By Julie Croushore
Claims Supervisor — Workers’ Compensation
National Interstate Insurance Company
This Opinion piece appears in the Jan. 4 print edition of Transport Topics. Click here to subscribe today.
The slow economic recovery is causing many Americans either to delay retirement or to return to the workforce after retiring to supplement income. A 2005 American Trucking Associations study found one in five truck drivers was older than 55 — and by 2014, it’s expected to be one in four.
Senior employees are a great asset, bringing vast experience and knowledge to the workforce, as well as maturity and professionalism. However, older employees also present an added risk of injury and workers’ compensation claims as many suffer from arthritis and other chronic pre-existing medical conditions.
During a recent National Council on Compensation Insurance conference, it was revealed that the fatality rate of injured workers aged 65 or older is triple that of workers aged 35-44. There also is a 50% increase in days missed from work by older injured workers.
Employers cannot ignore these alarming statistics or the fact that these risk factors can lead to increased workers’ compensation claims and, ultimately, higher insurance premiums. The nation’s aging workforce demands a proactive approach to risk management.
As a workers’ compensation claims management professional, I frequently am asked by employers, “Why do I have to pay for this?” Take, for example, this common claims scenario:
John Smith, age 65, retires from longhaul driving to be closer to home and family. He takes a position as a local delivery driver. Smith’s new employer is impressed, because he is a prompt, consistent, conscientious driver willing to take any run. But after a few months on the job, Smith begins to complain of knee pain from getting in and out of his truck constantly for deliveries. His doctor recommends a total knee replacement, and Smith files a workers’ compensation claim with his new employer.
Why did Smith go straight to workers’ comp instead of employment-based health insurance or even Medicare, given his age? No. 1, because he’s been around long enough to know workers’ comp means receiving wages while off work dealing with the injury. No. 2, because the doctor told him climbing in and out of the three-step truck made Smith’s knees worse, causing him to need surgery that would have been otherwise avoided. And No. 3, an employee with an on-the-job injury that aggravates a pre-existing condition is considered to have a work-related injury the employer must pay to treat.
For the record, Medicare always is a secondary payer, whether workers’ comp or employment-based health insurance is involved. In fact, insurers are now required to report all open workers’ comp claims and liability settlements to Medicare to ensure medical expenses for work injuries or other at-fault accidents aren’t shifted to Medicare.
None of this is good news for Smith’s new employer, who doesn’t understand why the company must pay for knee replacement, given Smith’s history of arthritis. The answer is that workers’ comp classifies aggravation of a pre-existing condition as a new injury.
The knee surgery and associated disability will run between $100,000 and $200,000, depending on which state has jurisdiction. An employer also can face residual expenses such as hiring a temporary worker to cover for the injured employee — and the possibility of similar claims from other employees. What’s more, Smith might file for discrimination under the Americans with Disabilities Act or the state’s fair-employment acts, which require employers to make accommodations for disabled employees.
On the plus side, most workers’ compensation claims are preventable. The trick is to determine ahead of time if an individual is capable of performing a job safely, particularly in the case of older workers with pre-existing and chronic conditions.
The ADA and state fair-employment acts prevent employers from actually questioning job candidates about prior injuries or disabilities. However, there are ways to assess job candidates:
• Engage a service or medical clinic to perform pre-employment physical examinations and/or test physical abilities.
• Invite the service’s medical director to tour your facility to better understand the nature and duties of your various positions.
• Provide clear job descriptions to the physician who performs your fit-for-duty exams.
How would this have applied to our John Smith? Let’s say his new delivery driver job requires entering and exiting the truck 20 times a day. When Smith applied for the job, the delivery company could have sent Smith for a pre-employment physical examination or abilities test to determine if he could safely deal with two to four steps 20 times a day.
Through the exam, the employer would have learned the extent of Smith’s arthritis and realized he couldn’t handle those truck steps many times a day. Knowing that would have enabled the delivery company to make a more informed employment decision — including a decision not to hire Smith because he was medically unable to perform the essential job function of a delivery driver safely. Or, the employer could have decided to offer him a driving position that didn’t involve many stops.
A certain number of workers’ compensation claims is unavoidable, but implementing a program of pre-employment physical exams and/or physical abilities testing with a reliable medical facility can reduce exposure significantly and go a long way toward ensuring you don’t “hire” your future workers’ compensation claims.
National Interstate Insurance Co., Richfield, Ohio, is a specialty property and casualty insurance company that focuses on the transportation industry.