Reducing Work-Related Long-term Disability with Secondary Prevention

W. Ruser
Executive Director
Workers’ Compensation Research Institute (WCRI)
Estados Unidos

John W. Ruser is Executive Director of the Workers’ Compensation Research Institute (WCRI).  The Institute is an independent, not-for-profit research organization providing high-quality, objective information about public policy issues involving the various state workers' compensation insurance systems in the United States. The Institute disseminates information obtained from its data collection efforts and peer-reviewed studies.  Dr. Ruser previously held several executive positions in the US government, including serving as Assistant Commissioner for Safety, Health and Working Conditions at the US Bureau of Labor Statistics (BLS).  In that position, he oversaw the national public health surveillance systems for work-related fatal injuries and non-fatal injuries and illnesses.  Earlier in his career, Dr. Ruser was a researcher and head of the BLS office that conducted research on employee compensation and working conditions in the US.  Dr. Ruser has written many peer-reviewed and non-technical articles and book chapters on occupational safety and health and workers’ compensation insurance.  He holds Ph.D. and M.A. degrees in economics from the University of Chicago and a B.A. in economics from Princeton University.

Disability caused by the workplace is first avoided by means of primary prevention, that is, preventing the occurrence of a workplace injury or illness.  But when a workplace injury or illness occurs, secondary prevention efforts can reduce the likelihood and impact of long-term disability.  This presentation discusses a variety of secondary prevention methods to improve long-term worker outcomes, including disability management and early return to work (putting workers on “light duty”), incentivizing appropriate care, and medical care “utilization review” with the application of evidence-based treatment guidelines.
Over the past quarter century, early return to work of injured workers has become a prominent feature of disability management in the United States.  Data from the US government document that, from being almost nonexistent in the 1980s, injury cases with no days away from work, but with some restricted work, are now 22 percent of all recordable workplace injuries.  Even cases with days away from work are now more likely to be associated with some additional days of restricted work.  Research demonstrates that early return to work lessens the probability that a worker will remain off work permanently.  Worker outcome surveys of the Workers’ Compensation Research Institute (WCRI) identify several predictors of return to work, including the importance of worker trust in the workplace.

In addition to disability management and early return to work, another important factor in reducing long term disability is appropriate early medical care.  Evidence from the US suggests that there are medical treatments, such as inappropriate prescribing of opioids for pain management and certain procedures, such as early magnetic resonance imaging (MRI) for lower back pain, that are associated with over-utilization of medical care and worse long-term outcomes for injured workers.  Data from WCRI show that the choice of medical treatment can be affected by a variety of workers’ compensation policies, such as regulation of fees paid to providers of medical care and the implementation of evidence-based treatment guidelines.  This presentation will feature some data from WCRI on the association between various workers’ compensation policies and costs and utilization of medical treatments for workplace injuries.