Column: Workers' Comp

Out of the Shadows

By: | September 1, 2013 • 2 min read
Peter Rousmaniere is a journalist and consultant in the field of work injury risk. He lives in Woodstock, Vermont. Peter can be reached at [email protected]

The rise of immigrant labor has been so incremental that it’s hard to pinpoint when the workers’ compensation community should have collectively realized that immigrant workers often pose a heightened work injury risk. But it’s clear that we are past that date.

Foreign-born workers (including legal and undocumented) comprised about one-tenth of the country’s workforce in 1990. Today, they amount to about 17 percent, and are more widely distributed geographically.


Since 2000, foreign-born workers have added more bodies to the workforce than have native-born Americans. Demographers expect this trend to continue through 2020.

Many immigrants are highly skilled. But a large share of those that are less well educated provide manual labor that is relatively injury-prone.

Our manual workforce is thus segregated by injury risk. Pair an immigrant and a native-born worker, both doing jobs that require limited education, and statistics reveal that the foreign-born worker encounters twice the risk of work injury as the native.

I estimate from federal data that in the top 30 jobs that don’t require a high school education, immigrants sustain at least one of every four injuries.

That’s based on an assumption that they report injuries at the same rate as native-born workers.

The immigrant worker is also less inclined to have health insurance. Having health insurance is widely thought to lower work-injury claims and to fund the treatment of co-morbidities which, left untreated, can complicate injury recovery.

You would think health care reform would address this, but it doesn’t. In fact, the Affordable Care Act and the current version of the Senate’s immigration reform bill prohibit access to health insurance for large numbers of non-naturalized immigrants.

A lack of English literacy further precludes immigrant workers from access to adequate health care and exposes them to a lack of understanding of safety procedures, making them even more vulnerable.

Further isolating immigrant workers is fear on the part of employers of legal prosecution should they be found harboring an illegal immigrant. Employers fear if they are too proactive, they will stumble over an undocumented worker and incur legal liability. Millions of supervisors, therefore, lack the education to effectively manage immigrant workers.

One positive step for employers would be to adhere to a timidly publicized OSHA requirement that “instruction must be provided in a language the employee can understand.”


Another step is for medical provider networks to expect that their providers adhere to a requirement arising out of the 1964 Civil Rights Act that health professionals conduct patient encounters in the preferred language of the patient.

We have a yet more difficult step ahead. Some say we are a multi-ethnic society. But, as with much of the world, we are moving towards a transnational society. Millions of American residents, including even naturalized citizens, see themselves as members of two societies. Many of our workers are transnationals rather than permanent immigrants, per the iconic Ellis Island narrative.

More from Risk & Insurance

More from Risk & Insurance

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.


That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.


Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]