Sunday, July 29, 2012

Part 2 Do the words we use to describe WC claims matter?

The basic terms we use in workers’ compensation have meanings, associations and connotations whether we like them or not. I received a lot of questions and comments on my last post about terms such as “old dog” and “long tail” claims and I want to explore the idea that the other basic terms we use in workers’ compensation can influence how we and other stakeholders think and potentially act.

If you ask someone about the purpose of workers’ compensation, you generally get a response about compensation for accidents and a few will add something about prevention. “Accident” is often defined or understood to mean a “fortuitous event” and has the connotation of randomness and inevitability. An analysis of work-related injuries shows that the vast majority of work-related events that result in injury are preventable. Calling the specifics of a work-related injury event an “accident” may subtly shift thinking away from causation and prevention and towards inevitability and “bad luck”.

A few years ago, WorkSafeBC shifted its terminology with respect to work-related injuries involving motor vehicles from Motor Vehicle Accidents (MVAs) to Motor Vehicle Incidents (MVIs). Unless referring to a specific term in legislation (such as the Accident Fund), WorkSafeBC actively avoids using the term accident in its annual report and services plan as well as other publications.

The word “claim” as a noun has several possible meanings, the most common of which has a connotative meaning of a statement that is not yet substantiated, doubted or contested. By extension, the connotation of the word “claimant” can be similar to that of supplicant—a connotation that sets up a power relationship that can be problematic. Even the synonyms of Plaintiff and Complainant set up an adversarial relationship. Although terms like claimant may be necessary in some very specific contexts, I use “injured worker” in place of claimant wherever possible. Workers’ compensation systems are there for injured workers. “Worker” generally has a positive connotation, a sense of dignity and attachment to an occupation and employer. “Injured” speaks to the the consequences of a work-related event rather than the bureaucratic process of filing a “claim” for workers’ compensation. This may not be a perfect alternative, but in my view, it is preferable. (As an aside, in the British Columbia, the word “claimant” only occurs in Schedule B to the Workers Compensation Act and only in the context of certain occupational cancers and hand-arm vibration).

Finally, the term “benefit” connotes something different from “compensation” in common parlance. “Benefit” is often thought of as an advantage or profit gained from something; it is hard to think of an injured worker profiting or gaining from a work-related injury particularly a serious one. Do we really need to tack on the word “benefit” to workers’ compensation?

My advice is use words that keep the focus on the needs of person and his or her family. Just think about the way the words sound and how they make you feel in the sentences below:

a) The injured worker requested assistance in obtaining a wheel chair to aid in recovery

b) The claimant made a claim for medical aid benefits to cover the cost of a wheel chair.

Both sentences convey similar meeting but the first is focused on the worker and the worker’s needs while the second is focussed on a claim for a benefit with a tone, to my ear, that questions entitlement and focuses on costs.

Not every situation will allow you to avoid the terms mentioned in this series. Even if you cannot avoid the terms, thinking about the words we use may help improve understanding of how words influence perceptions and actions in workers’ compensation

Monday, July 16, 2012

Do the words we use to describe WC claims matter?

Workers’ compensation is an extremely complex form of social insurance. Those who specialize in workers’ compensation tend to adopt jargon as a kind of shorthand to express concepts to those in the know. I’m sure you have heard (maybe even said), “I have this back claim…” when what is really meant is, “I am assisting a person with a work-related injury to the back…”. Unfortunately, this use of jargon can have unintended and negative consequences.

Recently, I have read blog posts and heard speakers at conferences referring to “old dog” claims. I have heard many explanations for the source of this idiom. One commentator said the term arose from the dog-eared corners of the large paper files that are the inevitable consequence of serious injuries and long-term claims management. Another suggested the term related to those serious and long-term claims that “hound” adjudicators and frustrate administrators due to their lack of resolution. Regardless its origin, those unfamiliar with the term may interpret “old dog” claims as somehow disparaging the people who made them. Worse yet, the internal use of a term with such a negative connotation may influence the way we think about or act on some claims.
A related term, “long-tail” claims can create barriers between workers’ compensation insurers and those the system intends to help. The “long tail” in workers’ compensation refers to the statistical property of the distribution of claims, particularly as it relates to duration. The vast majority of claims are very short duration but a few go on much longer and a very few go on with some benefits that may last a lifetime. It is impossible to know just how long a particular claim for a particular injury might require active claims management, adjudication of medical costs, and payment of benefits. Insurers use actuarial estimates based on experience to quantify the costs. Claims at the far end of the claim duration distribution—the “long tail” of a graphical depiction—will generally have the greatest costs.

Most of us are not actuaries or statisticians. Those of us who endured rather than enjoyed the statistics courses in our academic careers can probably still recognize the statistical aspect of the “long tail” and recall vaguely the problems of asymtopical distributions, skewing, and corrections for right-hand truncation. For those without statistical knowledge, the term “long tail” has a somewhat negative connotation, an implied variance from some level of “normal” or “typical”. To those individuals, the use of the term may create a barrier or put them on the defensive with the insurer, adjudicator, case manager or other workers’ compensation personnel. It is not hard to imagine people worrying that adjudicators in WC would be actively working to terminate claims in the interests of shortening that long tail—not a recipe for a trusting relationship.
A 2010 survey had good news and bad news for insurers regarding trust. The headline read “Trust in Canadian insurance industry jumps 17%”. The article revealed this significant increase was on a base of only 38%. At 51% of opinion leaders trusting insurers, this improved standing is still well down the in the ranking behind other sectors like health care and technology. Given this significant lack of trust in insurers, it is time we stopped using terms that have such negative connotations even in internal discussions.
I believe workers’ compensation professionals in state funds, private carriers, TPAs and related agencies are sincerely working in the best interests of those WC was created to serve. Abandoning jargon and shorthand terms like “old dog” and “long tail” claims may seem like a small thing but words matter. Words create perceptions and perceptions create reality.

Tuesday, July 10, 2012

Can we use workers’ compensation data as an effective occupation health and safety tool?

A few days ago, I was at a CDC-NIOSH workshop in Washington DC on the topic of using workers’ compensation data for occupational safety and health. This event was organized around six draft white papers that really illustrate the potential, the barriers, and the pitfalls of this pursuit.

The first session highlighted some of the successes in using workers’ comp data in health care injury prevention. Several papers demonstrated the advantages of linking workers’ comp data with other data files. Duke University, for example, has 30,000 employees and the data in its various electronic systems can be linked on employee ID. The research presented, while preliminary, showed an elevated relative risk of musculoskeletal injuries for certain health care employees over what might be expected. It also showed that certain administrative changes have a big impact on injury rates.

The second of the themed white papers looked at the burden of occupational injuries, illnesses and fatalities. By burden, we mean the total impact on society not just the dollar impact of claims, employer cost, or loss to the worker or family. Each of these components is important and needs to be part of the equation. When that total burden is calculated, the benefit-to-cost ratio of prevention becomes more evident. In this session, there were a number of papers. For me, Seth Seabury’s presentation on the work RAND and others have done through the linking of earnings data was a highlight. The research shows that workers who suffer a work-related injury lose income relative to their non-injured counterparts. The research technique that yields this result has been tried in CA, MN, MI, NM, OR, WA, WI, Ontario and BC. While far from a national or full North American perspective, the similarity of findings is helping to quantify that loss and allow policy makers to assess the adequacy of compensation.

The third white paper dealt with the contingent workers, a growing segment of the workforce. By “contingent workers”, we mean those without an explicit or implicit contract for employment. Day labour on a construction site might be an example. In some cases, contingent workers are hired to do jobs that are considered of lower value but may be of higher risk. Contingent workers are often not captured in data sets such as the Survey of Occupational Injuries and Illnesses (SOII). Temp agencies, professional employee organizations (PEOs) and some labour contractors pose challenges for prevention, enforcement, and underwriting.

Our white paper on the use of workers’ compensation data for loss prevention provided a backdrop for presentations from WorkSafeBC, Ohio BWC, and the California Department of Industrial Relations, among others. It also fit in well with NIOSH Director, John Howard’s remarks on the importance of workers’ compensation and its data to primary, secondary and tertiary prevention. His remarks were consistent with many of the presentations that underscored the need for better metrics and standards for the data.

The fifth white paper focused on state-level analysis of workers’ compensation data for public health purposes. The presentation by Jennifer Wolf-Horejsh, executive director for IAIABC, highlighted the work of that organization in standardizing reporting through its EDI (electronic data interchange) standard and training. Presentations from various groups during this session also revealed the degree to which data from other sources and innovative techniques may be used to confirm workers’ compensation data particularly estimating the cases not captured by various data sets. The examination OSHA recordkeeping practices and workers’ compensation claims in Washington was particularly revealing and points to some of the sources of error (undercounting) that may well exist in reported work injuries.

The final white paper on leading indicators provided a great opportunity to reflect on how we might better use data for prevention purposes. One intriguing approach was Allard Dembe’s paper on O*Net. O*Net, the Occupational Information Network, (an outgrowth of the old Dictionary of Occupational Titles so many of us used in the past). It describes nearly a thousand occupations with 277 descriptors for each occupation. His research, while very preliminary, demonstrated how some of these factors might be used to predict workers’ compensation claim outcomes.

The two-day workshop provided the hundred or so researchers with a wonderful opportunity to focus on some leading edge research. When the white papers and presentations are finalized and proceedings published, I am sure they will prove a valuable resource for other researchers, policy makers, and practitioners