Posts Tagged ‘Research’

How Americans die on the job

Friday, September 19th, 2014

in her post How Americans die on the job, in 5 charts, Danielle Kurtzleben of Vox media analyzes and summarizes data from the Labor’ Department’s most recent preliminary Census of Fatal Occupational Injuries, 2013 The charts offer a quick look at of some of the most deadly jobs, activities and demographics.
The good news is that fatalities continue trending down, as can be seen in the chart below. In 2013, 4,405 fatal work injuries were recorded in the United States, lower than the 4,628 recorded work fatalities in 2012. The numbers could adjust – final 2013 data isn’t released until the late spring of 2015. The Bureau of Labor Statistics says that, “Over the last 5 years, net increases to the preliminary count have averaged 165 cases, ranging from a low of 84 in 2011 to a high of 245 in 2012.”
work-fatalities.png

Policy Wonks, Lend Me Your Ears!

Thursday, February 7th, 2013

The Insider is very much looking forward to the Workers Compensation Research Institute (WCRI) annual conference, taking place on February 27-28 in the virtual epicenter of wonkiness, Cambridge MA. There is always much food for thought in these annual gatherings of insurance execs, state officials, policy makers, attorneys, medical specialists, employers and safety/loss control practitioners.
This year’s agenda has zeroed in on the fundamental medicine-related conundrums facing workers comp systems across the country. All of us in workers comp long for insights into the following:
Unnecessary medical care and its impact on treatment guidelines. (Back surgery, anyone?)
Medical price regulation: what are the essential elements of an effective fee schedule? (Beware of the state where the doctors love comp…did someone mention “Connecticut”?)
The Opioid epidemic: treatment protocols involving the generous and prolonged distribution of opioids are destroying lives across the country. Why are so many doctors so clueless about the proper use of pain killers? Whatever happened to “do no harm”?
WCRI’s head honcho, Dr. Richard Victor, will host a discussion on health care policy involving (the presumably liberal) Howard Dean and (the assuredly conservative) Greg Judd. The dialogue might not equal the fireworks of July 4th on the Esplanade, but it might come close. The Insider will be listening closely for any indications of that rarest of phenomena: a common ground.
From Gorilla to ?
Last year, Dr. Victor concluded the conference with a discussion of the “gorilla in the room”: the enormous and perhaps insoluble problem of structural unemployment among the 20 million people who lost jobs in the recent recession. For many of these people, especially those in their 50s and 60s, there is little prospect of returning to jobs with anywhere near the same rate of pay as before. Many will find themselves lost in the new economy, cobbling together part-time employment without benefits, while struggling to hold onto housing where mortgages exceed the value of the home. Tough times and, so far, not much in the way of effective solutions.
This year Dr. Victor will have to find some other animal analogy to glean lessons from history: Giraffe in the closet? Rhino in the den? He tells us that the lesson might have something to do with the first century Ephesians, toward whom St. Paul addressed some rather famous snail mail. While some might find such a teaser a bit obscure and full of religious overtones, the Insider looks forward to the story. Indeed, we look forward to this year’s entire conference with great anticipation. There are few things better for policy wonks – our people! – than listening to the latest research from WCRI. Diligent note-taking will be in order.
If you count yourself among those with wonkish tendencies and you haven’t signed up yet, you’d best jump on it immediately. If you have any questions about the conference, contact Andrew Kenneally at WCRI: 617-661-9274.

News Roundup: Study-Palooza, FMLA birthday, Out-of-This-World Workplace, Terminations & More

Wednesday, February 6th, 2013

Study-Palooza – Joe Paduda offers his analysis of work comp hospital costs as reported in WCRI’s recently released 20-state study on outpatient hospital costs. And Joe is really letting his nerd side show with a report on two other workcomp-related research studies, one dealing with back surgery outcomes and the other, the use and cost of compound medications.
Health data – While on the topic of research, you may want to bookmark the Pew Research Center’s Health research page. It offers excellent insight as to how people are using the Internet to access health-related information. A recent study shows that seven in ten (69%) U.S. adults track a health indicator for themselves or a loved one and many say this activity has changed their overall approach to health.
20 Years Today – Today is the 20th anniversary of the Family Medical Leave Act (FMLA). Occupational Health & Safety features a story on a survey conducted by the Department of Labor to learn how the law has affected employees and employers. The survey showed 16 percent of workers took FMLA leave within the last year, 56% of whom were women. More than half took leave for their own illness (57%), for new child-related reasons (22%) or to care for a family member with a serious health condition (19%). While the law is praised as “the first step in creating a more family-friendly American workplace” by many and hailed as a boon to families, there are some employees who would not agree. Plus, many employers would cite abuse, problems and confusion in implementing and complying with the law. Noncompliance can be costly – see Failing to Train Supervisors in FMLA: $1.2 Million Loss to Employer. One of the best resources we have found for keeping up with FMLA emerging issues, case law and changes is employment law attorney Jeff Nowak’s FMLA Insights. Jeff has comments about the FMLA anniversary and the DOL survey results, which he calls “curious.”
Terminations – Sharon Lauby hosts a blog delightfully name blog, HR Bartender, well worth keeping on your radar. She recently posted about How to fire an employee. This week, she followed up with Terminating Employees: How To Fire Right, which includes a valuable guide from employment law attorney Mark Neuberger, which you can download at no cost, and with no registration required. The first line in this guide gives a reason why you should go there and download it now: “Every termination decision should be based on the assumption that it will be challenged before an administrative agency, a court or both.”
Out-of-This-World Twitter posts – Some people’s work environments are a little more interesting than yours and mine. Canadian astronaut Chris Hadfield stunning images taken from the international space station. You can follow his Twitter feed for more: @Cmdr_Hadfield.
News Briefs

Health Wonk Review; Paduda recognized by IAIABC; Oregon Premium Rankings & More

Thursday, October 11th, 2012

Health Wonkery – David Williams hosts the October Surprise Edition of Health Wonk Review at Health Business Blog – and as might be expected in a pre-election climate, it’s a good one – with many submitters weighing in on the debates or other campaign related issues.
State premium rankings – The Oregon Department of Consumer & Business Services announces the availability of the 2012 Oregon Workers’ Compensation Premium Rate Ranking Summary (PDF). National premium rate indices range from a low of $1.01 in North Dakota to a high of $3.01 in Alaska. The 2012 median value is $1.88, which is a drop of 8 percent from the $2.04 median in the 2010 study. The authors of the study – Jay Dotter and Mike Manley – say: “One notable trend nationally is that the distribution of state index rates in our study continues to compress–there is less variation between the highest and lowest states, and there are 20 states within plus or minus 10 percent of the study median. This makes the rank values more volatile from one study to the next. I would recommend that states look also to their “Percent of study median” figure for comparisons over time.”
See Background information and historical state rankings since 1995. See also: Dave DePaolo on the Oregon study.
Paduda Earns IAIABC Award – At their recent 98th Annual Convention, the International Association of Industrial Accident Boards and Commissions (IAIABC) recognized Joe Paduda, Principal of Health Strategy Associates with the IAIABC Presidents Award for his efforts in raising awareness about opioid abuse in workers’ compensation. IAIABC noted that, “Through his weblog, during speeches, and in the course of his ongoing work with workers’ compensation stakeholders, Mr. Paduda has urged discussion and action on the growing use of opioids in the treatment of work injury. ” Kudos to Joe, who has clearly been a leader on this issue – as well as a driving force in raising awareness about the pricing abuses associated with physician dispensing and drug repackaging. See: IAIABC Award Recipients Uphold a Tradition of Excellence and Dedication.
Kudos also to seven other individuals who were recognized for their contributions and leadership. These include: Glenn Shor, California Division of Workers’ Compensation; Dr. Kathryn Mueller, Colorado Division of Workers’ Compensation; Ken Eichler of Reed Group; Christine Siekierski of the Wisconsin Compensation Rating Bureau; Gregg Lutz of NCCI; Terry Bogyo of WorkSafeBC; and Mike Manley of the Oregon Department of Consumer and Business Services.
Related: Joe Paduda has good things to say about IAIABC: Mutual Admiration Society.
Breast Cancer Screenings – October is National Breast Cancer Awareness Month – a good time to remind employees about screenings. The CDC’s National Breast and Cervical Cancer Early Detection Program make breast and cervical cancer screenings and diagnostic services available to low-income, uninsured, and underinsured women across the United States. Search for free and low-cost screenings in your state. The American Cancer Society offers good resources on dealing with a coworker who has cancer, including helpful tips for supervisors.
Nursing Homes – The Washington State Department of Labor & Industries has introduced a page of resources addressing Nursing and Residential Care Facilities. According to the U.S. Bureau of Labor Statistics, nursing and residential care facilities experienced some of the highest rates of lost workdays due to injuries and illnesses. In response, OSHA has introduced a National Emphasis Program, and Washington’s resources gather some helpful tools. See Washington’s A-Z list of Safety & Health Topics.
Risky BusinessRisk Scenarios are an interesting and noteworthy ongoing interactive feature by editors of Risk and Insurance. A Risk Scenario consists of two parts — The Scenario, a hypothetical situations that showcases an emerging risk, and The Analysis, which offers a summary of themes, as well as access to relevant articles and resources. They are interactive features that allow readers to decide how they would handle a situation and learn how peers and other industry experts would handle the situation. They cover a range of risks from data breaches and gas explosions to MRSA exposure and complex claims. Browse an archive of Risk Scenarios.
Other items of note from around the web

Risk roundup & other news briefs

Thursday, October 20th, 2011

Van R. Mayhall of Insurance Regulatory Law makes his debut as host of Cavalcade of Risk with his “Meet the Experts” edition. Mayhall is an expert himself – an attorney who practices in the areas of Business & Corporate Law and Insurance Regulatory Law. We welcome his participation!
Workers Comp Conference – Nancy Grover offers a sneak peek at highlights of the National Workers’ Compensation and Disability Conference & Expo which is on the docket for November 9 and 10 in Las Vegas. You can follow more about upcoming conference events on LinkedIn’s National Workers’ Compensation and Disability Conference & Expo Group.
Maximizing wellness program ROI – According to a post by Preston Diamond in Risk Management Monitor, “On average, employers can see a 30% reduction in Workers’ Compensation and disability claim costs, according to a review of 42 published studies involving the economic returns of wellness programs. Moreover, wellness programs will reduce the costs of absences that, according to the 2010 Kronos/Mercer Survey on the Total Financial Impact of Employee Absences, add up to 8.7% of payroll costs, more than half the cost of health care.” But experts caution that all wellness programs are not equal so employers need to implement with care. See 5 Steps Companies Should Take Before Launching a Wellness Program.
Performance Standards & Disabilities – Employment law attorney Daniel Schwartz posts an FAQ on Applying Performance Standards to Employees with Disabilities. He notes that although the ADA affirms an employer’s right to define jobs and to evaluate employees according to consistently applied standards governing performance and conduct, it’s a case where the devil is in the details. But he links to some lesser-known EEOC guidance on the matter that helps to address some common questions.
High costs of excessive alcohol consumption – According to a new study on the costs of excessive drinking by the Centers for Disease Control and Prevention, the cost of excessive alcohol consumption in the United States in 2006 reached $223.5 billion, which translates into about $1.90 per drink or $746 per person. Researchers also pointed out that 72% or the total costs could be attributed to losses in workplace productivity.
Is Ohio drinking the tea? – Looking at some ballot issues in Ohio, Roberto Ceniceros asks if a tea party initiative could end workers’ comp. He cites a Toledo Blade editorial which argues that although the intent of the measure is to thwart the health-care reform law, it may open the door to some unintended consequences.
A picture is worth a thousand wordsThe Geography of a Recession is an animated view of U.S. unemployment from 2007 to 2011. Hat tip to Workplace Prof Blog for the pointer.
Lift Gates – Tony Jones of the MEMIC Safety Blog offers a good overview on safety considerations related to lift gates, including equipment considerations, pre-operations, operations, and special considerations.
News briefs

NCCI study on safe lifting programs for long-term care facilities

Wednesday, March 30th, 2011

A few years ago, an important NIOSH study on nursing home lifting equipment demonstrated that the benefits outweigh the costs. In addition to recapping the equipment investment in less than three years, NIOSH found a 61% reduction in resident-handling workers’ compensation injury rates; a 66% drop in lost workday rates; and a 38% decline in restricted workdays. Plus, the rate of post-intervention assaults during resident transfers dropped by 72%. That’s pretty impressive.
Now we have further evidence based on the recently-released study by NCCI: Safe Lifting Programs at Long-Term Care Facilities and Their Impact on Workers Compensation Costs (PDF). The study was a collaborative effort with the University of Maryland School of Medicine. It was limited to facilities that have had safe lift programs in place for more than three years. Originally, researches intended to compare the experience of facilities with and without such programs, but during the course of the research, the rate of adoption of safe lifting devices was so great that close to 95% of facilities had them and about 80% of those used them regularly.
NCCI summarizes the study results:

“After controlling for ownership structure and differences in workers compensation systems across states, the statistical analysis performed as part of this study shows that an increased emphasis on safe lift programs at long-term care facilities is associated with fewer workplace injuries and lower workers compensation costs. More precisely, higher values of the safe lift index are associated with lower values for both frequency and total costs. The safe lift index captures information on the policies, training, preferences, and barriers surrounding the use of powered mechanical lifts. The institution’s commitment to effectively implementing a safe lift program appears to be the key to success.”

One of the interesting aspects of the study is the safe lift index, referenced above, which was developed by researchers to aggregate answers from the survey questions into a single number. Researchers looked at several variables pertaining to policies and procedures. These included the training of certified nursing assistants in proper use of mechanized lifts, preferences of the Director of Nursing for powered mechanical lift use, potential barriers to the use of powered mechanical lifts, and enforcement of the lift policies. The report discusses these factors in greater detail, and demonstrate that there are many variables beyond just the equipment that affect overall program efficacy.
Many states have safe patient handling laws
In recent years, a number of states have enacted legislation mandating safe patient lifting – and that no doubt has contributed to the rapid adoption rate noted by NCCI researchers. According to the American Nursing Association, a strong advocate for such legislation, 9 states have implemented safe patient handling laws. These include Illinois, Maryland, Minnesota, New Jersey, New York, Ohio, Rhode Island, Texas, and Washington, with a resolution from Hawaii. In addition, they are tracking states with pending legislation in 2001, currently 6 states: California, Illinois, Maine, Massachusetts, Missouri and Vermont. You can also track this legislation via a map and you can access additional resources and information at ANA’s excellent Safe Patient Handling website.
Prior posts on safe lifting
Texas enacts safe lifting guidelines for a hazardous industry
Washington passes “Safe Patient Handling” legislation
NIOSH study on nursing home lifting equipment: benefits outweigh costs
Safe Lifting and Movement of Nursing Home Residents

The Best Health Care in the World – Part Four: Do the Statistics Tell the Whole Truth?

Wednesday, March 19th, 2008

We have seen that America spends more on health care than other developed democracies around the world for outcomes that, on the whole, are no better than those achieved by the average OECD country. Our health care “system” perpetuates ever-increasing spending without delivering results to justify the expense. Moreover, because of our country’s isolation, both geographically and culturally, few Americans actually know about or appreciate this disparity. In the words of that eminent philosopher, Pogo, “We have met the enemy, and he is us.”
But not all the news is gloom and doom. We lead the world in medical technological innovation, and we have chosen to target this expensive technology at some very thorny problems. Further, statistics don’t always tell the whole or true story. Sometimes, one needs to lift up the rug and check what’s lying underneath.
Take infant mortality, for example.
The best place to find infant mortality data is (drum roll): the US Central Intelligence Agency, which tracks the rate of infant deaths in 241 countries around the world in its World Facts Book.
Currently, the CIA shows Angola, with 184 deaths per 1,000 births, as having the highest infant mortality rate (IMR) in the world, 241st out of 241. That is, more than 18% of Angola’s infants die shortly after birth. In fact, with the exception of Afghanistan, the 24 countries with the world’s highest infant mortality rates are all in Africa. It has long been known that IMR directly correlates with a nation’s per capita GDP.
At the other end of the scale, Singapore, a high-GDP country, ranks first, with the world’s lowest infant mortality rate – 2.3 deaths per 1,000 births, followed by Sweden, Japan, Hong Kong, Iceland and France.
And where in this mix is the United States you may ask. Well, with a rate of 6.37, we rank number 41 in the world.
Or do we? It all depends on how one treats the numbers, because not everyone defines infant mortality the same way. The most common definition is: the number of deaths of infants, one year or younger, per 1,000 live births. The question is – what is a live birth? The World Health Organization (WHO) defines a live birth as “any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat.” However, the United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. And the US is far more aggressive and advanced in attacking and treating significant neonatal complications. Visit any major teaching hospital’s neonatal ICU and you’ll see what I mean. The inference is that the US’s actual comparative infant mortality rate may actually be lower, perhaps much lower, than is statistically reported.
But those neonatal ICUs cost a lot of money. It’s an investment the US has chosen to make, unlike most other countries, and it is symptomatic of why we spend so much more than the rest of the world on health care.
Of course, if you spend a few minutes talking with a mother and father who have just brought a young child home, healthy and smiling, after six months, of so, in one of those expensive, neonatal ICUs, you might be excused for thinking, as they surely do, that the cost is worth every penny.
Prior entries in this series:
Part Three: What Do We Get for the Money?
Part Two – What does it cost?
Part One: The best Health Care Plan in America

RTW resources from Australia

Friday, March 14th, 2008

The RTW Knowledge Base Website is a free service from Australia providing research based information and links to external resources on work disability prevention. We received a notice about this site from Mary Wyatt, an Occupational Physician based in Melbourne Australia. She offered a good overview of the site’s features, so we will take the liberty of using her description of the site:
The Return to Work Knowledge Base was developed by ResWorks (a small Australian nonprofit) with the support of the WorkSafe Victoria RTW Fund. The site has been endorsed by the Australasian Faculty of Occupational & Environmental Medicine.
The website is designed to help with return to work. The site includes:

  • Research papers translated into plain language. The articles can be browsed in interest group collections – employee, employer etc. Alternatively all articles can be seen via the ‘View all Articles’ tab. On the summary pages the article title is the link to the full text. A search facility is available on all pages.
  • Resources – links to useful information on work disability such as patient handouts, work disability reports, treatment guidelines. The link to the Resources Page for each group is at the top of the left navigation menu on the summary pages. Most links are to patient handouts, guidelines, or reports on the topic. Other links are to webcasts or videos relevant to the field.

Research is often difficult to access and for most people research is hard to read. The site translates individual research papers into a format that can be understood and houses the information in a readily accessible format. Topics include consequences of being off work in the long term, medical issues, workplace factors, system factors, and people issues.
There are two broad ways the site can help:
1. Increasing peoples’ knowledge and understanding of the area through reading the information provided on the site.
2. Influencing others. Many working in this area practice best evidence care. However it can be difficult to influence others with a less enlightened approach. The site is designed for sharing of information with the ability to send links to colleagues or print articles (eg for patients, HR managers, supervisors).

Your Government at Work – Worker injury research you can actually use

Monday, November 19th, 2007

A cornerstone of Lynch Ryan’s work for more than twenty years, a long-held mantra, has been that employees who work for good employers — employers who care for their workers and show it by the way they treat them — report all work injuries when they happen, get expeditious treatment and return to work faster. Moreover, their injuries cost significantly less than those of employees who work for less caring employers. A major driver for low workers’ compensation costs is the quality of the relationship between employer and employee.
We’ve seen this in our consulting work time and again, but it’s nice to have independent research confirm the mantra.
In the mid-1960s, the Department of Labor’s Employment and Training Administration (at that time called the Office of Manpower, Automation, and Training ) wanted to understand specific issues pertaining to the U.S. labor market, such as retirement, the return of housewives to the labor force, and the school-to-work transition. To do that it began conducting longitudinal studies, studies that look at a random group of like people to see how they develop over time. The Office began four such studies following groups of young men, older men, young women and, no, not “older” women, but rather “mature” women. The studies were originally targeted for five years, but, because they were yielding a mountain of data, they were extended until 1983, allowing other agencies to piggy-back along to glean even more information about how these first baby-boomers and World War II veterans were maturing in post-war America.
Because of the success of these studies, the Bureau of Labor Statistics decided to conduct an even more ambitious project, and in 1979 it launched the “National Longitudinal Survey of Youth 1979,” (NLSY79)
NLSY79 randomly selected and interviewed a cohort of 12,686 young Americans, 14 to 22 years old, all born between January 1,1957 and December 31, 1965, and it has been interviewing them regularly ever since, for nearly three decades now. As of 2004, there were 7661 people still in the survey group. These people have provided profound and relevant data about the aging of the last of the eighty million American baby-boomers.
What does this have to do with workers’ compensation? Actually, quite a lot.
Until I read Joe Paduda’s recent blog post, I was unaware that any researchers had ever mined the NLSY79 data for workers’ compensation insights. Thanks to Joe I have been enlightened. Thank you, Joseph.
In 2005, Darius Lakdawalla, Robert Reville and Seth Seabury of the Rand Institute for Civil Justice published “How Does Health Insurance Affect Workers’ Compensation Filing” (this is a Working Paper, meaning it has not been formally peer-reviewed). Using NLSY79 data, they confirmed Biddle and Roberts 2003 Michigan study (purchase required), which found that only about 55% of workers sustaining lost time injuries ever file claims for benefits, as well as an Oregon state-sponsored study of the 2002 Oregon Population Survey suggesting that 54% of workers reporting workplace injuries filed claims. They also found that unionized workers were more likely to file claims following work injuries.
Moreover, the Rand researchers found that workers without health insurance are about 15% less likely to file a claim than injured workers with health coverage.
A still more surprising finding may be that workers at companies that merely offer health insurance benefits are 50% more likely to file a claim after suffering a work injury than workers at companies that do not offer health insurance benefits.
However – and here is the major finding for me – lost time, as well as the cost of lost time for these workers who file more claims is about 20% less than for the workers who are not offered health insurance.
Finally, other types of fringe benefits – like paid vacation days – also seem to be associated with higher filing rates. For example, when both health insurance offers and paid vacations are present in the same employer, both variables are significant (at the 95% confidence level) and both have coefficients around .10 for claim filing.
What does this tell us? Well, for me it reinforces our mantra. These employees may report more injuries, but, as the NLSY79 data show, they return to work faster and their injuries cost significantly less than do the injuries of employees who work for employers who do not provide these benefits. Quod est demonstrandum.
The Rand study is compelling and instructive, but you do have to know a few things about statistical research to get the most out of it. Nonetheless, it should provide fuel for further workers’ compensation research using the NLSY79 treasure chest of demographic data. This stuff is too good to sit on a shelf gathering dust.

A new prescription for back pain

Wednesday, February 11th, 2004

I have long suspected that the way this country treats back pain for work-related injuries is not only ineffective, it’s actually destructive. I have seen countless back claims degenerate into permanent and total disability following surgery. We are now beginning to see data that bears this out. In an article with profound implications for employers, insurers and workers with lower back pain, New York Times (free registration required) reporter Gina Kolata demonstrates the futility and the ineffectiveness of our current approach to back pain. The data calls for a transformation of the treatment paradigm itself.
Here’s the way it works now: A worker suffers a lower back strain. He’s in a lot of pain. He goes for an MRI, which reveals a herniated disc. The insurer assumes that the herniation is work related, the condition is compensable and treatment begins. Perhaps surgery is performed. However, a number of studies have suggested that in 85% of the cases it is impossible to say why a person’s back hurts. Beyond that, many studies have found that abnormal disks are usually inherited, with no links to occupation, sports injuries, or weak muscles. So the use of the MRI to confirm compensability is indeed questionable.

Then there is the issue of treatment. Studies confirm that there is little evidence that aggressive treatment is in any way helpful to the patient. One doctor quoted in the article says, “Maybe you are better off not going to a doctor.” Under the current system, if the employee is lucky, neither the treatment nor the surgery will permanently disable him and, eventually, he will return to work. The irony is that in most cases, doing nothing at all would be equally or even more effective than treating the injury with conventional medicine!

So what is the new treatment paradigm? In the view of Dr. James N. Weinstein, a professor of orthopedics and editor in chief of Spine, we should teach people to live with pain, to put aside the fear that any motion will aggravate their injury. This is a concept that many Americans have trouble accepting. If we experience pain, we seek an immediate cure. For back injuries, this approach just doesn’t work. We have to learn that “hurt doesn’t mean harm.” There will be pain for a while. During the natural recovery process, treatment should focus on “functional restoration:” That means working on training, strength, flexibility and endurance. And let’s not forget to offer the needed counseling that addresses fears of reinjury, anxiety, and depression.

Which brings me back to the employer’s best tool for fostering an active (but not necessarily pain free) recovery: Modified duty. Once we recognize that the vast majority of back injuries resolve themselves in a few months, with little or no treatment required, the need for proactive employers to help injured employees through the process – and the pain – becomes paramount. By providing modified duty, we give injured employees a reason for getting up in the morning and a place to go. We give them meaningful tasks, which help take their minds off the pain. Above all, we help them maintain their identities as productive workers. This is by far the most effective and the least expensive approach to lower back injuries. As with so many other workers compensation issues, proactive management is the best solution.