Workers' comp cost: Getting the devil out of the details

'Show the employer how much they would potentially save'

Trying to determine exactly what drives your biggest workers' compensation costs? The devil is in the details.

"You should look not only at the types of injuries you are having, but where they are occurring, the departments, supervisor involvement after the accident, and follow-up care for the injured worker," says Mary (Penny) B. Nicholls, RN, CCM, COHN-S, a disability consultant with Alabama Power Company in Birmingham and a member of the advisory board for the Deep South Center for Occupational Health & Safety at the University of Alabama at Birmingham.

To reduce worker's compensation costs, do these four things:

1. Do a thorough evaluation of individual job tasks to identify associated risks or hazards.

"You cannot be effective in delivering care to workers if you are not knowledgeable about specific work processes," says Kathy Dayvault, RN, MPH, COHN-S/CM, an occupational health nurse at PureSafety in Franklin, TN. "Be familiar with their potential or actual impact on workers."

Do a walkthrough at regular intervals and observe employees doing their jobs, accompanied by a safety professional, industrial hygienist, or member of management. "This helps you to learn about job concerns from a different perspective," says Dayvault. "An interdisciplinary team is essential in risk or hazard identification and reduction."

She points to research showing that back strain injuries in healthcare workers, and workers' compensation costs, were decreased after safe movement programs were implemented.1 "This type of program is a good example of a safety program which focuses on specific job risks," says Dayvault.

2. Obtain statistical data regarding injury type, department, frequency of injuries and reoccurrence.

Once you have this information, associated costs with injuries can be provided by the workers' compensation carrier or in-house claims adjuster. This information can identify areas of high injury rates.

"The carrier can provide a historical overview of injuries. This is important because it is the justification to make a change that might be considered costly," says Dayvault. "You can show the employer how much they would potentially save in the future if the change is made."

3. Learn as much as you can about the injured worker.

Nicholls says that in order to understand hidden worker's comp drivers, you must understand the injured worker's past medical history, social factors, and work environment. Learn about job dissatisfaction, interpersonal conflicts, the type of work they do, lack of upward mobility, and physical stressors.

"All of these will affect the response to medical treatment, either overtly or covertly," says Nicholls. "The more we know about our injured worker, the better we can control the medical treatment plan. Thus, there will be better outcomes, in both cost and recovery to maximum medical improvement with little or no impairment rating."

4. Don't overlook the cost of litigation.

"We can all compare our case costs with the Official Disability Guidelines predicted values and say what a good job we do when we are well below on visit frequency, physical therapy and diagnostic testing," says Nicholls.

However, the real costs are revealed when the final outcome for the worker is not as good as the statistics indicate they should be. If a lawsuit occurs, costs will take a significant hit.

"Rarely are the true costs of litigation captured under workers' compensation costs, but these should be," says Nicholls. "Many times, these costs are near the cost, or may exceed the cost, of medical treatment. "

For this reason, your efforts are best spent on developing a process to optimize work injury management that will meet everyone's needs. "The establishment of this type of process will reduce worker's compensation litigation and costs," says Nicholls.

However, Nicholls says that the real benefits of a successful resolution of an injured worker's case can't be measured in dollars. That's because the worker will become the company's best spokesperson after being treated fairly.

"The impact of a successful outcome on the injured workers is so great that the value cannot be truly measured," says Nicholls.


1. Sedlak CA, Doheny MO, Jones SL, et al. The clinical nurse specialist as a change agent: reducing employee injury and related costs. Clinical Nurse Spec 2009:23(6):309-313.


For more information on collaborating with safety, contact:

• Kathy Dayvault, RN, MPH, COHN-S/CM, Occupational Health Nurse, PureSafety, Franklin, TN. Phone: (615) 312-1242. Fax: (615) 367-3887. E-mail:

• Mary (Penny) Nicholls, RN, CCM, COHN-S, Birmingham, AL. Phone: (205) 257-3327. E-mail:

• Eileen Lukes, PhD, RN, COHN-S, CCM, FAAOHN, Mesa, AZ. E-mail:

• Emily Wallace, RN, BS, COHN-S, Occupational Health Consultant, Sanford, NC. E-mail: