A recurring concern among many in the workers’ compensation field, perhaps especially labor activists, is the case of workers not seeking workers’ compensation benefits after a work injury. The issue rears its head again with renewed criticism of California’s intimidating first report of injury form.

It’s time to review the evidence. Academic researchers, state agencies, and activists have prepared dozens of studies over the past few decades. Virtually all say that non-claiming is common, with rates from low double digits of injuries to well over 50%. Further, the injuries involved are not just minor ones.

A population of unionized workers in Michigan showed how a workforce, presumably confident with asserting their rights, might chose among an array of benefit alternatives to forego workers’ compensation. The workers often dispensed with filing claims for work injuries, even those with lost time. Jeffrey Biddle and colleagues published their analysis in 2003.

I’m not aware of any survey of a differentiated group of workers asking why they did or might not file a claim. But there are several hypotheses why non-claiming might be pervasive and not easily explained by employer intimidation alone. A “filtering” hypothesis, proposed in 2002 by Lenore Azaroff and colleagues, says that the worker, her manager and her doctors, and “the larger economic, legislative, and social contexts” tend to block or head off claims from happening.   

Another hypothesis is that workers are turned off by the workers’ compensation system.  Hester Lipscomb captured the idea in the title of her 2013 article, “You're pretty much screwed if you get hurt at work.” The complexity of the system can deter. Beth Kilgour with other Australian researchers reported earlier this year that 33.9% of claimants reported high levels of stress associated with understanding what they needed to do for their claim.

Numerous studies have tried to quantify the extent of non-claiming. One approach might be called the “amputation method,” because it often involves checking the reimbursement hospitals have received for amputations or other injuries known to be work-related.  Kenneth Rosenman of Michigan State University has been leading this research.

A more expansive approach is the “capture-recapture” study. The term refers to the original use of the method, to estimate a wildlife population, such as rabbits in Denali National Park.  

The idea is to compare OSHA and claims databases and estimate the under-count in each category. For OSHA undercounts alone, as J. Paul Leigh noted in 2004, 59% of lost work time injuries and 70% of all injuries were not reported in construction. In an April, 2014, article Leigh estimated the undercount in agriculture ranged from 61.5% to 88.3%.

In a six-state study published in 2008, Les Boden and colleagues matched OSHA and claims data. They reported that 10% of injuries were missing from both data sources. In the median state, 39% of work injuries failed to be entered in the workers’ compensation system, with the range from a high of non-claiming of 55% to a low of 15%. OSHA logs were estimated be short by 63% to 29%.

Reading as many studies as I have found on the subject, I am left with several questions.  First, how can we fairly assess the performance of the workers’ compensation system when non-claiming is pervasive, with no methods in place document alternative treatment paths?

And, why assume that today’s coverage policies of workers’ compensation are the proper point of reference? For years, some have asserted that workers’ compensation laws and processes turn away many work-related conditions. Emily Spieler and John Burton argue that legislatures have been shrinking coverage. Leigh has been arguing that both OSHA and claims data exclude most work-related fatalities and many non-fatal conditions, mainly occupational diseases.

In sum, there is a lot of complain about when one looks at how many injured workers never file for workers’ compensation benefits.

Articles cited in this column, listed in order of reference:

Biddle, J. et al. Claiming behavior in workers compensation. J Risk and Insurance. (2003) 70 (4): 759-780.

Azaroff, L. et al. Occupational Injury and Illness Surveillance: Conceptual Filters Explain Underreporting. Am J Publ Hlth (2002) 92: 1421-1429.

Lipscomb, H. Safety, incentives, and the reporting of work-related injuries among union carpenters: “You're pretty much screwed if you get hurt at work.”
Am J Ind Med (2013): 56: 389–399.

Kilgour E et al.  Interactions between injured workers and insurers in workers’ compensation systems: a systematic review of qualitative research literature May 2014 J Occ Rehabil.

Leigh, J. et al. An estimate of the U.S. government's undercount of nonfatal occupational injuries. J Occup Environ Med (2004) 46: 10-18.

Leigh J. et al. An estimate of the U.S. government's undercount of nonfatal occupational injuries and illnesses in agriculture. Ann Epidemiology (2014) 24 (4): 254-259.

Boden, L. et al. Capture-recapture estimates of non-fatal workplace injuries and illnesses. Ann Epidemiology (2008) 18: 500-506.

Spieler, E. et al. The lack of correspondence between work-related disability and receipt of workers’ compensation benefits. Am J Ind Med (2012) 55: 487-505.