Injury Prevention

Defending Against Cumulative Trauma

Cumulative Trauma, or CT claims, continue to harm workers and drive up costs. Defending against these claims means reducing, through analytics and engineering, the chance that workers get hurt to begin with.
By: | September 12, 2017 • 6 min read

Repetitive motion, or cumulative trauma injuries, stubbornly persist as generators of workers’ compensation claims and productivity losses year after year. Not only do such injuries harm workers, they can even leave them permanently disabled.

Remedies to these injuries do exist, however. Well-established risk management and safety strategies are known to provide effective relief. Additional risk-reduction opportunities exist for employers with those practices already in place, including the adoption of an expanded, macro view of ergonomics; one that considers how work gets done and the engineering of production processes.

Bill Spiers, VP and risk control practice leader, Southeast, Lockton Companies

Wellness programs are also showing early signs of helping mitigate the injuries that typically stem from the constant repetition of the same motion, sometimes over years.

Statistics show that risk mitigation practices have gradually slowed the overall volume of CT claims, along with mitigating a broader category of injuries that the federal Occupational Safety and Health Administration calls “musculoskeletal disorders.”

But several factors continue making repetitive motion injuries — commonly referred to as cumulative trauma claims in California — and musculoskeletal disorders persistent loss drivers.

Today’s younger workers begin taxing their small-muscle groups and motor skills at an early age with the frequent use of modern devices like smartphones and computer tablets. They now show signs of increased strain more typical of an older worker, said Sean McDonald, Workforce Strategies Ergonomics Practice Leader at Marsh Risk Consulting.

Simultaneously, aging workers now have more years of performing very common, repetitive work motions like the twisting, bending and lifting, all of which are known to eventually wear down body parts.

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Employers with their eyes on the bottom line who push for increased production are also taxing worker bodies more than before, especially when safety engineering is not properly considered.

“As production goals keep going up, the impact on the human is not always handled very well. So, you are asking more and more of people and you are outpacing any basic ergonomics with the pace of productivity,” McDonald said.

Bill Spiers, VP and risk control practice leader for the Southeast at Lockton Companies, agrees.

“Because of our effort to try and drive production efficiencies, sometimes we forget and leave out the effects that has on the human body,” Spiers said.

Repetitive stress cases, like OSHA’s broader category of musculoskeletal injuries, often present claims payers with challenges less common than when injury causes are easily witnessed and more obvious, as occurs with broken bones or burns, for example.

OSHA’s definition of musculoskeletal disorders includes upper and lower extremity injuries. The disorders impact the muscles, nerves, ligaments, tendons, and blood vessels with ailments ranging from carpal tunnel syndrome and tendinitis to shoulder and lower-back strains.

Rooting Out the Cause

Because repetitive motion or musculoskeletal injuries often occur over time, their cause is commonly rife with uncertainty. It is challenging to separate out the impacts of aging or harmful activities workers may engage in away from the workplace from legitimate, work-related causes.

About 85 percent of lower-back pain is idiopathic, lacking a specific or known cause, said Wayne Maynard, product director, ergonomics, at Liberty Mutual Risk Control Services. That makes pinpointing a work-related cause challenging and can leave employers paying for ailments they did not contribute to.

The claims are also highly susceptible to manipulation or outright fraud.

California, due to its legal environment, for example, has experienced growth in suspicious, highly-litigated and expensive cumulative-trauma claims filed after workers leave their jobs.

In 2016, the California’s Workers’ Compensation Insurance Rating Bureau reported that cumulative trauma claims, as a percentage of lost-time claims, more than doubled over the past decade. They comprised about 18 percent of the state’s indemnity cases during 2015.

Nationwide, however, there is good news in a Liberty Mutual Safety Index that annually ranks the top 10 causes of serious workplace injuries. It has shown a gradual, long-term decline in the nation’s total spend for cumulative trauma and musculoskeletal-type injuries.

“Because of our effort to try and drive production efficiencies, sometimes we forget and leave out the effects that has on the human body.” — Bill Spiers, VP and risk control practice leader, Southeast, Lockton Companies

Injury prevention programs, ergonomics, return-to-work efforts and the automation of tasks all contribute to the long-term decline.

That is good news because the costs can be steep.

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OSHA reported in 2014 that work-related musculoskeletal disorders account for one of every three dollars spent on workers’ comp. The U.S. Bureau of Labor Statistics estimates they account for 34 percent of all lost workdays.

OSHA’s report states that the disorders cost employers $20 billion annually in direct workers’ comp costs and up to five times that in indirect costs. The injuries also take a personal toll, with workers suffering and unable to work or live full personal lives.

Out-Engineer the Risk

A first line of defense after a cumulative trauma or musculoskeletal claim occurs requires reviewing the injured person’s workplace to learn whether the injury could have been avoided, and what measures will prevent a similar future occurrence, said consultant Barry D. Bloom, managing principal at The bdb Group.

“That is just general good risk management, but it really applies on any injurious exposure that is costly or physically incapacitating because we need as many people as can be to be employed and productive,” Bloom said.

Among other measures for managing a cumulative trauma claim, employers will want to obtain a high-quality, evidence-based medical assessment to help determine whether the injury is work related.

“Because in cumulative trauma, it’s not just that you have been exposed to something,” Bloom explained.

“In other words, it’s not just that you have used a mouse, for example, but you have to also prove that the exposure caused the injury. You can’t do that without a good quality medical assessment.”

Sophisticated employers don’t wait to see a repetitive motion claim before working to prevent them, Bloom added. The range of practices they adopt include evaluating how work is accomplished and what tasks they might automate.

That has led to practices like designing warehouse-type food stores so that workers move entire pallets of products into place with forklifts rather than manually stocking shelves. Other industries have increased the use of robotics.

Barry D. Bloom, managing principal, The bdb Group

Designing processes or engineering in solutions to eliminate risk is now a primary ergonomics practice that has expanded beyond the mere physical workstation adjustments for individual workers that were the focus of earlier ergonomics efforts.

Engineering risk out of jobs and processes, or at least greatly reducing it, is the goal of workplace ergonomics evaluations, McDonald said.

Administrative controls, like job rotations reducing the hours workers are exposed to stressful tasks, also play a role.

“But in our opinion there is no substitute for good design initially and engineering controls after a process has been implemented,” McDonald said.

“Administrative controls would fall last on the hierarchy on how you want to address these things.”

Engineering is critical because you can’t rely on human behavior to consistently perform motions in a safe manner, Spiers added.

“What you never want to do is depend on behavior,” he said.

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Although more outcomes data is necessary, combining safety and ergonomics with wellness programs also shows great potential to mitigate repetitive motion and musculoskeletal claims, Maynard said. That is particularly true with the comorbidities that impact claims severity.

“It’s a tremendous opportunity,” Maynard said

“And there is good data that fitness and overall health have a relationship with musculoskeletal types of disorders.”

Ergonomic assessments are not the only line of defense, Spiers said. Post-offer employment testing also has an important role.

“I laugh because we seem to leave out (employee) selection,” he said.

Making sure that a hire can physically perform the job is an often overlooked, yet obvious line of defense, Spiers said. &

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.

More from Risk & Insurance

More from Risk & Insurance

Exclusive | Hank Greenberg on China Trade, Starr’s Rapid Growth and 100th, Spitzer, Schneiderman and More

In a robust and frank conversation, the insurance legend provides unique insights into global trade, his past battles and what the future holds for the industry and his company.
By: | October 12, 2018 • 12 min read

In 1960, Maurice “Hank” Greenberg was hired as a vice president of C.V. Starr & Co. At age 35, he had already accomplished a great deal.

He served his country as part of the Allied Forces that stormed the beaches at Normandy and liberated the Nazi death camps. He fought again during the Korean War, earning a Bronze Star. He held a law degree from New York Law School.

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Now he was ready to make his mark on the business world.

Even C.V. Starr himself — who hired Mr. Greenberg and later hand-picked him as the successor to the company he founded in Shanghai in 1919 — could not have imagined what a mark it would be.

Mr. Greenberg began to build AIG as a Starr subsidiary, then in 1969, he took it public. The company would, at its peak, achieve a market cap of some $180 billion and cement its place as the largest insurance and financial services company in history.

This month, Mr. Greenberg travels to China to celebrate the 100th anniversary of C.V. Starr & Co. That visit occurs at a prickly time in U.S.-Sino relations, as the Trump administration levies tariffs on hundreds of billions of dollars in Chinese goods and China retaliates.

In September, Risk & Insurance® sat down with Mr. Greenberg in his Park Avenue office to hear his thoughts on the centennial of C.V. Starr, the dynamics of U.S. trade relationships with China and the future of the U.S. insurance industry as it faces the challenges of technology development and talent recruitment and retention, among many others. What follows is an edited transcript of that discussion.


R&I: One hundred years is quite an impressive milestone for any company. Celebrating the anniversary in China signifies the importance and longevity of that relationship. Can you tell us more about C.V. Starr’s history with China?

Hank Greenberg: We have a long history in China. I first went there in 1975. There was little there, but I had business throughout Asia, and I stopped there all the time. I’d stop there a couple of times a year and build relationships.

When I first started visiting China, there was only one state-owned insurance company there, PICC (the People’s Insurance Company of China); it was tiny at the time. We helped them to grow.

I also received the first foreign life insurance license in China, for AIA (The American International Assurance Co.). To date, there has been no other foreign life insurance company in China. It took me 20 years of hard work to get that license.

We also introduced an agency system in China. They had none. Their life company employees would get a salary whether they sold something or not. With the agency system of course you get paid a commission if you sell something. Once that agency system was installed, it went on to create more than a million jobs.

R&I: So Starr’s success has meant success for the Chinese insurance industry as well.

Hank Greenberg: That’s partly why we’re going to be celebrating that anniversary there next month. That celebration will occur alongside that of IBLAC (International Business Leaders’ Advisory Council), an international business advisory group that was put together when Zhu Rongji was the mayor of Shanghai [Zhu is since retired from public life]. He asked me to start that to attract foreign companies to invest in Shanghai.

“It turns out that it is harder [for China] to change, because they have one leader. My guess is that we’ll work it out sooner or later. Trump and Xi have to meet. That will result in some agreement that will get to them and they will have to finish the rest of the negotiations. I believe that will happen.” — Maurice “Hank” Greenberg, chairman and CEO, C.V. Starr & Co. Inc.

Shanghai and China in general were just coming out of the doldrums then; there was a lack of foreign investment. Zhu asked me to chair IBLAC and to help get it started, which I did. I served as chairman of that group for a couple of terms. I am still a part of that board, and it will be celebrating its 30th anniversary along with our 100th anniversary.

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We have a good relationship with China, and we’re candid as you can tell from the op-ed I published in the Wall Street Journal. I’m told that my op-ed was received quite well in China, by both Chinese companies and foreign companies doing business there.

On August 29, Mr. Greenberg published an opinion piece in the WSJ reminding Chinese leaders of the productive history of U.S.-Sino relations and suggesting that Chinese leaders take pragmatic steps to ease trade tensions with the U.S.

R&I: What’s your outlook on current trade relations between the U.S. and China?

Hank Greenberg: As to the current environment, when you are in negotiations, every leader negotiates differently.

President Trump is negotiating based on his well-known approach. What’s different now is that President Xi (Jinping, General Secretary of the Communist Party of China) made himself the emperor. All the past presidents in China before the revolution had two terms. He’s there for life, which makes things much more difficult.

R&I: Sure does. You’ve got a one- or two-term president talking to somebody who can wait it out. It’s definitely unique.

Hank Greenberg: So, clearly a lot of change is going on in China. Some of it is good. But as I said in the op-ed, China needs to be treated like the second largest economy in the world, which it is. And it will be the number one economy in the world in not too many years. That means that you can’t use the same terms of trade that you did 25 or 30 years ago.

They want to have access to our market and other markets. Fine, but you have to have reciprocity, and they have not been very good at that.

R&I: What stands in the way of that happening?

Hank Greenberg: I think there are several substantial challenges. One, their structure makes it very difficult. They have a senior official, a regulator, who runs a division within the government for insurance. He keeps that job as long as he does what leadership wants him to do. He may not be sure what they want him to do.

For example, the president made a speech many months ago saying they are going to open up banking, insurance and a couple of additional sectors to foreign investment; nothing happened.

The reason was that the head of that division got changed. A new administrator came in who was not sure what the president wanted so he did nothing. Time went on and the international community said, “Wait a minute, you promised that you were going to do that and you didn’t do that.”

So the structure is such that it is very difficult. China can’t react as fast as it should. That will change, but it is going to take time.

R&I: That’s interesting, because during the financial crisis in 2008 there was talk that China, given their more centralized authority, could react more quickly, not less quickly.

Hank Greenberg: It turns out that it is harder to change, because they have one leader. My guess is that we’ll work it out sooner or later. Trump and Xi have to meet. That will result in some agreement that will get to them and they will have to finish the rest of the negotiations. I believe that will happen.

R&I: Obviously, you have a very unique perspective and experience in China. For American companies coming to China, what are some of the current challenges?

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Hank Greenberg: Well, they very much want to do business in China. That’s due to the sheer size of the country, at 1.4 billion people. It’s a very big market and not just for insurance companies. It’s a whole range of companies that would like to have access to China as easily as Chinese companies have access to the United States. As I said previously, that has to be resolved.

It’s not going to be easy, because China has a history of not being treated well by other countries. The U.S. has been pretty good in that way. We haven’t taken advantage of China.

R&I: Your op-ed was very enlightening on that topic.

Hank Greenberg: President Xi wants to rebuild the “middle kingdom,” to what China was, a great country. Part of that was his takeover of the South China Sea rock islands during the Obama Administration; we did nothing. It’s a little late now to try and do something. They promised they would never militarize those islands. Then they did. That’s a real problem in Southern Asia. The other countries in that region are not happy about that.

R&I: One thing that has differentiated your company is that it is not a public company, and it is not a mutual company. We think you’re the only large insurance company with that structure at that scale. What advantages does that give you?

Hank Greenberg: Two things. First of all, we’re more than an insurance company. We have the traditional investment unit with the insurance company. Then we have a separate investment unit that we started, which is very successful. So we have a source of income that is diverse. We don’t have to underwrite business that is going to lose a lot of money. Not knowingly anyway.

R&I: And that’s because you are a private company?

Hank Greenberg: Yes. We attract a different type of person in a private company.

R&I: Do you think that enables you to react more quickly?

Hank Greenberg: Absolutely. When we left AIG there were three of us. Myself, Howie Smith and Ed Matthews. Howie used to run the internal financials and Ed Matthews was the investment guy coming out of Morgan Stanley when I was putting AIG together. We started with three people and now we have 3,500 and growing.

“I think technology can play a role in reducing operating expenses. In the last 70 years, you have seen the expense ratio of the industry rise, and I’m not sure the industry can afford a 35 percent expense ratio. But while technology can help, some additional fundamental changes will also be required.” — Maurice “Hank” Greenberg, chairman and CEO, C.V. Starr & Co. Inc.

R&I:  You being forced to leave AIG in 2005 really was an injustice, by the way. AIG wouldn’t have been in the position it was in 2008 if you had still been there.

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Hank Greenberg: Absolutely not. We had all the right things in place. We met with the financial services division once a day every day to make sure they stuck to what they were supposed to do. Even Hank Paulson, the Secretary of Treasury, sat on the stand during my trial and said that if I’d been at the company, it would not have imploded the way it did.

R&I: And that fateful decision the AIG board made really affected the course of the country.

Hank Greenberg: So many people lost all of their net worth. The new management was taking on billions of dollars’ worth of risk with no collateral. They had decimated the internal risk management controls. And the government takeover of the company when the financial crisis blew up was grossly unfair.

From the time it went public, AIG’s value had increased from $300 million to $180 billion. Thanks to Eliot Spitzer, it’s now worth a fraction of that. His was a gross misuse of the Martin Act. It gives the Attorney General the power to investigate without probable cause and bring fraud charges without having to prove intent. Only in New York does the law grant the AG that much power.

R&I: It’s especially frustrating when you consider the quality of his own character, and the scandal he was involved in.

In early 2008, Spitzer was caught on a federal wiretap arranging a meeting with a prostitute at a Washington Hotel and resigned shortly thereafter.

Hank Greenberg: Yes. And it’s been successive. Look at Eric Schneiderman. He resigned earlier this year when it came out that he had abused several women. And this was after he came out so strongly against other men accused of the same thing. To me it demonstrates hypocrisy and abuse of power.

Schneiderman followed in Spitzer’s footsteps in leveraging the Martin Act against numerous corporations to generate multi-billion dollar settlements.

R&I: Starr, however, continues to thrive. You said you’re at 3,500 people and still growing. As you continue to expand, how do you deal with the challenge of attracting talent?

Hank Greenberg: We did something last week.

On September 16th, St. John’s University announced the largest gift in its 148-year history. The Starr Foundation donated $15 million to the school, establishing the Maurice R. Greenberg Leadership Initiative at St. John’s School of Risk Management, Insurance and Actuarial Science.

Hank Greenberg: We have recruited from St. John’s for many, many years. These are young people who want to be in the insurance industry. They don’t get into it by accident. They study to become proficient in this and we have recruited some very qualified individuals from that school. But we also recruit from many other universities. On the investment side, outside of the insurance industry, we also recruit from Wall Street.

R&I: We’re very interested in how you and other leaders in this industry view technology and how they’re going to use it.

Hank Greenberg: I think technology can play a role in reducing operating expenses. In the last 70 years, you have seen the expense ratio of the industry rise, and I’m not sure the industry can afford a 35 percent expense ratio. But while technology can help, some additional fundamental changes will also be required.

R&I: So as the pre-eminent leader of the insurance industry, what do you see in terms of where insurance is now an where it’s going?

Hank Greenberg: The country and the world will always need insurance. That doesn’t mean that what we have today is what we’re going to have 25 years from now.

How quickly the change comes and how far it will go will depend on individual companies and individual countries. Some will be more brave than others. But change will take place, there is no doubt about it.

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More will go on in space, there is no question about that. We’re involved in it right now as an insurance company, and it will get broader.

One of the things you have to worry about is it’s now a nuclear world. It’s a more dangerous world. And again, we have to find some way to deal with that.

So, change is inevitable. You need people who can deal with change.

R&I:  Is there anything else, Mr. Greenberg, you want to comment on?

Hank Greenberg: I think I’ve covered it. &

The R&I Editorial Team can be reached at [email protected]