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Put Your Money Where Your Injuries Are... Like Your CTDs

Over the past two decades, specialization and automation in the workplace have contributed to an increase in repetitive job tasks. Often associated with risk factors such as an accumulation of stress or strain from repetition, force, awkward or fixed postures, or constant vibration, these job tasks can frequently lead to musculoskeletal injuries and cumulative trauma disorders (CTDs), which in turn can result in significant costs to employers. According to the Occupational Safety and Health Administration (OSHA), the direct medical costs for cumulative trauma disorders are $20 billion annually, with total costs nearing $100 billion. The National Institute for Occupational Safety and Health (NIOSH) has identified upper extremity cumulative trauma disorders as one of the ten most significant occupational health problems in the United States.

Case-by-case costs associated with cumulative trauma disorders are also significant enough to attract the attention of employers. Based on figures from the Bureau of Labor Statistics, repeated trauma cases cost U.S. business about $950 million annually in direct workers compensation costs and almost $3 billion when including indirect costs like overtime, training, and lost production (CTD News, June 1998). One of the most common workplace cumulative trauma disorders, carpal tunnel syndrome, averages more lost time than any other musculoskeletal injury — 25 days. Consider that the lost time associated with amputations is seven days fewer, causing only 18 lost days. Using this information combined with other published data, Intracorp developed a business case that shows that an employer with 10,000 employees would lose 6,250 workdays a year to carpal tunnel injuries, representing $4 million in lost-time costs. An employer with 75,000 employees would lose 46,875 days — enough days to make up 128 years and $30 million in lost-time costs.

Targeting Specific Injuries

The key to eradicating the lost days associated with cumulative trauma disorders is to establish a program that specifically targets high-cost, high-frequency, high-severity injuries — in this example carpal tunnel injuries — through prevention and postinjury management efforts. Oftentimes, employers know there is a problem, but may not know to what extent it exists, which locations are most prone to it, or how to prevent it. Furthermore, solutions for addressing carpal tunnel injuries are often complex or present little or no substantiated gains. Managing carpal tunnel injuries — with the intent of returning employees to work with no lost time — is a race against the clock. With ample preinjury planning, however, the race is a straight shot that follows a critical path. This column examines the steps risk managers should take to understand if carpal tunnel injuries are a significant peril for their organizations and, if so, how to effectively prevent and manage them.

Carpal Tunnel Syndrome

Carpal tunnel syndrome results when inflammation — and in some cases, damage — to the median nerve occurs in the carpal tunnel of the wrist. The carpal tunnel is a space surrounded by the carpal bones in which the median nerve and nine tendons are housed. The syndrome occurs when the tendons swell and place pressure on the median nerve. This pressure reduces the blood supply to the median nerve, causing numbness, tingling, and pain. This syndrome can be caused by medical conditions such as general edema or pregnancy. An accumulation of repetition or force without adequate rest breaks or recovery is also associated with the onset of this condition. In almost all cases, the syndrome can be lessened or abated by the control of those risks that create the pressure. Surgical intervention is needed in extreme cases.

Risk managers can minimize the complexity of dealing with carpal tunnel injuries while at the same time increase the effectiveness of the programs they implement by following five simple steps.

Evaluate the Organization

The first step is to take a macro-look at the organization — the number of locations, the nature of jobs, and the composition of the workforce. This will help present a clear picture of the business as well as provide the framework for a program that is suited to the specific needs of the organization.

The following sample case study shows how Watch This, Inc., a clearinghouse for infomercial companies, is implementing its carpal tunnel program to focus on the management and reduction of carpal tunnel claims. It has a disability management program that is successful, but its incidence and cost of carpal tunnel claims is rising enough to justify a more targeted approach.

Watch This employs 1,500 people and has a wide variety of jobs within the organization. Ten years ago, its biggest concern was injuries that occurred as a result of lifting. However, much of the physical exertion that was required then for many of the company’s positions is no longer necessary today. With the advancement of technology, Watch This is seeing a rise in its carpal tunnel injury experience, making the reduction of these injuries a priority.

Over a one-year period, the carpal tunnel injuries at Watch This rose from 42 injuries in 1998 to 60 in 1999. The number of lost-time cases is very high and increasing — from 71 percent to 75 percent over the past year. The average age of the company’s population is 35 and the base employee population is 72 percent female. The injured population is 88 percent female. The average tenure of an employee at Watch This is 7 years. Each claim for carpal tunnel, including its medical and indemnity components, but not indirect costs, is running approximately $30,000.

The primary areas of concern for this company are in the two departments that make up about 30 percent of its carpal tunnel costs: the packaging department and the call center department.

Evaluate Job Tasks

The second step a risk manager should take is to understand the tasks in a job that create risk of injury. For Watch This, an ergonomic evaluation of the risk factors within the two identified job areas can be used to minimize future injury exposures. The packaging department is charged with filling boxes with merchandise, topping off the boxes with packing popcorn, and positioning the boxes for electronic sealing. The positions in this area are not rotated and the majority of injuries are occurring in the merchandise-loading position. The call center is charged with sitting, answering phones, and entering data from callers who are placing orders.

Since Watch This fulfills orders for infomercial companies, staffing and productivity are managed in accordance with product airing schedules. Furthermore, the volume of orders placed determines the inventory packaging and scheduling necessary to meet production requirements. This means that the specific job tasks that workers must perform to package the numerous products sent out by the infomercial companies — ranging from videos, tape cassettes, and CDs to exercise equipment and cookware — are not predictable relative to the time spent per task.

Make Adjustments

The third step in the process is to make accommodations to prevent injuries and to establish transitional-duty jobs if injuries do occur. As a result of the risk analysis done in the second step, risk managers can identify the jobs that are resulting in injuries and then use ergonomic techniques to eliminate any injury-causing behavior, task, or workstation design. These accommodations should be considered part of the prevention-planning process and completed with the intention of maximizing productivity and reducing the likelihood of future injury.

The value of identifying transitional-duty jobs or tasks before more injuries occur ensures that there will be opportunities for safe, sustained work once they do. The basis of the transitional-duty concept is that recovery is incremental and once transitional-duty jobs are defined, employers can communicate them to employees and treating physician so that all are working toward the same goal: returning the injured worker to safe duty for maximum productivity.

For example, looking at the jobs within the Watch This packaging department, we determined through the ergonomic evaluation that less repetition and force was needed on the video packing and in the operation of the popcorn chute in order to reduce cumulative trauma disorders. The ergonomic evaluation also found that for the general population of workers, the conveyor was too high. This height caused shoulder flexion and abducted elbows, increasing the likelihood of upper extremity injuries. A floor platform that could be increased one to three inches higher was recommended for adapting the packaging conveyor to accommodate better postures, with employees’ being trained on the best working height for their stature. Recommended transitional duties consisted of a combination of low repetition tasks and alternating duties.

Create a Corporate Culture

While the first three steps in the process focused on evaluation and preparation, the fourth step is what actually enables the program to be a success — documentation and communication. All aspects of the program should be integrated into company and departmental manuals. For example, the availability of a program that seeks to prevent and better manage carpal tunnel injuries should be communicated to employees as a benefit. Job accommodations and transitional-duty assignments should be recorded in a process manual to ensure that when an injury occurs, an immediate and planned response can be put into effect. Treating physicians should be made aware of the company’s transitional duties and workers compensation objectives so that they can provide treatment and facilitate an appropriate return to work. Both written policies and in-person training on safe work practices should be completed and made available to supervisors and employees. In addition, an employee within the company should be designated as the “owner” of this process — preferably someone in administration that is available daily — to oversee the implementation of the program.

Dont’s Stop Now: The Postinjury Phase

As mentioned earlier, managing carpal tunnel injuries — with the intent of returning employees to work with no lost time — is a race against the clock. With ample preinjury planning, however, the race is along a more familiar path that is less likely to trip you up. The postinjury path covers getting injured workers to a qualified physician quickly, providing the physician with transitional-duty options, keeping employees focused on returning to work, and finalizing transitional-duty work descriptions. While early medical intervention is critical, it will not be as effective if an employee must return to the same job doing the same tasks. This is why preinjury planning is essential — it allows postinjury management to be an immediate undertaking.

But planning is not enough to sustain a successful program. Risk managers should have in place a solid medical management program that uses optimal treatment and disability duration guidelines. This will ensure that management of carpal tunnel is uniform throughout the organization, focusing on providing the best quality of treatment while also getting workers back to work expeditiously.

To ensure an effective focused carpal tunnel program, risk managers also must benchmark results in the postinjury phase. Two benchmarks are of utmost importance: the reduction in the number of claims if prevention accommodations are made and the reduction of lost work days. The lowered claim frequency may not be seen at first. In fact, experience dictates that initially a spike in frequency may occur due to increased awareness, but this should abate as the program evolves. The most important benchmark is the reduction in lost work days as this represents a significant reduction in lost costs.

What Savings To Expect

By implementing a program that puts the money where the injuries are, risk managers should see significant improvements in financial results. In the typical business case, if an employer with 10,000 employees would lose 6,250 work days a year to carpal tunnel injuries, representing $4 million in lost-time costs, an employer with 75,000 employees would lose 46,875 days and $30 million in lost-time costs. The assumption underlying this analysis is that there are 2.5 lost-time carpal tunnel claims per 100 employees and 25 lost workdays per claim (median reported by U.S. Department of Labor). This amounts to a cost of $640 per day per employee (based on the $16,000 cost per claim reported by the U.S. Department of Labor).

In our case study of Watch This, which specifically targeted carpal tunnel injuries through prevention planning and postinjury management efforts, risk managers could reasonably expect to see at least a 20 percent reduction in lost days. This would mean an employer with 10,000 employees would lose 1,250 fewer days to carpal tunnel, representing a savings of $800,000 a year. Likewise, an employer with 75,000 employees would lose 9,375 fewer days, representing a $6 million annual savings in lost-time costs. How would a $15 million savings look on the bottom line? By aggressively following this comprehensive approach that plans for and manages cumulative trauma disorders (here, carpal tunnel injuries), risk managers may even achieve a 50 percent reduction.

Risk managers have a unique opportunity to improve their workers compensation results by implementing a injury-specific preinjury and postinjury program. Furthermore, they can contribute positively to the profit and loss standings of their organizations, while at the same time improve employee satisfaction, productivity, and safety.

ABOUT THE AUTHOR

The Journal of Workers Compensation is a quarterly review of risk management and cost containment strategies published by Standard Publishing in Boston, Massachusetts. For more information, please visit our web site, www.standardpublishingcorp.com, or contact the editor at 800-682-5759, extension 222, or subscription services at extension 228.

riskVue | The webzine for risk management profesionals
April 2001