomics refers to fitting the work to the worker in order to enhance productivity, design workflow, control errors and reduce the musculoskeletal strain and fatigue from performing work tasks. Ergonomics reduces risk factors known to contribute to occupational ergonomic injuries.

Traditionally, ergonomics has been primarily used in the workplace for injury prevention. Ergonomic committees and safety teams have focused efforts on identifying high risk jobs and controlling ergonomic risks to reduce the rate at which work-related injuries occur and the costs associated with these injuries. For example, the ergonomics team may identify that injury rates have increased on a particular production line when compared to prior year incidence rates. This increase in injury rates results in losses in production and increases in the workers’ compensation costs. The ergonomic efforts would focus on identifying and controlling further work-related injuries from occurring on this line.

On the other hand, applying ergonomics to injury management, once a work-related injury has occurred, can have an even greater affect on work-related injury costs and challenges. For example, if a worker who has sustained a shoulder strain injury due to exposure to ergonomic risk factors such as high repetition, forceful exertions and positional strains such as frequent overhead lifting, the cost of this work-related injury may easily escalate out of control if the employee is unable to safely return to work or the ergonomic issues are not promptly addressed.

How to Use Ergonomics in Injury Management
There are three applications for applying ergonomics in injury management, they include: Injury Containment, Return to Work Transitions and Injury Reduction.

Injury Containment
Often times, when a worker is injured due to exposure to ergonomic risk factors, he or she is taken out of work temporarily or put on restricted work duty. Overtime, the injury heals either partly or completely and the injured worker is returned back to work at full duty and at full exposure to the ergonomic risk factors that may have potentially caused or influenced the development of the original injury. If these ergonomic risk factors are not identified and controlled, there is potential that the original injury may re-occur. In other scenarios, with repeated exposure to ergonomic risk factors, the injury may progress from a mild, relatively easy to treat disorder to a severe, catastrophic injury that may be costly and difficult to manage.

For example, a worker has sustained a wrist injury and is diagnosed with wrist strain. The injury has developed from exposure to the ergonomic risk factors of high repetitions, forceful grasping and repeated wrist flexion and wrist extension. If the injured worker returns to full work duty and full exposure to these risk factors, the wrist may be weakened and more susceptible to reinjury or further injury if the ergonomic risk exposure is not controlled. Overtime, the wrist injury may not heal or a mild wrist strain injury may progress to carpal tunnel syndrome, other inflammatory condition or even require a carpal tunnel release surgery and extensive rehabilitation. As the injury continues or progresses, the length of time away from work and productive duties increases and the average cost per injury claim increases. For example, the average cost per injury claim for a mild wrist injury, such as wrist strain is $8,000 (3). The average cost per injury claim for a moderate wrist injury, such as carpal tunnel syndrome is $14,000 (3). However, severe injuries such as carpal tunnel release, including; surgery, compensation, therapy, legal fees, administrative costs and settlements approach $250,000 (4).

By using ergonomic applications to identify and reduce the ergonomic risks that produce excessive strain to the wrist, the wrist injury can be contained to a mild disorder, as opposed to continuing or progressing to a more severe and costly injury or condition such as carpal tunnel syndrome. This concept is called “Injury Containment”, as ergonomic implementations control and contain the injury and the associated costs. The cost savings associated with injury containment for the wrist are illustrated below.

Return to Work Transitions
When a worker is injured at the workplace, the medical management of the injury includes an assessment of fit for duty or return-to–work readiness. As stated earlier, often times following a work-related injury, the worker may be temporarily out of work or put on work restrictions. The actual costs of a lost work day due to injury are staggering. For every $1 spent on direct costs of work injuries, $4-$10 are spent on the indirect or hidden costs such as training and lost productivity (5, 6).

The goal of any the organization, in regards to return to work, should be to provide a prompt return to work to minimize the lost work days due to the injury. The goal should be to provide alternate work duties that are productive, fall within the physician’s noted work restrictions and prevent the worker from becoming further deconditioned with a reduced activity level. Using ergonomics in injury management and return to work transitions can help facilitate a prompt return to work and allow the injured worker to work at moderate levels, remain productive and yet allow for the injured tissues to heal.

An example of using ergonomics for injury management in return to work transitions can be described in the following scenario. An injured worker has injured his back; the physician has imposed work restrictions of “No repetitive bending, squatting, twisting or lifting over 20#”. The employee’s supervisor has reviewed the employee’s job descriptions and has determined that the employee’s regular full time duty as a lineman requires physical demands that exceed these work restrictions. The supervisor first thinks to send the employee home, as he cannot perform 100% of his full duty activities with the imposed restrictions. The average indirect costs associated with lost time injuries are estimated at approximately $600 a week. Over a few weeks or months, the injury-related costs can accumulate into the thousands and tens of thousands of dollars.

When using ergonomics with injury management, the additional steps of reviewing alternate work duties, along with identifying the ergonomic risks and control measures can provide an alternate solution of return to work transitional duty and allow the injured employee to return to work, at a safe and productive level, immediately. The cost savings of last wages, training and lost productivity will be significant reduced. An example of using ergonomics with return to work transitional duties is illustrated below. In the example of the injured employee who is currently out of work because his full time job requirements involve physical demands that exceed the physician’s imposed work restrictions for his back injury. The supervisor or medical personnel may review the various aspects of the employee’s full time job, or alternate job duties within the same department. The job tasks that fall within the work restrictions should be identified. These activities may be components of full duty tasks or duties of an alternate, lighter job. In the case of the lineman, two of the essential functions of the job of a lineman are to clean and organize the truck and to assemble mechanical parts. Although these work tasks are essential to the job of a line man, these tasks are only a portion of the lineman’s essential work functions. By identifying these essential work tasks, or components of essential work tasks, as falling within the work restrictions, will provide productive work activities and a plan for increasing and transitioning the injured worker as the work restrictions are lifted and the employee becomes more functional.

Injury Reduction
The third aspect of using ergonomics in injury management results in injury reduction or the prevention of work-related injuries from occurring in other workers. This is considered injury reduction, as the presence of quantified ergonomic risk factors and control measures are identified and managed. A plan is implemented to control ergonomic risk, therefore reducing the work-related injuries that may have occurred had the ergonomic risks not been controlled. An example of injury reduction can be illustrated with the example of the production line worker with the shoulder injury who is exposed to the ergonomic risk factors of high repetition, forceful exertions and positional strains including frequent overhead lifting. Injury management occurs as the ergonomic risk factors are controlled for this individual and the employee is transitioned back to full duty. The specific ergonomic controls for this individual will focus on reducing shoulder strain and may include: alternating work duties to reduce repetition, lowering the production line height to eliminate the frequent overhead lifting and reducing package size to reduce the forceful exertions experienced at the shoulder joint. By controlling these ergonomic risk factors for the individual employee as part of injury management, these ergonomic risk factors were also controlled for all of the other production line workers who are also exposed to these same risks. The end result is a reduction in shoulder injuries at this production line.

Core Competencies for Using Ergonomics in Injury Management
The required skill and core competencies for using ergonomics for injury management include a strong clinical background and understanding of anatomy, work demands, the physiological affects of work, cumulative trauma development, the science of ergonomics and ergonomic risk control measures.

Adequate training and experience is recommended for those clinicians involved with ergonomics and work injury management. Competencies and clinical expertise in work factors and the body’s physiological respond to work factors is critical in work injury management and ensuring a safe and appropriate return to work. For example, if an injured worker is returned to work following an ergonomic-related injury, and the exposure to the ergonomic risk factors that caused or contributed to the initial injury are not controlled, there is a probability that the injury will not completely heal, re-occur or progress to a more severe condition. A thorough understanding of the anatomy and physiology of human work performance and work load factors is essential to identifying and controlling the exposure to the most severe ergonomic risks.

Summary
Preventing and controlling ergonomic risk factors in the workplace can effectively reduce workers’ compensation costs and increase company profitability. Often the costs associated with a workplace ergonomic and safety program are only a fraction of what one work-related injury claim would cost. For some companies, this may be the difference between being above or below the profit margin.

REFERENCES:
1) U.S. Department of Labor, Occupational Safety and Health Administration, www.osha.gov, Safety Pays.
2) Liberty Mutual Workplace Safety Index, 2001
3) J Kish, V Dobrila: “Carpal Tunnel Syndrome in Workers’ Compensation: Frequency, Cost and Claims Characteristics”. National Council on Compensation Insurance Inc. Vol. 3, Issue 3, June 1996.
4) L Hebert: “The Neck-Arm-Hand Book”, IMPACC U.S.A., 1989, p14.
5) Oregon-Occupational Health and Safety Administration, www.cbs.state.or.us.
6) Section Two- Employee Safety and Health Program, Chapter 5, Hazard and Accident Identification, Reporting and Analysis. RMTSA Vol. III, Section Two, Chapter 5, subchapter 5.2, May 1998.
7) www.ergorehabinc.com

More information about ErgoRehab, Inc. courses
--------------------

Other articles by Nichole:

Prompt Return to Work

Injury Prevention: The Shoulder Joint

Anthropometrics and Ergonomics

The History of Ergonomics

Why Offer Return-to-Work Programs?

What is Ergonomics?

Work Injury Prevention and Management

The Cost of Work Related Injuries

Ergonomics and Work Efficiency

Functional Outcomes in Worker Rehab

Conquering Barriers in Worker Rehab

Maximizing Reimbursement in Worker Rehab

Clinical Management in Worker Rehab

Work Injury Consultants

Marketing and Selling Ergonomics and Worker Rehab Services

The Economic Burden of Workplace Injuries

Keyboard Design

Health Ergonomic Objectives

Ergonomics: Work Design Principles

Ergonomics and Muscle Fatigue

Work Modifications using Administrative Controls