Examination of Workers' Compensation Gaps and Inequities in the US

Abstract The US Congress passed the Longshore and Harbor Workers’ Compensation Act (LHWCA) in 1927; it is administered by the US Department of Labor, Division of Longshore and Harbor Workers’ Compensation (DLHWC), and provides medical benefits, compensation for lost wages, and rehabilitation services to longshoremen, harbor workers, and other maritime workers such as pier, wharf, dock, or terminal workers who are injured during employment or suffer diseases caused or worsened by employment conditions. The LHWCA and the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) similarly define many terms (eg, injury, disability, impairment, permanent). Under the LHWCA, impairment ratings are performed for “scheduled injuries,” and disability benefits are determined by multiplying the percentage of “permanent disability” (eg, “permanent impairment”) for a specific body part by a specified number of weeks. For DLHWC impartial medical specialty evaluations, specific steps are taken to avoid prejudgment of a case, and contested cases are heard before administrative law judges. Physicians who perform impairment ratings should understand not only how to fairly rate permanent impairment according to the AMA Guides but also the specific needs of the groups that request these evaluations. Impairment ratings are required for scheduled injuries, hearing loss, and occupational disease cases covered by the LHWCA; physicians must express extremity ratings as the most distal body part applicable, not as a whole person impairment.

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Epidemiology of musculoskeletal injury in the California film and motion picture industry

Reviews on Environmental Health ◽

10.1515/reveh-2015-0023 ◽

2016 ◽

Vol 31 (2) ◽

Author(s):

Nicholas A. Kusnezov ◽

Hamed Yazdanshenas ◽

Eddie Garcia ◽

Arya N. Shamie

Keyword(s):

Motion Picture ◽

Body Part ◽

Workplace Safety ◽

Musculoskeletal Injury ◽

Musculoskeletal Injuries ◽

Workers Compensation ◽

The Us ◽

Significant Burden ◽

Isolated Injury ◽

Bureau Of Labor Statistics

AbstractMusculoskeletal injury exerts a significant burden on US industry. The purpose of this study was to investigate the frequency and characteristics of musculoskeletal injuries in the California (CA) film and motion picture (FMP) industry which may result in unforeseen morbidity and mortality.We reviewed the workers’ compensation (WC) claims database of the Workers’ Compensation Insurance Rating Bureau of California (WCIRB) and employment statistics through the US Bureau of Labor Statistics (BLS). We analyzed the frequency, type, body part affected, and cause of musculoskeletal injuries.From 2003 to 2009, there were 3505 WC claims of which 94.4% were musculoskeletal. In the CA FMP industry, the most common injuries were strains (38.4%), sprains (12.2%), and fractures (11.7%). The most common sites of isolated injury were the knee (18.9%), lower back (15.0%), and ankle (8.6%). Isolated musculoskeletal spine injuries represented 19.3% of all injuries. The most common causes of injury were work-directed activity (36.0%) and falls (25.5%).We present the first report on the unique profile of musculoskeletal injury claims in the FMP industry. This data provides direction for improvement of workplace safety.

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Longshore and Harbor Workers' Compensation Act: Use of AMA Guides

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2003.marapr01 ◽

2003 ◽

Vol 8 (2) ◽

pp. 1-12

Author(s):

Christopher R. Brigham

Keyword(s):

Body Part ◽

The United States ◽

The Body ◽

Workers Compensation ◽

Lower Extremity Injuries ◽

Us Congress ◽

Whole Person ◽

The Us ◽

Extremity Injuries ◽

Compensation Law

Abstract The US Congress passed the Longshore and Harbor Workers’ Compensation Act (LHWCA) in 1927 to provide coverage to longshore laborers working on navigable waters of the United States when no state workers’ compensation law applied. After amendments that extended and standardized the Act, the Longshore Compensation Act provides more than $670 million in monetary, medical, and vocational rehabilitation benefits to more than 72,000 individuals annually. Under the LHWCA, ratings are performed for “scheduled injuries” (ie, a scheduled member of the body), including upper extremity injuries (excluding the shoulder), lower extremity injuries, and hearing loss. Impairment ratings typically are expressed in terms of whole person permanent impairment, but under the LHWCA impairment is expressed in the smallest applicable body part (eg, an injury of two digits is expressed as a hand rating). Definitions of terms such as injury, disability, and impairment are similar in the LHWCA and the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). Claims examiners are advised to require any physician selected to evaluate permanent medical impairment to use the AMA Guides, where applicable, to be detailed in their assessment report, and to rate and report permanent impairment according to the AMA Guides. Boxes in the article present portions of the LHWCA that address compensation for disability and the basic elements required to evaluate anatomical impairment.

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Erroneous Impairment Ratings Companion: Impairment Rating Critique and the Longshore and Harbor Workers’ Compensation Act

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2006.julaug03 ◽

2006 ◽

Vol 11 (4) ◽

pp. 10-11

Author(s):

Craig Uejo ◽

Phil Walker

Keyword(s):

Upper Extremity ◽

Administrative Law ◽

Workers Compensation ◽

Department Of Labor ◽

The Us ◽

Expert’S Opinion ◽

Impairment Ratings ◽

Board Decision ◽

Upper Extremity Impairment ◽

Expert Physician

Abstract A 2005 Benefits Review Board decision by the US Department of Labor, Peter J. Desjardins vs Bath Iron Works Corporation affirmed a decision and order (2004-LHC-1364) regarding the utility of impairment rating critique. The administrative law judge credited the rating opinion of an expert physician reviewer (who had not seen the claimant) over that of the treating physician. The claimant's physician was awarded 20% upper extremity impairment, but, following the review and opinion of an expert reviewer, the award was reduced to 4%. The claimant appealed, largely on the argument that the expert reviewer had reviewed the report by the patient's physician, not the claimant himself and that the expert's opinion properly relied on the correct use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). The appeals judges noted that the administrative judge properly noted that the AMA Guides was suitable for use (and was the basis of the treating physician's award). The administrative law judge found that the expert reviewer's opinion was based on the specifics of the present case and on his knowledge and application of the AMA Guides, which together warranted determinative weight, based on the expert reviewer's credentials, experience, and well-reasoned opinion. This decision confirms that expert reviewers can provide evidence for the fact finder to evaluate the treating physician's opinion to determine if it is well reasoned and documented.

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Using Multi-Dimensional Credibility to Estimate Class Frequency Vectors in Workers Compensation

Astin Bulletin ◽

10.1017/s0515036100015063 ◽

2008 ◽

Vol 38 (1) ◽

pp. 73-85

Author(s):

Jose Couret ◽

Gary Venter

Keyword(s):

Workers Compensation ◽

Injury Type ◽

Additional Information ◽

Class Frequency ◽

The Us ◽

The World ◽

Claim Frequency ◽

Frequency Vectors ◽

Large Groups ◽

High Relative Frequency

The US workers compensation system is different from those in many countries, but it is reinsured in the world-wide market and so has international impact. From its origin in the early 20th century it has been a laboratory for actuarial credibility techniques. In recent years deductibles have been increasing, so that fairly high excess coverage is now commonplace. This puts growing emphasis on estimation of the percentage of loss that is excess of high deductibles. A key element of the excess percentage is the frequency of loss by injury type. Fatalities and permanent disabilities cost more than other injury types, so when they have high relative frequency, more of the claims cost arises from large losses. The vector of claim frequency by injury type can be estimated by class of business using multi-dimensional credibility techniques. Historically the fraction of costs excess of various retentions has been calculated for large groups of classes (hazard groups) and not individual classes. We show, by testing a hold-out sample, that credibility estimation by class does produce additional information in comparison to a widely-used seven-hazard-group system.

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Using Multi-Dimensional Credibility to Estimate Class Frequency Vectors in Workers Compensation

Astin Bulletin ◽

10.2143/ast.38.1.2030403 ◽

2008 ◽

Vol 38 (01) ◽

pp. 73-85

Author(s):

Jose Couret ◽

Gary Venter

Keyword(s):

Workers Compensation ◽

Injury Type ◽

Additional Information ◽

Class Frequency ◽

The Us ◽

The World ◽

Claim Frequency ◽

Frequency Vectors ◽

Large Groups ◽

High Relative Frequency

The US workers compensation system is different from those in many countries, but it is reinsured in the world-wide market and so has international impact. From its origin in the early 20th century it has been a laboratory for actuarial credibility techniques. In recent years deductibles have been increasing, so that fairly high excess coverage is now commonplace. This puts growing emphasis on estimation of the percentage of loss that is excess of high deductibles. A key element of the excess percentage is the frequency of loss by injury type. Fatalities and permanent disabilities cost more than other injury types, so when they have high relative frequency, more of the claims cost arises from large losses. The vector of claim frequency by injury type can be estimated by class of business using multi-dimensional credibility techniques. Historically the fraction of costs excess of various retentions has been calculated for large groups of classes (hazard groups) and not individual classes. We show, by testing a hold-out sample, that credibility estimation by class does produce additional information in comparison to a widely-used seven-hazard-group system.

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Costs of Musculoskeletal Injury in the California Film and Motion Picture Industry

Global Journal of Health Science ◽

10.5539/gjhs.v8n11p293 ◽

2016 ◽

Vol 8 (11) ◽

pp. 293

Author(s):

Eddie Garcia ◽

Hamed Yazdanshenas ◽

Nicholas A Kusnezov ◽

Arya Nick Shamie

Keyword(s):

Motion Picture ◽

Musculoskeletal Injuries ◽

Workers Compensation ◽

Anatomic Site ◽

Orthopedic Injury ◽

The Us ◽

Reducing Costs ◽

The Cost ◽

Type Of Injury ◽

Bureau Of Labor Statistics

INTRODUCTION: Musculoskeletal injuries may have a significant economic impact on the film and motion picture (FMP) industry. However, there is currently no comprehensive data on the cost of workers’ compensation (WC) claims in the FMP industry. We present the first analysis of the cost of musculoskeletal injuries in the California (CA) FMP industry.METHODS: We reviewed the WC claims database of the Workers’ Compensation Insurance Rating Bureau of California (WCIRB) from 2003 to 2007 and employment statistics through the US Bureau of Labor Statistics (BLS). We analyzed the medical cost and indemnity of musculoskeletal injuries and compared the CA FMP injury data to the data for all CA industries.RESULTS: From 2003-2009, the total cost of WC claims in the CA FMP industry was $19.1 million per year, 88.6% of which was attributed to musculoskeletal injuries. The anatomical sites which incurred the most expense were the knee, lower back, and ankle at $2.3, $1.5 and $1.1 million per year, respectively. The most expensive causes of injury were work-directed activity and falls, totaling $5.4 and $4.7 million per year, respectively. The most costly types of isolated injuries were dislocations and fractures at $57,000 and $55,000 per claim. Additionally, the average cost per anatomic site, cause of injury and type of injury were significantly different for the CA FMP compared to CA industry in general. Over the course of the seven years that data was reviewed, orthopedic injury cost $191.71 per worker per year while orthopedic injury cost $224.00 per worker per year across CA industries (p<0.001).CONCLUSION: Musculoskeletal injuries contribute substantially to both FMP expenditures and US WC costs. Though the costs for injuries were statistically significant between the FMP and CA industries, the clinical significance has yet to be seen. The data presented in this study provides detailed data to help guide future designs for reducing costs associated with workplace injury in both the FMP industry and across CA industries.

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The Eleventh Circuit Holds that Agreements in which Pharmaceutical Companies Pay Generic Companies Not to Compete May be Valid

The Journal of Law Medicine & Ethics ◽

10.1017/s107311050000749x ◽

2004 ◽

Vol 32 (1) ◽

pp. 181-184

Author(s):

Amy Garrigues

Keyword(s):

Pharmaceutical Companies ◽

Court Decisions ◽

Patent Holder ◽

Trial Court ◽

Court Of Appeals ◽

The Us ◽

Antitrust Laws ◽

Per Se ◽

Appeals Court ◽

Two Sides

On September 15, 2003, the US. Court of Appeals for the Eleventh Circuit held that agreements between pharmaceutical and generic companies not to compete are not per se unlawful if these agreements do not expand the existing exclusionary right of a patent. The Valley DrugCo.v.Geneva Pharmaceuticals decision emphasizes that the nature of a patent gives the patent holder exclusive rights, and if an agreement merely confirms that exclusivity, then it is not per se unlawful. With this holding, the appeals court reversed the decision of the trial court, which held that agreements under which competitors are paid to stay out of the market are per se violations of the antitrust laws. An examination of the Valley Drugtrial and appeals court decisions sheds light on the two sides of an emerging legal debate concerning the validity of pay-not-to-compete agreements, and more broadly, on the appropriate balance between the seemingly competing interests of patent and antitrust laws.

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