Controlling Workers' Compensation or Fitting
the Worker to the Work
Controlling
the cost of workers' compensation requires a global effort. Jobs must be well defined, new manufacturing or labor practices
should be approached with an eye toward its physiologic feasibility, people must be trained for the job so that they will
work safely and safety must be built in to the process where the law or good business practice would indicate.
As the
title of this article suggests, there is a choice between controlling the cost of workers' compensation or trying to fit
the worker to the task; doing the latter will assure that some workers will be unsuitable for a task and will suffer
injury rates greater than others. In order to control the former one must look at job requirements and try to achieve
production goals without causing harm to the worker at the same time. So the mission of any business should be to try
to fit the task to the worker. The rest of this article will discuss the various approaches to this end.
Who
do you want to hire? What are you permitted to do?
Ideally,
you want to hire healthy and fit individuals, conscientious workers who have healthy lifestyle practices, who avoid smoking
and drinking to excess, avoid drugs and never get sick. This will get you a discrimination suit. The Americans
with Disabilities Act (ADA) does not permit an employer the discretion of not hiring based on a real or perceived disability.
The employer is required to provide accommodations to the job in order to allow disabled persons an equal chance in the marketplace.
The ADA does not require the employer to hire someone who is not physically capable of fulfilling the essential functions
of the job. So, for instance, a paraplegic individual might have a very hard time demonstrating that he could perform
the functions of an aerial steel worker without significantly endangering himself or his co-workers. The employer is
not required to assume any risk that would be considered imminent to the prospective employee or other employees. (It
is interesting to note that in the area of job accommodations, a lineman who became paraplegic because of a job related injury
had his equipment modified so that he could return to work using a modified truck and cherry picker bucket.) What may
seem unreasonable or undoable from the perspective of the employer may not be impossible for the imaginative mind.
What
about pre - employment testing?
The
employer may have the prospective employee examined to be assured he or she is fit for the job and if found unsuitable, the
examining Occupational Physician may suggest ways to accommodate the examinee. In special instances where physical demands
are so great, the employer may require a physical endurance/agility test that is representative of the work and is not constructed
to exclude individuals because of age, gender, race or other reason . One may see these endurance tests used in hiring police,
firefighters, airline pilots, typists and the like.
What
about drug and alcohol abuse?
No employer
is required to hire a current abuser of drugs, legal or illegal. Drug testing has become widespread so that employers
can provide a safe and drug free workplace. Although smoking has yet to become an illegal drug, many employers are now
encouraging and even helping their employees to stop by paying for smoking cessation classes and by providing a smoke free
work environment. The effects of second hand smoke are such a great issue today, that some employers may think of smoking
as an unwarranted liability. Smoke-free workplaces are becoming the norm. Lately, many cities and states have
passed legislation with this in mind.. The employer must bear in mind that because of the Americans with Disabilities
Act he may not refuse to hire admitted recovering (but not currently abusing) alcoholics and drug abusers. In other
words, former drug abusers are protected under the ADA. What other measures may employers take to reduce workers' compensation
costs?
Have
an effective light duty program:
Workers'
compensation has four costs associated with it; the first is the medical cost of the injury and the second is the indemnity
cost of pay for work that is not rendered while the worker is "recovering". There, too, is the cost of lost productivity
due to absence and increased cost for replacement and training. These can amount to 3-10 times the cost of the injury
alone. Too often, the worker is allowed to stay off the job because the employer doesn't want the employee back until
he is 100% better. This strategy is employed in the mistaken belief that an injured worker is likely to hurt himself
more at work than at home. Useful work can be provided in almost any work situation if supervisors and managers understand
that the indemnity and productivity losses are as devastating to the bottom line as the perceived risk of increased injury.
If other workers can be switched to perform the work of the injured worker and the injured worker do some other useful work,
like some job that has to get done but is usually an "extra slow period " job, you maintain productivity and you eliminate
the indemnity portion of the equation. Fear of litigation is a poor reason to allow unrestricted time off because you are
more likely to incur a lawsuit when you try returning that worker to the job. By permitting unrestricted leave, you will have
contributed to the notion that the worker is "ill", and you are forcing an ill person back to work. If the company takes
an active interest in the recovery of "their patient", by demonstrating concerns such as making sure he gets to his medical
appointments on time, driving him to his physical therapy, providing full pay for light duty work and by treating him like
a sports star, the worker gains a sense of worth and his/her importance to the company.
Fitting
the work to the worker:
If you
make the effort to provide a safe work environment you will be rewarded many fold with increased productivity and decreased
work injury. I am reminded of a site visit to a major manufacturer of syringes. Part of the tour was to point
out to me that a new computer operated tram system was put in place at the cost of one million dollars, and had the effect
of eliminating the need for workers to carry 50-100 lb bags of raw plastic product to a plastic injection mold machine.
Instead, this was automatically called for when product was needed. I asked if this reduced the number of low back injuries
and indeed, it had; but the production manager stated that the reason for making such a costly investment was so that one
person could operate ten machines instead of only two, thus increasing productivity by a factor of five. This plant
remains this company's most productive plant despite the fact that other plants it owns around the world have labor forces
with one quarter of the pay.
Keep
the workforce healthy:
A company
can promote the health of its employees in many ways. Avoiding illness is the surest way to keep the worker on the job.
It has been well demonstrated by companies such as AT&T, Cargill, GTE, Honeywell and others that wellness programs and
general health promotion activities serve both the waistline and the bottom line. Companies often provide onsite health
clubs at little or no cost to the employee. They often allow their use during normal work hours. Smoking cessation
programs are effective and by comparison to the health care dollars saved, can have a dramatic impact on the number of healthcare
dollars spent by a company. Annual health fairs, emphasizing screening for cholesterol, elevated blood pressure, diabetes,
prostate cancer, breast cancer even cervical cancer are all ways to catch disease in the early, pre-morbid state, so that
effective therapy or prevention can be instituted. Sponsoring annual flu vaccination is easy and inexpensive preventive
that has a demonstrated impact on productivity.
By 2003,
an ECG analyzer will be on the market that will be able to predict, in high cardiac risk patients, those who are likely to
die of sudden cardiac arrhythmia. This new technology if applied prospectively could save about 40 billion dollars per year
in hospitalization costs alone.
To determine
which of these measures would be effective in your business you should consult the services of an Occupational Health specialist.
Questions about any of the above topics, or other workplace related health issues should be directed toward Robert E. Sterling
MD, Medical Director of Occupational Medicine Advisory Services.
