COMPACT

The Newsletter for Workers’ Compensation Professionals August 2001

Minnesota Department of Labor and Industry 443 Lafayette Road N. St. Paul, MN 55155

Inside ...
Articles
Workers’ compensation bill signed into law ..................................... 5 All DLI work comp forms revised July 1 ..... 7 DLI action on medical issue complaints ..... 8 IPC reminders: incomplete forms, blob factor .......................................... 12 Update: Effects of 104-week limit on TTD duration ........................................ 13 Outcomes of occupational burn injuries in Minnesota ........................................ 16 Minnesota Workplace Safety Report highlights ............................................ 23 New Research and Statistics Web pages offer more ........................................... 25 Benefit levels and provider fees increase October 2001 .......................... 26 Heat-related workplace injuries, fatalities .............................................. 28 DLI Customer Assistance gets results ...... 30

Tables
Complaint cases closed .......................... 8 Quarters of TD benefits by injury year ..... 15 Estimated numbers of TTD cases exhausting benefits as of June 2001 ........ 15 Demographic characteristics ................... 17 Injury characteristics: • part of body and cause of burn ....... 19 • age and gender ............................ 19 Incidence of burn injury ......................... 20 Claim characterictics ............................. 21 Lost work time ..................................... 21 Univariate assoc. with fully sustained employment after claim closure ............... 22 Multivariate assoc. with fully sustained employment after claim closure ............... 22 Injury and illness case incidence rates ..... 24 Highest total case rate industry groups .... 24 Statewide average weekly wage ............. 26 Compensation rates as of Oct. 1, 2001 .... 27 CA outcome logs (fiscal-year 2001) ......... 31

COMPACT is a publication of the Minnesota Department of Labor and Industry. Its purpose is to provide department news and workers’ compensation case information to professionals who work within Minnesota’s workers’ compensation system. Correspondence should be sent to: COMPACT editor, Minnesota Department of Labor and Industry, 443 Lafayette Road N., St. Paul, MN 55155; by e-mail at DLI.Communications@state.mn.us. Subscription requests should be sent to Customer Assistance Publications, Workers’ Compensation Division, 443 Lafayette Road N., St. Paul, MN 55155; by e-mail at DLI.brochure@state.mn.us. Visit www.doli.state.mn.us/compact.html to view this publication on the Web. Upon request to the editor, COMPACT will be made available in alternative formats such as Braille, large print or audiotape.

Forms
Training: Workers’ compensation insurers’ update .................................... 32 Form R-21 ........................................... 35 Form R-23 ........................................... 37 Publications order form .......................... 39 ‘Rule 101’ order form ............................. 41

Summaries of decisions
Workers’ Compensation Court of Appeals ........................................... D-1 Minn. Supreme Court decisions................ D-20

Outcomes of occupational burn injuries in Minnesota
By Kenneth Nagamoto, M.D., Resident in Occupational Medicine, Regions Hospital and William Lohman, M.D., Medical Consultant, Department of Labor and Industry

Introduction

The causes of occupational burns vary from chemical exposures to extreme temperature to explosions. There has been very little research addressing the problem of occupational burn injuries, even less attention has been paid to their vocational outcomes. Most of the medical literature focuses on the treatment of occupational burn injuries. Few studies have addressed the social and economic outcomes of occupational burn injuries. The purpose of this study is threefold: first, to describe the incidence of burn injuries in Minnesota workplaces; second, to analyze burn injury patterns and demographic characteristics of burn patients; and finally, to identify the vocational outcomes of these work-related burn injuries and factors influencing sustained employment after the initial return-to-work.
Methods

represent full-time equivalents (FTEs). Industry detail was classified according to the Standard Industrial Classification Manual (1987) for all covered employment. Rates of burn injuries by industry were calculated using the average number of claims in 1996 and 1997 – the two years for which there was a full 12 months of data – as a numerator and the average number of FTE workers in each industry for the same two years as the denominator. Whether an injured worker was able to stay at work after the work comp injury (“sustainability”) was studied after the date of claim closure. Data about weeks worked and earnings of claimants after claim closure were obtained from the Unemployment Insurance Wage Detail File at DES. Employment was defined as a dichotomous variable (yes/no), with any reported wages or hours worked taken as evidence of employment. Sustainability was expressed as the percent of quarters worked after claim closure. For purposes of analysis, sustainability was transformed into a dichotomous variable: 100 percent employment (i.e., wages or hours reported in each quarter of the observation period) versus anything less than 100 percent. A total of 12 quarters (three years) was studied in cumulative three-quarter periods: the first three quarters after return to work, the first six quarters, the first nine quarters and the entire 12 quarters. The influence of demographic factors, work characteristics, injury characteristics (anatomic sites) and indemnity benefits on sustainability in each of these time periods was assessed first by calculating univariate odds ratios. Finally, multivariate logistic regression models were fitted.
Statistical analysis

Data about claimants, injuries and claims was drawn from the Minnesota Department of Labor and Industry (DLI) workers’ compensation claims database. The claims data about all nonfatal burn injuries (NCCI, NOI code 4) that occurred in the 36-month period between March 1995 and April 1998 were reviewed. Information about the injured worker’s age, gender, marital status, employment status, wages, industry, occupation, cause of injury, part of body and nature of injury was abstracted from the First Report of Injury form. Information about indemnity benefits paid and claims duration was obtained from the Notice of Benefits Paid form and the Notice of Intent to Discontinue Benefits form. Frequency distributions were used to evaluate age, gender, marital status, employment status, wages, job tenure, indemnity benefits and anatomic site.

All data analysis was done using SPSS for Windows Version 10.0.7. Frequencies, means, medians and standard deviations were calculated for all variables. Univariate relationships between dependent and independent variables were analyzed using chisquare and odds ratios for categorical data and oneData about the size and composition of the workforce way ANOVA for continuous variables. Continuous was obtained from the Minnesota Department of variables were transformed into categorical variables for Economic Security (DES), then adjusted using data multivariate analyses using logistic regression models. from the federal Bureau of Labor Statistics to
COMPACT 16 August 2001

Results

There were approximately 164,000 work-related injuries/illnesses a year in Minnesota from 1995 to 1998. About 33,900 of those involved a loss of more than three days of work. We defined a wagecompensated burn injury as a burn injury that resulted in three or more days of lost work, a permanent partial disability benefit or both. There were 1,606 claims meeting the inclusion criteria during the 36-month observation period. The claims represented 1,599 injured workers, with seven individuals having two claims for burn injury during this time. The descriptive statistics and analysis of lost work-time and claim duration are based on this cohort. For the analysis of sustained employment after claim closure, additional exclusions were made. Sixty-two of the claimants lived outside of Minnesota; since their unemployment insurance wage detail data would not be available through Minnesota DES, they were excluded from this analysis. One hundred sixty-four claimants had another worker ’s compensation injury during the follow-up period and were not “at risk” for sustained employment throughout the follow-up period. They were also removed from the analysis of sustained employment. After these exclusions, there were 1,373 individual claimants with compensable burn injuries included in the analysis of sustained employment. Claimants averaged 33.6 years of age. Most burns occurred to workers 25 to 45 years of age (51.6 percent); however, workers younger than 25 accounted for 27 percent of the injuries, while those older than 45 were only 20 percent. Men accounted for 1,166 (72.9 percent) of the cases. More than half of the claimants were married (56.2 percent) and nearly half lived in the Minneapolis-St. Paul metropolitan area (48.7 percent). The average preinjury weekly wage was $392 and, though on average the injured worker had been employed at the company 4.2 years prior to the burn injury, 45.8 percent had been at the employer for less than a year. A large majority of claimants, 75.2 percent, had been employed full-time at the time of the injury. (Table 1)

Table 1. Demographic characteristics
Claimants Age (years) Male Married Residence 1,599 33.6 1,166 (72.9%) 56.2% 48.7% 47.4% 3.9% $392.47 17.4% 30.9% 26.5% 23.9% 67.9% 4.2 years 45.8% 54.2% 20 (1.3%) 12 (0.8%) 158 (9.9%) 398 (24.9%) 45 (2.8%) 614 (38.4%) 8 (0.5%) 316 (19.8%) 28 (1.8%)

Twin Cities Greater Minnesota out of state Pre-injury wage <$175/week $176-$350 $351-$525 >$525 Full-time employee Pre-injury tenure <one year >one year Industry agriculture mining construction manufacturing transportation trade FIRE* services public administration

* FIRE – financial, insurance, real estate

The upper extremity was the most frequently burned body region, accounting for 656 injuries (41 percent). Burns to the lower extremity were the second most frequent type with 387 workers injured (24.2 percent). In 315 cases (19.7 percent), the employee suffered burns to multiple areas of the body, while there was no information about the part of the body for 24 cases (1.5 percent). Hot gases were the most common cause of burns and accounted for 813 (50.8 percent) cases. The next most common causative agents were chemicals, with 204 cases (12.8 percent), and contact with a hot surface, with 203 cases (12.7 percent). The most common cause of burn injury varied by anatomic site. The most frequent sites of burns from hot gases were the upper and lower extremity (39.2 percent and 33.7 percent of all hot gas burns, respectively). Chemical burns were found most often in the head and neck area (44.1 percent of all chemical burns). Contact with a hot surface most often resulted in a burn to the upper extremity area (79.8 percent of all contact burns), while fires and explosions caused multiple burn injuries (45.6 percent and 60 percent). (Table 2, page 19)
Burn injuries, continued on page 18
August 2001

COMPACT

17

Burn injuries, continued from page 17

Men and women differed in the distribution of burn injuries. Men had more burns to the head and neck (86.3 percent of head and neck burns), torso (90.5 percent) and multiple areas (84.8 percent) than expected, while women had higher percentage burns to the upper extremity (50.6 percent of burns to women) than men (37.5 percent of burns to men). Distribution of burns also varied by age. Workers less than 25 years old had more burns to the arms than expected (31.8 percent of all upper extremity burns). (Table 3, page 19) The average annual incidence rate of work-related burn injuries was 2.6 per 10,000 FTE. Upper extremity burns had the highest overall incidence (1.1 per 10,000 FTE), while burns to the torso occurred least often. The industry-specific incidence rate per 10,000 workers varied and was highest for agriculture (8.4), trade (6.5), construction (5.6) and mining (4.0). The rate of burn was lowest for financial, insurance and real estate (0.3/10,000 FTE). The incidence of the site of burn injury also varied according to industry. Burns to the head and neck occurred at higher rates in agriculture and mining (1.1 and 1.3 per 10,000 FTE respectively). Burns to the upper (3.0/10,000 FTE) and lower extremities (1.7/10,000 FTE) were particular problems in the trades. Lower extremity burns were also a problem in construction (1.0/10,000 FTE). (Table 4, page 20) The mean total indemnity benefit paid to claimants was $1,847, while the median indemnity benefit was $334. As expected, employees with higher preinjury wages had higher total indemnity payments, as did males, full-time workers, workers with longer tenure in the company and married workers – all of whom had higher pre-injury wages than their counterparts. Though temporary total disability (TTD) benefits are payable at two-thirds of gross wage, because of maximum and minimum payment levels, 8.1 percent of claimants received less than two-thirds of their wages in TTD benefits, while 21.3 percent of claimants received more than two-thirds. (Table 5, page 21)

3.7 weeks, in comparison to an average of 9.1 weeks for all workers’ compensation injuries in Minnesota during 1996 and 1997. Only about a third (37.5 percent) of the burn-injured spent more than two weeks on TTD; only 13.5 percent collected TTD benefits for more than five weeks. (Table 5) Workers spent very little time, during the claim, back at work earning less than full wages as measured by the number of weeks of temporary partial disability: a median of 0 weeks and mean of 0.5 weeks. Overall, 42 burn-injured workers (2.6 percent) had either attorney representation or a stipulated settlement to a dispute about their claim. Claims among burn-injured workers closed, on average, 11.6 weeks after the date of injury, with half of all claims open two weeks or less. (Table 5) Permanent partial disability (PPD) ratings were given to 122 injured workers (7.6 percent of claimants), with an average rating of 7.6 percent and an average PPD payment of $5,744. Workers who received a PPD award had higher total indemnity paid (average $12,472), more lost work time (average 13.7 weeks) and a longer duration on claim (average 82.9 weeks). PPD recipients were also older (average 38 years), earned more before their injury (average weekly wage of $524) and were more likely to have suffered burns to multiple sites (29.5 percent of PPD recipients). (Table 5)

The duration of lost work time as measured by weeks of TTD was related to industry, part of body burned, severity of burn (as indicated by a PPD rating) and “friction” (presence of an attorney or stipulated agreement). Workers in the transportation industry were off work longer than any others, averaging 15.1 weeks of TTD. Employees in trades, services and public administration had slightly shorter durations. Burns at multiple sites had the longest lost work time at 5.8 weeks, followed by lower extremity burn cases, which averaged 4.3 weeks off work. Claimants with upper extremity burns had the shortest time off work, averaging 2.1 weeks. As noted above, PPD recipients, whose burns are more severe, were off work an average of 13.7 weeks. The presence of an attorney or of a stipulated settlement Lost time from work was measured by the number of resulted in the longest durations of lost time, 26.1 weeks. weeks in which TTD was paid. The median lost time for (Table 6, page 21) There was no statistically significant burn-injured workers was 1.6 weeks, with an average of differences in the duration of TTD benefits within categories
COMPACT 18 August 2001

COMPACT

Table 2. Injury characteristics – part of body and cause of burn
total
chemicals contact welding heat fire hot gas electric explosion

head-neck 90 4 17 25 4 13 2 61 3.8% 6 2 162 2 28 6 1 203 12.7% 1% 7.1% 50.8% 16 114 813 2 11 1 52 154 5 11 274 4 24 8 32 319 2 13 31 30 7 40 35 2 204 12.8% 656 (41%) 42 (2.6%) 387 (24.2%) 315 (19.7%) 24 (1.5%)

175 (10/9%)

9 16 10 3 33 24 1.5% 55 3.4%

upper extremity

torso

lower extremity

multiple

unknown

total % all burns

19

Table 3. Injury characteristics – age and gender
age:
<25 25-35 35-45 45-55 55-65 >65 male female

head-neck 200 174 11 83 85 6 423 27.8% 5 376 24.8% 87 99 8 4 58 51 1 210 13.8% 140 78 13 96 61 7 409 26.9%

32 64 37 18

12 33 4 23 19 2 93 6.1%

1 3 2 1 1 8 .5%

151 (86.3%) 437 (66.6%) 38 (90.5%) 255 (65.9%) 267 (84.8%) 18 (75%) 1,166 72.9%

24 (13.7%) 219 (33.4%) 4 (9.5%) 132 (34.1%) 48 (15.2%) 6 (25%) 433 27.1%

upper extremity

torso

lower extremity

multiple

unknown

Burn injuries, continued on page 20

total % all burns

August 2001

Burn injuries, continued from page 19

multiple

of gender, age, marital status, employee residence (metro vs. nonmetro), cause of the injury, length of employment with the company, full-time/part-time status, pre-injury wage or replacement rate (TTD weekly benefit divided by weekly wage). Overall, the majority of burn-injured workers were able to sustain employment after return to work. In the first three quarters, 76 percent of the cases had wages and hours in each quarter; only 6.4 percent showed no employment activity at all. In the whole 12-quarter (three-year) observation period, 59.8 percent had fully sustained employment. However, almost all claimants did work at least some of the time; in the 12-quarter period, only 3.4 percent show no wages or hours in any quarter. (Table 7, page 22) Gender and employee residence did not influence sustainability in any of the time periods evaluated, however, age and marital status did. The age group 25 to 55 was more likely to have 100 percent employment than those younger than 25 and older than 55. Likewise, married workers were also more likely than the unmarried to have fully sustained employment in each follow-up period. The site, cause and severity of burn as measured by a PPD rating had no effect on the sustainability of employment after claim closure. (Table 7) The injured worker’s pre-injury employment history did have a strong effect on post-injury employment. Fulltime workers, those with the company longer than one year and workers with higher wages were all more likely to have fully sustained employment after claim closure than their counterparts. However, the industry of preinjury employment was only related to sustainability in the first three quarters after claim closure: workers in the manufacturing and transportation industries were more likely than others to have wages and hours reported during that period. (Table 7) The only characteristic of the claim with any association with sustainability was the claimant’s replacement rate. Those with the higher replacement rate (more than twothirds of the pre-injury wage) were far less likely to have sustained employment than those receiving less in TTD.

rate

burns

lower extremity

rate

burns

rate

torso

Table 4. Incidence of burn injury

burns

upper extremity

rate

burns

rate

head-neck

burns

102 total 2.6

0.3
* FIRE – financial, insurance, real estate

1.1

1.3

0.6

0.4

0.4

0.5

0.1 14 0.3 1.4 services FIRE*

10

35

30

2

2

8

incidence

overall

8.4

4.0

5.6

3.0

1.3

6.5

manufacturing

transportation

COMPACT

public admin.

construction

retail trade

agriculture

mining

1.1

1

0.1

395

175

37

84

74

4

3

8

3

7

1.1

2.2

2.0

2.1

1.0

0.4

3.0

0.1

0.6

0.4

24

11

4

6

2

1

0.1

0.2

0.1

0.2

0.0

0.1

241

17

64

98

50

1

5

2

4

0.6

0.6

1.0

0.8

0.2

1.7

0.1

0.4

0.3

193

28

58

61

26

7

1

6

1

5

0.5

3.9

0.7

1.6

0.7

0.3

1.0

0.0

0.2

0.3

20

August 2001

Table 5. Claim characteristics
duration of TTD TTD paid duration of TPD TPD paid total indemnity paid claim duration replacement rate >2.3rds 2/3rds <2/3rds attorney or stipulation permanent partial disability indemnity paid claim duration mean 3.7 weeks $1,003 0.5 weeks $94 $1,847 11.6 weeks 340 (22.5%) 1,039 (68.9%) 129 (8.6%) 45 (2.6%) 122 (7.6%) $12,472 82.9 weeks median 1.6 $304 0 0 $332

associated with an increased likelihood of sustained employment. Pre-injury wages were significant in the first three quarters after returning to work, but not after. Age entered the model for the six-quarter follow-up, but not for the other periods. (Table 8, page 22)
Discussion

Table 6. Lost work time
industry agriculture mining construction manufacturing transportation trade FIRE services public administration site of burn head-neck upper extremity torso lower extremity multiple permanent partial disability yes no attorney or stipulation yes no average (weeks) 4.2 9.2 4.4 4.3 15.1 2.7 4.0 2.6 2.6 3.7 2.1 2.6 4.3 5.8 13.7 2.8 26.1 3.1

In this study, only a few of the factors studied are found to influence sustainability of employment after initial recovery and return to work. Of those that influenced sustained employment, different factors were significant during different parts of the observation period. Only tenure with the employer prior to the injury and working full-time prior to the injury were associated with employment during the entire three-year follow-up. Pre-injury wage and age at injury are important determinants of short-term sustainability, but not long term. Characteristics of the injury and of the claim process did not affect the sustainability of employment during any of the observation periods studied. This is in stark contrast to their relationship to duration of claim and, specifically, lost work time as measured by the length of TTD benefits. Our findings suggest that factors relating to duration of a claim, the initial return to work and the sustainability of employment after claim closure are different in burn-injured patients. In particular, sustainability is influenced by the nature of the claimant’s employment history before the burn injury and not by the injury itself or the claim process. Whether these findings are peculiar to burn-injured workers or are general to workers’ compensation claimants requires analysis of other groups of injuries. In addition, no attempt was made to analyze the effect of previous workers’ compensation claims on claim duration, return to work or sustainability in this group of individuals. And workers who suffered another work-related injury after the close of the index claim were dropped from the analysis of sustainability. If any of the factors studied here affect the likelihood of a subsequent injury, then this analysis underestimates those effects on the sustainability of work. Furthermore, this study focuses on whether these injured workers were able to sustain any
Burn injuries, continued on page 22
August 2001

The total amount of benefits paid, the total lost work time, presence of an attorney and a stipulated settlement were not associated with post-claim employment. (Table 7)
Multivariate analysis

In the multiple logistic regression models, the only variable that continued to be associated with sustained employment at each observation period was the tenure with the pre-injury employer. Those workers who had worked at the company for more than a year prior to the burn injury were twice as likely to have sustained employment. In the nine-quarter and 12-quarter followup periods, working full-time prior to injury was also
COMPACT 21

Table 7. Univariate associations with fully sustained employment after claim closure
three quarter six quarter 1,016 (65.3%) 73 (4.7%) OR (95%CI) 1.3 (1.1, 1.7) 2.1 (1.6, 2.7) 2.2 (1.7, 2.8) 1.3 (1.1, 1.7) 1.4 (1.1, 1.8) 2.4 (1.8, 3.1) OR (95%CI) OR (95%CI) 61 (4.0%) 47 (3.6%) 878 (57.8%) 649 (50.2%) 1,197 (76%) 101 (6.3%) OR (95%CI) 1.5 (1.1, 1.9) 2.1 (1.6, 2.8) 3.8 (1.3, 10.5) 4.5 (1.1, 17.7) 0.4 (0.2, 0.7) 0.5 (0.3, 0.8) 1.7 (1.2, 2.3) 2.3 (1.6, 3.2) 2.3 (1.6, 3.2) 1.8 (1.4, 2.3) 1.8 (1.4, 2.5) 1.9 (1.4, 2.6) 2.1 (1.4, 3.2) 1.8 (1.4, 2.3) 1.6 (1.2, 2.1) 1.8 (1.3, 2.5) 1.9 (1.3, 2.7) 2.1 (1.5, 3.0) 2.4 (1.7, 3.4) 1.6 (1.1, 2.2) 2.2 (1.5, 3.1) 2.7 (1.9, 3.9) 2.6 (1.8, 3.8) 2.1 (1.6, 2.8) 1.6 (1.1, 2.2) 1.7 (1.2, 2.4) 1.8 (1.2, 2.7) 0.6 (0.4, 0.9) 0.5 (0.3, 0.8) 1.8 (1.3, 2.6) 2.7 (1.9, 3.9) 2.6 (1.8, 3.8) 2.2 (1.6, 2.9) 1.7 (1.3, 2.4) 2.3 (1.6, 3.2) 2.2 (1.5, 3.3) married nine quarter 12 quarter

COMPACT

follow-up period:

fully sustained employment

no employment

odds of fully sustained employmt.

> one year w/pre-injury employer

manufacturing

transportation

replacement rate > 2/3rds

pre-injury wage $175-$350

Burn injuries, continued from page 21

pre-injury wage $351-$525

pre-injury wage > $525

full-time employee prior to burn

25-35 years old

36-45 years old

employment. The analysis did not look at how competitive these burn-injured workers were in the labor market after returning to work. That is, no attempt was made to analyze their post-injury earnings in comparison to their pre-injury status.

22

46-55 years old

Table 8. Multivariate associations with fully sustained employment after claim closure
three quarter OR (95%CI) 2.0 (1.4, 3.0) 2.7 (1.7, 4.4) 3.0 (1.8, 5.0) 2.6 (1.4, 4.6) 1.6 (1.1, 2.3) 1.6 (1.0, 2.4) 1.6 (1.1, 2.3) six quarter OR (95%CI) 2.1 (1.5, 2.9) nine quarter OR (95%CI) 2.1 (1.5, 2.9) 12 quarter OR (95%CI) 2.3 (1.6, 3.1)

follow-up period:

odds of fully sustained employmt.

> one year w/pre-injury employer

pre-injury wage $175-$350

pre-injury wage $351-$525

pre-injury wage > $525

full-time employee prior to burn

25-35 years old

August 2001