Initial return to work and long‐term employment patterns: Associations with work‐related permanent impairment and with participation in workers' compensation‐based return‐to‐work programs

Abstract

Background Roughly 10% of injured workers experience work injuries that result in permanent impairment and a permanent partial disability (PPD) award. This study aimed to characterize and quantify long‐term employment outcomes for injured workers, by the degree of whole body impairment (WBI) and by participation in several workers' compensation (WC)‐based return‐to‐work (RTW) programs. Methods A retrospective cohort of 43,968 Washington State workers were followed for up to 10 years after WC claim closure (2009–2017). Degree of impairment was classified as: (1) no PPD award, (2) PPD award with WBI < 10%, or (3) PPD award with WBI ≥ 10%. State wage files were used to construct employment outcomes for regression, modeling: (1) time to first RTW, (2) time to first RTW interruption, (3) RTW volatility, and (4) employment gaps. Results Wage patterns and employment outcomes differed significantly by the degree of impairment. Compared to other workers, workers with WBI ≥ 10% had delayed RTW, shorter average times to first RTW interruption, and higher rates of both RTW interruptions and quarters without wages. Time to first RTW averaged over a year, increasing with the degree of impairment. About 9% overall—and 27% of workers with ≥10% WBI—had no observed wages after claim closure. In adjusted models, workers with WBI ≥ 10% had significantly poorer employment outcomes, compared to workers with no PPD award (p < 0.001). Conclusions State wage files provide an efficient approach to identifying RTW patterns. Workers with permanent impairment were at substantially higher risk of poor employment outcomes. WC‐based RTW programs may promote better employment outcomes.

Workplace improvements to support safe and sustained return to work: Suggestions from a survey of workers with permanent impairments

“…The focus on safety‐related issues comports with previously published data from the same survey, which revealed that more than half of respondents thought their permanent impairment put them at higher risk of being reinjured at work, compared with pre‐injury (65.2%), or compared with coworkers in the same job (54.4%) 22 . The focus on safety‐related issues also aligns with findings from a large retrospective cohort of injured workers with WC claims linked to wage data, in which workers with work‐related permanent impairments had significantly higher reinjury risk compared with workers without permanent impairments—a risk differential that increased as degree of permanent impairment increased 11 …”

“…The open‐ended questions we included, in addition to corroborating the importance of the workplace factors covered by pre‐specified survey questions, also enabled the presentation of workers' voices with respect to the workplace factors they considered most important to their wellbeing. Another strength was that the survey was focused on the first year after claim closure—a time period which is high‐risk for reinjury and job loss, and which may also determine long‐term employment prospects 11,18 . However, because we interviewed only workers who had RTW at least briefly, our findings do not directly address workplace improvements that might facilitate RTW for workers with permanent impairments who do not RTW at all.…”

“…WC‐based PPD awards provide limited compensation for certain work‐related permanent impairments—those that do not entirely preclude RTW, but that do prevent working at full physical capacity (e.g., vision or hearing loss, amputation, spinal impairment). These injuries are associated with substantial subsequent wage and wealth losses relative to both uninjured workers 7,8 and injured workers without permanent impairments 9–11 …”

“…Moreover, initial RTW does not necessarily indicate sustained RTW; many workers with a permanent impairment face RTW interruption (i.e., breaks in ongoing employment after initial RTW). Numerous factors contribute to RTW interruption, including unstable health, disability, layoff, early retirement, negative treatment by managers and coworkers, lack of accommodation, and discrimination 11–13,15,17–21 . In particular, workers with a permanent impairment are at substantially higher risk of reinjury 18,22 .…”

Appraisal of Washington State workers' compensation‐based return‐to‐work programs and suggested system improvements: A survey of workers with permanent impairments

“…Despite having been deemed able to work, many workers with PPD awards do not RTW. 4,5 Those that do RTW face elevated risks of delayed RTW, RTW interruption, and reinjury (relative to workers without PPD awards), 5,6 which may be related to factors such as long-term functional disability, pain, unstable health, layoff, early retirement, negative treatment by managers and coworkers, lack of accommodation, and discrimination. 4,[6][7][8][9][10][11][12] Some of the multiple factors predisposing workers to negative outcomes-particularly workers with permanent impairments-may be amenable to intervention via WC-based vocational rehabilitation and other RTW programs, and overall WC system improvements.…”