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

Alternative Energy

A Shift in the Wind

As warranties run out on wind turbines, underwriters gain insight into their long-term costs.
By: | September 12, 2017 • 6 min read

Wind energy is all grown up. It is no longer an alternative, but in some wholesale markets has set the incremental cost of generation.

As the industry has grown, turbine towers have as well. And as the older ones roll out of their warranty periods, there are more claims.

This is a bit of a pinch in a soft market, but it gives underwriters new insight into performance over time — insight not available while manufacturers were repairing or replacing components.

Charles Long, area SVP, renewable energy, Arthur J. Gallagher

“There is a lot of capacity in the wind market,” said Charles Long, area senior vice president for renewable energy at broker Arthur J. Gallagher.

“The segment is still very soft. What we are not seeing is any major change in forms from the major underwriters. They still have 280-page forms. The specialty underwriters have a 48-page form. The larger carriers need to get away from a standard form with multiple endorsements and move to a form designed for wind, or solar, or storage. It is starting to become apparent to the clients that the firms have not kept up with construction or operations,” at renewable energy facilities, he said.

Third-party liability also remains competitive, Long noted.

“The traditional markets are doing liability very well. There are opportunities for us to market to multiple carriers. There is a lot of generation out there, but the bulk of the writing is by a handful of insurers.”

Broadly the market is “still softish,” said Jatin Sharma, head of business development for specialty underwriter G-Cube.

“There has been an increase in some distressed areas, but there has also been some regional firming. Our focus is very much on the technical underwriting. We are also emphasizing standardization, clean contracts. That extends to business interruption, marine transit, and other covers.”

The Blade Problem

“Gear-box maintenance has been a significant issue for a long time, and now with bigger and bigger blades, leading-edge erosion has become a big topic,” said Sharma. “Others include cracking and lightning and even catastrophic blade loss.”

Long, at Gallagher, noted that operationally, gear boxes have been getting significantly better. “Now it is blades that have become a concern,” he said. “Problems include cracking, fraying, splitting.

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“In response, operators are using more sophisticated inspection techniques, including flying drones. Those reduce the amount of climbing necessary, reducing risk to personnel as well.”

Underwriters certainly like that, and it is a huge cost saver to the owners, however, “we are not yet seeing that credited in the underwriting,” said Long.

He added that insurance is playing an important role in the development of renewable energy beyond the traditional property, casualty, and liability coverages.

“Most projects operate at lower capacity than anticipated. But they can purchase coverage for when the wind won’t blow or the sun won’t shine. Weather risk coverage can be done in multiple ways, or there can be an actual put, up to a fixed portion of capacity, plus or minus 20 percent, like a collar; a straight over/under.”

As useful as those financial instruments are, the first priority is to get power into the grid. And for that, Long anticipates “aggressive forward moves around storage. Spikes into the system are not good. Grid storage is not just a way of providing power when the wind is not blowing; it also acts as a shock absorber for times when the wind blows too hard. There are ebbs and flows in wind and solar so we really need that surge capacity.”

Long noted that there are some companies that are storage only.

“That is really what the utilities are seeking. The storage company becomes, in effect, just another generator. It has its own [power purchase agreement] and its own interconnect.”

“Most projects operate at lower capacity than anticipated. But they can purchase coverage for when the wind won’t blow or the sun won’t shine.”  —Charles Long, area senior vice president for renewable energy, Arthur J. Gallagher

Another trend is co-location, with wind and solar, as well as grid-storage or auxiliary generation, on the same site.

“Investors like it because it boosts internal rates of return on the equity side,” said Sharma. “But while it increases revenue, it also increases exposure. … You may have a $400 million wind farm, plus a $150 million solar array on the same substation.”

In the beginning, wind turbines did not generate much power, explained Rob Battenfield, senior vice president and head of downstream at JLT Specialty USA.

“As turbines developed, they got higher and higher, with bigger blades. They became more economically viable. There are still subsidies, and at present those subsidies drive the investment decisions.”

For example, some non-tax paying utilities are not eligible for the tax credits, so they don’t invest in new wind power. But once smaller companies or private investors have made use of the credits, the big utilities are likely to provide a ready secondary market for the builders to recoup their capital.

That structure also affects insurance. More PPAs mandate grid storage for intermittent generators such as wind and solar. State of the art for such storage is lithium-ion batteries, which have been prone to fires if damaged or if they malfunction.

“Grid storage is getting larger,” said Battenfield. “If you have variable generation you need to balance that. Most underwriters insure generation and storage together. Project leaders may need to have that because of non-recourse debt financing. On the other side, insurers may be syndicating the battery risk, but to the insured it is all together.”

“Grid storage is getting larger. If you have variable generation you need to balance that.” — Rob Battenfield, senior vice president, head of downstream, JLT Specialty USA

There has also been a mechanical and maintenance evolution along the way. “The early-generation short turbines were throwing gears all the time,” said Battenfield.

But now, he said, with fewer manufacturers in play, “the blades, gears, nacelles, and generators are much more mechanically sound and much more standardized. Carriers are more willing to write that risk.”

There is also more operational and maintenance data now as warranties roll off. Battenfield suggested that the door started to open on that data three or four years ago, but it won’t stay open forever.

“When the equipment was under warranty, it would just be repaired or replaced by the manufacturer,” he said.

“Now there’s more equipment out of warranty, there are more claims. However, if the big utilities start to aggregate wind farms, claims are likely to drop again. That is because the utilities have large retentions, often about $5 million. Claims and premiums are likely to go down for wind equipment.”

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Repair costs are also dropping, said Battenfield.

“An out-of-warranty blade set replacement can cost $300,000. But if it is repairable by a third party, it could cost as little as $30,000 to have a specialist in fiberglass do it in a few days.”

As that approach becomes more prevalent, business interruption (BI) coverage comes to the fore. Battenfield stressed that it is important for owners to understand their PPA obligations, as well as BI triggers and waiting periods.

“The BI challenge can be bigger than the property loss,” said Battenfield. “It is important that coverage dovetails into the operator’s contractual obligations.” &

Gregory DL Morris is an independent business journalist based in New York with 25 years’ experience in industry, energy, finance and transportation. He can be reached at [email protected]