Capture-recapture estimation of unreported work-related musculoskeletal disorders in Connecticut Timothy Morse, PhD et. al.

Timothy Morse, PhD ^{1 *}, Charles Dillon, MD, PhD ¹, Nicholas Warren, MAT, ScD ¹, Charles Hall, PhD ², Deborah Hovey, MSW ¹

¹Division of Occupational and Environmental Medicine, University of Connecticut Health Center, Farmington, Connecticut
²Department of Community Medicine, University of Connecticut Health Center, Farmington, Connecticut

email: Timothy Morse (tmorse@nso.uchc.edu)

Keywords

musculoskeletal disorders; cumulative trauma disorders; epidemiology; prevalence; workers' compensation

Abstract

Background

Estimates of the extent of musculoskeletal disorders (MSD) are usually based upon workers' compensation reports, although recent reports indicate that there may be widespread under-reporting of MSD.

Annotation by Depraved Indifference Patrice Woeppl (2008)

292 Connecticut residents with work-related upper extremity musculoskeletal disorders were indentified.  Of the 292, only 31 (10.6%) had filed a workers compensation claim.  Of the 31 cases, only 23 cases (7.9% of the 292) were accepted by the insurer.  Sixty percent of cases were primary wage earners.  Another 13% had been the primary wage earner prior to the injury.  Twenty-one (7.2%) reported job loss due to their condition.  The authors note that physical and occupational therapy were more likely to be paid out of workers’ compensation that other medical costs and procedures.  The study concludes that almost 90% of the likely work-related musculoskeletal disorders are not reported to workers’ compensation.

These studies also demonstrate how a very low percentage of worker injury costs are being covered by workers’ compensation.  If workers’ compensation is paying only a a small percentage of the cost of worker injuries, one must ask how these cost are being paid?

In the same Connecticut study referenced earlier, Morse et al (1998) found that 10.9% of medical visits and procedures were paid by general health insurance with another 8.1% being paid out of the patients pockets.

Rellsmells.com/ wants to know what has been done with the extra insurance profits in claims made vs. actuarial statistics or (pure premium).

Workers who file workers’ compensation claims often find themselves in a Catch-22.  Workers Compensation delays or denies the claim and thus does not pay for treatment, while the medical insurance refuses to cover treatment because it is a work related injury.  In 2001, a Harvard study found that medical problems accounted for about half those filing for personal bankruptcy, representing 2 million persons, including dependents.  Astonishingly, over 75% had medical insurance at the onset of their illness. 

“Workers’ Comp writes the book for the doctors to read “How to Treat the Claimant”: Discourage, Dismiss, Refuse and Alienate……” End Annotation.

Methods

An estimate of the incidence of arm and hand work-related MSD was made using capture-recapture analysis of the overlap between state workers' compensation reports and physician reports in Connecticut for 1995. The resulting estimate was compared to a population-based survey of MSD.

Results

There was very small overlap between the two state injury reporting systems: 6.7% of 793 reported workers' compensation cases, or 8% of 661 physician's reports. The estimate for MSD not captured by either system was 13,285, resulting in 14,686 (95% CI: 9,733-18,453) total reported and non-reported cases. This compares to an estimate of 13,775 cases (95% CI: 8,800-18,800) based on a phone survey.

Conclusions

This analysis points to substantial under-reporting of MSD in Connecticut: estimates of unreported cases exceed those officially reported by a factor of 11:1. The findings have an important bearing on injury prevention programs and policy making. Am. J. Ind. Med. 39:636-642, 2001. © 2001 Wiley-Liss, Inc.