For a century our nation has relied on the workers' compensation system to provide for workers injured on the job while making sure that each employer picks up his or her fair share of the costs. In theory, the system assigns the cost of workplace injuries and illnesses to employers through comp insurance premiums. An employer that invests in a strong safety program that prevents workplace injuries and illnesses can reap the rewards later through reduced insurance bills; an employer who doesn't, and sees too many claims filed, winds up paying a price on the back end when their insurance rates increase.

That's the theory. But if workers hesitate to file a workers' compensation claim -- deciding to live with the pain, pay for treatment out of pocket, or bill their private medical insurance -- the system breaks down. In the past, CPWR (Center for Construction Research & Training) researchers have investigated this phenomenon by surveying workers about their reluctance to report workplace injuries and file claims (see Reasons for not reporting and You're Screwed). More recently a CPWR team tackled this question with objective data: a large-scale review of general medical insurance claims.

Researchers reasoned that if construction workers were turning to private insurance for treatment of work-related injuries, their medical claims history would reflect this. So they compared private medical insurance claims filed by 1,475 floor layers to claims from a comparable sample of 14,750 workers in general industry.

The results confirmed the researchers' suspicions. The floor layers, who work on their knees much of the day, were twice as likely to file claims for knee injuries as were workers in general industry. It appears that many firms have succeeded in shifting the cost of treating these painful and often debilitating conditions from the comp system (and their premium bill) into the general medical insurance pool. The study, Comparison of musculoskeletal disorder health claims between construction floor layers and a general working population, has been published in Occupational and Environmental Medicine.