Repeat wrkers cmpensatin claims in Victria, Australia Alex Cllie, PhD 1. Chief Research Officer, ISCRR, Melburne, Australia; and 2. Senir Research Fellw, Schl f Public Health and Preventive Medicine, Mnash University, Melburne, Australia alex.cllie@mnash.edu Presentatin t Institute fr Wrk and Health, Trnt, Ontari, Canada. Tuesday 22 nd February 2011.
Acknwledgements ISCRR, Mnash University A/Prf Alex Cllie, Chief Research Officer Dr Rasa Ruseckaite, Research Fellw Dr Adam Vgel, Research Fellw Mr Andrew Brin, Data Manager WrkSafe Victria Mr Rbert Camern, Manager, Business Perfrmance Management Mr Peter McKee, Lead Analyst Ms Susan Tinley, Statistical Analyst Transprt Accident Cmmissin Mr David Giffrd, Executive Manager, Business Intelligence Mr David Attwd, Senir Manager, Claims Research Mr Garth O Brien, Senir Research Analyst Mr Gary Windblt, Senir Research Analyst
Backgrund
Wrkers cmpensatin in Australia 11 jurisdictins: 6 states, 2 territries, 3 federal Substantial differences between jurisdictins: System structure & administratin Eligibility / emplyer excess Injury definitin Incapacity benefits Permanent impairment threshlds & entitlements Access t cmmn law Dispute reslutin prcesses Cverage f jurney claims Fr example (emplyer excess) NSW = 1 week VIC = 10 days / $564 medical csts QLD = $740 WA = Nne SA = 14 calendar days per wrker per year TAS = 1 week / $200 ther csts NT = 1 day Cmcare = Nne
Wrkers cmpensatin in Victria Current legislatin established in 1985 (Accident Cmpensatin Act) but has been mdified ften. Fr example - access t cmmn law benefits 1992 (restricted t seriusly injured wrkers); 1997 (remved); 2000 (reinstated fr seriusly injured wrkers) Wrking ppulatin ~ 2.8 millin (~ 85% cverage by Victrian WrkCver Authrity - VWA) VWA respnsible fr plicy and premium. Six private insurers manage claims. Current emplyer excess = 10 days incapacity r first $564 medical csts Incapacity benefits: 95% pre-injury earnings fr first 13 weeks. Max $1250 per week. 75% pre-injury earnings frm 13 t 130 weeks (less capacity t earn). Max $1250 per week. Beynd 130 weeks must demnstrate permanent incapacity. Medical benefits = reasnable csts (n limit) Return t wrk: Return t wrk crdinatr mandatry if payrll > $1M Emplyer must prvide wrker with same r similar jb (12 mnth time limit) Financial incentive scheme fr emplyers t hire injured wrkers
N claims and claimants 1986 t 2008 160000 140000 N claims N claimants 120000 100000 80000 60000 40000 20000 0 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Surce: ISCRR Cmpensatin Research Database
N claims and claimants 1986 t 2008 160000 140000 N claims N claimants 120000 100000 80000 60000 40000 20000 0 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Legislative amendments
Cmpensatin Research Database (CRD) De-identified, secure database lcated at Mnash University Wrkers cmpensatin administrative data 1 Jan 1986 t 31 Dec 2009 ~1.8 millin claims frm 950,000 claimants Transprt accident cmpensatin administrative data 1 Jan 1987 t 31 Dec 2009 ~450,000 claims Steering cmmittee f WrkSafe, TAC and University representatives versees prject Research directin and data management plicies (security, access etc ) Establishment: Initial data received in tranches Sept 2009 t July 2010 Minimum dataset defined July 2010 Data dictinary develped July 2010 Further data t be added in future
CRD wrkers cmpensatin data Data Categry Wrker Injury / Disease Variable Unique identifier, Gender, Age at injury, Pstcde at injury, Occupatin at injury (ANZSCO), Type f emplyment, Weekly earnings prir t injury, Hurs wrked prir t injury Nature f injury (TOOCS v2), Mechanism f injury, Agency f injury, Bdily lcatin f injury, disability type (TP, TT, PP) Emplyer / Wrkplace Claim Benefit payments Current industry (ANZSIC), Industry at injury, Current emplyer, Current wrkplace, Emplyer size, Type f legal entity Date f ldgement, first day f incapacity, last day f incapacity, n days incapacity paid, claim status (pen, clsed), ldged by (emplyer, wrker), medical nly claim, self-insured claim (y/n), date returned t wrk. Ttal cst f claim, Incapacity benefits, Impairment benefits, Medical and like (and subcategries - eg, psychlgy, physitherapy), Lump sum payments, Other benefits (legal services etc). Treatment / Service T be added in next update
Repeat claims
N claims per claimant Sme bservatins 2.5 Wrksafe Victria - all claims 2.0 1.5 1.0.5.0 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Surce: ISCRR Cmpensatin Research Database
Sme bservatins (cnt d) 38% f Australian wrkers receiving cmpensatin reprt making a previus claim. Surce: Australian & New Zealand RTW Mnitr (2009/10).
Sme bservatins (cnt d)
Ratinale Occupatinal injury preventin initiatives are strngly influenced by analysis f wrkers cmpensatin data. It appears that 40% - 50% f wrkers cmpensatin claims are repeat claims. Vast majrity f analysis in this area treats the claim as a discrete event. Very limited (n) understanding f: Risk factrs fr repeat claims. Csts f repeat claims. Disability assciated with repeat claims.
Objectives 1. Describe factrs assciated with repeat wrkers cmpensatin claims and time between repeat claims. 2. Cmpare csts and disability arising in wrkers with single and multiple claims.
Data ISCRR Cmpensatin Research Database Wrkers cmpensatin dataset Participants Victrian wrkers > 14 years f age Claim inclusin criteria: First claim ldged 1 st Jan 1996 t 31 st Dec 2000 First claim accepted Secnd claim ldged 1 st Jan 1996 t 31 st Dec 2009 Secnd claim accepted Claim exclusin criteria: First claims fr ccupatinal disease Any third and subsequent claims
Data Perid 1 Perid 2 1996 2000 2009 Perid 1 = all injury claims included in dataset Perid 2 = all secnd claims frm thse wh ldged a claim in perid 1 included in dataset
Data analysis Define tw grups: 1. Single claim 2. Multiple claims Descriptive analysis Cmpare grups by age, gender, industry and ccupatin Descriptive analysis f first and secnd claims in Grup 2: % secnd claims injury vs disease by type f afflictin & bdily lcatin by ccupatin & industry by emplyer & wrkplace lcatin Cx prprtinal hazards mdel t cmpare impact f these factrs n time between claims T-tests t cmpare csts and disability (days incapacity fr wrk) assciated with initial and repeat claims.
Results Grup 1 Single claim Grup 2 Multiple claims p N (%) participants 107,388 (63%) 62,760 (37%) Gender N (%) Female 38,432 (35.8%) 17,523 (27.9%) < 0.001 N (%) Male 62,880 (58.6%) 42,877 (68.3%) < 0.001 N (%) missing 6,076 (5.7%) 2,360 (3.8%) < 0.001 Mean (SD) age in years at time f first claim Secnd claim 35.1 (12.3) 34.5 (11.4) < 0.001 N (%) ccupatinal injury N (%) ccupatinal disease - - 49,474 (78.8%) 13,286 (21.2%)
Percentage f Grup Occupatin at first claim 35 30 25 20 15 10 5 0 Missing Managers Prfessinals Technicians and trades wrkers Cmmunity and persnal service wrkers Clerical and administrative wrkers Sales wrkers Machinery peratrs and drivers Grup 1 5.7 5 14.5 19.1 6.9 5.8 4.9 9.4 28.6 Grup 2 3.9 3.1 11.5 22.9 8.6 3.1 2.8 11.8 32.4 Laburers Nte: all grup differences are statistically significant
Repeat claims by nature and lcatin f afflictin Categry* Same afflictin / Same bdily lcatin N (%) f participants Mean ± SD days between claims HR [95% CI] 11,586 (18.5%) 725 ± 807 1 Same afflictin / Different bdily lcatin 12,658 (20.2%) 866 ± 893.81 [.79 -.83] Different afflictin / Same bdily lcatin 9,907 (15.8%) 1,331 ± 1,143.55 [.53 -.57] Different afflictin / Different bdily lcatin 28,609 (45.5%) 1,248 ± 1,123.59 [.58 -.61] Ttal 62,760 1,088 ± 1,057 * Cded using the Type f Occurrence Classificatin System (TOOCS) versin 2
Repeat claims by ccupatin and industry Categry* N (%) f participants Mean ± SD days between claims HR [95% CI] Same industry / Same ccupatin Same industry / Different ccupatin Different industry / Same ccupatin Different industry / Different ccupatin 24,168 (38.5%) 927 ± 964 1 22,794 (36.3%) 925 ± 949.86 [.85 -.88] 4,474 (7.1%) 1,662 ± 1,149.94 [.91 -.97] 8,696 (13.9%) 1,764 ± 1,166.82 [.80 -.85] Missing 2,628 (4.2%) Ttal 62,760 1,088 ± 1,057 * Cded using the Australian New Zealand Standard Classificatin f Occupatins (ANZSCO) and the Australian New Zealand Standard Industry Classificatin (ANZSIC)
Repeat claims by emplyer and wrkplace lcatin Categry* N (%) f participants Mean ± SD days between claims HR [95% CI] Same wrkplace lcatin / Same emplyer Different wrkplace lcatin / Same emplyer 34,626 (55.2%) 666 ± 757 1 6,508 (10.4%) 1,181 ± 1,031.56 [.55 -.58] Different wrkplace lcatin / Different emplyer 21,626 (34.4%) 1,736 ± 1,139.41 [.39 -.41] Ttal 62,760 1,088 ± 1,057 * Cded using the WrkSafe internal V-CODE system
Repeat claims by emplyer and wrkplace lcatin Categry* N (%) f participants Mean ± SD days between claims HR [95% CI] Same wrkplace lcatin / Same emplyer Different wrkplace lcatin / Same emplyer 34,626 (55.2%) 666 ± 757 1 6,508 (10.4%) 1,181 ± 1,031.56 [.55 -.58] Different wrkplace lcatin / Different emplyer 21,626 (34.4%) 1,736 ± 1,139.41 [.39 -.41] Ttal 62,760 1,088 ± 1,057 * Cded using the WrkSafe internal V-CODE system
Benefits and wrk disability Grup 1 (N=107,388) Grup 2 (N=62,760) Impact Initial claim Initial claim Repeat claim Sig* Mean ± std ttal cst per claim Mean ± std cst f weekly cmpensatin paid Mean ± std cst f medical and like services paid $16,731 ± $87,011 $8,813 ± $50,938 $13,147 ± $65,100 a,b,c $5,249 ± $30,877 $2,631 ± $18,501 $4,875 ± $27,204 a,c $3,447 ± $29,128 $2,034 ± $9,996 $2,886 ± $13,025 a,b,c Mean ± std days f incapacity fr wrk 67 ± 278 42 ± 196 66 ± 244 a,c Nte: a = Grup 1 significantly different t Grup 2 (initial claim) b = Grup 1 significantly different t Grup 2 (repeat claim) c = Grup 2 (initial claim) significantly different t Grup 2 (repeat claim)
Benefits and wrk disability Grup 1 (N=107,388) Grup 2 (N=62,760) Impact Initial claim Initial claim Repeat claim Sig* Mean ± std ttal cst per claim Mean ± std cst f weekly cmpensatin paid Mean ± std cst f medical and like services paid $16,731 ± $87,011 $8,813 ± $50,938 $13,147 ± $65,100 a,b,c $5,249 ± $30,877 $2,631 ± $18,501 $4,875 ± $27,204 a,c $3,447 ± $29,128 $2,034 ± $9,996 $2,886 ± $13,025 a,b,c Mean ± std days f incapacity fr wrk 67 ± 278 42 ± 196 66 ± 244 a,c Nte: a = Grup 1 significantly different t Grup 2 (initial claim) b = Grup 1 significantly different t Grup 2 (repeat claim) c = Grup 2 (initial claim) significantly different t Grup 2 (repeat claim)
Summary 37% f initial claimants filed a repeat claim Cnsistent with self-reprt data frm telephne survey (35%) Repeat claimants: Yunger at time f first claim Greater prprtin f men Greater prprtin f blue cllar ccupatins 4 in 5 repeat claims fr subsequent injury Mean time between claims ~ 3 years Significantly less where emplyment and injury characteristics f claimants had nt changed 65.6% f repeat claims made while wrking fr same emplyer as initial claim Csts f initial claim less than repeat claim Wrk disability assciated with initial claim less than repeat claim
Hwever A prprtin f wrk-place injuries d nt appear n wrkers cmpensatin datasets (Driscll & Hendrie, 2002). WrkSafe Victria des nt have ppulatin cverage f wrkers in Victria. Claim acceptance requires 10 days incapacity fr wrk in Victria. Psychlgical and scial cnditins are less likely t be claimed under wrkers cmpensatin than physical cnditins (Cllie et al, in press). Therefre: Sme wrkers with initial claims will have had subsequent injuries that were nt cvered by WrkSafe Victria. Sme wrkers will have had initial injuries in anther jurisdictin, r minr injuries, prir t their first accepted claim in Victria. Sme wrkers will have psychlgical and scial cnditins subsequent t an initial claim that des nt appear n the database.
Cnclusins & Next steps Repeat claims are: cmmn. expensive. assciated with substantial wrk disability. There is a substantial pprtunity t reduce the scial, health and ecnmic burden f wrkplace injury by preventing re-injury in wrkers with a single claim: 24.3% file a secnd claim while wrking fr the same emplyer 2 years frm first t secnd claim Further investigatin f risk factrs fr repeat claims is necessary and warranted. We are nw lking at: emplyer factrs wrker factrs claim factrs cmbinatins f the abve
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Dr Alex Cllie Melburne, Victria, Australia e: alex.cllie@mnash.edu w: www.iscrr.cm.au