Fit to Work.

Insurers are educating policyholders on how to prevent repetitive-stress injuries.

A proofreader in a typesetting firm reports that her back aches so much after a day's work, she can't lift her 1-year-old son.

A librarian employed by a major U.S. university is considering retirement because her wrists continually ache from using a computer mouse.

Repetitive-stress injuries, such as these cited by ergonomics expert Marvin Dainoff during comments this spring on the Occupational Safety and Health Administration's proposed ergonomic standards, are fueling increased emphasis on ergonomically correct working conditions.

The concern is at the root of OSHA's proposed ergonomic standard, which would require employers to report and correct work-related situations that endanger the health and welfare of workers. The proposal would require that workers who experience covered musculoskeletal disorders receive a prompt response from their employer, including an evaluation of the injury and access to follow-up by a health-care professional, if necessary. Musculoskeletal disorders are repetitive-stress injuries involving the muscles, nerves and tendons of the upper limbs.

Additionally, the proposal would provide work-restriction protection for an employee when the company or its health-care professional has determined that the worker needs a change of routine because of musculoskeletal disorders. The proposal has drawn fire from those who believe it would interfere with state workers' compensation laws and administration.

The National Association of Manufacturers and insurance industry groups such as the Alliance of American Insurers have lobbied vigorously against the standard, citing problems with the cost for business owners to implement the plan.

OSHA defines ergonomics as the science of fitting the job to the worker. When there is a mismatch between the physical requirements of the job and the physical capacity of the worker, work-related musculoskeletal disorders can result. Workers who must repeat the same motion throughout their workday, who must do their work in an awkward position, who must use a great deal of force to perform their jobs, who must repeatedly lift heavy objects or who face a combination of these risk factors are most likely to develop such disorders.

The increased use of technology in the workplace is the culprit in many repetitive-stress injuries.

Drilling Down

Liberty Mutual, the largest U.S. workers' comp insurer, extensively analyzes such claims to reveal trends and prioritize solutions with its customers. "We get a description of the injury, develop loss source trends and drill down to find out why the loss is occurring," said Wayne Maynard, product director of ergonomics at Liberty Mutual's research center in Hopkinton, Mass.

Liberty Mutual's field loss team sifts through data looking for not only how an injury occurred, but for substantiating evidence, such as on which day of the week and in what part of the company it occurred and whether the employee was new or a veteran.

Claims management is essential in light of workers' comp's increasing combined ratios. A.M. Best Co. estimates that the current calendar-year combined ratio is approaching 120, vs. 115 for 1999. A combined ratio of more than 100 represents an underwriting loss.

The National Council of Compensation Insurance reports carpal-tunnel syndrome as the third most costly lost-time workers' comp claim at $12,611 in 1997, behind amputation and burns. Carpal-tunnel syndrome is an inflammatory disorder caused by repetitive stress that causes the tissues around the median nerve in the wrist to become swollen.

Carpal-tunnel syndrome accounts for 57.6% of injuries with more than 20 lost work days, according to OSHA. The U.S. Bureau of Labor Statistics reports that this type of disorder was the most common illness reported in 1997, with 276,000 new cases.

OSHA reports that musculoskeletal disorders alone account for about $15 billion to $20 billion in workers' comp costs annually, or roughly $1 for every $3 spent for workers' comp.

Seeing Is Believing 

Many workers' camp insurers demonstrate the need for ergonomics to their corporate policyholders in an effort to curb work-related injuries.

Liberty Mutual presents its Ergonomic Institute five to 10 times a year to policyholders throughout the country. The insurer also hosts an annual Ergonomics Interventions Symposium for risk managers and occupational health professionals.

Atlantic Mutual, the 33rd-largest workers' camp writer in the United States, has been holding ergonomic seminars for policyholders since 1997. The Madison, N.J.-based insurer invites clients that have a lot of repetitive-stress injury claims to attend the seminars.

"We offered the seminars because ergonomics has been identified as one of the top 10 risk-management issues," said Steven Skubish, vice president of Atlantic Risk Services Inc., a subsidiary of Atlantic Mutual.

Atlantic Mutual's seminars focused on new ergonomic topics such as the health concern most often reported by computer users--computer vision syndrome. This ailment, which is characterized by dry, irritated eyes and focusing difficulty, is transitory. Most vision problems result from poor posture, said Efethemia Hinman, an ergonomics specialist.

The seminars also demonstrated how to design an ergonomically correct workstation and how to adjust office chairs to ward off back problems. At a seminar last spring, Hinman demonstrated how to fit a mouse to the user and how to use it properly. Incorrect use of a mouse can lead to repetitive-stress injuries, Hinman said.

Kemper Insurance Cos., the eighth-largest workers' comp insurer, called on CorpMed.com, an online provider of employee health and training programs based in Boulder, Cob., to educate its clients. The program, ErgoClinic, is an ergonomic and safety training course that employees can use to correct the bad habits they incorporate into their daily work routine and that lead to injuries. "Companies also want employees trained on the correct and best way to use computers, because they are getting hammered on claims and workers are underperforming due to discomfort. Fortunately about 95% of cumulative trauma disorders are preventable," said Dr. Kevin Byrne, CorpMed's president and founder.

ErgoClinic's self-directed training is accessed by clients through the Web or a company's intranet. An employee can either view the entire training program or click on a self-care section that focuses on body parts that hurt. For example, the user might be hyperlinked to an elbow section and instructed how to avoid pain there by adjusting parts of the workstation. "About 95% of personnel do the adjusting during the program and 90% report improved comfort before finishing the 30-minute training program," Byrne said.

Greater Concern

Ergonomics is getting more attention because of dramatic changes in working conditions over the past 10 years, especially the increased use of computers, and a resulting rise in repetitive-stress injuries.

Years ago when office staff used typewriters, they didn't experience as many repetitive-task injuries because they stopped work frequently to change paper or hit the return lever, Hinman said. Additionally, office furniture more than 10 years old is designed for typewriters and is not ergonomically engineered for computer use. "The concept of the office has changed in the last 10 to 15 years; the human body hasn't," Atlantic Risk's Skubish said.

Small employers tend to put off introducing ergonomic standards the way would-be dieters procrastinate shedding extra pounds--they attend to it when there is no longer a choice. "They are concerned over how much an ergonomic evaluation will cost their company to implement changes. We advise them to spend the money before an injury rather than after," said Bonnie Bach, director of CompWorks, a division of occupational health-care company Industrial Health Care.

In addition to the cost of new equipment, employers can't place a price tag on the cost of not fitting the workplace to the worker. "It's not like asbestosis; there are differences in susceptibility," said Marvin Dain off, director of the Center for Ergonomic Research at Miami University, Oxford, Ohio.

Naysayers like Eugene Scalia, a partner in a Washington, D.C., law firm, argue that ergonomists are engineers, not physicians, which makes their medical theories controversial. In a paper published by the Cato Institute, Scalia dubs the science of ergonomics "notoriously doubt-ridden and controversial."

Liberty Mutual's Maynard retorts that such arguments "miss the point" about the benefit of ergonomics, but he acknowledges that it is difficult to assess the problem. "There is a problem when addressing these injuries, because there is no firm threshold about how much exposure is too much," he said. "We thought the OSHA ergonomic standards would make it easier for the public to understand ergonomics, but now we find, due to public misconception, we're defending it first and then going forth with education."

Claim Management

Pinpointing the cause of a claim is doubly difficult, because insurers must determine how an employee's off-site actions contributed to an injury. For example, how much does an employee's needlepoint or bowling hobby add to the cause of the reported injury?

A venture between MetLife and Travelers is one way to address the problem. The two insurers developed Synchrony to meld group disability and workers' comp services into one integrated approach.

MetLife and Travelers experts work side by side through Synchrony's Causation Assessment Program to handle claims and manage treatment protocols. The program's eight-point process leads case managers through steps that will determine if the claim is work related. If it isn't, it is passed to Synchrony's disability side. "We have a seamless process for reporting claims," said Dr.Adam Seidner, national medical director for Travelers Property Casualty and medical director of Synchrony.

The computer-based program researches whether the injury is reported in medical literature and how it fits into risks for a particular employee group. It also looks at timing associations of the claim, such as how long the worker has been performing the job procedure and whether any external forces prevailed at the time of the injury. "The pieces of the puzzle are fit together to make sense of the information," Seidner said. "If it's the process that's causing the injury, the employer has to make changes." In some cases, Synchrony's team of ergonomic professionals goes to the work site and tells the client how to modify the workstation.

Safeco assists its midsize and large commercial clients--those with 75 employees to more than 1,000--through SAFECOM, an Internet-based risk-management system. Seattle-based Safeco is the 19th-largest workers' comp insurer. About 8% of the insurer's annual premiums come from workers' comp sales, according to A.M. Best Co. data. Using SAFECOM, Safeco's business customers can benchmark the effectiveness of their return-to-work programs and download programs, such as LiftCalc. Safeco's LiftCalc identifies and evaluates risk factors in lifting and helps policyholders test various alternative job designs. SAFECOM also enables Safeco's customers to access a library of their workers' comp claims history to analyze loss trends so the proper controls can be implemented to reduce risk factors that lead to ergonomic injuries, said Bill Rankin of Safeco's commercial insurance enterprise.

CNA Insurance Cos., the second-largest workers' comp insurer, has provided claims reports to its customers for 20 years. In 1999, it moved Clearview onto the Web. Clearview provides access to workers' comp, commercial auto, liability, property, and disability claims information. Clearview contains numerous fields, such as location, type of loss, time and type of injury. The program provides clients with a long view of their claims situation so they can identify frequency and pinpoint areas where severity may exist. "It's like taking an MRI of the company; the policyholder will know where to place its attention," said George Busche, senior vice president of commercial insurance for CNA.

As technology becomes more pervasive in the U.S. workplace, insurers are expecting to continue to handle repetitive-stress injuries and to help their policyholders deal with them. "Ergonomics has become an essential part of management in American business," Dainoff said. "It gives workers the tools they need to do their job."

Challenges to Workers' Comp Insurers

Educating Policyholders: Insurers are discovering that they first must defend the science of ergonomics to their clients and then teach them how to implement it into their work systems.

Pinning Down Causation: Did the reported injury come from work or from the weekend needlepoint or handball hobby? Insurers are working at tracking down the real cause of repetitive-stress injuries.

Tracing the History of Ergonomics

Various resources place the birth of the word ergonomics, based on the Greek words "ergon," meaning work, and "nomos," meaning law or rule, around World War II, when the word first emerged in England.

The International Ergonomics Association reports that fitting the job to the worker became important during the designing of sophisticated military systems during World War II.

But repetitive-stress injuries were diagnosed in the 19th century, according to research by Joy Linn, an Oregon State University student, in 1995. In her research paper, Linn reports that in 1893, Gray's Anatomy described cumulative trauma disorders as occurring in washer women. The condition then was called glass arm or washer women's thumb. Linn also reports the health problem appearing in Morse code operators at the turn of the 19th century.

In 1979, the Occupational Safety and Health Administration, whose mission is to promote safety in the U.S. workplace, hired its first ergonomist. The federal agency published the Advance Notice of Proposed Rulemaking on Ergonomics in 1992, putting in motion a series of steps that would change the course of ergonomics history in the United States.

The proposed ergonomic standard is the most farreaching regulation in OSHA's history. Its proposals affect U.S. businesses that require heavy lifting or repetitive tasks, such as assembly-line jobs in manufacturing plants. OSHA said about 1.6 million employers would need to implement basic programs initially.

The proposed requirements include establishing a basic ergonomics program; analyzing jobs for ergonomic risk factors; and providing prompt response to an injured employee and access to a health-care professional for evaluation. For three years beginning in 1995, OSHA conducted a series of meetings with those affected by the proposed rules. In November 1999, OSHA published the proposed ergonomic standard for comment in the Federal Register. The standard is scheduled to go into effect by the end of this year.