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.

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