KANSAS DEPARTMENT OF HUMAN RESOURCES
Kansas Division of Workers Compensation 27th Annual Statistical Report Fiscal Year 2001
February 2002
Richard E. Beyer, Secretary of Human Resources Philip S. Harness, Director of Workers Compensation
For More Information Contact: KANSAS DIVISION OF WORKERS COMPENSATION Technology & Statistics Section David Sprick Research Analyst & Principal Author 800 SW Jackson Street, Suite 600 Topeka, Kansas 66612-1227 (785) 296-4120 ext. 208 [email protected] www.hr.state.ks.us/wc/html/wc.htm
Kansas Division of Workers Compensation
Annual Statistical Report
2001
ACKNOWLEDGEMENTS
This 27th Annual Report would not have been possible without the dedication and resourcefulness of the following people and organizations:
KANSAS DEPARTMENT OF HUMAN RESOURCES
Division of Workers Compensation
Philip S. Harness, Director Kenneth Hursh, Assistant Director Randall Williams, Director of Technology & Statistics Section David Sprick, Research Analyst and principal author Andrew Bell, Research Analyst, data administrator of the Open & Closed Claims Study Heather Mosqueda, Fraud & Abuse Ezra Ginzburg, Assistant Attorney General Jeanne Krehbiel, Research Analyst Georgia Rogers, Research Analyst Alan Stanton, Research Analyst
Software Application Development
Dan Urban, KDHR Information Systems Cover designed by: Connie Hammond, KDHR Division of Marketing and Communications Editing: Kristi Pankratz, KDHR Division of Marketing and Communications
KANSAS INSURANCE DEPARTMENT Insurance Experience and Workers Compensation Fund Tables furnished by: Sabrina Wells, Comptroller Michelle Brown Dick Cook WASHBURN UNIVERSITY Statistical Consultation: Dr. Ron Wasserstein, Professor of Statistics
Special thanks are due to the carriers, group pools, and self-insured entities that were asked to participate in the call for data that allowed the Division to include information in the section on open & closed claims in Kansas.
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Kansas Division of Workers Compensation
Annual Statistical Report
2001
TABLE OF CONTENTS
List of Tables & Figures ....................................................................................................................4 Message from the Director ..................................................................................................................7 Introduction .......................................................................................................................................8 Benefits Information...........................................................................................................................9 Personnel Directory .......................................................................................................................... 11 Organizational Chart......................................................................................................................... 12 SECTION ONE: Administrative Profile of the Division of Workers Compensation....................... 13 Business & Accounting ......................................................................................................... 14 Industrial Safety & Health..................................................................................................... 16 Judicial................................................................................................................................ 18 Workers Compensation Appeals Board.................................................................................. 20 Fraud & Abuse ..................................................................................................................... 21 Applications ......................................................................................................................... 22 Coverage & Compliance ....................................................................................................... 23 Data Collection & Data Entry................................................................................................ 24 Mediation............................................................................................................................. 25 Medical Services .................................................................................................................. 26 Ombudsman/Claims Advisory............................................................................................... 27 Rehabilitation ....................................................................................................................... 29 Research.............................................................................................................................. 30 Technology & Statistics ........................................................................................................ 31 SECTION TWO: Incidence of Workplace Injury & Illness in Kansas ............................................ 32 Occupational Injuries & Illnesses in Kansas for FY2001 ......................................................... 33 Kansas Occupational Injury & Illness Incidence Rates............................................................ 40 BLS Survey of Occupational Injuries and Illnesses............................................................... 40 Kansas Non-Federal Occupational Injury & Illness Incidence Rate ....................................... 42 SECTION THREE: Workers Compensation Claims Statistics ....................................................... 55 The Kansas Workers Compensation Fund .............................................................................. 56 Workers Compensation Insurance Experience ........................................................................ 57 The Kansas Open & Closed Claim Study ............................................................................... 58 A Comparative Analysis of Indemnity & Medical Claim Costs................................................ 75 SECTION FOUR: Workers Compensation Fraud & Abuse...........................................................82 Introduction.......................................................................................................................... 83 Referrals .............................................................................................................................. 84 Investigations ....................................................................................................................... 88 Collections ........................................................................................................................... 89 APPENDIX A: Technical Notes......................................................................................................92 Occupational Injury & Illness Incidence Rates........................................................................ 93 Kansas Open & Closed Claim (OCC) Study Methodology ...................................................... 93
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Kansas Division of Workers Compensation
Annual Statistical Report
2001
LIST OF TABLES & FIGURES
TABLES SECTION ONE
1-1 1-2 1-3 1-4 Assessments Colle cted During Calendar Year 2000 ................................................................... 15 Self-Insurance Summary .......................................................................................................... 15 Administrative Law Judges' Case Activity ................................................................................ 19 FY2001 Requests for Information from the Research Section ..................................................... 30
SECTION TWO
2-1 2-2 2-3 2-4 2-5 2-6 2-7 2-8 2-9 2-10 2-11 2-12 2-13 2-14 2-15 2-16 2-17 2-18 2-19 2-20 Kansas Total Occupational Injuries & Illnesses By Severity FY1992-FY2001 ............................. 34 Severity of Injury & Illness as Percentage of Total Injuries & Illnesses FY1992-FY2001 ............. 34 Counties Reporting Greatest Number of Total Injuries & Illnesses FY2001 ................................. 35 Most Frequent Source of Occupational Injuries & Illnesses (by Total Inj/Ill) FY2001................... 36 Most Frequent Cause of Occupational Injuries & Illnesses (by Total Inj/Ill) FY2001 .................... 36 Most Frequent Nature of Occupational Injuries & Illnesses (by Total Inj/Ill) FY2001 ................... 37 Body Member Most Frequently Associated with Occupational Injuries & Illnesses (by Total Inj/Ill) FY2001 .......................................................................................................... 38 Industries with Greatest Number of Total Occupationa l Injuries & Illnesses FY2001.................... 39 Occupational Injuries & Illnesses by Gender FY2001................................................................. 39 Occupational Injur ies & Illnesses by Age FY2001...................................................................... 40 Private Sector Kansas Occupational Injury & Illness Rate 1994-1999.......................................... 42 Kansas Non-Fatal Occupational Injury & Illness Rate FY1992-FY2001 ...................................... 44 Kansas Industrial Sector Occupational Injury & Illness Rate FY2001 .......................................... 45 Occupational Injury & Illness Rate for Selected Kansas Industries FY2001 ................................. 45 Location (County) of Occupational Injuries & Illnesses by Severity FY2001 ............................... 46 Source of Occupational Injuries & Illnesses by Severity FY2001 ................................................ 48 Cause of Occupational Injuries & Illnesses by Severity FY2001.................................................. 50 Nature of Occupational Injuries & Illnesses by Severity FY2001................................................. 51 Body Member Reported in Occupational Injuries & Illnesses by Severity FY2001 ....................... 52 Industries Reporting Occupational Injuries & Illnesses by Severity FY2001 ................................ 53
SECTION THREE
3-1 3-2 3-3 3-4 3-5 3-6 3-7 3-8 3-9 3-10 3-11 3-12 Workers Compensation Fund Case Load Scheduled ................................................................... 56 Workers Compensation Fund Expenditure Analysis ................................................................... 56 Workers Compensation Fund Receipts Analysis......................................................................... 57 Workers Compensation Insurance Experience Premiums ............................................................ 58 2001 Closed Claims Statistics ................................................................................................... 60 2001 Closed Claims Time Intervals ........................................................................................... 60 2001 Closed Claims Percentage of Impairment .......................................................................... 61 2001 Closed Claims Attorney Involvement with Claim............................................................... 61 2001 Closed Claims Legal Expenses Associated with Claim....................................................... 62 2001 Closed Claims Average Wage & Indemnity by Employer Payroll ....................................... 62 Closed Claims Statistics 1999-2001 Mean Costs ........................................................................ 75 Closed Claims Statistics 1999-2001 Median Costs ..................................................................... 76
SECTION FOUR
4-1 4-2 Overview of Fraud & Abuse Unit Activity................................................................................. 83 Who is Reporting Fraud? .......................................................................................................... 84
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Kansas Division of Workers Compensation
Annual Statistical Report
2001
LIST OF TABLES & FIGURES
TABLES Continued SECTION FOUR
4-3 4-4 4-5 Travel Hours............................................................................................................................ 85 Number of Cases...................................................................................................................... 89 Fraud & Abuse Collections ....................................................................................................... 90
FIGURES SECTION ONE
1-1 1-2 Industrial Health & Safety Administrative Activity .................................................................... 17 FY2000-FY2001 Ombudsman Contacts .................................................................................... 28
SECTION TWO
2-1 2-2 2-3 2-4 Kansas Rate of Occupational Injury & Illness Per 100 FTE by Severity FY1992-2001 ................. 55 Kansas Rate of Occupational Injury & Illness Per 100 FTE by Severity: Total Occupational Injuries & Illnesses FY1992-FY2001 ........................................................................................ 55 Kansas Rate of Occupational Injury & Illness Per 100 FTE by Severity: No Time Lost Occupational Injur ies & Illnesses FY1992-FY2001 .................................................................... 56 Kansas Rate of Occupational Injury & Illness Per 100 FTE by Severity: Time Lost Occupational Injur ies & Illnesses FY1992-FY2001 .................................................................... 56
SECTION THREE
3-1 3-2 3-3 3-4 3-5 3-6 3-7 3-8 3-9 3-10 3-11 3-12 3-13 3-14 3-15 3-16 3-17 3-18 3-19 3-20 3-21 Workers Compensation Insurance Premiums in Kansas 1979-2000 ............................................. 57 Distribution of Claimants by Age: Closed Claims 2001 .............................................................. 64 Average Claim Costs by Age of Claimant: Closed Claims 2001 .................................................. 64 Average Claim Costs by Gender of Claimant: Closed Clai s 2001 ............................................. 65 m Most Frequent Causes of Injury: Closed Claims 2001................................................................. 65 Average Claim Costs for the Most Frequent Causes of Injury: Closed Claims 2001 ...................... 66 Most Frequently Reported Nature of Claimant Injury: Closed Claims 2001.................................. 66 Average Claim Costs for Most Frequently Reported Nature of Claimant Injury: Closed Claims 2001 ...................................................................................................... 67 Most Frequent Major Body Region Injured by Claimant: Closed Claims 2001 ............................. 67 Average Claim Costs by Major Body Region: Closed Claims 2001 ............................................. 68 Most Frequent Scheduled Body Part Claims: Closed Claims 2001............................................... 68 Average Claim Costs for Most Frequent Scheduled Body Parts: Closed Claims 2001 ................... 69 Most Frequent Unscheduled Body Part Claims: Closed Claims 2001 ........................................... 69 Average Claim Costs for the Most Frequent Unscheduled Body Parts: Closed Claims 2001 .......... 70 Most Frequent Type of Claimant Injury: Closed Claims 2001 ..................................................... 70 Average Indemnity Costs by Type of Claimant Injury: Closed Claims 2001................................. 71 Claim Costs for Carpal Tunnel and All Other Cumulative Injuries: Closed Claims 2001 ............... 71 Most Frequently Reported Cause of Claimant Injury: Open Claims 2001 ..................................... 72 Most Frequently Reported Nature of Claimant Injury: Open Claims 2001 .................................... 72 Most Frequent Major Body Region Injured: Open Claims 2001 .................................................. 73 Most Frequent Scheduled Body Part Injured: Open Claims 2001................................................. 73
3-22 Most Frequent Unscheduled Body Part Injured: Open Claims 2001 ...................................74 5
Kansas Division of Workers Compensation
Annual Statistical Report
2001
LIST OF TABLES & FIGURES
FIGURES continued SECTION THREE continued
3-23 3-24 3-25 3-26 3-27 3-28 Distribution of Total Medical Costs 2001 .................................................................................. 77 Distribution of Total Indemnity Costs 2001 ............................................................................... 77 Comparison of Costs Associated with Workers Compensation Claims 1999-2001 ........................ 78 Comparison of Costs Associated with Workers Compensation Claims 1999-2001 ........................ 78 Comparison of Costs Associated with Workers Compensation Claims 1999-2001 ........................ 79 Comparison of Costs Associated with Workers Compensation Claims 1999-2001 ........................ 79
SECTION FOUR
4-1 4-2 4-3 4-4 4-5 4-6 Referrals by County ................................................................................................................. 85 Number of Fraud Cases Reported.............................................................................................. 86 Who is Committing Workers Compensation Fraud? ................................................................... 87 Victims of Workers Compensation Fraud .................................................................................. 88 2001 Collections ...................................................................................................................... 90 2001 Collections: Disbursement Chart....................................................................................... 91
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Kansas Division of Workers Compensation
Annual Statistical Report
2001
MESSAGE FROM THE DIRECTOR
Since my appointment as Director of the Division of Workers Compensation in August 1995, I have been pleased to be involved in many different projects and activities to make the administration of workers compensation both more efficient and effective. This administration has stressed quality management in our efforts to accomplish major improvements and update the present workers compensation system. This annual report contains information on the Division's operations by section for the past fiscal year, tables of data on the incidence of workplace injuries and illnesses, insurance industry premiums and losses for Kansas, fraud & abuse activity, and revenue and operating expenditures for the Kansas Workers Compensation Fund. The report also contains the results of a major statistical study on open & closed claims. The report, however, does not cover all aspects of what happens in the Division nor is it intended to do so, although all of those elements are important. The Division processed 92,248 accident and disease reports, 13,174 applications for hearings, and 3,548 employer elections. The Business section issued 250 self-insurance permits to employers, including 27 to new applicants. The Compliance section established more than 7,200 employer contacts. The Fraud & Abuse section referred an increased number of cases for criminal prosecution across the state, resulting in restitution by several defendants. The Industrial Safety & Health section conducted 1,182 inspections, consultations, and audits to assist employers in creating safer work environments for Kansas workers; the Boiler Safety unit conducted 3,964 inspections. In addition, the Ombudsman section provided information to 28,746 parties during the fiscal year. The Research section responded to more than 37,000 requests for workers compensation histories. The Technology & Statistics section managed the construction of a new database system to replace the mainframe applications, issued a Request for Proposal asking that qualified vendors respond with a system design plan and cost estimate for the Division's electronic data interchange (EDI) program, published an annual statistical report and a new supplement of the Workers Compensation book of laws and regulations, and added features to our Web site to improve this means of providing information to our customers. The Division hosted three seminars on workers compensation and industrial safety topics during FY2001. I thank all of the employees of the Division of Workers Compensation for the hard work, dedication, and loyalty that they exhibit on a daily basis. I also thank the Secretary of Human Resources, Mr. Richard E. Beyer, for his continued support. The Division continues to receive valuable insight from business and labor, legal counsel, the insurance industry, and health care providers on ways to improve the Kansas workers compensation system. Your assistance and guidance are always welcome. Finally, on behalf of the entire Division, I would like to express my sympathies to all the families of the victims of the terrorist attacks that occurred in New York and Washington, D.C. last fall. Sincerely,
Philip S. Harness, Director KDHR Workers Compensation Division
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Kansas Division of Workers Compensation
Annual Statistical Report
2001
INTRODUCTION
The Kansas Legislature enacted the state's first law governing workers compensation, as a no-fault system, more than nine decades ago, in 1911. Although many significant changes to its provisions have been made since then, the basic premise and purpose of that law have remained much the same. The premise is that those injured in industrial accidents should be compensated regardless of who is at fault. The purpose is to provide protection to the injured employee through employer safety efforts, medical treatment, and partial compensation for lost income.1 Until 1939, the responsibility for administering the workers compensation law resided with a "workmen's compensation commissioner" whose authority extended from a series of public commissions under to whom the posit ion reported, including the Public Safety Commission in the 1920s and the Commission of Labor and Industry in the 1930s. In 1939 the Kansas Legislature created, and transferred jurisdiction over workers compensation to, a stand-alone agency named the Office of the Workmen's Compensation Commissioner. In 1961, the legislature reorganized the office again, into the Office of the Director of Workers Compensation; this office subsequently became a Division under the Department of Human Resources. Today's Div ision of Workers Compensation, while having grown and having undergone considerable organizational changes, is essentially the same agency created in 1939. The current workers compensation law covers all employers in Kansas, regardless of the number of employees or the kind of work they do, with two exceptions: those employers engaged in agricultural pursuits; and any employer during a given calendar year who has an estimated payroll less than $20,000 for that year, unless the employer is a subcontractor. The State of Kansas pays no workers compensation benefits to injured workers unless they are state employees. Private employers pay all benefits owed to their injured workers, either directly from the employer's own resources, or indirectly through another party. While most covered employers obtain insurance from private carriers or group pools, provisions in the law establish criteria for certain employers to become self-insured. Potentially eligible employers must apply for approval from the Director of Workers Compensation. Criteria include continuous operation for at least five years, a minimum level of after-tax earnings, and a minimum debt/equity ratio. The Kansas Insurance Department approves the formation of group-funded self-insurance pools and determines whether an employer qualifies for membership in a pool.
1
Madison v. Key Work Clothes, 182 Kan. 186, 192, 318 P. 2d 991 (1957).
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Kansas Division of Workers Compensation
Annual Statistical Report
2001
BENEFITS INFORMATION
COMPENSATION
Kansas's workers compensation law requires that an employer or its insurance carrier pay an injured employee two-thirds of the employee's gross average weekly wage up to the amount of the applicable maximum benefits listed below. To find the appropriate maximum, look in the schedule below for the range of dates that would contain the date of injury, and then go to the right to find the maximum dollar amount of the benefit. For example, if the date of injury were August 21, 1993, the maximum weekly benefit one could receive would be $313. The actual amount one receives is the lesser of two amounts: either two-thirds of one's gross average weekly wage; or, the maximum in effect at the date of the injury. This effective maximum does not change over the life of one's claim, even though the maximum benefit level for each new 12-month interval usually increases by a small amount .
Maximum Compensation Schedule Date of Injury July 1, 1992-June 30, 1993 July 1, 1993-June 30, 1994 July 1, 1994-June 30, 1995 July 1, 1995-June 30, 1996 July 1, 1996-June 30, 1997 July 1, 1997-June 30, 1998 July 1, 1998-June 30, 1999 July 1, 1999-June 30, 2000 July 1, 2000-June 30, 2001 July 1, 2001-June 30, 2002 Current Weekly Minimum: Maximum Benefit $299 $313 $319 $326 $338 $351 $366 $383 $401 $417 $25
MEDICAL
A person injured on the job is entitled to all medical treatment that may be needed to cure or relieve the effects of the injury. Under the law, the employer has the right to choose the treating physician. If the worker seeks treatment from a doctor not authorized or agreed upon by the employer, the insurance company is only liable up to $500 toward such medical bills. The employee does have the right to apply to the Director of Workers Compensation for a change of doctor. An injured worker is generally entitled to mileage reimbursement for trips to see a physician for distances in excess of five miles for the round trip. The injured worker generally can also obtain reimbursement if transportation must be hired. Weekly compensation is payable at the above applicable rate for the duration of the disability. In no case can such payments exceed a total of $125,000 for permanent total or $100,000 for permanent partial or temporary disability.
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Kansas Division of Workers Compensation
Annual Statistical Report
2001
BENEFITS INFORMATION
CATEGORIES OF DISABILITY COMPENSATION BENEFITS
Temporary Total Disability is paid when the employee, due to an injury, is unable to engage in any type of substantial and gainful employment. Benefits are paid for the duration of the disability. Permanent Total Disability is paid when the employee, due to an injury, has been rendered completely and permanently incapable of engaging in any type of substantial and gainful employment. The loss of both eyes, both hands, both arms, both feet, or both legs, and any combination thereof, in the absence of proof to the contrary, shall also constitute a permanent total disability. Substantially total paralysis, or incurable imbecility or insanity, resulting from injury independent of all other causes, shall also constitute permanent total disability. Permanent Partial Scheduled Disability is paid when the employee sustains complete or partial loss of use of a body part, such as an arm, due to a job-related injury. Compensation is limited to a percentage of the scheduled number of weeks. Permanent Partial General Disability is paid when the employee sustains permanent partial disability not specifically covered by the schedule. Compensation is based on the percentage of disability remaining after recovery and is limited to 415 weeks. Survivors' Benefits of $250,000 are paid to an employee's surviving spouse and dependent children if death occurs as a result of injury. If there is no surviving spouse or dependents the legal heirs are entitled to $25,000. Burial expenses up to $5,000 are also covered.
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Kansas Division of Workers Compensation
Annual Statistical Report
2001
PERSONNEL DIRECTORY
Name/Office
Philip Harness, Director Assistant Director Kenneth Hursh Administrative Law Judges Brad Avery Bryce Bendict Pamela Fuller Robert Foerschler Steven Howard Julie Sample Bruce Moore John Clark Jon Frobish Nelsonna Potts -Barnes Workers Compensation Appeals Board Gary Korte (Chair) Self Insurance Tom Bradley Coverage & Compliance Don Palmer Fraud & Abuse Investigation Ezra Ginzburg (Asst Atty General) Mediation Jose Castillo Medical Services Terry Tracy MD Ombudsman/Claims Advisory Richard Thomas Rehabilitation Richard Thomas Technology & Statistics Randy Williams Industrial Safety & Health Rudy Leutzinger, Administrator Boiler Safety Unit Don Jenkins Industrial Hygiene Unit Helen Cook Industrial Safety Unit Marvin Dinkel Federal/State Data Operations Unit Gary Johnson Safety Consultations Unit Gil Samuels Special Activities Unit Paul Kosmala
Address/Floor
800 SW Jackson, 7 th Floor Topeka, KS 66612-1227 7th Floor
Tele phone No.
(785) 296-4000
(785) 296-4000
Lower Level Lower Level Garden City Overland Park Overland Park Overland Park Salina Wichita Wichita Wichita 14th Floor 6th Floor 6th Floor 8th Floor 7th Floor 10th Floor 7th Floor 7th Floor 6th Floor 512 SW 6th Avenue Topeka, KS 66603-3174 512 SW 6th Avenue White City 512 SW 6th Avenue 512 SW 6th Avenue El Dorado 512 SW 6th Avenue
(785) (785) (316) (913) (913) (913) (785) (316) (316) (316)
296-7012 296-7012 275-0414 642-7650 642-7650 642-7650 827-0724 264-0220 264-0220 264-0220
(785) 296-6694 (785) 296-3606 (785) 296-6767 (785) 296-6392 (785) 296-0848 (785) 296-0846 (785) 296-2996 (785) 296-2996 (785) 296-4120
(785) 296-7476
(785) 296-4589 (785) 349-2536 (785) 296-6326 (785) 296-2251 (316) 320-1784 (785) 296-4386
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Kansas Division of Workers Compensation
Annual Statistical Report
2001
Organizational Chart Kansas Department of Human Resources DIVISION OF WORKERS COMPENSATION
Secretary of Human Resources Director of Workers Compensation
Assistant Director
Medical Services Section
Workers Compensation Board
Assistant Director
Industrial Safety & Health
Technology & Statistics Section Business & Accounting Section Rehabilitation Section Ombudsman/Claims Section
Applications Section Data Collection Section Research Section Information Technology Network Administration
Coverage & Compliance Section Data Entry Section
Fraud & Abuse Section Judicial Section Mediation Section
Boiler Safety Unit Industrial Hygiene Unit Industrial Safety Unit Safety Consultations Unit Special Activities Unit Federal/State Data Operations Unit
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Kansas Division of Workers Compensation
Annual Statistical Report
2001
Section 1
Administrative Profile of the Kansas Division of Workers Compensation
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Kansas Division of Workers Compensation
Annual Statistical Report
2001
BUSINESS & ACCOUNTING SECTION
PRIMARY FUNCTIONS
§
§
§ § §
Review and approve or disapprove applications of individual employers requesting to become self-insured. Also, annually review existing permits to decide if a company still meets the criteria to be self-insured in the state of Kansas, pursuant to K.S.A. 44-532 and K.A.R. 54-14-4. Collect and tabulate information needed to issue assessments against insurance carriers, group pools, and self-insured employers to generate sufficient fees to support the Division, as mandated by K.S.A. 74-712 through 74-719. Prepare the budget annually within established deadlines and monitor monthly expenditures. Order equipment and supplies as needed to maintain the operations and efficiency of more than 100 employees in Topeka and in four regional offices. Sell workers compensation law books and medical fee schedules to the public.
ACCOMPLISHMENTS
§ §
Assessed and collected fees from 933 insurance carriers, group pools, and individual self-insured employers. Approved the renewal of a net 250 permits, approved 27 new applicants, and processed 17 cancellations.
OBJECTIVES
§ § §
Consult with self-insured companies in order to improve and simplify the application process. Complete the annual budget preparation prior to the established due dates. Complete a financial report containing review and analysis of all banks issuing letters of credit to selfinsured companies.
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Kansas Division of Workers Compensation
Annual Statistical Report
2001
BUSINESS & ACCOUNTING SECTION
Table 1-1 ASSESSMENTS COLLECTED DURING CALENDAR YEAR 2000
Reported losses paid in calendar year 2000 Current assessment factor Assessments collected during calendar year 2000 Number of carriers and self-insurers reporting $324,311,473 0.02790 $9,048,290 933
ESTIMATED EXPENDITURES TO ADMINISTER THE WORKERS COMPENSATION ACT FOR FY2002
Salaries and Wages (Division excluding Industrial Safety & Health) Contractual Services (communication, printing, rent, maintenance, travel) Commodities (general office supplies) Capital Outlay (furniture, equipment, books) Subtotal Salaries and Operating Expenses (Industrial Safety & Health, KDHR) Allocated Overhead and Data Processing Support (KDHR) Assessments Paid to General Fund, Dept. of Administration Subtotal Total Estimated FY2002 Expenditures $4,907,672 $1,316,203 $92,445 $275,000 $6,591,320 $632,844 $1,300,000 $200,000 $2,132,844 $8,724,164
The State of Kansas operates on a fiscal year that begins July 1 each year and ends on June 30 of the following named year. The law requires our Division to annually remit 20 percent (not to exceed $200,000), of all collected monies, to the Department of Administration in payment of services extended to us by them. The Division also pays an annual assessment to the Department of Human Resources, based on services provided.
Table 1-2 SELF-INSURANCE SUMMARY FY01 FY00 FY99 Employers' New Applications Approved Canceled Permits Qualified Employers Group-Funded Pools in Force 27 17 250 15 21 24 240 15 13 27 243 15
FY98 17 37 257 16
FY97 26 29 277 23
FY96 20 42 280 23
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Kansas Division of Workers Compensation
Annual Statistical Report
2001
INDUSTRIAL SAFETY & HEALTH SECTION
PRIMARY FUNCTIONS
§
§
§
§
§
§
21(d) CONSULTATION: offers assistance to private sector employers in safety and health program evaluations. Consultants offer advice in the recognition, evaluation, and control of hazards in the workplace. Assistance with program initiation and development is available. Training, both formal and informal, is performed in all areas of safety and health. All services are at no cost to the client. PUBLIC SECTOR COMPLIANCE: monitors the public sector--cities, counties, state agencies, and school districts--by performing compliance audits under KSA 44-636. Occupational hazards are identified and program elements are assessed. Hazards must be abated within 60 days. Investigations of employee complaints, near misses and fatalities are also conducted. ACCIDENT PREVENTION: evaluates insurance companies to ensure that they are offering safety and health services to their insureds as required by law. The quality and quantity of these services are evaluated by trained consultants by directly reviewing insurance company records. An annual report is c ompleted each year and forwarded to the insurance commissioner. BOILER SAFETY INSPECTIONS: performs periodic state-certified regular and special inspections of all boilers--private and public--as required by law. Boiler safety has a high priority as indicated under KSA 44-913 et seq. Boiler and pressure vessel manufacturers and repair firms are monitored. All new installations of pressure vessels in the state are inspected. Boiler safety has a high priority. The boiler program is fee funded. STATE WORKPLACE HEALTH & SAFETY: directs the establishment of health and safety programs in state agencies. Trained consultants perform inspections to identify hazards and assess program elements. Training is provided on a variety of occupational subjects from construction safety to office ergonomics. Employee complaints and accident investigations are also performed. SAFETY & HEALTH CONFERENCE COMMITTEE: plans and organizes the annual Kansas Safety & Health conference to bring industrial, academic, vendor, and government safety representatives together. The conference is self-supporting and seeks to address the relevant safety issues in a variety of workshops and presentations.
ACCOMPLISHMENTS
§ §
§
§
§ §
Performed 825 consultations over the most recent evaluation period; 4,120 hazards were identified, and 2,676 were classified as serious and were corrected. Performed public sector inspections in 155 cities, counties, school districts, and other establishments; 1,008 discrepancies were identified and corrected. 22 employee complaints were assessed and 3 public sector fatalities were investigated. More than 6,500 public sector employees were impacted by these inspections. Audited 202 workplaces with 15,096 employees under Accident Prevention. There were 1,540 types of hazards identified. Of the 134 insurance companies doing business in Kansas during FY2001, 132 reported that $6,616,043 had been spent on accident prevention services for Kansas employers. This included 10,534 inspections, 194 industrial hygiene studies, and 950 training programs. Conducted 3,964 boiler inspections during FY2001 which resulted in $317,440 in inspection fees. Additionally, sixteen shop reviews and 30 special inspections were conducted which brought in $9,245 and $13,971 respectively. The state general fund received 20 percent of these funds or $48,291 from these funds. During this year, nearly 10,000 certificates were issued. Performed 204 inspections of state agencies with 8,233 affected employees. During the course of these inspections, 1,872 hazards were identified and abated. Hosted 383 attendees at the 51st Annual Safety and Health Conference in Wichita, Kansas.
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Kansas Division of Workers Compensation
Annual Statistical Report
2001
INDUSTRIAL SAFETY & HEALTH SECTION
OBJECTIVES
§ § § § §
Complete 600-800 consultations under the 21(d) Consultation Program. Perform 200 compliance visits of cities, counties, and school districts. Respond to all public sector complaints and perform investigations of all fatalities and near misses. Increase the number of Accident Prevention audits to 400 and offer assistance to insurance carriers for improving the quality of safety and health services through an internship program. Establish health and safety programs in two state agencies with properly trained personnel. Conduct 3,400 boiler inspections, issue 10,000 certificates, and inspect all new boiler and pressure vessel installations in the state.
Figure 1-1
Industrial Safety & Health Administrative Activity
4500 3964 4000 3500 3000 Total Number Consultations 2500 2000 1500 1000 469 500 0 FY1999 FY2000 FY2001 231 331 119 175 812 268 93 825 Public Sector Inspections Workplace Audits Boiler Inspections State Agency Inspections 3377 3678
175 202
204
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Kansas Division of Workers Compensation
Annual Statistical Report
2001
JUDICIAL SECTION
PRIMARY FUNCTIONS
§ § §
Provide timely hearings in contested workers compensation claims. Issue a written decision within five days of the preliminary hearing. Issue an award following the regular hearing within 30 days of submission of the evidence.
ACCOMPLISHMENTS
§ § § §
§
Continued to provide technical training for several administrative law judges at the National Judicial College. Continued to effectively manage significant caseloads with a large number of preliminary, regular and post-award hearings. Continued implementation of a uniform policy for scheduling and holding preliminary or motion hearings within 21 days of the request for hearing. Continued educational outreach to the public about the workers compensation laws and fostered better understanding of the workers compensation judicial procedure. This was accomplished by several administrative law judges accepting public speaking invitations. Continued management training for all administrative law judges to assist in the efficient operation of each regional office.
OBJECTIVES
§ § § § § §
Continue to upgrade the section's information processing technology and to help the adminis trative law judge research, and to assist their staff in meeting production and record retention requirements. Provide additional training for the judicial section staff in order to efficiently accomplish the primary functions of the section. Implement a meeting schedule for the administrative law judges to discuss methods to enact systemic change in order to continue to provide timely hearings and decisions. Increase outreach programs to educate the public and eliminate myths concerning the workers compensation judicial process. Continue to provide additional technical training for the administrative law judges at judicial colleges. Continue having offices test new software applications to assist and improve performance of judicial duties.
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Kansas Division of Workers Compensation
Annual Statistical Report
2001
JUDICIAL SECTION
Table 1-3 ADMINISTRATIVE LAW JUDGES' CASE ACTIVITY
Cases Assigned Awards Agreed Awards Preliminary Hearing Held Regular Hearing Held Settlement Hearing Held Motion Hearing Held Post-Award Hearing Held Pre-Hearing Settlement Conference Held Case to Inactive Status Case Reinstated Cases Submitted for Decision Preliminary Awards Granted Temporary Total & Medical Temporary Total Medical Preliminary Order Preliminary Awards Denied Temporary Total & Medical Medical Additional Medical Miscellaneous Orders Orders to Inactive Docket Settlement of Cases Set for Hearing Settlement of Cases Not Set for Hearing
Source: Kansas Division of Workers Compensation
6,749 414 561 1,984 701 290 327 39 4,208 3,273 564 378 1,555 438 201 579 337 218 122 84 12 5,462 3,273 4,608 3,847
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Kansas Division of Workers Compensation
Annual Statistical Report
2001
WORKERS COMPENSATION APPEALS BOARD
PRIMARY FUNCTIONS
§ § § Responsible for providing de novo review of administrative law judge decisions appealed in workers compensation matters. Responsible for deciding all appeals from a final order or award. Jurisdiction of preliminary hearing appeals is limited to certain issues. Responsible for insuring that decisions are made in compliance with existing workers compensation laws and regulations.
ACCOMPLISHMENTS
§ § § Reduced the amount of time required from appeal to decision. Issued 525 decisions involving both awards and orders during the period July 1, 2000, through June 30, 2001. The board received 616 total appeals during this period of time. The total dismissals were 67. Continue to maintain and update the Workers Compensation Appeals Board Index of Decisions Web site. The Index is a quick reference and research tool supplementing the Division of Workers Compensation web site by accessing select Board decisions. The Web address is: www.wcboard.hr.state.ks.us. The Index is broken out into three separate sections. The Keyword Index and Table of Contents sections contain workers compensation topics that are each assigned a subsection number. Once a topic and corresponding subsection number are picked users can go to the Case Summaries section, which contains summaries of relevant Board decisions arranged by subsection numbers. The site includes a search engine and among other choices, allows users to: 1) calculate days/weeks when figuring awards, 2) look up frequently asked questions (FAQs), and 3) convert case names into docket numbers to access the full-text version of the Board's decisions.
OBJECTIVES
§ § Continue to work with the Director's office to implement rules and regulations that will simplify the appeal process and reduce the time between the filing of the application for review and the decision by the Board. Continue to reduce the time between the appeal and the Board's written decision.
Visit the Workers Compensation Appeals Board Web site at: www.wcboard.hr.state.ks.us
20
Kansas Division of Workers Compensation
Annual Statistical Report
2001
FRAUD & ABUSE SECTION
PRIMARY FUNCTIONS
§ § § § Created to combat fraudulent activities by claimants and to prevent abusive practices by respondents. Investigates alleged violations of the Workers Compensation Act. If a violation of the Act is discovered, the section attempts to pursue administrative remedies when appropriate. In certain cases, the section may ask county or district attorneys to file criminal charges. Reports other criminal activities discovered through its investigations. When appropriate, this section turns cases over to the Kansas Bureau of Investigation, Kansas Insurance Department or appropriate Federal & State authorities. Works with the Division's Compliance section to ensure that Kansas employers maintain the proper amount of workers compensation insurance as prescribed by law.
ACCOMPLISHMENTS
§ § § Investigated more than 1,000 alleged fraudulent or abusive acts. Filed numerous administrative actions. Many of these resulted in restitution paid to the victims, or fines paid to the Division. Conducted investigations that resulted in an increase during FY2001 in the number of criminal cases filed by county or district attorneys around the state. Disposition in many of these cases resulted in restitution by the defendant, and in some cases jail or probation time as well.
OBJECTIVES
§ § § Continue high standards of investigation and ensure the continued prosecution of criminal activity. Encourage County and District Attorneys to file more criminal proceedings against those who violate the Workers Compensation Act. Continue the positive working relationship that this section has with other law enforcement agencies as well as other sections of the Division. Continue educational programs designed to explain what workers compensation fraud is, what its costs are, and how to combat it.
§
FRAUD HOTLINE 1-800-332-0353 24hrs/day 1-785-296-6392 8:00-5:00
FRAUD E-MAIL ADDRESS [email protected]
21
Kansas Division of Workers Compensation
Annual Statistical Report
2001
APPLICATIONS SECTION
PRIMARY FUNCTION
§ Processing applications for hearings, including the creation of the physical docket file and the coding of information for entry into the Web-based database, which generates notices to all parties involved with each case.
ACCOMPLISHMENTS
§
Processed each preliminary hearing application in three or less days. There were 6,946 preliminary hearing applications and 6,228 applications for a regular hearing during FY2001. Assignment of an administrative law judge was made for each case, and notices were printed for all parties involved. There were 54 applications for a surviving spouse or dependent hearing filed with this unit. A total of 2,307 "miscellaneous" applications were processed by the unit and include all applications for amendments, review and modification, penalties, insolvent impleading, corrections, post-award medical, and returned notices.
OBJECTIVES
§ §
Continue to provide outstanding service to both internal and external customers. Develop a plant to implement an imaging system to process accident reports and other documents in the Division.
22
Kansas Division of Workers Compensation
Annual Statistical Report
2001
COVERAGE & COMPLIANCE SECTION
PRIMARY FUNCTIONS
There are currently two Units within the Coverage & Compliance Section. They include the following: § Compliance - Ensure all employers doing business in Kansas are in compliance with and aware of their responsibilities regarding the Workers Compensation Act. Enforce proof of coverage and compliance requirements. § Accident Reporting - Research and confirm illegible, incorrect or incomplete information received on accident report forms and prepare the corrected information for further processing.
ACCOMPLISHMENTS
§ Compliance - Established more than 7,214 contacts regarding proof of coverage. Of these, 704 were required to obtain new coverage and 1,069 were starting new businesses in Kansas that this section investigated. Enforcement efforts ensured the employee a safe and protected work environment. In doing so, it generated more than $1,260,000 in additional premiums for the insurance industry. Accident Reporting - A keen eye for detail enabled the Accident Reporting Unit to research, confirm, and process more than 1,590 illegible, incorrect, or incomplete accident reports.
§
OBJECTIVES
§ § § Expand the Coverage & Compliance Section to meet the growing need of the business community. Establish electronic data reporting between NCCI and Contributions and develop a plan to improve the processing of accident reports. Maintain cooperation between various state and national entities.
23
Kansas Division of Workers Compensation
Annual Statistical Report
2001
DATA COLLECTION SECTION
PRIMARY FUNCTIONS
§
Reviews awards, settlements, and final receipt and releases of liability data of amounts paid for temporary total and permanent partial disability, attorney fees, and medical costs. This unit prepares all cases, which are being sent to the Court of Appeals, for mailing.
ACCOMPLISHMENTS
§
Collected information on dollar amounts, type of payments made, body part being compensated, percent of disability rating, and attorney fees; information was collected from 377 awards, 560 agreed awards, 8,495 settlements, 69 joint petition and stipulations, and approximately 161 final receipt and release of liabilities. Court reporter fee information was also collected.
OBJECTIVES
§ §
Continue to provide outstanding service to customers in and out of the Division. Develop a plan to implement an imaging system to process accident reports and other documents in the Division.
DATA ENTRY SECTION
PRIMARY FUNCTIONS
§ § Codes and enters data into a computerized database, from all accident reports filed with the Division.
Data Entry - Assure all accident reports received are accurately coded and keyed into the Web-based database system in a timely fashion.
ACCOMPLISHMENTS
§ Coded and entered into the mainframe computer 92,248 accident and disease reports during this fiscal year. Codes provide information such as body part, cause, nature, and source of the injury. Carrier and employer information is also gathered from accident reports filed. The reports entered also generate labels for letters to the injured workers, answering questions about benefits and procedures. Statistics for the annual statistical report are made available from the information on the accident reports.
§
Data Entry - Diligent effort put forth by the three Data Entry staff ensure the accident reports are accurately coded and keyed. Future statistics and all accident reporting information is based on the exceptional coding and keying skill of the Data Entry staff.
OBJECTIVES
§ § § Code and enter all accident reports within three days of receipt in the office. Continue to provide outstanding service to customers in and out of the Division. Develop a plan to implement an imaging system to process accident reports and other documents in the Division.
24
Kansas Division of Workers Compensation
Annual Statistical Report
2001
MEDIATION SECTION
PRIMARY FUNCTIONS
§ § §
Provide parties a means of resolving disputes in an informal and non-adversarial atmosphere. Assist parties in resolving their disputes. Provide mediation conferences in a timely manner.
ACCOMPLISHMENTS
§ § § Maintained a mediation process that is user friendly and responsive to our customers' needs. Conducted mediation conferences in a timely manner (within seven days or as requested by the parties). Provided educational training to insurance carriers on the benefits of using the mediation process as a means of resolving disputes.
OBJECTIVES
§ § § § Educate the public on the benefits of using mediation as a means of resolving disputes. Increase the use of the mediation process. Provide cost savings to the workers compensation system by reducing the number of issues being litigated. Implement video conferencing technology within the mediation process.
25
Kansas Division of Workers Compensation
Annual Statistical Report
2001
MEDICAL SERVICES SECTION
PRIMARY FUNCTIONS
§
§ §
Administration of the medical fee schedule. The schedule of maximum fees is to be current, reasonable, and fair. Revision of the schedule is required, as necessary, every two years, in order to promote health care cost containment, yet insure the availability of necessary treatment and care for injured employees. Administration of plans for both utilization review and peer review of health care services. Act as a liaison between health care providers, attorneys, employers, employees, and insurance carriers or self-insured businesses.
ACCOMPLISHMENTS
§ § Completion of a new medical fee schedule revision, while retaining the conversion factors and relative value units with appropriate modifications. Issuance of the revised schedule is planned for December 1, 2001. Refinement of a Diagnosis Related Group (DRG) based prospective payment system for hospital inpatient services. The payment system was developed as a cooperative effort between the Division and the Kansas Hospital Association, utilizing a steering committee with representation from the health care and business communities. Refinement of the present Workers Compensation health care database development, with quarterly updates to remain current with plans for related cost containment. Implementation and refinement of regulations for hearings in Workers Compensation cases which involve health care utilization review and/or peer review. Formation and implementation of a new cooperative plan for an extended health care database system utilizing resources of both the Kansas Division of Workers Compensation and the Kansas Department of Health and Environment.
§ § §
OBJECTIVES
§ § § Develop, during the next several years, an Ambulatory Patient Group (APG) based prospective payment system for hospital outpatient services. This system would utilize experience from the APG-based system recently implemented by Medicare as a new payment system. Implement legislative proposals requiring that hospital data be submitted to the Division of Workers Compensation for expanded database development. This database will be utilized in future revisions of the medical fee schedule. Implementation of an updated CD-ROM version of the new medical fee schedule, planned for late 2001 or early 2002.
26
Kansas Division of Workers Compensation
Annual Statistical Report
2001
OMBUDSMAN/CLAIMS ADVISORY SECTION
PRIMARY FUNCTIONS
§ § §
Assist injured workers, employers, and other parties to protect their rights under the workers compensation act. To provide technical assistance to all parties on workers compensation. Assist unrepresented claimants in obtaining a hearing, mediation or appeal.
ACCOMPLISHMENTS
§ § § § § §
Provided a point of contact for all parties to clarify issues and obtain information. Handled contacts included general information, specific issues regarding reported and unreported accidents, and site visits to employers. Provided educational opportunities for several employers and insurance groups, including employers in the assigned risk pool. Increased public awareness of resources for parties needing presentations of workers compensation. Provided technical assistance to employers through on-site visits and training. Established a set of protocols and guidelines for services to employers.
OBJECTIVES
§ § § §
Increase employer contacts by providing more training to employer groups and making more on-site visits to employers who need assistance. Increase the section's ability to initiate contact with injured workers to see if appropriate information is being received as required by statute. Increase public awareness of the availability of ombudsmen assistance in alternative dispute resolution. Develop a reporting system to track number and types of individuals reached by presentations and on-site visits.
27
Kansas Division of Workers Compensation
Annual Statistical Report
2001
OMBUDSMAN/CLAIMS ADVISORY SECTION
Figure 1-2 FY2000-FY2001 OMBUDSMAN CONTACTS
Total Contacts Omb Files Miscellaneous Health Care Attorneys Insurance Agents Insurance Carriers Employers Employees 0 5000 10000 4197 3310 2058 858 901 1296 1430 778 521 1570 1966 3484 3176 13253 13836 15000 20000 25000 30000 35000 28746 30416 6528
FY2000
FY2001
28
Kansas Division of Workers Compensation
Annual Statistical Report
2001
REHABILITATION SECTION
PRIMARY FUNCTIONS
§ § § § Coordinates vocational rehabilitation services for injured workers when the insurance company/employer elects to provide services. Refers injured workers to the Division of Rehabilitation Services, in the Kansas Department of Social and Rehabilitation Services, when the insurance company/employer elects not to provide services. Monitors the effectiveness of both private and public vocational rehabilitation services for injured Kansas workers. Provides technical assistance for private and public vocational rehabilitation providers by telephone and personal visits.
ACCOMPLISHMENTS
§ Received 983 medical management referrals with 677 closures. There were 153 vocational rehabilitation referrals with 141 closures during FY2001. At the end of FY2001, there were 47 active rehabilitation cases. There were 893 medical management cases active with the Division at the end of FY2001. There were a total of 30 injured workers returned to work. Informed 215 injured workers of vocational options available through the private and/or public sector vocational services. At the end of FY2001, 97 of these referrals were in rehabilitation plans and 6 were successfully employed. These referrals were made to Kansas Rehabilitation Services and out of state vocational rehabilitation agencies. Provide d technical assistance for Kansas Division of Rehabilitation Services staff members through presentation and individual consultation. Researched vocational rehabilitation services for 41 out of state residents and referred them to appropriate programs. Consulted with insurance providers, employers, and attorneys about individual cases and appropriate vocational option/services. Established a close working relationship with a major Kansas employer assisting the return to work using vocational plans for returning to the same employer.
§
§ § § §
OBJECTIVES
§ § § § Increase public awareness of the vocational assistance available through the Rehabilitation Section. Continue to educate insurance providers, employers, attorneys, and injured workers of the options and resources available through vocational rehabilitation. Increase the provision of information to all parties and coordinate informational resources with the Ombudsman section. Increase referrals to various vocational service options.
29
Kansas Division of Workers Compensation
Annual Statistical Report
2001
RESEARCH SECTION
PRIMARY FUNCTION
§ Searches through computerized and hard copy files for the workers compensation histories of injured workers, to provide copies of documents to appropriate parties.
ACCOMPLISHMENTS
§
Responded to more than 37,000 requests from attorneys, insurance carriers, and employers for workers compensation claimant histories .
OBJECTIVES
§ §
Keep turnaround time for research requests to within four days. Continue to provide outstanding service to customers in and out of the Division.
FY2001 Requests for Information from the Research Section
Insurance Social Attorneys Company Walk-ins Security 643 212 10 714 281 5 742 238 1 797 241 4 747 230 0 606 239 1 811 287 3 730 311 3 835 398 1 795 303 2 845 367 1 833 324 1 9098 36.25 3431 13.67 32 0.13 Kansas Insurance Employers Dept Misc. 1 1720 74 4 2166 5 4 1931 5 1 1962 6 2 1858 6 2 1532 6 0 1924 10 0 2078 2 0 2261 7 2 1946 3 5 3007 6 0 2696 0 25081 99.92 130 0.52
Table 1-4
Month
July August September October November December January February March April May June Total Requests For Year Average Requests Per Day
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0.00 2660 3175 2921 3011 2843 2386 3035 3124 3502 3051 4231 3854 37793 150.57
21 0.08
30
Kansas Division of Workers Compensation
Annual Statistical Report
2001
TECHNOLOGY & STATISTICS SECTION
PRIMARY FUNCTIONS
§ §
§
Responsible for working with a database developer to implement the transition from a mainframe system for Workers Compensation to a Web-based, client-server system. Responsible for research studies mandated by statute, including studies of closed claims and the effectiveness of the Workers Compensation Act. The section performs program evaluations as requested, including design of survey instruments, data collection, statistical analysis, and reporting. It responds to individual research requests from internal and external customers. Responsible for providing workers compensation information to the public and legislature through an annual statistical report, periodic Division newsletter, Internet Web site, and outcome reports form research studies/evaluations. The staff maintains a database of information on work-related accidents in Kansas.
ACCOMPLISHMENTS
§
§
§ § § § §
Reviewed the proposals received from vendors for client server system design, planning and cost estimates, in association with staff in the DHR Information Systems unit. The contract was awarded in November 2000. Participated with the selected vendor in identifying screens and reports needed for the Division, based on the feasibility report from 1999. The unit also arranged meetings between the vendor and Division supervisors to ensure business needs were addressed. Published the annual report for the Division, containing statistical data on closed claims derived from a recent sample of insurers. Published a new edition of the Workers Compensation book of law and regulations. Processed medical fee data received from insurance carriers and self-insured employers. Completed many specialized research projects in response to external customer inquiries. Continued to add to and improve the agency's Web site, including the Spanish Web page, and made all Division forms available.
OBJECTIVES
§ § § §
§
Complete in partnership with a database vendor the migration of the Workers Compensation mainframe database to a Web-enabled, client-server environment. Publish and distribute an annual statistical report to more than 900 interested parties. Continue to conduct statistical searches and prepare reports for internal and external customers. Continue to accept accident reports electronically and start a three-year plan for increasing the number of insurance carriers, group pools, and self-insured employers submitting their accident reports electronically. The section will continue to participate in a national project to decide standards for electronic reporting of accidents. Continue to collect medical fee data to help the Medical Fee section in analyzing appropriateness of the medical fee schedule. Technology & Statistics staff is preparing to implement a system to monitor compliance, and ensure reporting as prescribed by law.
31
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Section 2
Incidence of Workplace Injury & Illness in Kansas
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
The state of Kansas has a compelling interest in the safety, health & productivity of its workforce. An important aspect of that commitment is the Division's daily monitoring of the workplace environment and periodic analysis of the incidence and severity of occupational injuries & illnesses within the state. Every year the Division publishes its decision support data for the Legislature and interested parties. In the first part of this section we report on many aspects of occupational injuries & illnesses in the state of Kansas for fiscal year 2001- including the causes, nature & source, industries & counties in which they occur and the body member implicated in the reported injuries & illnesses. Next, we briefly discuss the widely reported private industry injury incidence rates published by the federal Bureau of Labor Statistics (BLS) of the United States Department of Labor and the Kansas Department of Health & Environment (KDHE) and compare & contrast our calculated incidence rates for "non-federal" employment in the state of Kansas for the last ten fiscal years with those of BLS.
Occupational Injuries & Illnesses in Kansas
Kansas classifies nonfatal occupational injuries, according to severity, as "no time lost," "time lost," and "hospitalized." "Time lost" injuries are those that "incapacitate the person injured from labor or service for more than the remainder of the day, shift or turn." "No time l st" injuries are defined as those in o which the employee did not miss work beyond the remainder of the day, shift or turn. Injuries requiring "hospitalization" are reported as well as workplace injuries & illness resulting in death ("fatal"). In other words, the most severe types of occupational injury or illness are classified as "fatal" while the least severe are reported as "no time lost" cases. Table 2 contains the aggregate totals (by severity) of -1 Kansas's occupational injuries & illnesses for the last ten fiscal years.
§
§ § §
§ §
There were 87,969 occupational injuries & illnesses reported to the Division of Workers Compensation during FY2001. The FY2001 total, including fatalities, represents a decrease of slightly less than 1,000 reported injuries & illnesses or a 1.1 percent decrease from last year's total. From another perspective 241 employees per day were either injured or killed on the job in Kansas last fiscal year. Workplace fatalities, the most severe type of injury, decreased 25 percent from the previous year and the number of reported deaths (52) was below the ten-year average of 62 reported cases. The 67,578 "no time lost" injuries & illnesses reported constitute 77 percent of all reported injuries & illnesses. "No time lost" injuries are down 5 percent from the previous year's numbers. "Time lost" injuries & illnesses totaled 17,687, a 25 percent increase (an increase of 3,640) from the previous year but considerably less than the reported totals from FY1992-FY1995. Injuries & illnesses that required hospitalization (2,652) were down 22 percent from last fiscal year.
One limitation of reported aggregate totals is that they do not account for year-to-year changes in the workforce population. Perhaps the least sophisticated benchmark statistic for comparing year-to-year totals without controlling for workforce population increases would be to calculate the percentage of total injuries & illnesses that resulted in "no time lost," "time lost," "hospitalization" and in fatality. The rationale being that the state has an interest in knowing what percentage of total injuries & illnesses constitute the range of severity that either disrupt labor participation or that result in death.
§
In FY2001 77 percent of total injuries & illnesses classified as "no time lost," down just over 3 percent from the ten-year high in FY2000 (80 percent).
33
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
§ § § § §
The data in Table 2-2 show that the percentage of "no time lost" injuries, the least severe of the four categories, as a percentage of total injuries has increased by over 23 percent from FY1992. "Time lost" injuries account for roughly 20 percent of total injuries in FY2001 and this constitutes a decrease of over 24 percent from FY1992. As a percentage of total injuries and illnesses over the past ten fiscal years "no time lost" cases have increased by 23 percent while "time lost" injuries have decreased by over 24 percent. Workplace fatalities have historically accounted for less than 1/10,000 of a percent of total injuries & illnesses. The percentage of "hospitalization" cases has historically hovered between two and five percent of total injuries with the notable exception of FY1998 (24 percent) & FY1999 (27 percent). The explanation for the sudden spike in "hospitalization" cases is due to administrative error in the coding of data at the point of entry into the Division's mainframe.
Below we discuss the incidence rate per 100 full-time equivalent workers in order to do a fair year-to-year comparison.
Table 2-1 Kansas Total Occupational Injuries & Illnesses By Severity FY1992-FY2001
Fiscal Year 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992
No Time Lost Time Lost Hospitalized Fatal Total Inj/Ill
67,578 71,440 64,121 68,218 75,795 66,860 58,510 51,954 55,269 48,140
17,687 14,047 6,256 7,457 19,004 24,979 47,537 49,104 46,331 40,385
2,652 3,409 25,829 24,218 5,658 2,721 2,813 2,422 2,242 2,072
52 70 68 63 71 67 70 57 49 54
87,969 88,966 96,274 99,956 100,528 94,627 108,930 103,537 103,891 90,651
Source: Kansas Division of Workers Compensation
Table 2-2 Severity of Injury & Illness as Percentage of Total Injuries & Illnesses FY1992-FY2001
Fiscal Year 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992
No Time Lost Time Lost Hospitalized Fatal Total Inj/Ill
0.768 0.803 0.666 0.682 0.754 0.707 0.537 0.502 0.532 0.531
0.201 0.158 0.065 0.075 0.189 0.264 0.436 0.474 0.446 0.445
0.030 0.038 0.268 0.242 0.056 0.029 0.026 0.023 0.022 0.023
0.000591 0.000787 0.000706 0.000630 0.000706 0.000708 0.000643 0.000551 0.000472 0.000596
87,969 88,966 96,274 99,956 100,528 94,627 108,930 103,537 103,891 90,651
Source: Kansas Division of Workers Compensation
34
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
Occupational Injuries & Illnesses by County
§ § §
§
As expected, counties with the largest population totals report the greatest number of occupational injuries & illnesses (see Table 2-3). Kansas's largest city, Wichita, is located in Sedgwick County, which reported the most number of cases. Johnson County, part of metropolitan Kansas City, includes the second and fifth largest cities in Kansas (Overland Park and Olathe respectively) and reported the second largest number of total injuries & illnesses. 72 percent of the total injuries & illnesses reported in Sedgwick County & 75 percent of total cases from Johnson County resulted in no time lost from work. Shawnee County, which includes the capital of Topeka, had the third largest number of reported total cases.
The aggregate totals for all Kansas counties are listed in Table 2-15.
Table 2-3 Counties Reporting Greatest Number of Total Injuries & Illnesses FY2001
County SEDGWICK JOHNSON SHAWNEE UNKNOWN WYANDOTTE DOUGLAS SALINE RENO MONTGOMERY FINNEY
No time Lost Time Lost Hospitalized Fatal Total Inj/Ill
10,037 10,039 4,762 4,968 3,756 2,052 2,201 1,679 1,350 1,306
3,096 3,013 1,253 931 1,128 502 385 414 372 380
746 280 180 216 86 72 26 45 97 70
6 4 5 6 2
1 1
13,885 13,336 6,200 6,121 4,972 2,626 2,612 2,139 1,819 1,757
Source: Kansas Division of Workers Compensation
Source of Occupational Injury & Illness
§ § §
The most frequent source of both total occupational injuries & illnesses and "not time lost" cases are classified as "miscellaneous" (See Table 2-4). Interestingly enough, the most frequent source of "time lost" injuries is not classifiable by Division staff for a multitude of reasons. Boxes, barrels, containers and other employees continue to constitute a large source of total injuries & illnesses.
The aggregate totals for all types of sources of injury & illness are listed in Table 2-16.
35
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
Cause of Occupational Injury & Illness
§ § §
The physical act of lifting is the most frequent cause of occupational injury for "total injuries & illnesses," "no time lost" & "time lost" cases (See Table 2-5). 25 percent of lifting injuries result in time lost for the injured worker while only 2 percent required hospitalization. Just over 11 percent of cumulative injuries require hospitalization, the highest percentage of any of the Division's cause of injury categories.
The aggregate totals for all causes of injury & illness are listed in 2-17.
Table 2-4 Most Frequent Source of Occupational Injuries & Illnesses (by Total Inj/Ill) FY2001
Source of Injury & Illness MISC.(EARPLUGS,SHEETROCK ETC) BOXES,BARRELS,CONTAINERS,PKGS PERSON, OTHER THAN INJURED BODILY MOTION NOT IN TABLE FURNITURE,FIXTURES METAL ITEMS, UNS ICE, SNOW NO EXPLANATION FLOOR
Source: Kansas Division of Workers Compensation No Time Lost Time Lost Hospitalized Fatal Total Inj/Ill
6,852 4,242 4,585 2,747 54 2,731 2,718 2,473 2,278 2,162
1,356 1,385 766 895 3,138 611 539 550 536 531
208 105 86 52 450 60 73 58 75 65
4
1 1
8,420 5,732 5,437 3,694 3,642 3,402 3,331 3,082 2,889 2,758
Table 2-5 Most Frequent Cause of Occupational Injuries & Illnesses (by Total Inj/Ill) FY2001
Cause of Injuries & Illnesses LIFTING OTHER INJURY (NOT CLASSIFIED) ON SAME LEVEL OBJECT BEING LIFTED OR HANDLED HAND TOOL, UTENSIL; NOT POWERED FALLING OR FLYING OBJECT CUMULATIVE INJURY (NOT CLASSIFIED) FOREIGN BODY IN EYE REPETITIVE MOTION PUSHING OR PULLING
Source: Kansas Division of Workers Compensation No Time Lost Time Lost Hospitalized Fatal Total Inj/Ill
6,888 6,851 5,392 4,096 3,871 3,329 2,519 3,076 2,784 2,521
2,415 1,487 1,263 1,120 596 793 672 463 632 798
193 271 194 128 89 128 405 49 50 70
6 1
2 9
9,496 8,615 6,850 5,344 4,556 4,252 3,605 3,588 3,466 3,389
36
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
Nature of Occupational Injury & Illness
§ § §
15,957 reports of occupational injuries, or 18 percent, filed with the Division failed to include an explanation of the nature of the occupational injury or illness (See Table 2-6). Of the accident reports filed that did include an explanation strains and lacerations are the two most common types of injurie s reported. 72 percent of the reported strains and over 82 percent of reported lacerations did not result in lost work time
The aggregate totals for all natures of injury & illness are listed in 2-18.
Table 2-6 Most Frequent Nature of Occupational Injuries & Illnesses (by Total Inj/Ill) FY2001
Nature of Illnesses & Injuries NO EXPANATION STRAIN LACERATION ALL OTHER CONTUSION OTHER CUMULATIVE INJURIES FOREIGN BODY PUNCTURE INFLAMMATION SPRAIN
No Time Lost Time Lost Hospitalized Fatal Total Inj/Ill
12,690 9,529 9,978 8,980 5,886 3,507 3,170 2,919 2,545 2,220
2,805 3,387 1,795 2,774 1,541 1,071 488 366 539 722
450 249 316 216 143 528 41 75 46 56
12 1 4 24 1 1
15,957 13,165 12,090 11,974 7,570 5,130 3,699 3,361 3,130 2,999
Source: Kansas Division of Workers Compensation
Body Member Associated with Occupational Injury & Illness
Table 2-7 lists the body member most frequently associated with reported occupational injuries & illnesses for FY2001.
§ § §
Injuries & illnesses involving multiple body parts constitute the greatest number of total reported cases. In cases where a single body part is implicated a worker's fingers is most often reported as the injured body member. Of cases involving fingers 82 percent result in no lost time while only 15 percent require time away from work. In contrast, 70 percent of injuries involving the low back are "no time lost" cases while just over 27 percent result in time lost for the worker
The aggregate totals for all body members associated with injury & illness are listed in 2-19.
37
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
Table 2-7 Body Member Most Frequently Associated with Occupational Injuries & Illnesses (by Total Inj/Ill) FY2001
Body Member MULT. BODY PARTS FINGER(S) LOW BACK (LUMBAR) MULT. UPPER EXTREMS. KNEE HAND EYE(S) WRIST UPPER ARM THUMB
No Time Lost Time Lost Hospitalized Fatal Total Inj/Ill
9,086 7,671 5,770 4,199 3,961 4,186 4,260 2,943 2,460 2,551
2,441 1,435 2,237 977 1,253 866 724 735 761 432
492 263 154 205 119 143 89 112 58 80
31
1
12,050 9,369 8,161 5,381 5,334 5,195 5,073 3,790 3,279 3,063
Source: Kansas Division of Workers Compensation
Industries with Greatest Number of Total Occupational Injuries & Illnesses
Table 2-8 lists the industries in Kansas that reported the greatest number of total occupational injuries & illnesses to the Division of Workers Compensation over the past year.
§
§
§ §
State and local public sector employment ranks first for FY2001, however, of the reported injuries & illnesses 81 percent were "no time lost" cases while only 15 percent constituted "time lost" cases and 2 percent required hospitalization. The health services industries reported the second largest number of total injuries & illnesses but 87 percent were no lost time cases while only 12 percent resulted in an interruption in employment. The third ranked industry, educational services, reported 4,242 less total cases than health services but had a similar percentage of "no time lost" injuries & illnesses (87 percent). Of the industries listed in Table 2-8 six- the public sector, health services, educational services, business services, eating & drinking places and general merchandising stores- are service oriented and tend to be more labor intensive than tradition manufacturing. We would expect that more injuries & illnesses would be associated with industries employing large numbers of Kansans and the top four ranked industries for FY2001 seem to confirm this preliminary observation.
The aggregate totals for all industries are listed in Table 2-20.
38
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
Table 2-8 Industries with Greatest Number of Total Occupational Injuries & Illnesses FY2001
Industry Executive, Legislative, and General Government Health Services Educational Services Business Services Transportation Equipment Food and Kindred Products Eating and Drinking Places Construction - Special Trade Contractors Motor Freight Transportation and Warehousing General Merchandise Stores
Source: Kansas Division of Workers Compensation No Time Lost Time Lost Hospitalized Fatal Total Inj/Ill
8,381 8,007 4,342 3,796 2,899 3,730 2,837 2,579 2,161 1,335
1,531 1,067 556 986 1,396 936 914 934 1,133 933
248 150 84 106 538 112 93 136 97 201
5 1 1 5 2 4 6 2
10,165 9,225 4,983 4,893 4,833 4,780 3,844 3,653 3,397 2,471
Age and Gender Characteristics of Injured Workers
Tables 2-9 & 2-10 list the age and gender characteristics of injured workers for FY2001
§ § § § §
Men outnumber women in total occupational injuries & illnesses for FY2001 by 19,405 reported cases (see Table 2-9). However, as a percentage of total injuries men & women report a similar percentage of cases resulting in no lost time, 79 percent for women and 75 percent for men. The percentage of "time lost" cases for women numbered 18 percent while the percentage for men was slightly higher at 21 percent. Workers in their twenties (20,023) and thirties (20,612) report the greatest total number of injuries & illnesses to the Division of Workers Compensation for FY2001 (see Table 2-10). The 40-49 age stratum reported 19,559 injuries & illnesses, third most for the fiscal year.
Table 2-9 Occupational Injuries & Illnesses by Gender FY2001
Gender Female Male
No Designation
No Time Lost
Time Lost Hospitalized
Fatal
Total Inj/Ill
27,133 40,351 94
6,213 11,448 26
868 1,776 8
4 48
34,218 53,623 128
Source: Kansas Division of Workers Compensation
39
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
Table 2-10 Occupational Injuries & Illnesses by Age FY2001
Age
None Designated No Time Lost Time Lost Hospitalized Fatal Total Inj/Ill
19 & Under 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99
7,026 3,309 15,296 15,714 15,043 8,635 2,132 324 35 64
1,594 934 4,108 4,294 3,909 2,231 498 100 11 8
214 137 612 595 595 349 107 34 8 1
9 1 7 9 12 8 3 3 0 0
8,843 4,381 20,023 20,612 19,559 11,223 2,740 461 54 73
Source: Kansas Division of Workers Compensation
Kansas Occupational Injury & Illness Incidence Rates
BLS Survey of Occupational Injuries and Illnesses
The Survey of Occupational Injuries and Illnesses is a Federal/State program administered by the United States Department of Labor's Bureau of Labor Statistics (BLS) and cooperating state agencies throughout the nation. In Kansas the cooperating state agency that helps administer the survey is the Department of Health & Environment (KDHE). The annual survey measures the incidence rates of workplace injuries and illnesses for the nation as a whole, for each participating state, as well as case and injured worker demographic data (see Appendix A). "Total Lost Workday Cases" injuries & illnesses per 100 full-time workers is a statistic used to measure the incidence of injuries that meet the criterion of "lost workday." BLS defines a lost workday as "the number of workdays (consecutive or not) beyond the day of injury or onset of illness." This number includes both actual days away from work & employees assigned, due to the injury or illness, to restricted work activity 1 and is a proxy for measuring the severity of injury incurred by the employee. Its logical counterpart is "Cases Without Lost Workday Cases" which is defined as the obverse of injury resulting in time away from work or restricted work activity. It too is a proxy for measuring severity and would include any injury incurred that did not result in lost workdays or restricted activity. For example, if a Kansas employee were to cut their finger while preparing food and did not return for the rest of the day (presumably to receive medical treatment) but did return the following scheduled workday they would be designated as a "Case Without Lost Workday." In other words, no time is lost beyond the day of injury or onset of illness.
1
Restricted work activity includes assigning an employee to another job on a temporary basis, less than full-time employment or a reduction in duties for the position of which the injury occurred.
40
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
While it is true that there is no absolute acceptable level of injury incidence, relatively speaking, the lower the rate of injury the better. An important question is how should the average Kansan interpret the "Total Injuries & Illnesses" incidence rate? For example, if the incidence rate for total injuries & illnesses for Kansas for any given year is 5.3 injuries per 100 full-time workers would it be reasonable to conclude that roughly 5 percent of full-time workers suffered some sort of occupational injury that year? We believe that this would be a fair interpretation provided that we assume each worker within this 5.3 percent was injured only once during the year under study. In other words, for every one hundred full-time private sector workers in Kansas there were 5.3 injuries reported that year for our hypothetical example. If consumers of this information would want to know what occupations in Kansas are more at risk for injury than others then the total injury & illness incidence rate would not provide that information. They would need to consult the industry cluster estimates of injury incidence provided annually by the Kansas Department of Health and Environment or the non-federal incidence rates reported in the Kansas Division of Workers Compensation Annual Statistical Report (see below).
Findings of the BLS Survey of Occupational Injuries and Illnesses
§
§
§
§
§
§ §
§
BLS reported an incidence rate of 9.8 injuries & illnesses per 100 full-time workers for Kansas in 1994. That incidence rate dropped to a six-year low of 7.6 injuries & illnesses per 100 full-time workers in 1999, the most recent year of the survey (See Table 2-11). A six-year analysis of the "Total Injuries and Illnesses" incidence rate for the private sector in Kansas reveals a decrease in the frequency of occupational injury & illness every successive year (See Table 2-11). This is consistent with the national trend (yearly declines) in "Total Injury & Illness" incidence rates but Kansas still has a higher frequency of injuries than the national average for every year of the study. The "Total Lost Workday Cases" incidence rate for Kansas declines or remains level from 1994 (4.2 per 100 workers) to 1999 (3.6 per 100 workers). The Kansas numbers are slightly higher than the national average for each of the six years, which also has declined every year to a low of three lost workday injuries per 100 full-time workers. The "Lost Workday Cases with Days Away from Work" incidence rate for the Kansas private sector has dropped from 2.7 injuries & illnesses per 100 workers in 1994 to 1.9 per 100 workers in 1999 (Table 11). This trend in injuries resulting in days away from work mirrors what is occurring at the national level and is a good sign that the severity of the Kansas injuries are no greater than the national average. Figure 4 shows that the "Cases Without Lost Workdays" incidence rate in Kansas has declined from 5.6 injuries per 100 workers (1994) to 4 per 100 workers in 1999. Kansas has higher than average (national) rates for cases without lost workdays for every year of the study which indicates that a greater percentage of the state's total injuries & illnesses do not result in days away from work or restricted work activity. In other words, Kansas has a greater frequency of the less severe type of occupational injuries & illnesses. The data in Table 2 -11 show that the Kansas private sector has experienced a decrease in its occupational injury & illness incidence rates for all four major variables from 1994 to 1999. 2 The Kansas "Total Injuries & Illnesses" rate is down by 2.2 injuries & illnesses per 100 workers. Similarly, the national average for total injuries has decreased by 2.1 injuries & illnesses per 100 workers. "Total Lost Workday Cases" in Kansas has declined by 0.6 injuries & illnesses per 100 workers. The national average for the same incidence rate is down 0.8 injuries & illnesses.
2
1999 is the most recent incident rate data included at the time of the printing of this year's report.
41
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
§
§
Kansas "Lost Workday Cases with Days Away from Work" has remained fairly steady over the six-year period declining by only 0.8 injuries & illnesses per 100 workers. The national average for days away from work injuries and illnesses declined by 0.9 injuries over this same period. Finally, "Cases Without Lost Workdays" in Kansas are down by 1.6 injuries & illnesses per 100 workers from 1994 and the nation as a whole is experience a similar decline.
Table 2-11 Private Sector Kansas Occupational Injury & Illness Incidence Rate* 1994-1999
Total Injuries & Illnesses* Year National Average Kansas Total Lost Workday Cases* National Average Kansas Lost Workday Cases with Days Away from Work* National Average Kansas Cases Without Lost Workdays* National Average Kansas
1994 1995 1996 1997 1998 1999
8.4 8.1 7.4 7.1 6.7 6.3
9.8 9.7 8.9 8.6 8.5 7.6
3.8 3.6 3.4 3.3 3.1 3
4.2 4.2 4 4 3.7 3.6
2.8 2.5 2.2 2.1 2 1.9
2.7 2.5 2.2 2.1 1.9 1.9
4.6 4.4 4.1 3.8 3.5 3.3
5.6 5.5 4.9 4.6 4.8 4
Source: Bureau of Labor Statistics, U.S. Department of Labor *Per 100 Full-time Equivalent Private Sector Workers
Non-Federal Occupational Injury & Illness Incidence Rate in Kansas
The Division of Workers Compensation does not directly participate in the BLS survey but is an active consumer of its information. The Division believes that the private sector incidence rates provided by BLS and KDHE help augment both our annual report and our statutory obligation to monitor the workplace injuries & illnesses in the state for health and safety purposes. However, the Division does believe that it can contribute to the discussion on workplace injury incidence rates in Kansas for several reasons. First, employers covered under the Workers Compensation Act are required to report all employee occupational in juries & illnesses to the Division within 28 days of the date of injury or onset of illness. The Division has aggregated and reported this data in its annual statistical report for many years but has never published its calculated rates of incidence per 100 full-time equivalent employees. For the first time this year we report our own calculated occupational injury incidence rates (see Appendix A for methodology). Second, the Division does have an institutional advantage, relative to BLS and KDHE in that we, by law, are able to collect data on the entire population of workplace injuries & illnesses. The Division also has the authority to collect injury data on state & local public sector employees.3 This is
3
Under its commerce power granted by the Federal Constitution, and as interpreted by the United States Supreme Court (See U.S. v. Lopez, 514 U.S. 558-559 (1995); "three broad categories of activity that Congress may regulate under its commerce power...Congress may regulate the use of the channels of interstate commerce...Congress is empowered to regulate and protect the instrumentalities of interstate commerce, or persons or things in interstate commerce, even though the threat may come only from intrastate activities...Congress' commerce authority includes the power to regulate those activities having a substantial relation to insterstate commerce,...i.e., those activities that substantially affect interstate commerce."), the federal government can require employers to log all occupational injuries and illnesses and report them to BLS or OSHA. The Federal Constitution, however, does not
42
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
important because the state and local public sector workforce is one of the largest employers in Kansas and reports a significant percentage of the total workplace injuries & illnesses each year. Finally, it should be noted that the Division of Workers Compensation is able to publish its occupational injury statistics in a timelier manner than both BLS & KDHE. In this report we publish incidence rates for all employers covered under the Workers Compensation Act through fiscal year 2001 (up to and including June 30, 2001) whereas the most recent data available from BLS is through calendar year 1999 and from KDHE through calendar year 1998. We may be able to identify injury & illness trends more quickly and use this in-house information as a basis for targeting resources, through our Industrial Safety & Health Section, for injury prevention and/or safety education. The BLS measures of "Total Lost Workday Cases" and "Cases Without Lost Workdays" are similar to measures reported by the Division of Workers Compensation in past annual statistical reports. Under the statute, employers are required to report to the Division:
[I]f the personal injuries which are sustained by such accidents, are sufficient wholly or partially to incapacitate the person injured from labor or service for more than the remainder of the day, shift or turn on which such injuries were sustained.4
The Division classifies nonfatal occupational injuries as "lost time," "no lost time," and "hospitalized." "Lost time" injuries are those that "incapacitate the person injured from labor or service for more than the remainder of the day, shift or turn." "No lost time" injuries are defined as those in which the employee did not miss work beyond the remainder of the day, shift or turn. Injuries requiring hospitalization are reported as well. All of the Division's severity classifications are similar to the BLS variables in the Occupational Injuries & Illnesses Survey and are broad enough to describe the diversity of injuries within each category yet specific enough to discern substantive differences in severity. However, a year-to-year comparison between the BLS study and the Division's data is difficult due to both the time lag in reporting by BLS/KDHE and the differing time frames of the studies. Table 2-12 lists the Kansas non-fatal occupational injury & illness rate for the last ten fiscal years as calculated by the Division of Workers Compensation. 5 See Figures 2-1, 2-2, 2-3 & 2-4 below.
§
§
§
For "total injuries & illnesses" the incidence per 100 full-time equivalent workers (FTE hereafter) in the private and non-federal public sectors was 8.42 in FY1992. The incidence rate rose slightly to just above 9 injuries & illnesses per 100 FTE for the next three years (9.5 in FY1993, 9.26 in FY1994 & 9.43 in FY1995) and has slowly declined every year since to the rate of 6.6 total injuries & illnesses per 100 FTE in FY2001. Since the ten-year peak of 9.43 injuries & illnesses per 100 FTE in FY1995 the incidence rate has dropped 30 percent, or 2.83 per 100 FTE. The "time lost" injuries & illnesses incidence rate was 3.75 per 100 FTE in FY1992 and rose above 4 per 100 FTE from FY1993 through FY1995. The time lost rate dropped to 2.11 per 100 FTE in FY1996 and has been below 2 injuries & illnesses per 100 FTE ever since, a decrease of 70 percent from the peak rate in FY1994 to the most current rate for FY2001. 6 The "no time lost" injuries & illnesses incidence rate has been consistently between the range of 6.22 and 4.47 per 100 FTE for the past ten fiscal years. In FY2001 the incidence rate for "no
give Congress the authority to regulate the states (and its political subdivisions) as states and therefore, compel them to report the workplace injuries of state and local public servants to the Bureau of Labor Statistics.
4
K.S.A.44-557.
5 6
See Appendix A for details on how the Division calculated its incidence rates. The incidence rates for FY1998 & FY1999 reflect coding difficulties at the point of entry to the Division's database and not a dramatic decrease in the time lost rate. Time lost injuries were coded as "hospitalized" cases and this is reflected in the hospitalization rate for FY1998 & FY1999.
43
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
time lost" injuries & illnesses was 5.07 per 100 FTE, down 18 percent from the peak rate of 6.22 in FY1997.
Table 2-12 Kansas Non-Fatal Occupational Injury & Illness Incidence Rate* FY1992-FY2001
No Time Lost Illnesses & Injuries* Time Lost Injuries & Illnesses* Injuries & Illnesses Requiring Hospitalization*
Year
Total Injuries & Illnesses*
FY1992 FY1993 FY1994 FY1995 FY1996 FY1997 FY1998 FY1999 FY2000 FY2001
8.42 9.50 9.26 9.43 8.00 8.24 7.90 7.43 6.79 6.60
4.47 5.05 4.65 5.07 5.65 6.22 5.39 4.95 5.45 5.07
3.75 4.23 4.39 4.12 2.11 1.56 0.59 0.48 1.07 1.33
0.19 0.20 0.22 0.24 0.23 0.46 1.91 1.99 0.26 0.20
Source: Kansas Division of Workers Compensation, Kansas Labor Market Information Services
*Per 100 Full-time Equivalent Non-Federal Workers
Table 2-13 lists the injury incidence rate for industrial sectors in Kansas for FY2001.
§
§ § §
The construction sector had the highest incidence of total injuries & illnesses with 9.79 per 100 FTE while the lowest incidence rate, 2.17 per 100 FTE, was found in the finance, insurance and real estate sector. The second lowest incidence rate for total injuries was in the non-federal public sector (public administration) for FY2001 with 4.83 injuries & illnesses per 100 FTE. The "time lost" incidence rate is highest in the construction industry (2.41 per 100 FTE) with manufacturing a close second (2.20 per 100 FTE). Manufacturing reported the highest "no time lost" incidence rate for FY2001 (7.14 per 100 FTE) while construction had the second highest incidence rate, with 7.01 per 100 FTE.
44
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
Table 2-13 Kansas Industrial Sector Occupational Injury & Illness Incidence Rate** FY2001
Industrial Sector* Wholesale Trade Mining Construction Manufacturing Transportation, Communications, Electric, Gas, and Sanitary Services Retail Trade Finance, Insurance and Real Estate Services Public Administration
No Time Lost Time Lost Total Inj/Ill
4.13 5.53 7.01 7.14 4.76 3.59 1.76 5.86 3.98
1.33 2.01 2.41 2.20 1.75 1.30 0.36 1.00 0.72
5.61 8.04 9.79 9.75 6.67 5.08 2.17 6.99 4.83
Source: Kansas Division of Workers Compensation, Kansas Labor Market Information Services * Industrial sector refers to the U.S. Department of Labor's Standard Industrial Code "major groupings" ** Per 100 Full-time Equivalent Non-Federal Workers
Table 2-14 Occupational Injury & Illness Incidence Rate* for Selected Kansas Industries FY2001
Specific Industries of Interest Oil & Gas Meat Products Grain Mill Products Stone, Clay, Glass, and Concrete Products Aircraft and Parts Food and Kindred Products Transportation Equipment Machinery and Electrical Equipment
No Time Lost Time Lost Total Inj/Ill
5.69 10.99 5.95 7.63 4.11 11.10 5.02 7.01
2.29 2.90 1.62 1.68 2.49 2.79 2.42 2.09
8.58 14.33 7.67 9.53 7.69 14.23 8.38 9.21
Source: Kansas Division of Workers Compensation, Kansas Labor Market Information Services *Per 100 Full-time Equivalent Non-Federal Workers
In Table 2-14 the incidence of injury & illness is listed for selected Kansas industries of interest.
§
§ §
The meat products industry had the highest incidence rate, of those calculated, for "total injuries & illnesses" for FY2001 (14.33 per 100 FTE) which was slightly higher than the rate for the food and kindred products industry (14.23 per 100 FTE). Of the industries listed, the grain mill products industry reported the lowest incidence of injury & illness per 100 FTE (7.67) for the total injuries severity category. It is interesting to note that the meat products & food and kindred products industrie s have the two highest rates of "no time lost" injuries & illnesses while both of their "time lost" incidence rates (2.9 & 2.79 respectively) are comparable to the other industries listed.
45
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
Table 2-15
Location (County) of Occupational Injuries & Illnesses by Severity FY2001
Kansas County
ALLEN ANDERSON ATCHISON BARBER BARTON BOURBON BROWN BUTLER CHASE CHAUTAUQUA CHEROKEE CHEYENNE CLARK CLAY CLOUD COFFEY COMANCHE COWLEY CRAWFORD DECATUR DICKINSON DONIPHAN DOUGLAS EDWARDS ELK ELLIS ELLSWORTH FINNEY FORD FRANKLIN GEARY GOVE GRAHAM GRANT GRAY GREELEY GREENWOOD HAMILTON HARPER HARVEY HASKELL HODGEMAN JACKSON JEFFERSON JEWELL JOHNSON KEARNY KINGMAN KIOWA LABETTE LANE LEAVENWORTH LINCOLN LABETTE LANE LEAVENWORTH
No time Lost Time Lost Hospitalized Fatal Total Inj/Ill
308 88 468 72 684 381 213 927 33 48 258 35 69 178 234 196 36 934 913 92 541 106 2,052 70 41 613 248 1,306 974 493 877 54 46 151 83 28 116 79 190 631 81 37 585 156 48 10,039 68 120 53 863 39 822 51 863 39 822
72 18 158 19 156 119 44 175 6 11 90 8 9 46 43 35 23 216 150 12 164 67 502 19 8 149 38 380 210 152 243 6 13 26 20 9 20 12 42 145 15 8 51 60 7 3,013 22 25 16 182 10 254 12 182 10 254
9 5 7 2 14 9 5 38 2 1 7 4 8 8 6 4 21 22 8 8 9 72 7 6 18 7 70 23 22 22 1 1 6 3 2 7 6 4 22 7 1 16 4 2 280 2 5 3 9 2 32 1 9 2 32
2 1
1
1 1
1 1
1
1
1 4
1 1 1 1
389 111 633 93 854 511 262 1,141 41 60 355 43 82 232 285 237 63 1,172 1,085 112 713 182 2,626 96 55 780 293 1,757 1,208 667 1,142 62 60 184 106 39 144 97 236 799 103 46 652 221 57 13,336 92 150 72 1,055 51 1,109 64 1,055 51 1,109
Source: Kansas Division of Workers Compensation
46
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
Table 2-15
Location (County) of Occupational Injuries & Illnesses by Severity FY2001
Kansas County
LINCOLN LINN LOGAN LYON MARION MARSHALL MCPHERSON MEADE MIAMI MITCHELL MONTGOMERY MORRIS MORTON NEMAHA NEOSHO NESS NORTON OSAGE OSBORNE OTHER STATE OTTAWA PAWNEE PHILLIPS POTTAWATOMIE PRATT RAWLINS RENO REPUBLIC RICE RILEY ROOKS RUSH RUSSELL SALINE SCOTT SEDGWICK SEWARD SHAWNEE SHERIDAN SHERMAN SMITH STAFFORD STANTON STEVENS SUMNER THOMAS TREGO UNKNOWN WABAUNSEE WALLACE WASHINGTON WICHITA WILSON WOODSON WYANDOTTE
No time Lost Time Lost Hospitalized Fatal Total Inj/Ill
51 110 57 1,047 184 309 741 53 468 104 1,350 79 115 151 601 43 116 152 107 1,257 63 280 83 342 220 24 1,679 96 162 1,211 155 60 158 2,201 102 10,037 840 4,762 37 138 60 79 33 77 312 205 55 4,968 48 21 83 18 299 42 3,756
12 27 13 371 39 66 215 24 99 35 372 12 44 35 124 20 27 34 25 405 14 53 20 91 60 7 414 19 37 293 28 10 29 385 25 3,096 165 1,253 13 44 6 16 8 15 55 60 12 931 12 1 26 8 52 4 1,128
1 3 4 49 7 7 23 2 12 3 97 4 6 7 18 1 4 5 1 79 4 6 1 8 11 1 45 8 7 27 4 1 2 26 5 746 22 180 1 2 3 4 3 10 6 5 2 216 2 3 4 1 7 1 86
1
1 1
5
1 1
1
1
6 1 5 1
1 6
1 2
64 140 74 1,468 230 382 979 80 579 143 1,819 95 165 193 743 64 147 191 133 1,746 81 339 105 442 291 32 2,139 123 206 1,531 187 72 189 2,612 132 13,885 1,028 6,200 51 185 69 99 44 102 373 270 70 6,121 62 25 113 27 359 47 4,972
Source: Kansas Division of Workers Compensation
47
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
Table 2-16
Source of Occupational Injuries and Illnesses by Severity FY2001
Source of Injury & Illness
AIR PRESSURE AIRCRAFT ANIMAL PRODUCTS ANIMALS, INSECTS, ETC, UNS BLOOD BOAT OR SHIP BODILY MOTION BOILERS, PRESSURE VESSELS BOTTLES, JUGS, FLASKS, ETC BOXES,BARRELS,CONTAINERS,PKGS BUILDINGS & STRUCTURES CERAMIC ITEMS(BRICK,ETC) CHEMICALS CLOTHING, APPAREL, SHOES COAL AND PETROLEUM PRODUCTS COLD (ATMOSPHERIC,ENVIRO.) CONVEYERS DRUGS AND MEDICINES EARTHMOVER & CONSTR. MACHINES ELEC. APPARATUS(APPLIANCES) FLAME, FIRE, SMOKE FLOOR FOOD PRODUCTS (COOKING OIL) FUMES - (GAS, PAINT) FURNITURE,FIXTURES GLASS ITEMS (FIBERGLASS) GROUND OUTDOORS HAND TOOLS, NOT POWERED HAND TOOLS, POWERED HEAT, ENVIRONMENTAL HEATING EQUIPMENT HIGHWAY VEHICLES HOISTING APPARATUS ICE, SNOW INFECTIOUS, PARASITIC AGENTS KNIVE OR RAZOR LADDERS LIQUIDS (WATER, LIQUIDS NEC) MACHINES, UNS METAL CHIPS,SPLINTERS METAL FASTENERS METAL ITEMS, UNS METAL PARTS(EXC.AUTO,UNASSEM) No Time Lost 45 95 614 1,283 212 11 2,747 1 166 4,242 1,695 86 1,261 164 152 19 206 39 90 941 139 2,162 545 117 2,731 623 867 1,840 1,183 112 103 296 276 2,473 287 2,221 684 525 1,399 986 868 2,718 72 Time Lost 1 6 187 186 3 3 895 24 1,385 374 16 191 49 44 2 72 6 30 206 14 531 106 12 611 91 297 284 261 43 17 148 79 550 14 220 247 86 311 140 132 539 24 Hospitalized 2 1 17 41 4 2 52 3 105 44 1 49 5 8 1 11 1 11 46 9 65 16 6 60 23 38 52 41 23 4 35 14 58 14 64 46 14 77 12 28 73 2 1 1 1 1 1 1 2 1 4 Fatal Total Inj/Ill 48 106 818 1,510 219 16 3,694 1 193 5,732 2,113 103 1,501 218 204 22 290 46 132 1,195 162 2,758 668 135 3,402 737 1,203 2,176 1,485 178 124 480 369 3,082 315 2,505 977 625 1,787 1,138 1,028 3,331 98
Source: Kansas Division of Workers Compensation
48
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
Table 2-16
Source of Occupational Injuries and Illnesses by Severity FY2001
Source of Injury & Illness
MINERAL ITEMS MISC.(EARPLUGS,SHEETROCK ETC) MULTIPLE SOURCES OF INJURY NEEDLES NO EXPLANATION NOISE NON POWERED HANDTRUCK,DOLLIES NONCLASSIFIABLE NOT IN TABLE OFFICE MACHINES OUTDOOR SIDEWALKS,PATHS,WALKS PALLETS, SKIDS PAPER AND PULP ITEMS PARTICLES - UNIDENTIFIED PERSON, INJURED PERSON, OTHER THAN INJURED PIPE AND FITTINGS PIT PLANT OR INDUSTRIAL VEHICLES PLANTS, TREES, VEGETATION PLASTIC ITEMS POTS, PANS, DISHES, TRAYS POWERED FORKLIFTS, STACKERS PRINTING MACHINES PUMPS/PRIME MOVERS (ENGINES) RADIATING SUBSTANCE(SUN,XRAY) RAIL VEHICLES (TRAIN) RAMPS RECREATION & ATHLETIC EQUIP. ROOFS RUBBER PRODUCTS RUNWAYS, PLATFORMS SAWS (NOT HAND TOOLS) SCRAP,DEBRIS,WASTE MATERIALS SHEARS, SLITTERS, SLICERS STAIRS, STEPS INC. ESCALATORS STEAM STITCHING, SEWING MACHINES STREET, ROAD TEXTILE ITEMS UNUSED VEHICLES, UNS WOOD ITEMS WOOD ITEMS, NEC No Time Lost 701 6,852 1,397 1,100 2,278 32 1,080 1 54 891 425 625 268 1,657 923 4,585 421 154 116 528 208 405 330 20 189 11 26 80 220 30 523 121 93 141 448 1,102 82 34 37 48 1 1,408 513 124 388 131 24 104 12 2 17 48 5 4 26 35 18 191 38 29 22 64 283 19 7 15 25 3 8 4 6 2 22 7 9 3 12 42 3 1 1 1 Time Lost 179 1,356 292 30 536 2 267 1 3,138 105 118 150 45 152 204 766 99 60 55 125 44 61 93 450 13 18 21 3 31 72 86 26 2 8 16 3 11 9 1 16 1 9 Hospitalized 31 208 76 21 75 1 36 2 Fatal 1 4 3 Total Inj/Ill 912 8,420 1,768 1,151 2,889 35 1,385 2 3,642 1,009 561 796 316 1,840 1,208 5,437 546 216 179 669 256 477 432 21 253 16 39 110 261 51 736 166 131 166 524 1,427 104 42 52 76 1 1,917 656 150
Source: Kansas Division of Workers Compensation
49
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
Table 2-17
Cause of Occupational Injuries & Illnesses by Severity FY2001
Cause of Injuries & Illnesses
ACID CHEMICALS ANIMAL OR INSECT BROKEN GLASS BURN OR SCALD(HEAT/COLD EXPOSURE CAUGHT IN OR BETWEEN MISCELLANEOUS COLLISION WITH A FIXED OBJECT COLLISION WITH ANOTHER VEHICLE CONTACT WITH ELECTRIC CURRENT CONTACT WITH HOT OBJECT CRASH OF AIRPLANE CUMULATIVE INJURY (NOT CLASSIFIED) CUT,PUNCTURE,SCRAPE INJURY BY MISC DUST, GASES, FUMES OR VAPORS EXPLOSION OR FLARE BACK FALL OR SLIP INJURY MISCELLANEOUS FALLING OR FLYING OBJECT FIRE OR FLAME FOREIGN BODY IN EYE FROM DIFFERENT LEVEL FROM LIQUID OR GREASE SPILLS HAND TOOL OR MACHINE IN USE HAND TOOL, UTENSIL; NOT POWERED HOLDING OR CARRYING JUMPING LADDER OR SCAFFOLDING LIFTING MACHINE OR MACHINERY MOTOR VEHICLE MOTOR VEHICLE MISCELLANEOUS MOVING PARTS OF MACHINE NO EXPLANATION NOT IN TABLE OBJECT BEING LIFTED OR HANDLED OBJECT HANDLED OBJECT HANDLED BY OTHERS ON SAME LEVEL OTHER INJURY (NOT CLASSIFIED) POWERED HAND TOOL, APPLIANCE PUSHING OR PULLING RADIATION REACHING REPETITIVE MOTION ROBBERY OR CRIMINAL ASSAULT SANDING,SCRAPING,CLEANING SLIPPED, DID NOT FALL STATIONARY OBJECT STEAM OR HOT FLUIDS STEPPING ON SHARP OBJECT STRAIN OR INJURY BY MISCELLANEOUS STRIKING AGAINST/STEPPING ON MISC STRUCK BY OR INJURED BY MISC TEMPERATURE EXTREMES USING TOOL OR MACHINE VEHICLE UPSET WELDING OPERATIONS 5 4,096 477 171 5,392 6,851 645 2,521 4 504 2,784 27 445 441 1,425 484 227 1,532 1,484 2,380 102 298 162 212 2,519 1,285 411 36 2,347 3,329 102 3,076 1,482 1,180 312 3,871 707 191 437 6,888 510 26 123 113 672 240 78 13 831 793 18 463 490 341 69 596 224 88 204 2,415 160 13 43 44 1 304 1,120 121 36 1,263 1,487 246 798 3 148 632 11 86 131 305 101 41 676 392 425 39 103 59 57 15 128 21 8 194 271 33 70 1 12 50 3 6 18 51 17 7 37 13 70 15 25 36 2 2 1 1 6 No Time Lost 410 1,083 410 987 1,778 76 712 143 365 Time Lost Hospitalized 117 159 70 160 456 23 234 23 65 27 25 15 52 89 6 82 19 5 1 405 24 23 3 63 128 9 49 89 20 8 89 15 4 36 193 46 4 8 12 1 1 2 1 4 9 2 1 19 2 Fatal Total Inj/Ill 554 1,267 495 1,199 2,325 106 1,047 187 435 5 3,605 1,549 512 53 3,241 4,252 129 3,588 2,062 1,541 389 4,556 946 283 677 9,496 716 44 174 169 1 324 5,344 619 215 6,850 8,615 924 3,389 8 664 3,466 41 537 590 1,782 602 275 2,245 1,889 2,875 156 426 259 271
Source: Kansas Division of Workers Compensation
50
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
Table 2-18
Nature of Occupational Injuries & Illnessess by Severity FY2001
Nature of Illnesses & Injuries
AIDS ALL OTHER AMPUTATION AMPUTATION (BONE LOSS) ANGINA PECTORIS ASBESTOSIS ASPHYXIATION BURN BYSSINOSIS CANCER CARPAL TUNNEL SYNDROME CONCUSSION CONTAGIOUS DISEASE CONTUSION CRUSHING DERMATITIS DISLOCATION DUST DISEASE NOC ELECTRIC SHOCK ENUCLEATION FOREIGN BODY FRACTURE FREEZING HEARING LOSS(TRAUMATIC) HEAT PROSTRATION HERNIA INFECTION INFLAMMATION LACERATION LOSS OF HEARING MENTAL DISORDER MENTAL STRESS MULTIPLE TYPES OF INJURY MYOCARDIAL INFARCTION NO EXPLANATION NONCLASSIFIABLE NOT IN TABLE OTHER CUMULATIVE INJURIES OTHER OCCU. DISEASE POISONING-CHEMICAL POISONING-METAL PUNCTURE RADIATION RESPIRATORY DISORDERS RUPTURE SEVERANCE SPRAIN STRAIN VASCULAR LOSS VDT-RELATED DISEASE VISION LOSS 439 40 14 2,220 9,529 5 1 14 5 3 409 85 78 5,886 352 686 234 3 95 3 3,170 1,414 12 22 116 263 142 2,545 9,978 18 2 23 3 15 12,690 3 1 3,507 13 12 8 2,919 7 2,805 2 28 1,071 5 22 1 366 1 87 28 9 722 3,387 20 7 6 56 249 1 1 75 1 1 528 1 2 24 18 450 4 12 10 2 95 42 14 1,541 135 131 117 5 19 1 488 778 2 10 52 153 48 539 1,795 2 22 40 9 46 316 1 41 227 8,980 48 2 3 2 10 1,541 23 5 2 335 4 66 2 1 13 12 2 143 20 9 14 1 12 2 2 No Time Lost Time Lost Hospitalized 7 2,774 36 1 216 22 4 Fatal Total Inj/Ill 7 11,974 106 3 3 7 12 1,944 29 1 517 139 94 7,570 507 826 365 9 128 4 3,699 2,419 14 32 190 456 199 3,130 12,090 20 2 35 3 44 15,957 5 30 5,130 19 36 9 3,361 1 547 75 29 2,999 13,165 5 1 22
Source: Kansas Division of Workers Compensation
51
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
Table 2-19
Body Member Reported in Occupational Injuries & Illnesses by Severity FY2001
Body Member
ANKLE BRAIN CHEST(RIBS/STERNUM) DISC EAR(S) ELBOW EYE(S) FACIAL BONES FACIAL SOFT TISSUE FINGER(S) FOOT HAND HEART HIP INTERNAL ORGANS KNEE LARYNX LOW BACK (LUMBAR) LOWER ARM LOWER LEG MOUTH MULT. BODY PARTS MULT. HEAD INJURY MULT. INJURY MULT. LOWER EXTREMS. MULT. UPPER EXTREMS. MULT.MEMBERS INJURED MULTIPLE TRUNK NO EXPLANATION NONCLASSIFIABLE NOSE NOT IN TABLE PELVIS SACRUM AND COCCYX SKULL SOFT TISSUE SPINAL CORD TEETH THIGH THUMB TOE(S) TRACHEA UPPER ARM UPPER BACK AREA VERTEBRAE WRIST No Time Lost 2,076 11 903 63 213 1,520 4,260 41 864 7,671 1,856 4,186 16 436 293 3,961 3 5,770 1,804 779 187 9,086 644 208 2,073 4,199 1 1,951 1,451 1 203 17 25 45 1,026 385 10 246 269 2,551 464 18 2,460 375 14 2,943 36 145 29 19 253 91 7 29 85 432 149 4 761 184 5 735 55 13 2 4 10 80 13 1 58 11 1 112 2 9 48 6 2,237 335 227 22 2,441 104 76 564 977 2 719 303 55 72 10 154 59 44 7 492 21 14 122 205 1 1 31 Time Lost Hospitalized 747 2 275 45 35 337 724 16 101 1,435 621 866 8 129 122 1,253 86 2 38 3 3 62 89 5 19 263 74 143 15 24 39 119 1 4 2 Fatal Total Inj/Ill 2,909 15 1,218 111 251 1,919 5,073 62 984 9,369 2,551 5,195 43 589 454 5,334 3 8,161 2,198 1,050 216 12,050 769 298 2,760 5,381 4 2,725 1,836 1 248 210 60 64 1,336 489 19 279 364 3,063 626 23 3,279 570 20 3,790
Source: Kansas Division of Workers Compensation
52
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
Table 2-20
Industries Reporting Occupational Injuries & Illnesses by Severity FY2001
Industry
Administration of Economic Programs Administration of Environmental Quality and Housing Programs Administration of Human Resource Programs Agricultural Production-Crops Agricultural Production-Livestock and Animal Specialties Agricultural Services Amusement and Recreation Services Apparel and Accessory Stores Apparel and Other Finished Products Made From Fabrics and Similar Materials Automotive Dealers and Gasoline Service Stations Automotive Repair, Services, and Parking Building Construction - General Contractors and Operative Builder Building Materials, Hardware, Garden Supply, and Mobile Home Dealers Business Services Chemicals and Allied Products Coal Mining Communications Construction - Special Trade Contractors Depository Institutions Eating and Drinking Places Educational Services Electric, Gas, and Sanitary Services Electronic and Other Electrical Equipment and Components, Except Computer Equipment Engineering, Accounting, Research, Management, and Related Services Executive, Legislative, and General Government, Except Finance Fabricated Metal Products, Except Machinery and Transportation Equipment Fishing, Hunting, And Trapping Food and Kindred Products Food Stores Furniture and Fixtures General Merchandise Stores Health Services Heavy Construction Other Than Building Construction - Contractors Holding and Other Investment Offices Home Furniture, Furnishings, and Equipment Stores Hotels, Rooming Houses, Camps, and Other Lodging Places Industrial and Commercial Machinery and Computer Equipment Insurance Agents, Brokers, and Service Insurance Carriers Justice, Public Order, and Safety No Time Lost 152 28 35 60 388 390 748 137 84 968 440 1,282 621 3,796 300 2 444 2,579 181 2,837 4,342 1,104 401 272 8,381 1,141 9 3,730 1,743 144 1,335 8,007 750 59 338 321 1,836 72 245 106 Time Lost Hospitalized 22 6 4 13 105 114 85 34 33 195 108 422 158 986 71 1 109 934 29 914 556 176 174 79 1,531 198 3 936 481 53 933 1,067 232 9 106 96 493 23 25 23 112 49 3 201 150 41 1 14 14 25 3 4 3 2 1 1 2 1 2 2 1 30 20 56 55 106 17 1 4 136 9 93 84 17 7 4 248 22 5 1 1 2 4 5 2 2 5 1 2 5 29 37 21 4 2 2 Fatal 2 Total Inj/Ill 181 35 41 80 524 541 854 175 117 1,195 568 1,762 834 4,893 388 4 557 3,653 219 3,844 4,983 1,299 582 355 10,165 1,362 12 4,780 2,274 200 2,471 9,225 1,025 69 458 431 2,356 99 275 132
Source: Kansas Division of Workers Compensation
53
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
Table 2-20 continued
Industries Reporting Occupational Injuries & Illnesses by Severity FY2001
Industry Leather and Leather Products Legal Services Local and Suburban Transit and Interurban Highway Passenger Transportation Lumber and Wood Products, Except Furniture Measuring, Analyzing, and Controlling Instruments; Photographic, Medical & Optical Goods Membership Organizations Mining and Quarrying of Nonmetallic Minerals, Except Fuels Miscellaneous Manufacturing Industries Miscellaneous Repair Services Miscellaneous Retail Motion Pictures Motor Freight Transportation and Warehousing Museums, Art Galleries, and Botanical and Zoological Gardens National Security and International Affairs Nonclassifiable Establishments Nondepository Credit Institutions Oil and Gas Extraction Paper and Allied Products Personal Services Petroleum Refining and Related Industries Pipelines, Except Natural Gas Primary Metal Industries Printing, Publishing, and Allied Industries Private Households Real Estate Rubber and Miscellaneous Plastics Products Security and Commodity Brokers, Dealers, Exchanges, and Services Services, Not Elsewhere Classified Social Services Stone, Clay, Glass, and Concrete Products Textile Mill Products Tobacco Products Transportation by Air Transportation Equipment Transportation Services United States Postal Service Water Transportation Wholesale Trade - Durable Goods Wholesale Trade - Nondurable Goods No Time Lost 14 41 75 443 149 322 66 176 293 750 67 2,161 21 2 105 48 336 375 246 66 33 667 996 57 512 1,005 24 109 1,526 519 75 4 187 2,899 151 4 1 1,651 1,594 16 5 135 86 70 22 6 145 216 16 130 360 11 40 270 114 21 5 39 1,396 17 14 4 463 583 51 62 1 2 2 538 1 5 26 15 1 1 8 44 1 14 20 35 9 2 2 7 Time Lost 2 9 33 177 52 68 11 73 58 329 20 1,133 1 6 11 15 6 97 6 1 2 5 18 2 14 1 Hospitalized Fatal Total Inj/Ill 16 52 114 638 203 404 77 255 362 1,095 93 3,397 22 2 128 53 506 470 318 90 39 820 1,256 74 656 1,385 35 154 1,823 648 97 9 228 4,833 169 18 5 2,166 2,241
Source: Kansas Division of Workers Compensation
54
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
Figure 2-1
Kansas Rate of Occupational Injury & Illness Per 100 FTE by Severity FY1992-FY2001 10.00
9.00 Incidence Per 100 FTE 8.00 7.00 6.00 5.00 4.00 3.00 2.00 1.00 0.00
FY 19 97 FY 19 92 FY 19 93 FY 19 94 FY 19 95 FY 19 98 FY 19 96
9.50 9.26 9.43
8.42
8.00 8.24 7.90 5.65 6.22 5.39
7.43
6.79 6.60 5.45 5.07
5.07 5.05 4.65 4.47 4.23 4.39 4.12 3.75
4.95
2.11
1.56 0.59 0.48
FY 19 99 FY 20 00
7.90
1.07 1.33
Year Total inj/ill No time lost Time lost
Figure 2-2
Kansas Rate of Occupational Injury & Illness Per 100 FTE by Severity Total Occupational Injuries & Illnesses FY1992-FY2001
10.00 9.00 8.00 Incidence per 100 FTE 7.00 6.00 5.00 4.00 3.00 2.00 1.00 0.00 FY1992 FY1993 FY1994 FY1995 FY1996 FY1997 FY1998 FY1999 FY2000 FY2001 Fiscal Year 8.42 9.50 9.26 9.43 8.00 8.24
FY 20 01
7.43 6.79 6.60
55
Kansas Division of Workers Compensation
Annual S tatistical Report
2001
Figure 2-3
Kansas Rate of Occupational Injury & Illness Per 100 FTE by Severity No Time Lost Occupational Injuries & Illnesses FY1992-FY2001
7.00 6.22 6.00 5.05 Incidence per 100 FTE 5.00 4.00 3.00 2.00 1.00 0.00 FY1992 FY1993 FY1994 FY1995 FY1996 FY1997 FY1998 FY1999 FY2000 FY2001 Fiscal Year 4.47 4.65 5.07 5.65 5.39 4.95 5.45 5.07
Figure 2-4
Kansas Rate of Occupational Injury & Illness Per 100 FTE by Severity Time Lost Occupational Injuries & Illnesses FY1992-FY2001
5.00 4.50 4.00 Incidence Per 100 FTE 3.50 3.00 2.50 2.00 1.50 1.00 0.50 0.00 FY1992 FY1993 FY1994 FY1995 FY1996 FY1997 FY1998 FY1999 FY2000 FY2001 Fiscal Year 0.59 0.48 2.11 1.56 1.33 1.07 3.75 4.23 4.39 4.12
56
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Section 3
Workers Compensation Claims Statistics
Kansas Division of Workers Compensation
Annual Statistical Report
2001
The Kansas Workers Compensation Fund
The Workers Compensation Fund is a guaranty fund that operates as a payer of last resort for injured workers in the state of Kansas. The fund is administered by the Commissioner of Insurance through the Kansas Insurance Department and makes workers compensation payments "[i]f an employer has no insurance to secure payment of compensation...and such employer is financially unable to pay compensation to an injured worker as required by the workers compensation act, or such employer cannot be located and required to pay such compensation."1 Tables 3-1, 3-2 & 3-3 lists the Workers Compensation Fund caseload, expenditures and receipts for FY1999-FY2001.
Table 3-1
WORKERS COMPENSATION FUND CASE LOAD SCHEDULED
FY2001 FY2000 FY1999
Total Number of Impleading
112
144 838
162 709
Total Number of Closed Cases 292 Source: Kansas Insurance Department
Table 3-2
WORKERS COMPENSATION FUND EXPENDITURES ANALYSIS
FY2001 % of Total FY2000 % of Total FY1999 % of Total
Disability Compensation Work Assessment Medical
$2,459,939 $23,302 $631,814
44.8 $3,480,211 0.4 $28,445 11.5 $600,249
44.4 $6,836,720 0.4 $65,983 7.6 $632,903
54.9 0.5 5.1
Reimbursement to Insurance Companies [K.S.A. 44-569(a) & K.S.A.44-569]; lump $1,630,703 sum and medical may be included Attorney Fees $322,011 Court Costs, Deposition, Medical $42,277 Reports, etc Refunds $0 Other Operating Expense $370,565 Total Expenditures Source: Kansas Insurance Department $ 5,480,611
29.8 $2,812,607 5.9 0.8 0.0 6.8 $432,706 $66,826 $0 $417,621
35.9 $3,668,757 5.5 0.9 0.0 5.3 $722,493 $97,054 $0 $419,817
29.5 5.8 0.8 0.0 3.4 100.0
100.0 $7,838,665
100.0 $12,443,727
1
K.S.A. 44-532a.
58
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Table 3-3
WORKERS COMPENSATION FUND RECEIPTS ANALYSIS
FY2001 % of Total FY2000 % of Total $9,073,818 $0 $306,162 $0 $9,379,980 $58,257 26.9 0.0 0.9 0.0 27.8 0.2 FY1999 $8,346,272 $18,500 $157,195 $0 $8,521,967 $30,623 % of Total 22.7 0.1 0.4 0.0 23.2 76.7 0.1 100.0
Assessment Receipts Non-Dependent Death Receipt* Misc. Reimbursements Fines & Penalties Total Receipts Previous Year Carryover Balance
$3,163,438 $0 $72,200 $67,075 $3,302,713 $25,881,340
10.8 0.0 0.1 0.1 11.0 0.1
88.9 $24,340,025 100.0 $33,778,262
72.0 $28,239,376 100.0 $36,791,966
Cancelled Checks $84,360.82 Total Funds Available $29,268,414 Source: Kansas Insurance Department *Non-Dependent death prior to 5-98
Workers Compensation Insurance Experience
The Kansas Insurance Department reports that the total direct paid losses for calendar year 2000 was $170,366,708, an increase of only $222,599 from the previous year (See Table 3-4). However, total paid losses has risen every year for the past 3 years but is still well below the 22-year peak of $243,751,957 in 1991 (See Figure 3-1). Direct losses incurred for 2000 were $159,226,348, a decrease of $20,150,433 from 1999. Workers compensation written policies totaled $271,480,320 while premiums earned were $247,235,161. The losses paid to premiums earned ratio, as calculated by the Insurance Department, was 68.9 while the losses incurred to premiums written ratio was 64.4 for calendar year 2000.
Figure 3-1
Workers Compensation Insurance Premiums in Kansas 1979-2000
Source: Kansas Insurance Department
$400,000,000 $350,000,000 $300,000,000 $250,000,000 $200,000,000 $150,000,000 $100,000,000 $50,000,000 $0 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Direct Premiums Written Direct Losses Paid
Direct Premiums Earned Direct Losses Incurred
59
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Table 3-4 WORKERS COMPENSATION INSURANCE EXPERIENCE PREMIUMS
DIRECT PREMIUMS WRITTEN $118,240,623 $141,189,216 $156,207,756 $154,944,245 $147,137,981 $141,097,428 $172,985,620 $208,167,277 $223,674,161 $257,039,527 $264,102,264 $291,804,714 $341,012,872 $366,672,022 $367,030,245 $338,173,750 $312,745,351 $274,014,862 $261,121,536 $250,588,819 $251,341,523 $271,480,320 DIRECT PREMIUMS EARNED $113,676,699 $138,145,343 $149,261,425 $152,315,135 $148,669,330 $140,223,325 $170,955,138 $202,033,619 $222,846,661 $259,548,305 $263,386,009 $293,048,038 $337,125,586 $363,578,560 $365,646,558 $312,116,539 $322,205,785 $282,897,458 $261,895,503 $261,594,835 $252,545,287 $247,235,161 DIRECT LOSSES PAID $60,281,756 $72,697,056 $80,425,265 $88,345,714 $96,289,968 $106,701,375 $120,755,675 $134,554,116 $147,885,631 $164,553,813 $184,857,801 $222,309,953 $243,751,957 $236,878,948 $220,091,021 $185,502,395 $159,776,412 $149,616,189 $145,248,549 $156,594,835 $170,144,109 $170,366,708 DIRECT LOSSES INCURRED $82,086,752 $102,896,246 $101,691,667 $107,979,341 $115,282,150 $125,520,390 $147,438,366 $170,153,475 $195,885,084 $208,332,654 $239,142,874 $265,726,660 $321,497,577 $293,894,584 $231,228,324 $192,914,048 $139,528,898 $130,595,593 $134,603,154 $126,164,370 $179,376,781 $159,226,348 LOSSES PAID TO PREMIUMS EARNED 53.0 52.6 53.9 58.0 64.8 76.1 70.6 66.6 66.4 63.4 70.2 75.9 72.3 65.2 60.2 59.4 49.6 52.9 55.5 59.9 67.4 68.9 LOSSES INCURRED TO PREMIUMS WRITTEN 69.4 72.9 65.1 69.7 78.3 89.0 85.2 81.7 87.6 81.1 90.5 91.1 94.3 80.2 63.0 57.0 44.6 47.7 51.5 50.3 71.4 64.4
YEAR 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Source: Kansas Insurance Department
The Kansas Open & Closed Claim Study
The Workers Compensation Act requires that employers (or their insurers) submit only a first report of injury to the Division. Not every injury, however, results in a claim by the injured worker for medical and/or indemnity compensation. Generally the Division becomes aware of a claim and obtains information that a given claim has closed, and about the costs and duration of that claim, through only two means. One occurs when that claim has been litigated through the Division's administrative law court system. The second occurs when a sample of insurers is required by statute to provide information to the Division. To remedy this situation the Kansas Legislature has mandated that the Division of Workers Compensation "compile and publish statistics to determine the causation of compensable disabilities in the state of Kansas and compile and maintain a database of information on claim characteristics and costs related to open and closed claims, in order to determine the effectiveness of the workers compensation act
60
Kansas Division of Workers Compensation
Annual Statistical Report
2001
to provide adequate indemnity, medical and vocational rehabilitation compensation to injured workers and to return injured workers to remunerative employment."2 The intent of this statutory mandate is that the Division should provide the legislature with information that it can use in deciding whether changes in the provisions of the Workers Compensation Act are needed and if so, to help formulate policy responses to identified problems with the program as presently administered. The Division has typically responded to the first part of the legislature's mandate by publishing an annual (fiscal year) statistical report. For the last three years, however, the Division has met its obligation to the second part of the statutory mandate by conducting periodic surveys to collect claims data from insurance carriers. The expectation is that the scope of claims data collected will provide a foundation upon which to construct meaningful conclusions about the costs and factors involved in the workers compensation system in Kansas & identify trends in claims characteristics over time. The Open & Closed Claims (OCC) study is repeated on an annual basis using the first completed survey study as a baseline for comparison of successive samples. The Division will continue to annually collect data from insurance carriers, group pools and self-insured entities for the purpose of meeting the legislative mandate. There are, at present, two likely means for collecting claims data. The first is to maintain the OCC research design. The second is to require electronic submittal of information through a national standard using electronic data interchange (EDI). The major insurance carriers already utilize this data transmittal process. Many, in fact, requested that the Division undertake the EDI process in order to forgo the sampling procedure currently in place. The Division is examining the feasibility of requiring data submittal through EDI for coverage providers.
The 2001 Open & Closed Claims Study
The 2001 Open & Closed Claim (OCC) Study marks the third consecutive year that the Division has collected claims data directly from a stratified random sample of insurance carriers, self-insured organizations and group-funded pools underwriting workers compensation in the state of Kansas. The following section summarizes the findings of the OCC for this past calendar year.
Highlights From The 2001 Closed Claims Study
§
Of the 2,209 closed claims in the 2001 sample the mean total indemnity costs totaled $6,531 (See Table 3-5 below). The median total indemnity costs for the same sample of closed cla ims was $2,296, indicating that there were several claims with large indemnity payouts that skewed the mean indemnity costs higher than the median. The mean total medical costs for closed claims totaled $7,109 (See Table 3-5 below). Out of this total, the mean hospital costs was $4,315, mean total payments to physicians were $2,282, and the mean costs listed as "other medical" was $2,137. As with indemnity claims, the median claim total medical expense was only $3,834, indicating the presence of several large medical claims that skewed the mean total costs higher than the median. The average lump sum settlement was $9,412 (for the 613 claims that had a lump sum involved). See Table 3-5 below. For the 17 cases that reported vocational rehabilitation expenses, the mean incurred costs were $1,150 and median costs were $772 (See Table 3-5 below).
§
§ §
2
K.S.A. 44-557a(a).
61
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Table 3-5 2001 Closed Claims Statistics
Mean Median Count
Total Indemnity Total Incurred Vocational Rehab Total Incurred Medical Vocational Rehab Evaluation Expense Paid to Date Vocational Rehab Maintenance Paid to Date Vocational Rehab Education Paid to Date Other Vocational Rehab Paid to Date Hospital Costs Paid to Date Total Payments to Physicians Other Medical Paid to Date Lump Sum Settlement
Source: Kansas Division of Workers Compensation
$6,531 $2,296 2,209 $1,150 $772 17 $7,109 $3,834 2,209 $873 $772 $1,445 $1,445 $1,820 $1,820 $0 $0 17 2 1 0
$4,315 $2,300 1,640 $2,282 $1,352 2,122 $2,137 $683 1,771 $9,412 $6,087 613
§ §
§
The mean duration of a claim (from date disability began to the date given by the insurer as the date of closing) was 401 days. Half of the claims in this year's sample were closed within 295 days. See Table 3-6 below. It took an average of 18 days for an insurer to be notified following an accident, with half of all closed claims taking less than seven days. Insurers took an average of 52 days from the date disability began to make the first payment (but only 16 days for half of all claims). See Table 3-5 below. Claimants who lost time from work due to an injury and then returned to work at a later date on average lost 108 days of work, with half of the claimants losing only 51 days or less. See Table 3-5 below.
Table 3-6 2001 Closed Claims Time Intervals*
Time Taken to Notify Insurer 18 7 2,209 650 0 Time Taken for Insurer to Get First Payment OutTime Off Work 52 108 16 51 1,642 1,472 2,483 1,267 1 1
Mean Median Count Max Min
Claim Duration 401 295 1,642 3,277 12
Source: Kansas Division of Workers Compensation *All time intervals listed are in days.
62
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Table 3-7 2001 Closed Claims Percentage of Impairment
Bracket Count
1-9% 10-19% 20-29% 30-39% 40-49% 50-59% 60-69% 70-79% 80-89% 90-99% 100% TOTAL
Source: Kansas Division of Workers Compensation
610 269 68 22 7 6 1 1 1 1 1 987
§ §
§
Of the 987 claims listing a percentage of impairment of the injured worker greater than 0 percent, 879 claims had a percentage of impairment between 1 percent and 19 percent. See Table 3 -6 above. Nearly 21 percent of the injured workers in the sample had secured the services of an attorney to handle their claim. The mean indemnity costs for claims involving an attorney ($13,058) were nearly two and three-quarter times as much as claims without an attorney ($4,800). See Table 3-7 below. Mean total medical costs for claims involving an attorney totaled $10,34. For claims not involving attorneys Mean total medical costs were $6,250. Mean lump sum settlements for claims involving attorneys ($5,194) were more than two and a half times greater than for claims without attorneys ($1,927). See Table 3-7 below.
Table 3-8 2001 Closed Claims Attorney Involvement with Claim
Claimant Attorney Involved No Claimant Attorney All Cases
Count Average Indemnity Average Medical Average Lump Sum 463 $13,058 $10,348 $5,194 1,746 $4,800 $6,250 $1,927 2,209 $6,531 $7,109 $2,612
Source: Kansas Division of Workers Compensation
63
Kansas Division of Workers Compensation
Annual Statistical Report
2001
§
Mean employer legal expenses, for the 830 claims that had these expenses reported, totaled $1,039 while mean claimant legal expenses was more than nearly three times as high at $3,551. The respective medians for employer & claimant legal expenses associated with a claim were $382 and $2,466. The median claimant legal expense were nearly six and one half times as greater than the median employer legal expense. See Table 3-8 below.
Table 3-9 2001 Closed Claims Legal Expenses Associated with Claim
Employer's Claimant's Legal Legal Expenses Expenses
Mean Median Count
Source: Kansas Division of Workers Compensation
$1,039 $382 830
$3,551 $2,466 101
Table 3-10 2001 Closed Claims Average Wage & Indemnity by Employer Payroll
Average of Average Weekly Wage Average of Total Indemnity Count of Return To Total Cases in Work Each Category
$0 $1-100,000 $100,001-$1,000,000 $1,000,001-$10,000,000 Over $10,000,000 Grand Total
Source: Kansas Division of Workers Compensation
$454 $465 $419 $426 $444 $438
$2,283 $4,030 $7,855 $7,427 $7,206 $6,531
61 143 448 513 356 1,521
61 537 590 594 427 2,209
§ §
§
Injured workers in the 30-39 year-old age stratum had the greatest number of claims (615) in the sample, while claimants in the 40-49 year-old age stratum were a close second with 600. See Figure 3-2. Injured workers in the 50-59 year-old age stratum reported the highest mean indemnity costs ($7,822), with those in the 40-49 year-old age stratum a close second at $7,147. The 4 injured workers in the 80-89 year-old age stratum reported the highest mean medical expenses ($8,694) but for age groupings with over 100 claims in the sample the 40-49 year-old age stratum had the highest mean medical costs at $8,126. See Figure 3-3. Male claimants outnumbered female claimants by more than two-to-one in the sample but reported slightly lower mean indemnity costs ($6,467 for male claimants and $6,652 for female claimants) and slightly higher mean medical costs ($7,151 for males and $7,024 for females). See Figure 3-4.
64
Kansas Division of Workers Compensation
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2001
§ § §
§
§ §
§
§
Lifting was the most frequent cause of injury resulting in a claim for this year's study. The mean indemnity costs for lifting injuries was $6,491 and mean medical costs were $6,277. See Figures 3-5 & 3-6. Repetitive motion injuries had the highest mean indemnity costs by cause of injury ($8,143) while injuries caused by falling, slipping or tripping on the same level reported the highest mean medical costs ($8,713). See Figure 3-6. 31 percent of the closed claims sample reported strains as the nature of the worker's injury. The second most common nature of injury was sprains followed by fractures. See Table 3-7. However, mean indemnity costs for cumulative injuries ($11,900) and carpal tunnel syndrome claims ($11,687) were the highest costs by nature of injury. See Figure 3-8. The most frequently injured major body region (which consist of all the body parts condensed down into much broader categories) was the upper extremities (arms, wrists, hands, elbow, etc. ). Lower extremities were second with the back region the next most frequently reported injured body region. However, the highest mean indemnity costs for major body region were with claims involving an injured neck ($9,264) while the highest mean medical costs were with claims involving multiple body parts ($8,848). See Figures 3-9 and 3-10. The knee was the most frequently injured body part resulting in scheduled indemnity benefits but shoulder claims had the highest mean indemnity costs ($7,103) and mean medical costs ($8,158). See Figures 3-11 & 3-12. Injuries involving multiple body parts were the most often injured body part resulting in unscheduled indemnity benefit with the lower back area a close second. However, hip injuries had the highest mean indemnity ($11,916) and mean medical costs ($13,301) for all unscheduled body part claims. See Figures 3-13 & 3-14. Temporary total disability (TTD) claims constituted 81 percent of all closed claims in the sample had a mean of $3,255 for indemnity costs. However unscheduled permanent partial injuries had the highest non-fatal mean indemnity costs with $11,807. The highest mean indemnity payout by type was $18,933 for death benefits but this was a function of the small number of claims of this type (n=3) used in the calculation of the mean. See Figures 3-15 & 3-16. Carpal tunnel syndrome injuries had mean indemnity costs of $11,687 and mean total medical costs of $6,845. All other cumulative injuries had mean indemnity costs of $11,900 and mean medical costs of $9,042. See Figures 3-17.
Highlights From The 2001 Open Claims Study
§
Due to the dynamic and continually evolving nature of medical and indemnity payments for claims not yet closed (open claims) no meaningful statistics on costs could be reported. Claim costs for medical, indemnity, vocational rehabilitation and other expenses are discussed in the sections on closed claims. Lifting was the most frequent cause of injury reported for claims still open in 2001. See Figure 318 below. The most frequent nature of injury for open claims were strains with sprains a distance second. See Figure 3-19 below. Again this year, the upper extremities were the most injured body region for our open claims sample. See Figure 3-20 below. The most frequently injured scheduled body part was the knee with the wrist a close second. See Figure 3-21 below. The most frequently injured unscheduled body part for our open claims was the low back area with multiple body parts a close second. See Figure 3-22 below.
§ § § § §
65
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Figure 3-2
Distribution of Claimants by Age Closed Claims 2001
0-19 20-29 30-39 Age Bracket 40-49 50-59 60-69 70-79 800 4 100 200 300 Frequency 400 500 600 700 18 111 343 75 443 615 600
Figure 3-3
Average Claim Costs by Age of Claimant Closed Claims 2001
$3,429 $4,467 $6,275 $7,055 $6,947 $8,126 $7,437 $6,841 $7,822 $7,837 $7,177 $5,957 $6,350 $0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000 $9,805 $14,546 $16,000
0-19 20-29 Age Bracket 30-39 40-49 50-59 60-69 70-79 80-
$1,349
Average Claim ($)
Average Indemnity
Average Medical
66
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Figure 3-4
Average Claim Costs by Gender of Claimant Closed Claims 2001
Average Indemnity Average Medical
$6,593
Unknown (4)*
$8,377
$7,024
Female (724)*
$6,652
$7,151
Male (1481)*
$6,467
$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000
Average Claim ($)
Figure 3-5
Most Frequent Causes of Injury Closed Claims 2001
Lifting Strain or Injury by NOC Object Being Lifted or Handled Cause of Injury Repetitive Motion Pushing or Pulling On Same Level From Different Level (Elevation) Fall, Slip or Trip, NOC Falling or Flying Object From Ladder or Scaffolding 0 50 76 69 100 150 200 Frequency 250 300 350 400 127 125 123 112 100 97 89 354
67
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Figure 3-6
Average Claim Costs for the Most Frequent Causes of Injury Closed Claims 2001
Lifting Strain or Injury by NOC Object Being Lifted or Handled Causes of Injury Repetitive Motion Pushing or Pulling On Same Level From Different Level (Elevation) Fall, Slip or Trip, NOC Falling or Flying Object From Ladder or Scaffolding $0 $3,508 $6,277 $6,491 $6,912 $6,804 $7,873 $7,295 $6,556 $8,143 $6,407 $7,424 $8,713 $6,381 $6,702 $7,181 $8,166 $7,257 $5,664 $7,162 $7,520 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000 $10,000 Average Claim ($) Average Indemnity Average Medical
Figure 3-7
Most Frequently Reported Nature of Claimant Injury Closed Claims 2001
Strain Sprain Fracture Nature of Injury All other Specific Injuries, NOC Contusion Laceration Carpal Tunnel Syndrome Hernia Inflammation All Other Cumulative Injury, NOC
0
695 282 223 223 148 113 89 75 59 43
100 200 300 400 500 600 700 800
Frequency
68
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Figure 3-8
Average Claim Costs for Most Frequently Reported Nature of Claimant Injury Closed Claims 2001
Strain Sprain Fracture Nature of Injury All other Specific Injuries, NOC Contusion Laceration Carpal Tunnel Syndrome Hernia Inflammation All Other Cumulative Injury, NOC $0 $2,000 $4,000 $6,000 $8,000 $1,485 $4,432 $4,200 $6,858 $9,042 $10,000 $11,900 $12,000 $14,000 $1,965 $4,771 $3,711 $3,995 $6,845 $11,687 $5,974 $6,174 $8,832 $8,132 $8,015 $7,430 $9,741 $8,029
Average Claim ($)
Average Indemnity
Average Medical
Figure 3-9
Most Frequent Major Body Region Injured by Claimant Closed Claims 2001
Upper Extremities Lower Extremities Back Multiple Body Parts/Miscellaneous Trunk Head Neck 0 56 39 100 200 300 400 500 600 700 800 900 209 197 367 564 777
Body Region
Frequency
69
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Figure 3-10
Average Claim Costs by Major Body Region Closed Claims 2001
Upper Extremities Lower Extremities Body Region Back Multiple Body Parts/Miscellaneous Trunk Head Neck Average Medical $0 Average Indemnity $5,256
$6,569 $6,330 $7,565 $7,491 $8,828 $9,253 $8,848 $5,656 $4,040 $4,898 $5,306 $6,675 $9,264 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000 $10,00 0 Average Claim ($)
Figure 3-11
Most Frequent Scheduled Body Part Claims Closed Claims 2001
Knee Finger(s) Shoulder(s) Wrist Body Part Ankle Hand Upper Arm Foot Elbow Lower Leg 0 43 40 50 100 Frequency 150 200 250 74 72 83 92 116 113 112 237
70
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Figure 3-12
Average Claim Costs for Most Frequent Scheduled Body Parts Closed Claims 2001
Knee Finger(s) Shoulder(s) Wrist
Body Part
$2,258
$4,375 $4,192 $7,103 $5,809 $3,989 $3,744 $4,406 $4,913 $4,436 $6,523 $5,723 $6,087
$6,000 $7,000
$8,006
$8,158
$6,784
Ankle Hand
$5,866 $5,831 $7,700
Upper Arm Foot Elbow Lower Leg
$0 $1,000 $2,000 $3,000 $4,000
$4,518
$5,000 Average Claim ($)
$8,000
$9,000
Average Medical Average Indemnity
Figure 3-13
Most Frequent Unscheduled Body Part Claims Closed Claims 2001
Multiple Body Parts (including Body Systems & Body Parts) Lower Back Area Multiple Trunk Abdomen Multiple Upper Extremities Internal Organs Upper Back Area Multiple Head Injury Chest Hip 0 22 21 20 20 50 100 150 200 Frequency 250 300 350 400 62 56 54 42 321 346
71
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Figure 3-14
Average Claim Costs for the Most Frequent Unscheduled Body Parts Closed Claims 2001
Multiple Body Parts (including Body Systems & Body Parts) Lower Back Area Multiple Trunk Abdomen Body Part Multiple Upper Extremities Internal Organs Upper Back Area Multiple Head Injury Chest Average Medical Average Indemnity Hip $0 $2,000 $4,000 $6,000 $8,000 $2,550 $4,978 $13,301 $11,916 $10,000 $12,000 $14,000 $1,454 $2,781 $4,663 $4,831 $6,795 $6,514 $1,464 $4,601 $7,836 $9,583 $7,196 $8,387 $8,058 $9,051 $10,190 $10,032
Average Claim ($)
Figure 3-15
Most Frequent Type of Claimant Injury Closed Claims 2001
Indemnity Portion of Expenses* Temporary Partial Temporary Total Unscheduled Permanent Partial Scheduled Permanent Partial Permanent Total Disability Death 0 4 3 200 400 600 800 1000 Frequency 1200 1400 1600 1800 2000 299 335 119 67 1,790
72
Type of Injury
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Figure 3-16
Average Indemnity Costs by Type of Claimant Injury Closed Claims 2001
Indemnity Portion of Expenses* Temporary Partial Temporary Total Injury Type Unscheduled Permanent Partial Scheduled Permanent Partial Permanent Total Disability Death $0 $2,000 $4,000 $6,000 $6,768 $6,235 $18,933 $8,000 $10,000 $12,000 $14,000 $16,000 $18,000 $20,000 Average Indemnity ($) $810 $3,255 $11,807 $5,205
Figure 3-17
Claim Costs for Carpal Tunnel and All Other Cumulative Injuries Closed Claims 2001
Average of Other Medical Payments* Average Payments to Physicians* Average Hospital Cost*
$1,169 $2,304 $2,950 $2,981 $2,726 $3,757 $6,845 $9,042 $11,687 $11,900 $0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000
Payment Type
Average Total Medical
Average Indemnity
Average Claim ($)
All Other Cumulative Injury, NOC
Carpal Tunnel Syndrome
73
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Figure 3-18
Most Freqeuntly Reported Cause of Claimant Injury Open Claims 2001
Lifting Strain or Injury by NOC Repetitive Motion From Different Level (Elevation)
Cause
235 121 88 87 81 75 72 70 56 47
0 50 100 Frequency 150 200 250
Object Being Lifted or Handled Fall, Slip or Trip, NOC On Same Level Pushing or Pulling Falling or Flying Object Other-Miscellaneous, NOC
Figure 3-19
Most Frequently Reported Nature of Claimant Injury Open Claims 2001
Strain Sprain Fracture All other Specific Injuries, NOC Nature Contusion Inflammation Carpal Tunnel Syndrome Laceration All Other Cumulative Injury, NOC Rupture 0
542 170 169 124 105 59 58 51 34 32
100 200 300 Count 400 500 600
74
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Figure 3-20
Most Frequent Major Body Region Injured Open Claims 2001
Upper Extremities Lower Extremities Back Multiple Body Parts/Miscellaneous Trunk Head Neck 0
523 339 303 195 75 46 43
100 200 300 Frequency 400 500 600
Body Region
Figure 3-21
Most Frequent Scheduled Body Part Injured Open Claims 2001
Knee Wrist Shoulder(s) Upper Arm Body Part Ankle Finger(s) Hand Elbow Foot Lower Leg 0 20
177 105 82 72 50 47 43 32 31 25
40 60 80 100 Frequency 120 140 160 180 200
75
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Figure 3-22
Most Frequent Unscheduled Body Part Injured Open Claims 2001
Lower Back Area Multiple Body Parts (including Body Systems & Body Parts) Multiple Upper Extremities Multiple Trunk Body Part Disc - Trunk Multiple Neck Injury Upper Back Area Multiple Lower Extremities Abdomen Hip 0
249 239 58 37 31 22 21 17 16 15
50 100 150 Frequency 200 250 300
76
Kansas Division of Workers Compensation
Annual Statistical Report
2001
A Comparative Analysis of Indemnity & Medical Claim Costs
Mean total indemnity costs have declined in Kansas for the third consecutive year. The average indemnity paid per claim in 2001 was down nearly 10 percent ($704) from the previous year's average and nearly 18 percent from 1999, the first year of the Open & Closed Claims Study (See Table 3 -10 below). However, mean total incurred medical costs have risen for the third consecutive year. The average total medical costs for claims in 2001 were $7,109, which constituted a 3.4 percent increase from 2000 and a 21 percent increase from 1999 (See Table 3-10 below).
Table 3-11 Closed Claims Statistics 1999-2001 Mean Costs
2001 Mean Total Indemnity Mean Total Incurred Vocational Rehab Mean Total Incurred Medical Mean Vocational Rehab Evaluation Expense Paid to Date Mean Vocational Rehab Maintenance Paid to Date Mean Vocational Rehab Education Paid to Date Mean Other Vocational Rehab Paid to Date Mean Hospital Costs Paid to Date Mean Total Payments to Physicians Mean Other Medical Paid to Date Mean Lump Sum Settlement Source: Kansas Division of Workers Compensation 2000 1999
$6,531 $1,150 $7,109 $873 $1,445 $1,820 $0 $4,315 $2,282 $2,137
$7,235 $1,267 $6,873 $913 $2,705 $5,616 $3,885 $4,215 $2,770 $1,604
$7,933 $1,010 $5,859 $1,037 $616 $0 $1,850 $3,613 $2,039 $1,777
$9,412 $11,105 $12,258
The median total costs for both medical and indemnity for each of the past three years has been significantly lower than the reported means, an indication that extremely costly indemnity & medical payments are pulling the mean upward in a positive direction. This is sometimes referred to as an inflated mean. Median total indemnity dropped 28 percent from 1999 ($2923) to 2000 ($2,115) but has risen 8.5 percent over the past year to $2,296 (See Table 3-11 below). Median total medical costs for 2001 were $3,834, a 15 percent increase from last year ($3,342) and a 56 percent increase from 1999 levels. See Figures 3-24, 3-25, 2-26 & 3-27 below for visual representations of the median and mean figures for all claim costs for 1999-2001.
77
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Table 3-12 Closed Claims Statistics 1999-2001 Median Costs
2001 Median Total Indemnity Median Total Incurred Vocational Rehab Median Total Incurred Medical Median Vocational Rehab Evaluation Expense Paid to Date Median Vocational Rehab Maintenance Paid to Date Median Vocational Rehab Education Paid to Date Median Other Vocational Rehab Paid to Date Median Hospital Costs Paid to Date Median Total Payments to Physicians Median Other Medical Paid to Date Median Lump Sum Settlement Source: Kansas Division of Workers Compensation 2000 1999
$2,296 $2,115 $2,923 $772 $335 $353 $3,834 $3,342 $2,451 $772 $290 $584 $1,445 $2,705 $172 $1,820 $5,616 $0 $0 $3,885 $1,860 $2,300 $2,052 $1,661 $1,352 $1,369 $1,042 $683 $557 $518 $6,087 $7,000 $7,142
Average Claim Costs: The Mean or the Median?
Over the past three years the Division has reported both the mean and median total indemnity & medical costs of claims in the OCC study. Which measure, the mean or the median, is a better statistical indication of the typical or average costs associated with workers compensation claims? Means and medians are both measures of central tendency that are used to summarize a body of data. Many times the term "average" is used instead of either mean or median but these two measures are not the same and should not be treated the same. Technically, the mean is the arithmetic average of all the data points in a sample. The median is simply the midpoint value (50th percentile) of the distribution, half of all values are above it and half are below it. In a perfectly normally distributed sample the median and mean claim cost would be the same value. For each of the last three years, however, the closed claim sample distributions for both total indemnity & total medical paid have been positive ly skewed. In a positively skewed sample the median will be lower in value than the mean for a simple reason: every observation is used to calculate the value of the mean but not every value is used to calculate the median. Because of this extreme values, or outliers, will have a "disproportionate influence on the mean and may thus affect how well the mean represents the data."3 This is not necessarily the case with a sample median. The median is a more resistant measure than the mean because it is relatively unaffected by (or resistant to) outlier values and thus, less likely to be distorted by high cost claims. The histograms below (Figure 3-23 & 3-24) are a graphical summary of the distribution of both total indemnity & total medical claim costs samples for the 2001 OCC study. Compared to the normal distribution, the classic bell curve, the distribution of both total medical & indemnity costs are skewed to the right. After three years of analyzing claims data the Division has concluded that the distribution of total medical & total indemnity costs in Kansas is not normally distributed and therefore, the median may be a more appropriate measure of central tendency for summarizing the closed claims data.
3
Kenneth J. Meier & Jeffrey L. Brudney, Applied Statistics for Public Administration 4th Edition (Ft. Worth, TX: Harcourt Brace Publishers); 25.
78
Frequency
1000 1200 1400 200 400 600 800 0
Frequency
1000 1200
Kansas Division of Workers Compensation
200
400
600
800
0
Frequency
Distribution of Total Medical Costs 2001
Distribution of Total Indemnity Costs 2001
Figure 3-24
Frequency Cumulative %
Figure 3-23
Cumulative %
Annual Statistical Report
$1 $4 3 ,80 6 $9 ,59 $1 9 4,3 9 $1 1 9,1 8 $2 4 3,9 7 $2 7 8,7 7 $3 0 3,5 6 $3 3 8,3 5 $4 6 3,1 4 $4 8 7,9 41 $5 2,7 3 $5 4 7,5 2 $6 7 2,3 2 $6 0 7,1 1 $7 3 1,9 0 $7 5 6,6 9 $8 8 1,4 91 $8 6,2 8 $9 4 1,0 7 $9 7 5,8 $1 70 00 ,6 $1 62 05 ,45 5 M ore
$ $8 9 ,21 $1 0 6,4 1 $2 2 4,6 1 $3 3 2,8 1 $4 4 1,0 1 $4 6 9,2 1 $5 7 7,4 1 $6 8 5,6 1 $7 9 3,8 2 $8 1 2,0 2 $9 2 0,2 2 $9 3 8,4 $1 25 06 ,6 $1 26 14 ,8 $1 27 23 ,0 $1 29 31 ,2 $1 30 39 ,4 $1 31 47 ,6 $1 32 55 ,8 $1 34 64 ,0 $1 35 72 ,2 $1 36 80 ,43 8 M ore
0%
0%
20%
40%
60%
80%
20%
40%
60%
80%
100%
120%
100%
120%
2001
79
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Figure 3-25
Comparison of Costs Associated with Workers Compensation Claims 1999-2001
$7,109
Mean Total Incurred Medical
$6,873 $5,859
$1,150
Mean Total Vocational Rehab
$1,267 $1,010
$6,531
Mean Total Indemnity
$7,235 $7,936
$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000
1999
2000
2001
Figure 3-26
Comparison of Costs Associated with Workers Compensation Claims 1999-2001
$3,834
Median Total Incurred Medical
$3,342 $2,450
$772
Median Total Vocational Rehab
$335 $353
$2,296
Median Total Indemnity
$2,115 $2,926
$0 $500 $1,000 $1,500 $2,000 $2,500 $3,000 $3,500 $4,000 $4,500
1999
2000
2001
80
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Figure 3-27
Comparison of Costs Associated with Workers Compensation Claims 1999-2001
$2,137
Mean Other Medical Paid to Date
$1,604 $1,775
$2,282
Mean Total Payments to Physicians
$2,770 $2,040
Mean Hospital Costs Paid to Date
$4,315 $4,215 $3,613
$0 $500 $1,000 $1,500 $2,000 $2,500 $3,000 $3,500 $4,000 $4,500 $5,000
1999
2000
2001
Figure 3-28
Comparison of Costs Associated with Workers Compensation Claims 1999-2001
$683
Median Other Medical Paid to Date
$557 $516
$1,352
Median Total Payments to Physicians
$1,369 $1,042
Median Hospital Costs Paid to Date
$2,300 $2,052 $1,665
$0 $500 $1,000 $1,500 $2,000 $2,500
1999
2000
2001
81
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Section 4
Workers Compensation Fraud and Abuse
82
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Introduction
The Workers Compensation Fraud & Abuse Investigation Unit was established in 1994. Staffing for the Unit comprises an Assistant Attorney General, who acts as the Unit's manager, three investigators and one clerical person. The Unit's responsibilities includes identifying potential fraud & abuse by investigating allegations of wrongdoing that are referred to the Unit and taking legal action when evidence gathered in the investigations indicates possible wrongdoing. In addition, the Unit sanctions employers who fail to file accident reports as required by K.S.A. 44-557. The Unit is dedicated to the investigation and prosecution of suspected workers compensation fraud, however the Unit also has directed its attention to the education of the public and the insurance industry. Also the Unit has filed cases against employers who have failed to file accident reports as required by K.S.A. 44-557. Fraud in the workers compensation system may occur at any level involving employees, employers, insurance carriers, self-insured entities, attorneys, physicians and others who attempt to obtain or deny workers compensation benefits in a fraudulent manner. K.S.A. 44-5,120 lists 21 acts that constitute fraud and or abuse of the workers compensation system. K.S.A. 44-5,125 makes some acts a felony crime. The Fraud & Abuse Unit of the Division of Workers Compensation set a record this past year, as the data in this section will evidence.
§
This year the Fraud & Abuse Unit collected the most in restitution and civil penalties ever. The Fraud & Abuse Unit has stepped up prosecution of workers compensation fraud violators. Not only is prosecution up, but enforcement of the judgment, i.e. collection of fines, penalties, and restitution has significantly increased. During 2001, the Fraud & Abuse Unit performed 199 investigations of those individuals, selfinsured entities and employers who were alleged to have violated the Kansas Workers Compensation act. The Unit has provided Kansans with an aggressive program to fight fraud in the workers compensation system. Also in 2001, the Unit pursued employers who failed to file accident reports as required by K.S.A. 44-557.
§
The Unit performs a vital service in helping reduce and punish workers compensation fraud violators and insures compliance with other relevant workers compensation laws in Kansas. However, this is not enough. The direct involvement of all Kansans is required to send the message that fraud will not be tolerated in Kansas.
Table 4-1
Civil Cases Filed Criminal Cases Filed Fines & Restitution Ordered Moneys Collected
Overview of Fraud & Abuse Unit Activity 37 2 $202,465.09 $77,768.56
Source: Kansas Division of Workers Compensation
83
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Referrals
Information Received by the Unit
The Fraud & Abuse Unit receives information on alleged fraud violators by phone, fax, e-mail, regular mail or a submission from one of the other sections of the Division of Workers Compensation. Allegations of fraud & abuse are designated as a referral. This referral is reviewed by the Assistant Attorney General to determine if sufficient information is evident to warrant an investigation. If there is sufficient information, the case is given to an investigator for investigation. If insufficient information exists, the matter is either returned to the complaining party for further information or if that is not possible, then the referral is recorded but no investigation commences.
Reporting Fraud
Table 4-1 below indicates who reports allegations of fraud to the Unit. As noted, reports come in from all persons within the workers compensation system.
Table 4-2 Who is Reporting Fraud?
Fraud Reporting Persons Claiming Benefits Employers Subject to Workers Compensation Requirements Insurance Companies Renderers of Medical Care Attorneys Anonymous In-House Other
Source: Kansas Division of Workers Compensation
Percent of Total
12% 8% 22% 1% 13% 10% 23% 11%
Referrals by Location
The Fraud & Abuse Unit records the location of the referrals by the county in which the fraud allegedly occurred. Figure 4-1 lists the number of referrals received from each county.
§
Of the 199 referrals, (123) or 61.8 percent came from Sedgwick, Wyandotte, Johnson and Shawnee. Out of the 105 counties in Kansas, 60 percent or 63 counties did not have any reported referrals.
84
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Figure 4-1 Referrals by County
The Unit has recorded travel by the investigators and the Assistant Attorney General. This travel would include investigation, criminal prosecution, administrative actions, and educational presentations to the general public, law enforcement, and the insurance industry.
Table 4-3 Travel Hours
Assistant Attorney General Special Investigators
20 1,017.75
Source: Kansas Division of Workers Compensation
85
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Types of Fraud
The Unit classifies the type of fraud reported as it relates to the fraud & abuse statutes as well as the compliance statutes. Figure 4-2 lists the types of fraud reported to the Unit over the past year.
Figure 4-2
NUMBER OF FRAUD CASES REPORTED
1 2 3 4 5 6 7 8 9 10 11 12
0
82 2 8 3 2 22 13 0 10 46 3 9
10 20 30 40 50 60 70 80 90
KEY FOR FIGURE 4-2
1. 2. 3. 4. 5. 6. 7. 8. 9. 10 . 11 . 12 .
Obtaining or denying benefits by making false statements either orally or written, K.S.A. 44-5, 120 (D)(4). Misrepresenting provisions of the Act to an employee, employer, or medical provider, K.S.A. 445, 120 (D)(11). Failure to confirm benefits to anyone providing treatment to a claimant, K.S.A. 44-5, 120 (D)(15). Failure to initiate or reinstate compensation when due, K.S.A. 44-5, 120 (D)(16). Misrepresenting the reason for changing compensation, K.S.A. 44-5, 120 (D)(17). Refusing to pay compensation as and when due, K.S.A. 44-5, 120 (D)(18). Refusing to pay any order awarding compensation, K.S.A. 44-5, 120 (D)(19). Refusing to timely file reports or records, K.S.A. 44-5, 120 (D)(20). Receiving TTD or PTD benefits while working, K.S.A. 44-5, 125 (D). Failure to maintain workers compensation insurance when required, K.S.A. 44-532 (c). Collecting fees outside the medical fee schedule, K.S.A. 44-510 (D). All other Fraud and Abusive Practices.
86
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Type of Violators
Figure 4-3 below indicates the alleged violators of the fraud & abuse statute.
§
Of the 199 referrals for the year, claimants were indicated in 78, employers 110, insurance entities 10, renderers of medical care 0, attorneys 0, and others 1. The chart below indicates the percentages for each.
Figure 4-3
Who Is Committing Workers Compensation Fraud?
5% 1% 39%
55%
Person Claiming Benefits 39% Employers Subject to Workers Comp Requirements 55% Insurance Companies 5% Other 1%
87
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Fraud Victims
Figure 4-5 below indicates who is the potential victim of the fraud being perpetrated. Of the 199 referrals for the year, claimants were indicated in 72, employers 77, insurance entities 1, renderers of medical care 0, and the State of Kansas (Workers Compensation Fund or compliance) 49. The chart indicates the percentages for each.
Figure 4-4
Victims of Workers Compensation Fraud
25% 1% 38% Persons Claiming Benefits 36% Employers Subject to Workers Comp Requirements 38% Insurance Companies 1% State of Kansas 25% 36%
Investigations
The Fraud Unit has three full time investigators. These investigators are not law enforcement officers, however, they perform almost identical investigative duties as sworn law enforcement. The investigation process includes activities such as interviewing witnesses, collecting evidence, forming liaisons with law enforcement groups as well as special fraud investigation units within the insurance industry and testifying in administrative and criminal actions.
§
Of the 199 referrals received by the Unit, 188 were fully investigated.
88
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Once an investigation is complete, the investigator will prepare an investigative summary for the Assistant Attorney General to review. Criminal or administrative action commences if the Assistant Attorney General determines there is sufficient information to sustain the burden of proof in either a criminal or administrative action. If the information indicates an insurance company as the alleged fraud violator, that information is referred to the Kansas Insurance Department for review. Per Kansas's law, the Kansas Insurance Department has authority to bring a fraud and/or abusive practice violation against insurance companies.
§
Of the 199 referrals, 13 were referred to the Kansas Insurance Department for investigation.
If the information developed is insufficient to sustain the burden of proof in any action, the case is closed with no further action to be taken.
§
The average time for an investigation was 61 days. The Assistant Attorney General made a decision to prosecute, refer or close the file within an average of 7 days.
Prosecution
The Unit is authorized to initiate criminal or administrative action against individuals and entities that appear to have committed fraud or abuse of the workers compensation system. The Unit has been extremely aggressive in this area. Civil actions are broken out into compliance and fraud actions.
§
Criminal cases were filed in Johnson and Seward Counties.
Table 4-4 Number of Cases Civil Fraud Compliance Criminal Total
Source: Kansas Division of Workers Compensation
20 17 2 39
Collections
This year the Unit has devoted serious effort to collection of fines, penalties and restitution. During either a criminal or administrative action, a penalty, fine, or restitution is requested but not necessarily ordered by the judge or hearing officer. The chart below shows the request that was made by the Unit and what was actually ordered and collected.
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Kansas Division of Workers Compensation
Annual Statistical Report
2001
Table 4-5 Fraud & Abuse Collections Amount Requested Amount Ordered Amount Collected
$420,596.17 $202,465.09 $77,768.56
Source: Kansas Division of Workers Compensation
The Unit makes every attempt to collect the funds due and owed to the Unit without any assistance. However in some instances the Legal Services Division of the Kansas Department of Human Resources is used to file collection action. Figure 4-6 below indicates the amount collected by each agency.
Figure 4-5
2001 COLLECTIONS
$10,158.46
$67,610.10 Collected by Fraud Unit Collected by KDHR Legal Services
Once the money is received, by law it must be deposited in the appropriate fund. Figure 4-7 shows the breakdown of which fund receives the money collected. Restitution is money that is returned to the victim of the fraud.
90
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Figure 4-6
2001 COLLECTIONS Disbursement Chart
$3,268.44
$7,082.08
$67,418.04
Fee Fund
Work Comp Fund
Restitution
Conclusion
The Division of Workers Compensation Fraud & Abuse Unit is and will continue aggressively investigating and prosecuting workers compensation violators. If you wish to report an employer failing to comply with the Workers Compensation Act, fraud or just have questions for the Unit, please do not hesitate to contact the Division.
91
Appendix A
Technical Notes: Occupational Injury & Illness Incidence Rates and Open & Closed Claims Study
Kansas Division of Workers Compensation
Annual Statistical Report
2001
Occupational Injury & Illness Incidence Rates
BLS Survey of Occupational Injuries and Illnesses : BLS, with the help of the state agencies,
selects a non-proportional stratified probability sample of employment establishments and mails them questionnaires. Employers are instructed to record all nonfatal employee injury & illness incidents, number of days away from work for each recorded injury/illness, the number of employee hours worked and the establishment's average employment. Participants in the annual survey consist of employers who maintain Occupational Safety and Health Administration (OSHA) records on employee injuries & illnesses on a regular basis under federal law and smaller employers who are exempt from OSHA record keeping requirements. The data collection process differs for the former and the latter. The former are mailed a questionnaire in February, following the survey year, and are asked to transfer from their records all injuries and illnesses incurred as well as demographic and hours worked data. The latter, exempt employers (fewer than 11 employees and those designated as "low-hazard industries" by OSHA), are notified in December of the prior year (contacted in December of 1999 to record injuries for the 2000 survey) that they have been chosen to participate in the survey and must keep records of all employee injuries. The participating state agencies are responsible for collecting data from employers within their jurisdiction and for submitting these questionnaires to BLS for analysis. The BLS uses its incidence rates as a benchmark by which to compare the frequency of injuries & illnesses occurring within jurisdictions, industries or specific occupations for a calendar year. The variable "Total Injuries & Illnesses per 100 Full-time workers" (the most widely quoted measure) is calculated as follows:
Formula: IR= (N/EH) x 200,000 IR= Incidence Rate N= Total number of occupational injuries & illnesses EH= Total hours worked by all private industry employees during the calendar year 200,000= Base for 100 equivalent full-time workers- 40 hrs per and 50 weeks per year
Kansas Occupational Injury & Illness Incidence Rates: The Division collects data on the entire
population of workplace injuries & illnesses in the state of Kansas for FY2001 through its first report of injury form and stores it in its relational database. Every employer covered under the Workers Compensation Act that has workplace injuries must submit first reports of injury. The severity of each occupational accident or illness & the industrial classification code are mandatory data elements that must be reported by employers to the state. The Div ision's analysts utilized the BLS statistical formula (see above) to calculate the incidence of injury for each severity classification for Kansas non-federal employment hours for the past ten fiscal years. Data used in the calculation of incidence rates was obtained from the Kansas Labor Market Information Services & Division databases.
Kansas Open & Closed Claim (OCC) Study Methodology
The following is a description of the methodology used by the Technology and Statistics section of the Division for the 2001 Open & Closed Claim (OCC) Study. Sample Design: For both reasons of efficiency & effectiveness the Division consulted with a Washburn University professor of statistics on the OCC sample design. The Division decided to sample the population of Kansas's workers compensation claims for several reasons. To collect data from the entire population of claims for a calendar year is impractical (resulting in very large data sets), extremely expensive and labor-intensive especially since Division researchers can randomly sample the population and make valid inferences about its characteristics using reliable & credible statistical tools.
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Kansas Division of Workers Compensation
Annual Statistical Report
2001
Since the OCC has been in existence the Division has utilized a two-stage type of probability sample design referred to as "stratified" or as it is formally known as "disproportionate stratified sampling." Unlike a simple random design, in which each of the total sampling units have an equal probability of being selected, the stratified sample design ensures that different groups within the population will be adequately represented in the sample to increase the accuracy of the parameter estimations. While the strata or subsets will tend to be more homogeneous than the population of claims as a whole, once combined, the resulting sample will be reasonably representative of the entire population (heterogeneous) of claims. The goal of simple random sample designs is to ensure that each element in the population has an equal chance of being selected for the study. However, this is not an option for the OCC study since the Division must have a large enough sample size in order to do statistical inference. Carriers with higher paid losses tend to have elements in the claims population with a greater amount of variation and therefore, we sampled a larger percentage of these carriers in order to ensure that our sample is representative of the larger population. The study team estimated that sampling approximately 35-40 insurance carriers, pools and self-insured organizations, could obtain a statistically significant sample. The sampling method is as follows. The population is first stratified according to paid losses (the variable that the Division uses to stratify the carrier and self-insured population is percent of total paid losses for all workers compensation claims in the state of Kansas). Next, within each stratum, the Division selects carriers that will be asked to randomly select from their database claims that meet the OCC study criteria by utilizing a random number generator to select study participants from all listed carriers and self-insured within each range (each carrier had equal chance of being selected). In consultation with our statistician, the OCC study selects all of the carriers and self-insured that have 2 percent or more (top strata) of total paid losses. For the remaining stratum the Division utilizes different sampling fractions ("disproportionate stratified sampling" design). From the second stratum (1 percent to <2 percent of paid losses) we randomly select 50 percent of carriers, for the third (.5 percent to <1 percent) 25 percent are randomly selected and for the fourth (.25 percent to <. 5 percent) and fifth (.10 to <. 25 percent) strata the Division randomly selects 10 percent for inclusion in the study. Technically, the bottom two strata could be combined if so desired since the number of claims within each is considerably less than the upper strata. Data Collection: The organizations included in the study were then asked by the Divisio n to randomly sample from their database 200 or less (if they do not have 200) claims for the specified calendar year. The sample was to be taken from each entity's pool of claims including both medical and indemnity payments. Each claim in the sample was also required to have been open at least one day during the period of January 1, 2000 to December 31, 2000. The expected sample size of open and closed claims was approximately 4725 random claims. The Division secured permission from the National Council on Compensation Insurance to print and use the Detailed Claim Information (DCI) survey instrument in order to create data definitions and structure for the Kansas Open & Closed Claim Study survey. DCI is a national standard for reporting comprehensive claim data from insurance carriers. Adhering to the DCI structure, programmers in the Kansas Department of Human Resources created two software packages to assist reporting entities. One package was a manual entry system; the other application allowed a text file to be imported electronically. Both products included editing limitations on inputs to certain data fields. In addition, the Division's analysts performed data scrubbing on the data sets to ensure that accurate aggregate statistics were reported to the Legislature. To assist reporting organizations in understanding data requirements and use of the new software, the Division sponsored informational meetings in Topeka, Kansas in January 2001. Following distribution of both software products, reporting entities were asked to provide data by August 15, 2001 on the complete
94
Kansas Division of Workers Compensation
Annual Statistical Report
2001
history of their sample of claims. In addition, the Division asked that information on charges paid for certain types of services are reported quarterly for claims remaining open within the sample group. Response Rate : Non-response bias is always a threat to the accuracy of a sample because non-responders may differ significantly from survey respondents. In order to assess whether the OCC sample suffered from non-response bias the Division assumed that claims reported by the carriers in the sample (those reporting less than the required 200) were, in fact, all of their claims for the year 2000. For carriers that did not submit data, and for purposes of calculating the non-response rate, we estimated the total number of claims not reported by comparing the number of submitted claims from carriers in the study with similar paid losses within the same stratum. The total number of claim records the Division received was 3,733 out of an estimated 4,725 sampling units. Using a standard formula (R=1[n-r/r]) the Division's analysts calculated a response rate at 79 percent and a non-response rate of 21 percent. The Division, in consultation with our statistician, concluded that the sample did not suffer from systematic non-response bias.
95
Free Annual Report 2001 - Kansas
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| Date: | February 26, 2003 |
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| State: | Kansas |
| Category: | Workers Compensation |
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