Construction Safety

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2/21/20, 11:04 AM1902.2 – General policies. | Occupational Safety and Health Administration

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Page 1 of 2https://www.osha.gov/laws-regs/regulations/standardnumber/1902/1902.2

By Standard Number / 1902.2 – General policies.

Part Number: 1902
Part Number Title: State Plans for the Development and Enforcement of State Standards
Subpart: 1902 Subpart A
Subpart Title: General
Standard Number: 1902.2
Title: General policies.
GPO Source: e-CFR

1902.2(a)
Policy. The Assistant Secretary will approve a State plan which provides for an occupational safety and health program with respect to covered issues that in his judgment meets
or will meet the criteria set forth in 1902.3. Included among these criteria is the requirement that the State plan provide for the development and enforcement of standards
relating to issues covered by the plan which are or will be at least as effective in providing safe and healthful employment and places of employment as standards promulgated
and enforced under section 6 of the Act on the same issues. In determining whether a State plan satisfies the requirement of effectiveness, the Assistant Secretary will measure
the plan against the indices of effectiveness set forth in 1902.4.

1902.2(b)
Developmental plan. A State plan for an occupational safety and health program may be approved although, upon submission it does not fully meet the criteria set forth in
1902.3, if it includes satisfactory assurances by the State that it will take the necessary steps to bring the State program into conformity with these criteria within the 3-year
period immediately following the commencement of the plan’s operation. In such case, the State plan shall include the specific actions it proposes to take and a time schedule
for their accomplishment not to exceed 3 years, at the end of which the State plan will meet the criteria in 1902.3. A developmental plan shall include the date or dates within
which intermediate and final action will be accomplished. If necessary program changes require legislative action by a State, a copy of a bill or a draft of legislation that will be or
has been proposed for enactment shall be submitted, accompanied by (1) a statement of the Governor’s support of the legislation and (2) a statement of legal opinion that the
proposed legislation will meet the requirements of the Act and this part in a manner consistent with the States constitution and laws. On the basis of the State’s submission the
Assistant Secretary will approve the plan if he finds that there is a reasonable expectation that the State plan will meet the criteria in 1902.3 within the indicated 3-year period. In
such case, the Assistant Secretary shall not make a determination under section 18(e) of the Act that a State is fully applying the criteria in 1902.3 until the State has completed
all the developmental steps specified in its plan which are designed to make it at least as effective as the Federal program, and the Assistant Secretary has had at least 1 year to
evaluate the plan on the basis of actual operations. If at the end of 3 years from the date of commencement of the plan’s development, the State is found by the Assistant
Secretary, after affording the State notice and opportunity for a hearing, not to have substantially completed the developmental steps of the plan, the Assistant Secretary shall
withdraw the approval of the plan.

1902.2(c)
Scope of State plan.

1902.2(c)(1)
A State plan may cover any occupational safety and health issue with respect to which a Federal standard has been promulgated under section 6 of the Act. An “issue” is
considered to be an industrial, occupational or hazard grouping which is at least as comprehensive as a corresponding grouping contained in

https://www.osha.gov/laws-regs/regulations/standardnumber

https://www.osha.gov/laws-regs/interlinking/standards/1902.2

https://www.ecfr.gov/cgi-bin/text-idx?SID=65b279ee2e7530009034c1f152d451e5&tpl=/ecfrbrowse/Title29/29tab_02.tpl

https://www.osha.gov/laws-regs/interlinking/standards/1902.2(b)

https://www.osha.gov/laws-regs/interlinking/standards/1902.2(c)

2/21/20, 11:04 AM1902.2 – General policies. | Occupational Safety and Health Administration

Page 2 of 2https://www.osha.gov/laws-regs/regulations/standardnumber/1902/1902.2

1902.2(c)(1)(i)
one or more sections in Subpart B or R of Part 1910 of this chapter, or

1902.2(c)(1)(ii)
one or more of the remaining subparts of Part 1910. However, for cause shown the Assistant Secretary may approve a plan relating to other industrial, occupational or hazard
groupings if he determines that the plan is administratively practicable and that such groupings would not conflict with the purposes of the Act.

1902.2(c)(2)
Each State plan shall describe the occupational safety and health issue or issues and the State standard or standards applicable to each such issue or issues over which it
desires to assume enforcement responsibility in terms of the corresponding Federal industrial, occupational or hazard groupings and set forth the reasons, supported with
appropriate data, for any variations the State proposes from the coverage of Federal standards.

1902.2(c)(3)
The State plan shall apply to all employers and employees within the affected industry, occupational or hazard grouping unless the Assistant Secretary finds that the State has
shown good cause why any group or groups of employers or employees should be excluded. Any employers or employees so excluded shall be covered by applicable Federal
standards and enforcement provisions in the Act.

UNITED STATES
DEPARTMENT OF LABOR

Occupational Safety & Health
Administration
200 Constitution Ave NW
Washington, DC 20210
! 800-321-6742 (OSHA)
TTY
www.OSHA.gov

FEDERAL GOVERNMENT

White House
Severe Storm and Flood Recovery
Assistance
Diaster Recovery Assistance
DisasterAssistance.gov
USA.gov
No Fear Act Data
U.S. Office of Special Counsel

OCCUPATIONAL SAFETY & HEALTH

Frequently Asked Questions
A – Z Index
Freedom of Information Act – OSHA
Read The OSHA Newsletter
Subscribe to the OSHA Newsletter
OSHA Publications
Office of Inspector General

https://www.dol.gov/

tel:+18003216742

https://www.dol.gov/general/contact-phone-call-center%23tty

https://www.osha.gov/

https://www.whitehouse.gov/

https://www.dol.gov/general/stormrecovery

https://www.dol.gov/general/disasterrecovery

https://www.disasterassistance.gov/

https://usa.gov/

https://www.dol.gov/oasam/programs/crc/NoFearResult.htm

https://osc.gov/

https://www.osha.gov/faq

https://www.osha.gov/a-z

https://www.osha.gov/foia

https://www.osha.gov/quicktakes/

https://www.osha.gov/quicktakes/%23subscribe

https://www.osha.gov/pls/publications/publication.html

https://www.oig.dol.gov/

2/21/20, 11:05 AM1910.12 – Construction work. | Occupational Safety and Health Administration

Page 1 of 2https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.12

By Standard Number / 1910.12 – Construction work.

Part Number: 1910
Part Number Title: Occupational Safety and Health Standards
Subpart: 1910 Subpart B
Subpart Title: Adoption and Extension of Established Federal Standards
Standard Number: 1910.12
Title: Construction work.
GPO Source: e-CFR

1910.12(a)
“Standards.” The standards prescribed in part 1926 of this chapter are adopted as occupational safety and health standards under section 6 of the Act and shall apply,
according to the provisions thereof, to every employment and place of employment of every employee engaged in construction work. Each employer shall protect the
employment and places of employment of each of his employees engaged in construction work by complying with the appropriate standards prescribed in this paragraph.

1910.12(b)
“Definition.” For purposes of this section, “Construction work” means work for construction, alteration, and/or repair, including painting and decorating. See discussion of these
terms in 1926.13 of this title.

1910.12(c)
“Construction Safety Act distinguished.” This section adopts as occupational safety and health standards under section 6 of the Act the standards which are prescribed in part
1926 of this chapter. Thus, the standards (substantive rules) published in subpart C and the following subparts of part 1926 of this chapter are applied. This section does not
incorporate subparts A and B of part 1926 of this chapter. Subparts A and B have pertinence only to the application of section 107 of the Contract Work Hours and Safety
Standards Act (the Construction Safety Act). For example, the interpretation of the term “subcontractor” in paragraph (c) of 1926.13 of this chapter is significant in discerning the
coverage of the Construction Safety Act and duties thereunder. However, the term “subcontractor” has no significance in the application of the Act, which was enacted under
the Commerce Clause and which establishes duties for “employers” which are not dependent for their application upon any contractual relationship with the Federal
Government or upon any form of Federal financial assistance.

1910.12(d)
For the purposes of this part, to the extent that it may not already be included in paragraph (b) of this section, “construction work” includes the erection of new electric
transmission and distribution lines and equipment, and the alteration, conversion, and improvement of the existing transmission and distribution lines and equipment.

UNITED STATES
DEPARTMENT OF LABOR

https://www.osha.gov/laws-regs/regulations/standardnumber

https://www.osha.gov/laws-regs/interlinking/standards/1910.12

https://www.ecfr.gov/cgi-bin/text-idx?SID=65b279ee2e7530009034c1f152d451e5&tpl=/ecfrbrowse/Title29/29tab_02.tpl

https://www.osha.gov/laws-regs/interlinking/standards/1910.12(a)

https://www.osha.gov/laws-regs/interlinking/standards/1910.12(b)

https://www.osha.gov/laws-regs/interlinking/standards/1910.12(c)

https://www.dol.gov/

2/21/20, 11:05 AM1910.12 – Construction work. | Occupational Safety and Health Administration

Page 2 of 2https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.12

Occupational Safety & Health
Administration
200 Constitution Ave NW
Washington, DC 20210
! 800-321-6742 (OSHA)
TTY
www.OSHA.gov

FEDERAL GOVERNMENT

White House
Severe Storm and Flood Recovery
Assistance
Diaster Recovery Assistance
DisasterAssistance.gov
USA.gov
No Fear Act Data
U.S. Office of Special Counsel

OCCUPATIONAL SAFETY & HEALTH

Frequently Asked Questions
A – Z Index
Freedom of Information Act – OSHA
Read The OSHA Newsletter
Subscribe to the OSHA Newsletter
OSHA Publications
Office of Inspector General

tel:+18003216742

https://www.dol.gov/general/contact-phone-call-center%23tty

https://www.osha.gov/

https://www.whitehouse.gov/

https://www.dol.gov/general/stormrecovery

https://www.dol.gov/general/disasterrecovery

https://www.disasterassistance.gov/

https://usa.gov/

https://www.dol.gov/oasam/programs/crc/NoFearResult.htm

https://osc.gov/

https://www.osha.gov/faq

https://www.osha.gov/a-z

https://www.osha.gov/foia

https://www.osha.gov/quicktakes/

https://www.osha.gov/quicktakes/%23subscribe

https://www.osha.gov/pls/publications/publication.html

https://www.oig.dol.gov/

Unit Assessment

QUESTION 1

Which of the following is NOT a responsibility of employers under the OSH Act?

	1.	To post OSHA citations
To compensate workers for wages lost due to injury
To allow workers to review their exposure and medical records
To inform workers how to report injuries and illnesses

QUESTION 2

If a State has an OSHA-approved occupational safety and health plan, but it does not cover construction workers, what standards would apply to those workers?

Local standards

NFPA standards

ANSI standards

OSHA standards

QUESTION 3

Which of the following statements is TRUE?

OSHA has separate standards covering women in the workplace.

OSHA requires all employees to speak English.

OSHA recognizes that PPE designed for men may not be adequate for women.

OSHA standards do not apply to temporary employees on construction sites.

QUESTION 4

Which of the following is NOT an employee right under the OSH Act?

To contest an OSHA citation

To file a complaint with OSHA

To request access to hazard exposure records

To review the employer’s current injury log

QUESTION 5

If a specific workplace hazard is not addressed in OSHA’s construction standards, what standard(s) can be used to determine compliance?

NFPA 101

29 CFR 1910

29 CFR 1926

OHSAS 18001

QUESTION 6

What might be some reasons that the construction industry has a higher fatality rate than other industries?
Your response should be at least 75 words in length.

QUESTION 7

Imagine you are the supervisor of a construction crew in which half of the workers speak only limited English. What steps should you take to ensure everyone is equally protected?
Your response should be at least 75 words in length.

QUESTION 8

Explain the rationale for workers’ compensation. What are the objectives of workers’ compensation? Who is covered by this program, and how does it help prevent future accidents?
Your essay should be at least 200 words in length and include an introduction, a body, and a conclusion.

2/21/20, 11:06 AMWomen in Construction | Personal Protective Equipment | Occupational Safety and Health Administration

Page 1 of 2https://www.osha.gov/doc/topics/women/ppe.html

UNITED STATES
DEPARTMENT OF LABOR

! ” # $ % &

Women in Construction ‘ CONSTRUCTION
INDUSTRY

Best Practice: In addition to compliance with the OSHA regulations,
whenever employers are required to purchase PPE, they should purchase
these items in size ranges suitable for women. Employers should maintain a
directory of PPE manufacturers and suppliers on hand, identify a wide
selection of size ranges for PPE, keep appropriate size ranges in stock, and
ensure direct accessibility, as required. Remember: One size does not fit
all!

Personal Protective Equipment
Many women in nontraditional jobs, such as the construction trades, have encountered improperly fitting personal
protective equipment (PPE) and personal protective clothing (PPC) which may compromise their personal safety.

Personal protective equipment used by women workers should be based upon female anthropometric (body
measurement) data. Women should make a point to test employer provided PPE, and if the provided PPE is
uncomfortable, or not suitable for the worker (e.g., improperly fitting or damaged from wear or defect) they should
report this condition to their employer for a suitable replacement.

PPE must fit properly so that it can effectively protect the employee from the hazard for which it was designed. Today
there has been tremendous progress in the availability of PPE for women. The International Safety Equipment Association
(ISEA) reports that many employers now provide a full range of sizes for PPE. ISEA lists manufacturers who offer safety
equipment in various sizes that is appropriate for women in construction.

The Ontario Women’s Directorate and the Industrial Accident Prevention Association (IAPA) co-authored a 35 page
publication titled, Personal Protective Equipment For Women – Addressing the Need.

Both, the ISEA list and IAPA publication can be found under PPE for Women.

Other Related Factors Include:

Limited employer knowledge in how to obtain health and safety products specifically, designed for females working in
non-traditional jobs, and
Limited availability of a full range of stock and sizes of PPE, at the retail/wholesale/distributor levels for health and
safety product lines designed for women workers.
Providing Safety and health Protection for a Diverse Construction Workforce: Issues and Ideas. NIOSH/CDC, DHHS
(NIOSH) Publication 99-140, 5 pages (1999).

UNITED STATES
DEPARTMENT OF LABOR

Safety and Health Topics / Women in Construction

Occupational Safety and Health Administration CONTACT US FAQ A TO Z INDEX ENGLISH ESPAÑOL

OSHA STANDARDS TOPICS HELP AND RESOURCES

https://www.dol.gov/

https://www.facebook.com/departmentoflabor

Tweets by OSHA_DOL

https://www.instagram.com/USDOL/

https://www.osha.gov/rss/

https://www.osha.gov/quicktakes%23subscribe

https://www.youtube.com/user/USDepartmentofLabor/

https://www.osha.gov/doc/index.html

http://elcosh.org/document/1198/d001110/Personal+Protective+Equipment+for+Women+-+Addressing+the+Need.html

https://www.cdc.gov/niosh/docs/99-140/

https://www.osha.gov/SLTC/text_index.html

https://www.osha.gov/

https://www.osha.gov/contactus

https://www.osha.gov/faq

https://www.osha.gov/a-z

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https://www.osha.gov/aboutosha

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https://www.osha.gov/news

2/21/20, 11:06 AMWomen in Construction | Personal Protective Equipment | Occupational Safety and Health Administration

Page 2 of 2https://www.osha.gov/doc/topics/women/ppe.html

Occupational Safety and Health
Administration
200 Constitution Ave NW
Washington, DC 20210
( 800-321-6742 (OSHA)
TTY
www.OSHA.gov

FEDERAL GOVERNMENT

White House
Severe Storm and Flood Recovery
Assistance
Disaster Recovery Assistance
DisasterAssistance.gov
USA.gov
No Fear Act Data
U.S. Office of Special Counsel

OCCUPATIONAL SAFETY AND
HEALTH

Frequently Asked Questions
A – Z Index
Freedom of Information Act
Read the OSHA Newsletter
Subscribe to the OSHA Newsletter
OSHA Publications
Office of Inspector General

ABOUT THE SITE

Freedom of Information Act
Privacy & Security Statement
Disclaimers
Important Website Notices
Plug-Ins Used by DOL
Accessibility Statement

tel:800-321-6742

https://www.dol.gov/general/contact-phone-call-center%23tty

https://www.osha.gov/

https://www.whitehouse.gov/

https://www.dol.gov/general/stormrecovery

https://www.dol.gov/general/disasterrecovery

https://www.disasterassistance.gov/

https://www.usa.gov/

https://www.dol.gov/agencies/oasam/civil-rights-center/resports/notification-and-federal-employee-antidiscrimination-retaliation-act-of-2002

https://osc.gov/

https://www.osha.gov/faq

https://www.osha.gov/a-z

https://www.osha.gov/foia

https://www.osha.gov/quicktakes

https://www.osha.gov/quicktakes/%23subscribe

https://www.osha.gov/pls/publications/publication.html

https://www.oig.dol.gov/

https://www.dol.gov/general/foia

https://www.dol.gov/general/privacynotice

https://www.dol.gov/general/disclaim

https://www.dol.gov/general/aboutdol/website-policies

https://www.dol.gov/general/aboutdol/file-formats

https://www.dol.gov/general/aboutdol/accessibility

2/21/20, 11:07 AMTemporary Workers | Occupational Safety and Health Administration

Page 1 of 2https://www.osha.gov/temp_workers/

UNITED STATES
DEPARTMENT OF LABOR

! ” # $ % &

Protecting Temporary Workers

Employer Responsibilities to Protect Temporary Workers

To ensure that there is a clear understanding of each employer’s role in protecting employees, OSHA
recommends that the temporary staffing agency and the host employer set out their respective
responsibilities for compliance with applicable OSHA standards in their contract. Including such terms in a
contract will ensure that each employer complies with all relevant regulatory requirements, thereby
avoiding confusion as to the employer’s obligations.

Joint Responsibility

While the extent of responsibility under the law of staffing agencies and host employers is dependent on
the specific facts of each case, staffing agencies and host employers are jointly responsible for maintaining
a safe work environment for temporary workers – including, for example, ensuring that OSHA’s training,
hazard communication, and recordkeeping requirements are fulfilled.

OSHA could hold both the host and temporary employers responsible for the violative condition(s) – and
that can include lack of adequate training regarding workplace hazards. Temporary staffing agencies and
host employers share control over the worker, and are therefore jointly responsible for temporary workers’
safety and health.

OSHA has concerns that some employers may use temporary workers as a way to avoid meeting all their
compliance obligations under the OSH Act and other worker protection laws; that temporary workers get
placed in a variety of jobs, including the most hazardous jobs; that temporary workers are more vulnerable
to workplace safety and health hazards and retaliation than workers in traditional employment
relationships; that temporary workers are often not given adequate safety and health training or
explanations of their duties by either the temporary staffing agency or the host employer. Therefore, it is
essential that both employers comply with all relevant OSHA requirements.

Both Host Employers and Staffing Agencies Have Roles

Both host employers and staffing agencies have roles in complying with workplace health and safety
requirements and they share responsibility for ensuring worker safety and health.

A key concept is that each employer should consider the hazards it is in a position to prevent and correct,
and in a position to comply with OSHA standards. For example: staffing agencies might provide general
safety and health training, and host employers provide specific training tailored to the particular workplace
equipment/hazards.

The key is communication between the agency and the host to ensure that the necessary protections
are provided.
Staffing agencies have a duty to inquire into the conditions of their workers’ assigned workplaces. They
must ensure that they are sending workers to a safe workplace.

Workers’ Rights

Highlights

Recommended Practices: Protecting
Temporary Workers
Policy Background on the Temporary Worker
Initiative
Temporary Worker Initiative (TWI) Bulletin
No. 1 – Injury and Illness Recordkeeping
Requirements
Temporary Worker Initiative (TWI) Bulletin
No. 2 – Personal Protective Equipment
Temporary Worker Initiative (TWI) Bulletin
No. 3 – Whistleblower Protection Rights
Temporary Worker Initiative (TWI) Bulletin
No. 4 – Safety and Health Training
Temporary Worker Initiative (TWI) Bulletin
No. 5 – Hazard Communication
Temporary Worker Initiative Bulletin No. 6 –
Bloodborne Pathogens
Temporary Worker Initiative Bulletin No. 7 –
Powered Industrial Truck Training
Temporary Worker Initiative Bulletin No. 8 –
Respiratory Protection
Temporary Worker Initiative Bulletin No. 9 –
Noise Exposure and Hearing Conservation
Temporary Worker Initiative Bulletin No. 10
– The Control of Hazardous Energy
(Lockout/Tagout) NEW
Temporary Worker Initiative Bulletin No. 11
– Safety and Health in Shipyard
Employment NEW

Occupational Safety and Health Administration CONTACT US FAQ A TO Z INDEX ENGLISH ESPAÑOL

‘ SEARCH OSHAOSHA STANDARDS TOPICS HELP AND RESOURCES

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https://www.facebook.com/departmentoflabor

Tweets by OSHA_DOL

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https://www.youtube.com/user/USDepartmentofLabor/

https://www.osha.gov/workers/

https://www.osha.gov/Publications/OSHA3735

https://www.osha.gov/temp_workers/Policy_Background_on_the_Temporary_Worker_Initiative.html

https://www.osha.gov/temp_workers/OSHA_TWI_Bulletin

https://www.osha.gov/Publications/OSHA3780

https://www.osha.gov/Publications/OSHA3781

https://www.osha.gov/Publications/OSHA3859

https://www.osha.gov/Publications/OSHA3860

https://www.osha.gov/Publications/OSHA3888

https://www.osha.gov/Publications/OSHA3889

https://www.osha.gov/Publications/OSHA3952

https://www.osha.gov/Publications/OSHA3953

https://www.osha.gov/Publications/OSHA3964

https://www.osha.gov/Publications/OSHA3981

https://www.osha.gov/

https://www.osha.gov/contactus

https://www.osha.gov/faq

https://www.osha.gov/a-z

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https://www.osha.gov/SLTC/

https://www.osha.gov/news

2/21/20, 11:07 AMTemporary Workers | Occupational Safety and Health Administration

Page 2 of 2https://www.osha.gov/temp_workers/

Ignorance of hazards is not an excuse.
Staffing agencies need not become experts on specific workplace hazards, but they should determine
what conditions exist at their client (host) agencies, what hazards may be encountered, and how best
to ensure protection for the temporary workers.
The staffing agency has the duty to inquire and verify that the host has fulfilled its responsibilities for a
safe workplace.
And, just as important: Host employers must treat temporary workers like any other workers in terms
of training and safety and health protections.

How Can OSHA Help?

Workers have a right to a safe workplace. If you think your job is unsafe or you have questions,
contact OSHA at 1-800-321-OSHA (6742). It’s confidential. We can help. For other valuable worker
protection information, such as Workers’ Rights, Employer Responsibilities and other services OSHA
offers, visit OSHA’s Workers’ page.

OSHA also provides help to employers. OSHA’s On-Site Consultation Program offers free and
confidential occupational safety and health services to small and medium-sized businesses in all
states and several territories, with priority given to high-hazard worksites. To locate the OSHA On-
Site Consultation Program nearest you, call 1-800-321- 6742 (OSHA) or visit
www.osha.gov/consultation.

Temporary Workers’ Rights Pamphlet

News Releases

November 13, 2018 [Region 7 News
Release] U.S. Department of Labor Cites
Nebraska Staffing Agency Following Heat-
Related Fatality

May 11, 2018 [Region 4 News Release]
U.S. Department of Labor Cites Contractor
and Staffing Agency Following Fatal Trench
Collapse at Alabama Work Site

Suggested Reading

Are you looking for more insight on the topics discussed in this unit? Access the items listed below to view
videos and additional information to gain further insight and understanding.

Occupational Safety & Health Administration. (n.d.). 40 year history video [Video]. Retrieved from
https://www.osha.gov/osha40/video/video.html

Occupational Safety & Health Administration. (2009). Reflections on OSHA’s history [Brochure]. Retrieved
from https://www.osha.gov/history/OSHA_HISTORY_3360s

Occupational Safety & Health Administration. (n.d.). Links to state plans’ safety and health regulations.
Retrieved from https://www.osha.gov/dcsp/osp/statestandards.html

Occupational Safety & Health Academy. (n.d.). All about calculating workers’ compensation premiums.
Retrieved from http://www.oshatrain.org/notes/4anotes05.html

Occupational Safety & Health Administration. (n.d). Workers’ compensation costs of falls in construction.
Retrieved from https://www.osha.gov/doc/topics/residentialprotection/2012_fall_costs/index.html

Learning Activities (Nongraded)

If your state has an OSHA-approved occupational safety and health plan, find some information about it on
the Internet. Compare the state standards to OSHA. Are there areas where the state is more restrictive than
OSHA? If your state does not have an approved plan, take a look at the state plans for California or Oregon
and compare them to OSHA.

https://www.osha.gov/osha40/video/video.html

https://www.osha.gov/history/OSHA_HISTORY_3360s

https://www.osha.gov/dcsp/osp/statestandards.html

http://www.oshatrain.org/notes/4anotes05.html

https://www.osha.gov/doc/topics/residentialprotection/2012_fall_costs/index.html

https://www.dir.ca.gov/dosh/

http://www.orosha.org/

UNIT x STUDY GUIDE

Title
Nongraded Learning Activities are provided to aid students in their course of study. You do not have to submit
them. If you have questions contact your instructor for further guidance and information.

NIOSH’s Office of Construction Safety and Health:

Accomplishments in our First Four Years

BACKGROUND

Creation and function of CSH

Since its inception in December 2009, the Office of Construction Safety and Health (CSH) has

adhered to it mission in providing Institute‐wide senior scientific and administrative leadership

for construction research and related activities. CSH ensures that research elements from the

National Construction Center are fully integrated and included in all designs and plans for

construction research and its implementation. Together the CSH Director and Deputy Director

formulate the strategic vision and goals, develop proposals; guide the direction of the National

Occupational Research Agenda (NORA) Construction Sector Council; and implement research

plans that ensure that the construction research program is responsive to comments and

contributions from emerging research, the National Construction Center, stakeholders, external

reviewers, and the NIOSH Director.

CSH actively develops partnerships within NIOSH and among its external stakeholders, and

coordinates construction research and related activities among NIOSH divisions, labs and other

offices. It extends this coordination within and among the NIOSH‐funded National Construction

Center
1
and other extramural construction researchers, with the Directorate of Construction in

the Occupational Safety and Health Administration (OSHA), with OSHA’s public Advisory

Committee on Construction Safety and Health (ACCSH), the OSHA Construction Alliance, and

with several trade associations.

Establishing the Construction Program Manager and Coordinator positions as dedicated full‐

time personnel within NIOSH through CSH has improved the Institute’s ability to align

1
CPWR—The Center for Construction Research and Training has successfully applied to serve as the National

Construction Center since 1994.

NIOSH CSH, Accomplishments, 2009‐2013, Page 1 of 27

construction resources with the its national priorities. It has improved coordination among the

NIOSH divisions and laboratories that are conducting research in construction, and has

improved, as well, the coordination between those divisions and the National Construction

Center. Much of this is accomplished through regular meetings with DLO representatives on the

Construction Steering Committee, as well as with direct meetings with construction researchers

and DLO management. Furthermore, this interaction has improved and enhanced the

integration of research conducted by extramural researchers supported through the NIOSH

Office of Extramural Programs. The personnel decision has led also to better management of

the work of the

NORA Construction Sector Council.

Stewardship of NORA Construction Sector Council

The NORA Construction Sector Council was the first council to develop a national research

agenda in October 2008 (http://www.cdc.gov/niosh/nora/comment/agendas/construction/). This

was the first national effort to create an occupational safety and health research agenda for the

construction industry. Efforts are still underway to address the goal of answering the question:

“What information do we need to be more effective in preventing injuries and illnesses in

construction?” A description of research needs and information gaps was one important basis

for the agenda. The other basis was “research to practice” (r2p); specifically, a description of

how research findings could be used by construction stakeholders to bring about needed

changes in the industry. The NORA Construction Sector Council seeks to promote the most

important research, understand the most effective intervention strategies, and learn how to

implement those strategies to achieve sustained improvements in workplace practice.

Developing the National Construction Agenda provided a vehicle by which construction industry

stakeholders could describe the most relevant issues, gaps, and safety and health needs in the

industry. The resulting agenda consists of 15 research strategic goals designed to address ten

top problems in construction safety and health. These included seven “outcome” goals related

to important sources of injury or illness, and eight “contributing factor” goals related to

important influences that impact prevention and control measures throughout the industry. In

a recent analysis conducted by the NIOSH Office of Extramural Programs, the Construction

Sector had more strategic goals that were being addressed by both extramural and intramural

researchers when compared to the other sectors. The Construction Sector currently has 12 out

of its 13 active goals that are being addressed by either extramural or intramural researchers.

Beginning in 2010, the Manager and Coordinator of the NORA Construction Sector Council

oversaw the selection of two of the 15 goals for priority activity. All 15 goals are important and

relevant; however, making significant accomplishments in all areas within the decade is

daunting given budgetary realities and other considerations. The selected goals were Goal 1

(Reduce Construction Worker fatalities and serious injuries caused by falls to a lower level), for

NIOSH CSH, Accomplishments, 2009‐2013, Page 2 of 27

http://www.cdc.gov/niosh/nora/comment/agendas/construction

which a falls prevention campaign is an intermediate goal; and Goal 13 Increase the use of

“prevention through design (PtD)” approaches to prevent or reduce safety and health hazards

in construction, for which green jobs in construction is a component. The selection has allowed

the Council to better harness its energies and work collectively to make significant progress and

bring research accomplishments to the industry.

The Manager and Coordinator oversaw a mid‐decade review by the Sector Council of all 15

goals to determine progress toward meeting the goals. The review began in 2011, the half‐way

point in the decade‐long NORA effort. CSH and the NORA Construction Sector Council

undertook a review of efforts to date, which provided an opportunity to take stock of overall

developments; look at NORA projects and partnerships underway; examine the impact of the

economic recession on construction generally, and on safety and health developments in

construction; and to provide additional strategic direction and fine‐tuning. The report of the

mid‐decade review is available upon request.

Progress on each goal was assessed, and goals were categorized into:

Exploratory ‐ important issue but still defining problems and solutions

Developmental – some solutions are available but they are not ready for impact

Ready for Impact – sufficient solutions are available and we know what contractors

need to do for impact in the industry

Six goals fall into the ‘Ready for Impact’ category. The Construction Sector Council reviewed the

performance measures and roadmaps for each Ready for Impact strategic goal, and prepared a

mid‐decade report with the progress of each of these goals.

NORA Goals

Ready for
Impact

6 Falls (1); Struck by (3); Silica (5);
Culture (8); Disparities (12); PtD (13)

Developmental 7 Electrocution (2): Noise (4)
Welding Fumes (6) MSD (7)
S&H Management (9) Training (11)
Surveillance (14)

Exploratory 2 Industry Organization (10) Engage the Media (15)

This categorization has proven effective in moving forward, assessing progress, and, more

importantly, assessing impact among the 15 second decade NORA goals in construction.

NIOSH CSH, Accomplishments, 2009‐2013, Page 3 of 27

ACCOMPLISHMENTS – Office of Construction Safety and Health

I. Construction Falls Prevention Campaign

In 2011, the rate of fatal injuries in construction was the second highest of

any U.S. industry. Within the industry, falls at construction sites are the

leading cause of death, accounting for 35% of deaths among private sector

construction workers (not including government or self‐employed workers)

in 2011; most of these deaths were attributed to falls from roofs, scaffolds,

and ladders. Deaths and injuries from falls represent a major, persistent,

yet preventable public health problem.

Under the auspices of the NORA Construction Sector Council, a campaign, national in scope, to

prevent falls among construction workers was conceived, developed and led to address one of

the NORA ‘Ready for Impact’ goals “Reduce Construction Worker fatalities and serious injuries

caused by falls to a lower level“ (Strategic Goal #1). The Sector Council identified the campaign

as one of two goals on which to focus. A National Construction Campaign Coordinating

Committee was formed with the charge to: (1) Explore how various campaigns have been used

to advance safety and health goals; (2) Gather basic information needed to identify and address

fundamental questions on planning and implementation of a construction fatality campaign;

and (3)Prepare options for discussion by the full NORA Construction Sector Council. The goal of

the campaign, in part, was to develop a national campaign aimed at construction contractors,

onsite supervisors, and workers to address and reduce falls, fall‐related injuries, and fall‐related

fatalities among construction workers. The scientific underpinnings of the campaign were

prepared during 2010‐2011 by Sector Council members working in groups, along with staff in

CSH, the NIOSH Communication and Research Translation Office (CRTO),2 the National

Construction Center and OSHA. The latter two are represented on the Council, and played key

roles in developing the campaign. The National Construction Center hired a social marketing

firm to prepare an environmental scan of construction fall prevention campaigns in the United

States and abroad. CSH hired the same social marketing firm to prepare a social marketing

plan. Because the campaign relies heavily on completed research, it is a major r2p endeavor.

The National Construction Center then hired the same social marketing expert to conduct focus

groups to test messages that could be used in a campaign. The campaign theme and messages

were determined by NIOSH, OSHA and the National Construction Center. The national

construction falls prevention campaign (also described as Safety Pays, Falls Cost) is a

remarkable accomplishment among NIOSH, OSHA and the NORA Construction Sector Council.

2
CRTO changed organizationally to become the Office of Communications (OC) in September 2014.

NIOSH CSH, Accomplishments, 2009‐2013, Page 4 of 27

The campaign kickoff was hosted by U.S. Department of Labor Secretary Hilda Solis on Workers

Memorial Day on April 26, 2012.

The National Construction Center hosts the non‐government principal web presence supporting

the campaign (http://www.stopconstructionfalls.com) and responds to inquiries about the

campaign through e‐mail (falls@cpwr.com). Their website contains fall prevention information

and materials, and allows stakeholders to share their own campaign success stories. Print

campaign materials are available through OSHA (www.osha.gov/stopfalls). Other resources,

including research findings, training aides and videos, are available on the three official

campaign websites: www.osha.gov/stopfalls/, www.cdc.gov/niosh/construction/stopfalls.html,

and www.stopconstructionfalls.com. OSHA’s campaign website, www.osha.gov/stopfalls/ is

now available in both English and Spanish.3 With simple language, clear illustrations, and easy‐

to‐follow instructions, our campaign materials include posters, factsheets, safety videos,

stickers, and public service announcements, spot‐the‐hazards cards.

The campaign was a re‐launched on Workers Memorial Day on April 28, 2013 with new

products for active dissemination, including a “Local Partners Manual” for persons or

organizations at the local, state or regional levels who wish to start their own local campaigns.

The National Association of Counties, for example, mentioned the campaign in their April 2013

newsletter (http://www.naco.org/newsroom/countynews/Current%20Issue/4‐8‐

2013/Pages/OSHA‐launches‐safety‐campaign‐to‐prevent‐falls.aspx). Having the information

about the campaign posted for city and county officials across the country, has been expected

to assist dissemination, especially at permit and registration offices where construction

contractors frequent. Several local areas have made the campaign a priority, and have created

innovative ways to disseminate campaign messages. Boston, Massachusetts and Montgomery

County, Maryland, for example, have worked with the public transportation systems to post

some of the campaign posters on busses, metro‐rail trains and highway digital billboards. State

agencies have been encouraged to support the campaign, and several have spearheaded their

state’s efforts in collaboration with NIOSH’s Fatality Assessment and Control Evaluation (FACE)

program.

The momentum of this extremely well‐received campaign has been such NIOSH, OSHA and the

National Construction Center agreed to add a third year (2014). The focus of the campaign in

Year 3 was expanded to all types of construction, and no longer focused only on residential

construction. In support of Year 3, NIOSH announced the campaign in CDC’s Morbidity and

Mortality Weekly Report (MMWR)

(http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6316a7.htm?s_cid=mm6316a7_e). Also,

a video, “A construction framer talks about protecting his crew from falls”

3
Campaign fact sheets are available on the OSHA website in English, Spanish, Polish, Portuguese and Russian.

NIOSH CSH, Accomplishments, 2009‐2013, Page 5 of 27

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6316a7.htm?s_cid=mm6316a7_e

http://www.naco.org/newsroom/countynews/Current%20Issue/4-8

www.osha.gov/stopfalls

http:www.stopconstructionfalls.com

www.cdc.gov/niosh/construction/stopfalls.html

www.osha.gov/stopfalls

mailto:falls@cpwr.com

http:http://www.stopconstructionfalls.com

(http://www.youtube.com/watch?v=MFthzInDdLQ&feature=youtu.be) was posted to the

NIOSH website in May 2014. The footage was taken on a visit to residential construction sites in

Phoenix, Arizona to which NIOSH was invited by a LeBlanc Building Company., Inc. based on

their practice of requiring all of their workers to use fall protection when working at height. A

national Construction Safety Stand‐Down (June 2‐6, 2014) was also added in Year 3. The stand‐

down was conceived as a voluntary event for employers to talk directly to employees about

hazards, protective methods, and the company’s safety policies, goals and expectations. CPWR

created an easy, cost‐free, day‐by‐day list of suggested activities that could be tailored to

individual jobsites, and posted these to www.stopconstructionfalls.com.

Impact: The research to support the strategic planning and execution of the national

construction falls prevention campaign was awarded the 2012 Thoth Award in the category of

Research/Evaluation from the Public Relations Society of America. The three campaign

websites (NIOSH, OSHA and CPWR) received over half a million page views in 2012. Campaign

partners and stakeholders also spread the campaign’s message to thousands of employers (the

primary target audience) and construction workers through blast e‐mails, radio and television

broadcasts, webinars, publications, trainings and outreach events.

The National Construction Center designed an evaluation plan for the campaign. The evaluation

of the campaign’s first year served three key purposes: (1) assess audience response to the

campaign messages and materials (focus groups); (2) document campaign reach (metrics); and

(3) examine partnership quality. The evaluation was conducted among small residential

construction contractors, owners, supervisors, and foremen to assess exposure to campaign

messages and materials at the four‐month point from the campaign launch. Conducted in

August 2012 in the Washington, DC metropolitan area, the evaluation findings suggested that

the campaign did not have a high level of awareness among contractors four months after the

campaign was first launched. Some summary recommendations informed by the focus group

results are included in Appendix I. Subsequent campaign efforts were aimed to improve

dissemination to the primary target audience.

To examine partnership quality, eight pre‐selected campaign partners (representing a range of

unions, academia, business and government) were surveyed to assess the success of campaign

partnerships in implementing the first year of the campaign. The summary conclusions from

this component of the evaluation are listed in Appendix I.

Some metrics of interest are visits to websites designed to support the construction falls

prevention campaign.

 51,676 products were downloaded from www.stopconstructionfalls.com in the first year
of the campaign.

NIOSH CSH, Accomplishments, 2009‐2013, Page 6 of 27

http:www.stopconstructionfalls.com

http://www.youtube.com/watch?v=MFthzInDdLQ&feature=youtu.be

 The three campaign websites hosted by NIOSH, OSHA and CPWR received over half a
million page views in 2012.

 As of October 2014 NIOSH had 13,411 page views (9,880 visits) to its
www.cdc.gov/niosh/construction/stopfalls.html. Five of the ‘top ten’ tweets from

Construction@NIOSH were centered on construction falls.

 As of October 2014, www.stopconstructionfalls.com hosted by National Construction
Center CPWR had 900,215 page views (96,892 unique visits). The campaign also

generated 503 email inquiries and 62 campaign partners.

 A Facebook page “Stop Construction Falls” was developed for the campaign by a NORA
Construction Sector Council member at Washington University School of Medicine in St.

Louis. The Facebook page has 315 ‘likes,’ and has reached 14 states in the U.S. and 44

countries worldwide.

 As of June 12, 2014, OSHA’s compilation of data indicated that 4,399 certificates were
obtained online; that 729,032 workers were engaged through the stand‐downs; and

that there were 186,324 page views on the web page that OSHA developed for the

stand‐down (there were more than 282,770 views for campaign and stand‐down pages

together for during 03/17/14 to 06/11/14). The stand‐down page will be available

through mid‐July, so data collection will continue.

For Year 3 of the campaign and the stand‐down, we observed more and broader engagement

by contractors of all sizes. Safway (http://www.safwaygroup.com/) is the largest provider of

construction access equipment (e.g., scaffolds) in North America. Safway became a partner

with the construction falls prevention campaign in 2014

(http://www.safway.com/Press/newsDetail.asp?id=104). They invested approximately

$100,000 to adapt existing and develop new company‐specific campaign materials (e.g.,

mailers, promotional items) for their staff, trainees, and business partners.

All U.S. Air Force Ground Safety forces based in the United States and abroad participated in

the campaign (year 3) and the stand‐down, including through their training activities, audits,

internal newspaper articles, internal television network, posters, and briefings at the Air Force

Ground Safety Commander’s calls. All 2,000 Air Force Ground safety professionals were

required to focus on fall protection awareness during the entire week of the stand‐down, with

an expectation that the 650,000 Ground Safety staff at every at Air Force base would be

reached.

The construction falls prevention campaign will continue distributing information and providing

outreach. This includes a partnership with two Latino groups facilitates distributing the Spanish

version of the falls prevention campaign materials.

NIOSH CSH, Accomplishments, 2009‐2013, Page 7 of 27

http://www.safway.com/Press/newsDetail.asp?id=104

http:http://www.safwaygroup.com

http:www.stopconstructionfalls.com

www.cdc.gov/niosh/construction/stopfalls.html

II. Nail Gun Safety

Dr. Hester Lipscomb at Duke University identified key risk factors associated with nail gun use

through a decade of NIOSH‐funded research,4 and demonstrated the effectiveness of trigger

and training interventions. Such interventions, however, have not been adopted by nail gun

manufacturers or users. There were no OSHA regulations, furthermore, that explicitly address

nail guns. In response to these practice gaps, the issue was brought before OSHA’s Advisory

Committee for Construction Safety and Health (ACCSH), and a work group was formed to

examine the issue in more detail. CSH worked with the work group co‐chairs to arrange for

presentations by Dr. Lipscomb so that she could share study findings. ACCSH eventually passed

a motion unanimously asking OSHA to develop guidance and/or regulations.

In addition, the NORA Construction Sector Council’s Strategic Goal

#3 (related to “struck by” incidents) addresses preventing these

injuries by developing guidance.1 NIOSH took the lead role in

working with OSHA to create co‐branded guidance for contractors to

address this goal. The NIOSH‐OSHA co‐branded document, Nail Gun

Safety: A Guide for Construction Contractors

(http://www.cdc.gov/niosh/docs/2011‐202/) was published in

September of 2011. The Spanish language version was published in

October 2012.

The publication provides the latest information on how nail gun injuries occur; descriptions of

worksite nail gun incidents; specific training recommendations; and practical advice that

contractors can use to prevent nail gun injuries. NIOSH and CPWR‐funded research, identifying

both the problem and effective interventions, was used substantially in the publication.

Expertise in both research and communication was used to customize content for the target

audience. For example, the Guide used sidebar sections to provide both key research findings

(“You should know”) and actual cases (“Worksite story”) to help convey key messages. A

dissemination plan was designed cooperatively by the National Construction Center, OSHA

Directorate of Construction, and CRTO and CSH in NIOSH.

Using some of the information in the Nail Gun Safety: A Guide for Construction Contractors in

June 2013, NIOSH released an innovative new publication, Straight Talk About Nail Gun Safety

(http://www.cdc.gov/niosh/docs/2013‐149/), which is also available in Spanish. The

publication was designed and developed by James Albers while he was with the Division of

Applied Research and Technology, and uses a comic format to illustrate the potential risks of

traumatic injury using nail guns, and how these risks can be reduced. Real‐life examples from

4
Through its responsibilities as the National Construction Center, CPWR hosts a research consortium of which Dr.

Lipscomb is a member.

NIOSH CSH, Accomplishments, 2009‐2013, Page 8 of 27

http://www.cdc.gov/niosh/docs/2013-149

http://www.cdc.gov/niosh/docs/2011-202

residential building construction are used to explain nail gun traumatic injury risks related to

the two different nail gun triggering systems and a variety of residential framing nailing

tasks. The information in this publication is based on focus group discussions with residential

building subcontractors, safety specialists and workers; NIOSH supported research; and Nail

Gun Safety: A Guide for Construction Contractors. As a safety awareness publication, Straight

Talk About Nail Gun Safety provides potential and new nail gun users with basic information to

help them recognize potentially unsafe conditions and nail gun features that increase the risk of

traumatic nail gun injury. The publication can be used in conjunction with safety training

required by OSHA, or to reinforce previous nail gun safety training.

Impact: By design, most requests for the Nail Gun Safety: A Guide for Construction Contractors

publication were routed through OSHA and NIOSH websites, respectively.

 As a result of effective dissemination efforts, the English version of the Nail Gun Safety:
A Guide for Construction Contractors received 14,578 page views (10,606 visits) to the

NIOSH website while the Spanish version of the Guide received 1173 page views (874

visits). The English version of Straight Talk About Nail Gun Safety received 9,542 page

views (6,867 visits) to the NIOSH website, while the Spanish version of the comic

received 1,007 page views (724 visits).

 OSHA has had over 108,000 unique visitors at the OSHA website containing information
about the Guide. OSHA printed 50,000 copies of the Guide initially in September 2011,

and has almost exhausted a second printing of 50,000.

 NIOSH, OSHA and the National Construction Center partnered to present a nail gun
safety webinar under the auspices of the American Society of Safety Engineers (ASSE).

As part of the diffusion plan, a dedicated nail gun safety website (www.nailgunfacts.org) was

launched in October 2011 to provide additional videos, worker testimonials, and news reports

about nail gun injuries, training resources, and research information to construction audiences.

The website was developed and launched by Dr. Lipscomb and her carpenter colleagues. The

site is funded by the National Construction Center.

The NIOSH Office of Construction Safety and Health conducted an informal evaluation of the

Nail Gun Safety: A Guide for Construction Contractors by reaching out to nine stakeholders to

get feedback on the Guide, stories about its impact, or other ideas on dissemination. From what

we have heard, the Guide has been a real help to the industry. Members the Associated

General Contractors of America (AGC), an important stakeholder and member of the NORA

Construction Sector Council, expressed their pleasure with the document. In fact, one

contractor called it “the best document he has ever received from the [federal] government,”

and he said that he has made it required reading for all of his staff. The findings from this

evaluation are included in Appendix II.

NIOSH CSH, Accomplishments, 2009‐2013, Page 9 of 27

http:www.nailgunfacts.org

III. Green Jobs in Construction

Integrating Safety and Health into Green Construction: One of the six “Ready for Impact”

goals of the NORA Construction Sector Council relates to green construction (Goal 13.0:

Increase the use of “prevention through design” approaches to prevent or reduce safety and

health hazards in construction). Under the auspices of the NORA Construction Sector Council,

an ad hoc work group was formed with the charge go: (1) Explore strategies and tactics that are

or can be used to integrate safety and health into green building and construction initiatives in

the United States; (2) Review the draft NIOSH White Paper, “NIOSH Perspectives on Sustainable

Buildings: GREEN …AND SAFE,” and draft recommendations and other suggestions for action

among construction safety and health stakeholders, including members of the NORA

Construction Sector Council; (3) Explore other relevant green construction issues, not covered

in the NIOSH white paper, that might be appropriate for discussion and action among

construction safety and health stakeholders; and (4) Prepare options for discussion by the full

NORA Construction Sector Council.

NIOSH’s Prevention through Design (PtD) national initiative addresses design‐related

occupational injuries and illnesses by encouraging the elimination of hazards and minimizing

risks to workers across all industry sectors and settings. CSH has used PtD principals that

examine the potential for hazards throughout the life cycle of work premises, tools, equipment,

machinery, substances, and worker processes. This includes their construction, manufacture,

use, maintenance, and ultimate disposal or reuse. PtD has been the linchpin of NIOSH’s efforts

to integrate occupational safety and health into green and sustainable construction. Together,

the NIOSH Construction and PtD programs collaborate on efforts to increase the use of design

interventions to address safety and health hazards early in the pre‐design and design processes

in the construction sector. As part of the PtD initiative, CSH and its construction stakeholders

developed a framework to create awareness, provide guidance, and address occupational

safety and health issues associated with green jobs and sustainability efforts. CSH has taken a

number of key steps to advance this issue, articulating the case for why green construction

represents an opportunity to promote worker safety and health as a fundamental dimension of

true sustainability.

For example, CSH staff assisted in writing the entry to NIOSH’s Science Blog, “Going Green: Safe

and Healthy Jobs” (http://blogs.cdc.gov/niosh‐science‐blog/2010/01/green‐2/) was published

in January 2010 following the NIOSH “Making Green Jobs Safe” Workshop held in December

2009. At the Workshop, 170 representatives from the occupational safety and health and

environmental communities within industry, labor, academia, government agencies, and

nongovernment organizations met to consider how to emphasize that green jobs should be

NIOSH CSH, Accomplishments, 2009‐2013, Page 10 of 27

http://blogs.cdc.gov/niosh-science-blog/2010/01/green-2

safe and healthy for workers. Several NORA Construction Sector Council members participated

in the Workshop, and found the discussions in the construction track to be very stimulating.

In addition, armed with its white paper, NIOSH formally approached the USGBC in February

2011 about the merits of integrating occupational safety and health generally, and PtD

specifically, into its Leadership in Energy and Environmental Design (LEED) rating system.

NIOSH, with colleagues from the NORA Construction Sector Council, prepared a ”credit‐by‐

credit” review of the 2009 LEED credits, and identified six credits that could be enhanced by

inserting additional language to the credit to address safety and health. Additional reference

material was also developed. NIOSH shared these materials with USGBC in 2011 and continues

to work with them on strategies to incorporate safety and health into now LEED version 4. The

USGBC is working with NIOSH to outline other modes by which the USGBC stakeholders can

become knowledgeable about the merits of integrating occupational safety and health into

other LEED credits (e.g., June 26, 2012 seminar on integrating occupational safety and health

into LEED by Christine Branche and Matt Gillen to USGBC headquarters staff in Washington,

DC). In January 2013, CSH participated in the USGBC’s Summit on Green Buildings and Human

Health. The Summit was very successful, and USGBC is open to including worker issues into

their initiatives. At USGBC’s invitation, NIOSH authored a blog that appears on their website.

This blog on “Green Building and Human Health” was co‐posted on the NIOSH Science blog in

June 2013.

In April 2013, CSH presented at the Good Jobs, Green Jobs Conference delivering a presentation

using a “Life Cycle Safety” approach to ensure that green buildings are safe buildings. In June

2013, CSH presented at the Associated General Contractors of America (AGC) Environmental

Conference delivering a presentation on integrating safety and health into green buildings and

rating systems. Also in June 2013, CSH presented at the American Society of Safety Engineers

(ASSE), Professional Development Conference delivering a presentation on integrating safety

and health into green construction. In November 2013, the CSH presented at the USGBC

National Conference (Greenbuild) on the topic of life cycle safety and its role in social equity

issues.

NIOSH CSH, Accomplishments, 2009‐2013, Page 11 of 27

NIOSH is working with Virginia Tech on designing a “safe roof design guide” to serve as stand‐

alone guidance material in the LEED version 4 Reference Guide or as input for several LEED

credits that relate to roofs and skylights. The safe roof design concepts presented in this guide

are aimed at owners, developers, and designers; they are to be used in the design phases.

There are specific design suggestions specific to roofs and tools and processes that designers

can use. NIOSH worked with Virginia Tech to develop a pilot credit (“Safe Roof Plan”) and is

discussing its potential use with USGBC.

On the state and local levels, the California Fatality Assessment and Control Evaluation (FACE)

program responded to a rash of deaths among construction workers installing solar panels by

producing a video and fact sheets about risks and preventive measures. These include using fall

protection systems and ensuring that lifts are available to hoist solar panels to the roof, so that

workers aren’t trying to manually carry panels up ladders. One of their digital stories,

“Preventing Falls Through Skylights,” won the 2012 APHA Digital Technology Award Contest.

Two of the co‐workers of the roofing supervisor who died tragically after he fell through a

skylight decided to be part of this digital story. They highlight the events that led up to his death

and explain what could have been done to prevent it. The moving video will be used by roofers

and others in trainings to prevent similar fatalities from occurring. This video was promoted as

a part of the 2013 Workers Memorial Day events commemorating workers who gave their lives

for their work and highlight efforts to prevent workplace deaths.

CSH views this as an important initiative that will take time to deliver results. CSH has

established a working relationship with the USGBC and expects this to provide insights and

perspectives on how best to move ahead. This effort faces many challenges such as the lack of

architect, designer or owner involvement in safety. The USGBC itself is in the process of

rethinking its approach to several issues now that LEED version 4 has been released and users

are commenting on it. Because the USGBC’s LEED is the most widely used rating system in

green construction, it makes our discussions with USGBC prodigious. NIOSH has made progress

in working with the USGBC and others to integrate worker health and safety into green building

design; more information can be found on our Prevention through Design site.

NIOSH CSH, Accomplishments, 2009‐2013, Page 12 of 27

ASSISTANCE WITH DISSEMINATION

IV. Residential Construction Safety Guard Rail System

Driven by the prevalence of fatalities and severe injuries caused by workers falling through roof

and floor openings, and existing skylights, NIOSH worked with residential carpenters to develop

a multi‐functional guardrail system that could be used in numerous work situations to prevent

workers from falling to lower levels. Researchers within NIOSH’s Division of Safety Research

(DSR) designed, developed, and patented (U.S. Patent No. 7,509,702, issued on March 29,

2009) a multi‐functional guardrail system that can be used on numerous residential and

commercial‐industrial work sites. This research is being led by Dr. Thomas Bobick5 and supports

NORA Construction Sector ‘Ready for Impact” Strategic Goal #1 to “Reduce Construction

Worker fatalities and serious injuries caused by falls to a lower level.” This guardrail system is

capable of providing protection to personnel who must work near (1) unguarded roof surfaces,

(2) unguarded skylights, (3) unguarded roof and floor holes, and (4) on stairs that have not yet

had handrails installed. The easy‐to‐install fall‐prevention system was designed to meet all

OSHA safety requirements for guardrails. Through extensive testing in NIOSH labs, the final

design will support more than twice the OSHA 200‐pound top‐rail strength requirement for a

worker falling against it. It can be used on commercial, industrial, and residential flat roofs, as

well as being adjustable to 7 different residential roof slopes (from 6‐in‐12 [27°] to 24‐in‐12

[63°]). In addition, four other variations were developed for installation on flat and vertical

surfaces that are unprotected, including staircases before the handrails are installed.

Impact: The impact of using the NIOSH guardrail system is an adaptable fall‐prevention system

that is readily available to improve safety conditions for residential and commercial

construction workers. The safety intervention can be installed to protect workers in situations

where fall protection is not normally used. From September 2011 to October 2012, a field

evaluation was conducted by the West Virginia University Safety and Health (WVUS&H)

Extension Office. One local WV residential contractor was evaluated during this time.6 The

contractor used the system on a variety of homes to meet the requirements of the OSHA fall‐

protection standards. Through a contract with NIOSH, the WVUS&H Extension Office provided

training in the use of the fall‐prevention system, using installation instructions developed by the

project team. The owners of the contracting firm commented that they normally do not use

guardrails during residential construction; however, after the training session, all crew

5
Dr. Bobick was chosen in 2013 as CDC’s Civilian Engineer of the Year.

6
During the field study, the contractor used the guardrail system, both externally on the roof and internally on

stairs and for internal edge protection.

NIOSH CSH, Accomplishments, 2009‐2013, Page 13 of 27

members felt very positive about using the system,7 and the contractor plans to continue using

the system in their home as well as a commercial business. Verbal feedback from workers and

management indicate high acceptance of this system.

V. Ladder Application

Falls from ladders are an important source of preventable construction injuries. Misjudging the

ladder angle is an important risk factor for a fall. If the ladder is set too steeply, it is more likely

to fall back or slide away during use, and if it is set too shallow then the bottom can slide out.

Researchers within NIOSH’s Division of Safety Research (DSR) designed and developed the first

NIOSH construction related application (app). This research is being led by Dr. Peter Simeonov

and supports NORA Construction Sector ‘Ready for Impact” Strategic Goal #1 to “Reduce

Construction Worker fatalities and serious injuries caused by falls to a lower level.” The NIOSH

Ladder Safety phone app is designed to improve extension ladder safety and has an angle of

inclination indicator making it easy to set an extension ladder at the proper angle of 75.5

degrees. This free and popular app became available in June 2013 through the NIOSH website

(http://www.cdc.gov/niosh/topics/falls/), the Apple App‐store

(https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewSoftware?id=658633912&mt=8),
and the Android Market

(https://play.google.com/store/apps/details?id=gov.cdc.niosh.dsr.laddersafety). The science

that led to the development of the app received awards in 2014 from both NIOSH and the

Department of Health and Human Services.

The app’s inclination indicator allows most cell phones to provide both a visual and an

audible signal when the ladder angle is correctly set. NIOSH’s Division of Safety

Research tested and patented the concept of the app’s inclination indicator. They

compared existing ladder positioning methods and found that the indicator improved

both the accuracy and efficiency for ladder positioning. The Ladder Safety app also

includes other handy information about ladder safety, i.e., ladder selection, inspection,

accessorizing, and use. The science and research behind the development of the ladder

safety app can be found at http://www.cdc.gov/niosh/topics/falls/. A Spanish language

version of the Ladder Safety app has also been released.

7
Training included a hands‐on practice installing the system on three typical construction situations (sloped,

horizontal, and vertical orientations).

NIOSH CSH, Accomplishments, 2009‐2013, Page 14 of 27

http://www.cdc.gov/niosh/topics/falls

https://play.google.com/store/apps/details?id=gov.cdc.niosh.dsr.laddersafety

https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewSoftware?id=658633912&mt=8

http://www.cdc.gov/niosh/topics/falls

VI. Safety Solutions – Home Building Booklet

Home building is physically demanding work and manual material handling may be the most

difficult part of the job. These activities increase the risk of painful strains and sprains and more

serious soft tissue injuries.

NIOSH’s Division of Applied Research & Technology designed and developed

Simple Solutions for Home Building Workers: A Basic Guide for Preventing

Manual Material Handling Injuries, which is also available in Spanish as

Soluciones Simples: Para los Trabajadores de la Construcción Residencial:

Guía Básica Para Prevenir Lesiones en el Manejo Manual de Materiales. This

project supports NORA Construction Sector Strategic Goal #7 to “Reduce

Construction Worker fatalities and serious injuries caused by falls to a lower

level.“

Simple Solutions for Home Building Workers was made available June 2013 as a web publication

for printing or download at http://www.cdc.gov/niosh/docs/2013‐111/ and

http://www.cdc.gov/spanish/niosh/docs/2013‐111_sp/. The publication was written especially

for young and less experienced home building workers. Original drawings and non‐technical

language are used to describe manual material handling injury risks and how these risks can be

reduced and/or eliminated for certain activities. It provides basic information about readily‐

available work practices and equipment that can help both new and experienced workers,

contractors and builders prevent serious manual material handling injuries.

VII. NIOSH Research Guidance Targeted Towards OSHA’s Needs

In March 2014, OSHA convened its informal public hearings for the proposed rule in

occupational exposure to respirable crystalline silica. NIOSH researchers provided testimony,

addressing the health effects of exposure to respirable crystalline silica based on its long history

of research and extensive efforts to develop recommendations and controls for preventing

worker exposures to silica. NIOSH researchers have studied the use of engineering control

technology for grinding concrete, sandblasting, rock drilling, hydraulic fracturing (fracking),

concrete floor polishing, cutting fiber cement siding, tuck pointing, and asphalt milling. In fact,

NIOSH construction researchers played a significant role in helping to develop Table 1 of

OSHA’s proposed rule concerning “Exposure Control Methods for Selected Construction

Operations.” NIOSH has also promoted the prevention of silicosis through model partnerships

and cooperative agreements with government, industry, labor and academia. NIOSH methods

research has shown that the proposed OSHA standard is measurable by techniques that are

valid, reproducible, attainable with existing technologies, and available to industry and

government agencies.

NIOSH CSH, Accomplishments, 2009‐2013, Page 15 of 27

http://www.cdc.gov/spanish/niosh/docs/2013-111_sp

http://www.cdc.gov/niosh/docs/2013-111

NIOSH provided comments to the OSHA Request for Information (RFI) Standards Improvement

Project ‐Phase IV (SIP‐IV) published in the Federal Register (FR) in 2012 [77 FR 72781]. NIOSH

supports updating the decompression tables in Appendix A of the OSHA Underground

Construction, Caissons, Cofferdams and Compressed Air standards (29 CFR part 1926, subpart

S) in SIP‐IV (page 72783 of the RFI). Early studies by Kindwall et al. found that the OSHA

decompression tables were not sufficiently protective of worker health. Alternative

decompression tables are available that are more protective than the current OSHA tables.

NIOSH supported research to develop and test four new tables in 1981, including one based on

oxygen use, that are now accessible to the construction and safety and health community via a

new NIOSH topic page http://www.cdc.gov/niosh/topics/decompression/nioshDeveloped.html.

These tables, known as the “Edel‐Kindwall” tables, have been used for variances to the OSHA

standard and have been shown in laboratory and field trials to decrease the incidence of

dysbaric osteonecrosis (Downs and Kindwall 1986). Use of the alternative tables may be more

cost‐effective because (1) they reduce the need for time‐consuming variances; (2) they use

staged decompression and oxygen decompression which potentially shorten decompression

times for employees and employers; and (3) they may result in fewer health complications and

lower associated medical costs (Downs and Kindwall 1986). NIOSH is working with OSHA to

determine if additional data are needed to protect workers on tunneling projects at pressures

greater than 50 psi.

VIII. NIOSH Funded Extramural Research

NIOSH Extramural funded construction research continues to ensure relevant applied research,

translational research, and research‐to‐practice activities through a mix of investigator‐initiated

grants and cooperative agreements. NIOSH funding continues to stimulate quality research and

research‐to‐practice efforts for addressing new and ongoing challenges in the construction

sector.

Relationship with the National Construction Center

The National Construction Center provides national leadership and coordination on research‐

to‐practice (r2p) to effectively transfer research findings to construction stakeholders by: (a)

translating research recommendations and outputs for use by consensus organizations,

regulatory agencies, professional associations, and construction employers, unions, and

workers; (b) facilitating the adoption of or hastening the transfer of research recommendations

and outputs, technologies, and information into practice or to worksites; and (c) expanding the

body of knowledge about r2p in the construction sector. NIOSH intramural scientists consult

with scientists at the National Construction Center or with scientists who are part of its

collaborating network. CPWR—The Center for Construction Research and Training has

successfully applied to serve as the National Construction Center since 1994.

NIOSH CSH, Accomplishments, 2009‐2013, Page 16 of 27

http://www.cdc.gov/niosh/topics/decompression/nioshDeveloped.html

In FY2010, CPWR began increasing its research‐to‐practice capabilities and capacity through an

r2p program supplement. One facet of the plan is improving program infrastructure for

distribution and support of r2p products to‐and with intermediary organizations. An

interagency workgroup is steering planning processes including coordination with NIOSH.

Outputs include Guidance for the selection of completed research ready for r2p (and triage

tool), ‘best practices’ information, specialty trade ‘toolkits’, CPWR Impact (tri‐fold) card, and

CPWR Data Brief (Hispanic worker injury data), and CPWR Update e‐bulletin.

In 2013 CPWR published the fifth edition of The Construction Chart Book: The U.S.

Construction Industry and its Workers. The Chart Book is widely regarded as a leading resource

for U.S. construction industry data and statistics and has been a go‐to reference for

construction stakeholders for 16 years. The Chart Book characterizes the changing American

construction industry and workforce, monitors the impact of such changes on worker safety

and health, and identifies priorities for future safety and health interventions. The Chart Book

includes statistics on traditional construction topics, but it also addresses green construction,

the aging workforce, employment projections, as well as OSHA inspections, violations, and

citations. It contains approximately 250 charts and tables on 55 topic pages.

From: The Construction Chart Book, Page 38, Chart 38a

The restructured eLCOSH.org was released in October 2012 containing a free national

repository of construction safety and health information. In 2013, the site broke 15 million page

views since its launch in 2000. The website provides user‐friendly safety and health

NIOSH CSH, Accomplishments, 2009‐2013, Page 17 of 27

http:eLCOSH.org

information, in English and Spanish, for construction workers and others on a wide range of

topics and sources. Some 850 documents and videos, including more than 150 in Spanish, are

posted. eLCOSH is a global resource for construction safety and health training and

management documents, with more than 50 annotated site links provided. The eLCOSH

Facebook page has developed an avid community of active followers and over 10,000

Facebook

users “like” the page.

CPWR partnered with McGraw‐Hill Construction to survey hundreds of construction contractors

of various sizes and trades to learn about their safety management practices. Respondents,

drawn from McGraw‐Hill’s contractor research panel, participated in the survey in December

2012. Developing a site‐specific health and safety plan; analyzing potential site safety hazards

before construction begins; and assigning project safety personnel before construction begins

were the leading topics identified by contractors as especially effective methods by which to

increase project safety. While large firms reported extensive use of critical safety practices,

fully‐inclusive safety programs were much less common in smaller firms.

CPWR organized two national workshops: one on safety culture and climate and another on r2p

partnerships. CPWR took the lead responsibility for writing and publishing (April 2014) the

Safety Culture and Climate report stemming from that workshop, Safety Culture and Climate in

Construction: Bridging the Gap between Research and Practice, available online at CPWR’s

website. It also published several reports including an Intellectual Property Patent & Licensing

Guide for Construction Safety & Health Researchers.

NIOSH CSH, Accomplishments, 2009‐2013, Page 18 of 27

IX. SOCIAL MEDIA

Beginning in 2011, a study of the use of social media by CSH, conducted by NIOSH OC, as well as

work by the National Construction Center shaped efforts to disseminate outputs from NIOSH’s

construction program. It is now standard practice to use social media and to involve the

National Construction Center, as well as other partners such as OSHA where relevant, in

dissemination efforts.

Twitter

Outreach through social media, specifically, Twitter, has been important. As of October 2014,
there were 12,400 followers for Construction@NIOSH. Of the 14 Twitter accounts associated
with NIOSH, @NIOSHConstruct is the second most popular account in terms of followers,
behind the main NIOSH account, @NIOSH. To understand more about the makeup of our
followers, an evaluation of 2.5% of our followers was performed and showed:
 50% in construction
 22% personal accounts
 13% other businesses
 13% OSH practitioners
 2% political/social/academic

As far as Twitter engagement, for every original tweet we’ve had on average about 4
interactions (retweets or replies). Interactions on Twitter are key indicators as to whether users
on Twitter are responding to content. Five of the ‘top ten’ tweets were centered on
construction falls and were sent out as part of our Construction Falls Prevention Campaign
messaging. As far as Twitter reach, of the 135 different Twitter accounts that had either
retweeted or replied to a @NIOSHConstruct tweet (during a sample 2 month period), there
were 334,748 Twitter accounts following them.

Facebook

The National Construction Center has enhanced communication through development of two
Facebook pages which as of October 2014 have a combined total of 14867 ‘likes’.

For the Construction Falls Prevention Campaign, a Facebook page “Stop Construction Falls” was
developed by a NORA Construction Sector Council member at Washington University School of
Medicine in St. Louis. The “Stop Construction Falls” Facebook page has 235 ‘likes’ and has
reached 14 states in the U.S. and 44 countries worldwide.

NIOSH CSH, Accomplishments, 2009‐2013, Page 19 of 27

Appendix I – Construction Falls Prevention Campaign – Evaluation Summary Findings

As informed by the focus group results, moving forward with Safety Pays, Falls Cost campaign
outreach strategies and products, we recommend the following:

Channels of Dissemination
 Partner with home improvement stores such as Home Depot or Lowes to post and

disseminate campaign messages and materials.
 Identify an OSHA or related official that is able to distribute campaign materials in

person and provide brief mini‐demonstrations on campaign topics.
 Distribute products directly to contractors.
 Hold events such as “construction safety block parties” where campaign products can be

distributed in‐person.

Product Types
 Use real contractors in materials whose facial expressions match the copy of the

material.
 Depict individuals who are in obvious physical discomfort if they are relaying a story in

which they were injured.
 Provide materials that are easy to distribute such as stickers and business cards.
 Laminate products such as one‐page information sheets so they have a long shelf‐life.
 Keep copy brief and provide correct procedures (not only incorrect procedures).

Campaign Website
 Reduce the amount of information on any one Page; create click‐thru Pages to specific

topics.
 Create separate Pages for roofs, scaffolds and ladders.
 Provide a search capability.
 Place the compelling CPWR “Don’t Fall For It” video on the home page.
 Either move the map on the home page or make it more active – e.g., show where users

can access campaign materials in their geographic region.

 Add short safety video clips.

The following conclusions can be drawn from the Safety Pays, Falls Cost Campaign partner

interviewee and survey findings.

Partner Level of Effort
 Partners reported primarily disseminating existing Safety Pays, Falls Cost Campaign

materials through their own media channels and by posting the
stopconstructionfalls.com link on their websites.

 Partners reported that they had not, at least as of the writing of this document,

produced special safety events as part of the Safety Pays, Falls Cost Campaign.

NIOSH CSH, Accomplishments, 2009‐2013, Page 20 of 27

http:stopconstructionfalls.com

Partner Receipt of Campaign Products
 The disbursement of Safety Pays, Falls Cost Campaign materials to partners appears to

have occurred only on a one‐time basis.
 Partners, across the board, did not appear to receive the same amount of products or

the same type of products.

Rewarding and Challenging Aspects of the Campaign
 Partners reported feeling satisfied and rewarded for participating in a campaign to

promote height safety in the construction arena. They believed in the importance of the
campaign and found it rewarding that their organization is part of a larger effort to
promote construction safety.

 Partners reported feeling very gratified when there was evidence that campaign
messages are being forwarded by other organizations.

 Partners reported feeling it will be challenging to sustain their participation in the Safety
Pays, Falls Cost Campaign over time because they did not receive additional materials to
distribute throughout the year.

 Partners reported challenges in finding vehicles and venues for delivering materials
directly into the hands of small residential contractors and employees.

 Partners reported not knowing or being uncertain as to whether campaign messages,
materials, and other products influence the way small residential contractors and their
employees conduct their work duties.

Areas for Improvement
 Some partners reported wanting to receive materials more frequently so that,

subsequently, they could distribute those materials and have much more touch‐points
with the target audience.

 Some partners reported wanting materials emailed to them as frequently as weekly or
monthly.

 Some partners reported wanting materials that provided motivators for small residential
contractors to raise awareness of height‐safety procedures on construction sites
including:

o Statistics on injuries and fatalities
o Cost points associated with injuries resulting from work‐related falls

 Partners reported not having received any technical assistance. However, the
challenges articulated by partners as to the difficulties in reaching small residential
contractors indicate that they could use assistance in:

o Identifying possible locations in their communities that are frequented by small
residential contractors and employees

o Exploring existing activities targeting small residential contractors and
employees that partners could leverage to distribute messages, materials and
products.

NIOSH CSH, Accomplishments, 2009‐2013, Page 21 of 27

Continued Partner Involvement after the Campaign’s First Year
 Most partners reported intending to continue their involvement in the Safety Pays, Falls

Cost Campaign after the first year.
 Most partners said that their organization’s involvement will be similar to that of the

first year of the campaign and mostly include distribution of campaign materials and
website links.

 A couple of partners stated that their organizations will incorporate new strategies in
their campaigns to disseminate messages, materials and products including:

o Transit ads
o Tool box talks
o Community outreach events
o Medial outreach
o Outreach to local apprenticeship programs and community health centers.

Recommendations for Potential Campaign Partners
 Many partners suggested that potential partners with access to small residential

contractors and their employees included local chapters of national associations in the

industry such as local chapters of the National Roofing Contractors Association, the

Home Builders Association, and the National Safety Council.

NIOSH CSH, Accomplishments, 2009‐2013, Page 22 of 27

Appendix II – Nail Gun Evaluation: Findings

Several common themes emerged based on our stakeholder interviewees. This section will
address these commonalities as well as cover some other key findings.

Spanish outreach
Three of the nine stakeholders we reached out to were primarily focused on reaching Spanish‐
speaking construction workers. We wanted to ensure we were able to get feedback from this
target audience since we developed a Spanish‐speaking version of the nail gun guide and
actively worked to disseminate this guide to construction organizations focused on reaching
Spanish‐speaking construction workers.

From talking to these three stakeholders, some significant findings are highlighted below.

El Nuevo Constructor (only Spanish‐language magazine in the construction industry):
We thought this information would be of interest as we serve as a portal to Hispanic
construction workers.

Hispanic Contractors Association de Tejas (largest contractors association in the country)
When asked about reaching small and hard to reach residential contractors, our
respondent mentioned that they have a have a program to try and reach this workforce
called the “OSHA 10 hour marathon” where they train 400‐500 of these types of
workers in a day. They are planning to distribute the nail gun safety guide to all of these
workers at this training.

National Hispanic Construction Association
There was some turnover in this organization during our survey period, but have since followed
up with this organization and their new CEO is very interested in promoting the nail gun
guidance document as well as any other safety documents for workers in the construction
industry. After our initial conversation on the nail gun guide, he has since asked if his
organization could be a formal partner in the construction falls prevention campaign.

Extending the reach
One of our main objectives was to try and gauge how many people have seen this nail gun
guide. We asked each of our stakeholders if they had further disseminated the nail gun guide
and what methods did they use to extend the reach. All of the respondents said that upon
receiving the email with the link to this new product, they then shared this resource within
their organization and often times outside their organization. Each organization disseminated
the information in a slightly different fashion. We’ve captured below how each organization
further distributed the information in the nail gun guide.

NIOSH CSH, Accomplishments, 2009‐2013, Page 23 of 27

National Association of
Home Builders (NAHB)

‐posted on our website & sent out via electronic newsletter to our members
(140,000 members)

The Associated General
Contractors of America
(AGC)

‐included in our Safety & Health e‐newsletter which reaches ~ 10,000
people;
‐shared it with the Safety & Health Committee as a safety alert

Liberty Mutual Insurance ‐devoted a quarterly construction newsletter to it ‐
posted on our web
‐worked with a group of construction specialists to distribute (access 700
companies)

SkillsUSA ‐sent to all 300,000 of our members (20% Hispanic/Latino)
‐sent to state directors who then sent out to their advisors and the
schools/teachers

Carpenters’ District
Council of Greater St.
Louis and Vicinity

‐sent it to all the carpenter training schools
‐take to the various job sites (several 100)
‐promote on www.nailgunfacts.org

National Hispanic
Construction Association

‐incorporated into our November newsletter
‐posted in the “newflash” section of our website
‐posted update with link on our Facebook page

Hispanic Contractors
Association de Tejas

‐posted on our website
‐sent via email blast to our members (2500 people, which includes about 90
OSHA 500 trainers)

El Nuevo Constructor ‐posted on our website
‐incorporated the update with the link into our weekly “info‐bulletin” that
we send out

This information allowed us to get an estimate on how many people have heard of or seen the
information in the nail gun guide which gives us a sense of the reach we’ve been able to have
with this document. It also informed us on the various mechanisms construction stakeholders
have in place to get messages out to their organizations. This could help shape future outreach
dissemination strategies for our office by knowing the various ways people receive information
across the construction industry.

Impressions
Another area we were interested in gaining further insight was on each stakeholder’s
impression of the nail gun guide. We were interested in any feedback they had or any feedback
they had received on the content/layout of the document. All of the stakeholders mentioned a
favorable impression. We wanted to highlight some of the actual impressions we heard in the
below.

NIOSH CSH, Accomplishments, 2009‐2013, Page 24 of 27

NIOSH took the extra step to go out to the residential construction sites and capture images with these
nail guns being used like they normally would be. This adds great value to the publication.

The part on actual accidents that occurred rings very true;
I liked that you didn’t pull all the fatality accidents and have more of a mix.

The six steps to nail gun safety are practical and comprehensive.

I like the columns with useful terms you should know and worksite stories.

The photograph on the front page really helped get workers to share stories from guys they knew that
had nail gun injuries and that’s what sold them on it.

The cover is really dramatic. It absorbs a person to read what’s inside.
You don’t see “gore” you see the result.

NIOSH did a great job at the translation of this document to make it easily understandable by Spanish‐
speaking construction workers.

We heard from several respondents that the way the nail gun guide was written made complex
information easily understandable. We also received a lot of positive feedback about the layout
of the guide.

We did receive a few technical comments from one of the stakeholders that had experience
working as a nail gun user. He offered a few potential modifications to include:

 The advice to keep your hand 12 inches away – may not be practical, often is 6 inches.
 The advice on ‘only using the nail gun with the dominant hand’. You can operate with your non‐

dominant hand just like a cell phone. It doesn’t matter what hand when you hold it six hours a
day.

 As far as the information on full sequential vs. single actuation: a table may be better for our
guys. Most have a high school education or less and may have hard time understanding this
aspect.

 Another aspect that wasn’t really covered that contributes to injury from nail guns is the air
compressor. A lot of times they skip or double pass if there is too much pressure or not enough.
Knowing the pressure required to operate the nail gun and how to make it happen with the tools
you have is important.

How do we get workers to “pick it up and read it”?
Besides this being a great document, we heard that the challenge really is on how we get
people to “pick it up and read it”. A few of the respondents mentioned developing additional
materials targeted at the average construction worker (simpler format, shorter read). One
person even mentioned the need to develop this into a nail gun safety app where users could

NIOSH CSH, Accomplishments, 2009‐2013, Page 25 of 27

download the pertinent information onto a smart phone. Also we heard from a several
respondents that we should look to develop this into a short video that could be accessed via
YouTube. One organization said they’d be willing to work with us to develop an educational
video on nail gun safety. A lot of construction workers just use YouTube to type in the topic
they want to learn about and listen/watch someone tell them how to do whatever it is they’re
interested in.

How to get to those small ‘hard‐to‐reach’ residential contractors?

 This is the biggest problem our industry faces.  .

A lot of our respondents mentioned that targeting the small ‘hard‐to‐reach’ residential
contractors was also a challenge for their organizations. A common theme we heard was
working at the local level with community organizations that these types of workers go to for
trusted safety and health information & resources. We also heard that getting out this
information in multiple ways is useful using different avenues and media outlets. One
innovative idea we heard was getting a “NIOSH nail gun safety racecar”.

Who else should we reach out to?
Several respondents mentioned NIOSH should
reach our to Home Depot and Lowe’s at the national
level. It was mentioned that Home Depot has a nail
gun buyer’s guide that doesn’t mention triggers.
 One of the respondents mentioned it would be nice to have this “cutting edge NIOSH

produced brochure to accompany the nail gun buyer’s guide.”
 Another mentioned these stores should be “handing out this guide to those buying

framing tools”.

ISANTA (the International Staple, Nail, And Tool Association), the manufacturers of nail guns
were also mentioned as an organization NIOSH should reach out to. Their nail guns are pictured
in the nail gun guide.
 “It’s in their best interest and their members’ best interest”.

Habitat for Humanity was an organization that was also mentioned for us to reach out to.

To target some of the “hard‐to‐reach” workers, we heard it would be worthwhile to find a way
at the local level to reach out to community organizations where many of these workers go for
educational materials.

All of the respondents mentioned that it was still too early to identify any cases of impact as far
as behavior change of workers (switching to sequential triggers) due to the release of this new
nail gun guidance document. Several respondents did mention that they will be incorporating

NIOSH CSH, Accomplishments, 2009‐2013, Page 26 of 27

this new nail gun guidance into their training curriculums. They mentioned they will be
capturing feedback during their trainings and would share any stories of impact.

NIOSH CSH, Accomplishments, 2009‐2013, Page 27 of 27

Workers’ Compensation Insurance:
A Primer for Public Health

Department of Health and Human Services

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

Workers’ Compensation Insurance: A Primer for Public Health

Workers’ Compensation Insurance:
A Primer for Public Health

David F. Utterback,
Alysha R. Meyers,

Steven J. Wurzelbacher

Department of Health and Human Services
Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

January 2014

Workers’ Compensation Insurance: A Primer for Public Healthii

This document is in the public domain and may be freely copied or reprinted.

Disclaimer

Mention of any company or product does not constitute endorsement by the National Institute
for Occupational Safety and Health (NIOSH). In addition, citations to Web sites external to
NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or their programs
or products. Furthermore, NIOSH is not responsible for the content of these Web sites. All Web
addresses referenced in this document were accessible as of the publication date.

Ordering Information

To receive documents or other information about occupational safety and health topics,
contact NIOSH:
Telephone: 1–800–CDC-INFO (1–800–232–4636)
TTY: 1-888-232-6348
Email: cdcinfo@cdc.gov
Or visit the NIOSH Web site at www.cdc.gov/niosh

For a monthly update on news at NIOSH, subscribe to NIOSH eNews by visiting
www.cdc.gov/niosh/eNews.

DHHS (NIOSH) Publication No. 2014–110
January 2014

Workers’ Compensation Insurance: A Primer for Public Health iiiWorkers’ Compensation Insurance: A Primer for Public Health

Foreword

Occupational safety and health research and surveillance are essential for the prevention and
control of injuries, illnesses and hazards that arise from the workplace. Research and surveil-
lance can fill gaps in knowledge about where hazards exist and what interventions are effective at
preventing workplace injuries, illnesses and fatalities. Workers’ compensation insurance records
are a resource used for these primary prevention purposes. In addition, workers’ compensation
records may be used for early detection of health outcomes in populations of workers which is
part of secondary prevention. They may also be used to help identify effective medical treatment
which is part of tertiary prevention.

Workers’ compensation insurance covers nearly all workers in the U.S. and provides those who
are injured or become ill as a result of work with medical treatment, a portion of lost wages, and
a lump sum for some permanent impairments. Nonetheless, there are limitations to conducting
studies that rely on workers’ compensation records since not all injuries and illnesses result in
claims being filed. Furthermore, the data that are collected are not readily combined if obtained
from multiple sources since requirements vary substantially among the states.

The National Institute for Occupational Safety and Health (NIOSH) joined with a number of
public and private sector co-sponsors to convene two workshops on the use of workers’ com-
pensation data for occupational safety and health. Creation of this document was suggested at
the second workshop as a means to describe elements of the workers’ compensation insurance
programs in the U.S. and the potential to utilize the records for public health purposes.

Public health agencies, the workers’ compensation industry, trade associations and the state-level
programs share interests in utilizing these data to protect workers from occupational injuries and
illnesses. To help facilitate these goals, NIOSH has created a Center for Workers’ Compensation
Studies. Further information on the center may be obtained at http://www.cdc.gov/niosh/topics/
workerComp/CWCS/.

John Howard, M.D.
Director
National Institute for Occupational Safety and Health
Centers for Disease Control and Prevention

http://www.cdc.gov/niosh/topics/workerComp/CWCS/

Workers’ Compensation Insurance: A Primer for Public Healthiv

Acknowledgements

We thank the participants at the Use of Workers’ Compensation Data for Occupational Safety
and Health Workshop that was held in Washington, DC in June 2012 for suggesting that a docu-
ment like this primer be developed. Many of those participants and other stakeholders provided
essential input on the scope and contents of this primer. We also thank the internal and external
reviewers for their valuable comments.

Acronyms and Abbreviations

AASCIF – American Association of State Compensation Insurance Funds
ACORD – Association for Cooperative Operations Research and Development
ACS – American Community Survey
AIA – American Insurance Association
CBP – County Business Patterns
CDC – Centers for Disease Control and Prevention
CES – Current Employment Statistics
CFOI – Census of Fatal Occupational Injuries
CFR – Code of Federal Regulations
CPS – Current Population Survey
DHHS – Department of Health and Human Services
EDI – Electronic Data Interchange
FEIN – Federal Employer Identification Number
FROI – First Report of Injury
FTE – Full-time Equivalent
HIPAA – Health Insurance Portability and Accountability Act
IAIABC – International Association of Industrial Accident Boards and Commissions
ICD – International Classification of Disease
IRS – Internal Revenue Service
MSHA – Mine Safety and Health Administration
NAICS – North American Industry Classification System
NASI – National Academy of Social Insurance
NAIC – National Association of Insurance Commissioners
NCOIL – National Conference of Insurance Legislators
NCCI – National Council on Compensation Insurance
NIOSH – National Institute for Occupational Safety and Health
OES – Occupational Employment Statistics
OIICS – Occupational Injury and Illness Classification System
OSHA – Occupational Safety and Health Administration
PCIAA – Property and Casualty Insurers Association of America
PEO – Professional Employment Organizations
QCEW – Quarterly Census of Employment and Wages
SDS – Supplementary Data System
SIC – Standard Industrial Classification System
SOC – Standard Occupational Classification System
SOII – Survey of Occupational Injuries and Illnesses
TPA – Third-party Administrator
WCIO – Workers’ Compensation Insurance Organizations
WCRI – Workers’ Compensation Research Institute

Workers’ Compensation Insurance: A Primer for Public Health vWorkers’ Compensation Insurance: A Primer for Public Health

Table of Contents

Foreword …………………………………………………………………………………………………………………………………… iii

Acknowledgements …………………………………………………………………………………………………………………… iv

Acronyms and Abbreviations …………………………………………………………………………………………………… iv

1. Introduction

………………………………………………………………………………………………………………………….. 1

2. Background

…………………………………………………………………………………………………………………………… 2

3. Brief History of Workers’ Compensation in the U.S. ……………………………………………………………….. 4

4. Workers’ Compensation Insurance Benefits

……………………………………………………………………………. 7

5. Workers’ Compensation Insurance Providers

……………………………………………………………………….. 11

6. State Workers’ Compensation Agencies

…………………………………………………………………………………12

7. Third-Party Administrators

…………………………………………………………………………………………………..13

8. Types of Policies

……………………………………………………………………………………………………………………13

9. Policy Premiums

……………………………………………………………………………………………………………………18

10 Workers’ Compensation Records ………………………………………………………………………………………….19

11. Standardized Codes and Systems in Workers’ Compensation

………………………………………………21

12. Loss Prevention

………………………………………………………………………………………………………………….22

13. Workers’ Compensation Associations ………………………………………………………………………………….23

14. Public Health Research and Surveillance

……………………………………………………………………………..25

15. Public Health Regulations

……………………………………………………………………………………………………26

16. Breaking through Barriers

…………………………………………………………………………………………………..27

References

…………………………………………………………………………………………………………………………………29

Tables
Table 1 ………………………………………………………………………………………………………………………………………..8

Table 2 ………………………………………………………………………………………………………………………………………14

Table 3 ………………………………………………………………………………………………………………………………………16

Appendices
Appendix A: Workers’ Compensation Primer Glossary ……………………………………………………………35

Appendix B: Preparing for Engagement ……………………………………………………………………………………41

Workers’ Compensation Insurance: A Primer for Public Health

Workers’ Compensation Insurance: A Primer for Public Health 1Workers’ Compensation Insurance: A Primer for Public Health

1. Introduction

The purpose of this document is to help public
health researchers and practitioners, particu-
larly those in occupational safety and health,
to broaden their understanding of workers’
compensation insurance, relevant aspects of the
insurance industry records, and the potential
uses of that information for public health pur-
poses. Workers’ compensation insurance has
been established in all states to provide income
protection, medical treatment, and rehabilita-
tion for employees who are injured or become
ill as a result of work. Workers’ compensation
claims and medical treatment records along with
other information resources have been used to
conduct occupational safety
and health research and
surveillance and to identify
intervention needs.

Several government agencies
and private organizations
sponsored two workshops
in September 2009 and June 2012 on the use of
workers’ compensation data for occupational
safety and health purposes. The workshops
featured discussions of opportunities for collabo-
ration in the analysis of workers’ compensation
data in order to help reduce the risks of occupa-
tional injuries and illnesses. Participants included
representatives from private insurance carriers,
insurance associations, self-insured corporations,
academic institutions and government agencies.

Presentations in the first workshop described
differences among state laws, proper interpreta-
tion of common industry terms, proprietary
interests in insurance data, public release of
internal analyses, methods for linking workers’
compensation records with other health and
employment records, and independent analysis
of claims data by health scientists, economists and
government agencies [NIOSH 2010; Utterback
et al. 2012]. One of the principal messages
from the first workshop was that even though
workers’ compensation records are primarily
designed and used by the insurance industry to
administer claims, public health investigators are
interested in them for prevention and control of

occupational injuries and illnesses. The interested
parties have different perspectives on the value
and potential uses of workers’ compensation
data. Relationships would need to build trust and
respect for the various stakeholder perspectives
to foster collaboration.

The second workshop included discussions of six
draft white papers along with 35 platform and
poster presentations on research with workers’
compensation data [NIOSH 2013a]. Although
much progress is being made in understand-
ing the merits of workers’ compensation data
resources, significant limitations exist. For
example, these data appear to constitute an
incomplete record of occupational injuries and

illnesses at the state level.
While standards for col-
lecting and compiling the
data exist, they are not uni-
versally used. Some fields
on the record forms are
often blank or incomplete
and essential information

for public health purposes, such as occupation,
race, ethnicity, and duration of employment,
may not be recorded. Multiple parties add data
to the records at various stages as claims work
their ways through the employees, employers,
medical facilities, third-party administrators and
state agencies. Nonetheless, important public
health research can be conducted with available
data as long as the limitations and their effects
on generalizability are considered.

At the end of the second workshop, some com-
mented that the public health and the insurance
communities may have different interpretations
of terms in common usage and overcoming that
barrier might be facilitated by a summary of the
workers’ compensation industry and a crosswalk
of terminology used by each group. A team began
work on this document as a result.

Following the background and brief history of
the workers’ compensation programs in the U.S.,
this primer describes: (1) benefits and premiums;
(2) the relationship between premiums and safety
incentives; (3) roles of insurers, state agencies and
third party administrators; (4) types of policies;

Two workshops on the use of
workers’ compensation data for
public health purposes have been
held and proceedings are available.

Workers’ Compensation Insurance: A Primer for Public Health2

(5) claims and other workers’ compensation insur-
ance information on medical treatments, costs
and disability status; (6) limitations of current
industry data standards; (7) loss prevention
programs; and (8) public health research, sur-
veillance and regulations. A glossary of workers’
compensation terms begins on page 35 and a
guide for prospective research and surveillance
projects follows on page 41.

2. Background
The economic and social burden of occupational
injuries and illnesses can only be roughly esti-
mated [Leigh and Marcin 2012; Leigh 2011].
Uncertainties are due to many factors including:
(1) workers receive only a portion of regular wages
through workers’ compensation; (2) occupational
illnesses are frequently not compensated; (3)
medical treatment costs for many occupational
injuries are paid by other insurance; (4) insurance
data are fragmented; and (5) data are protected
for proprietary and personal
identification purposes.
No central repository for
workers’ compensation
claims information exists
in the U.S.

The National Academy of
Social Insurance (NASI),
a non-governmental organization, produces
an annual report on workers’ compensation
insurance. The most recent version, Workers’
Compensation Benefits, Coverage, and Costs,
2010, states that workers’ compensation insurance
covered more than 124 million U.S. workers at a
total estimated cost to employers of $71 billion in
2010 [Sengupta et al. 2012]. Total insured medical
payments to providers and insured cash benefits
to workers were estimated at $28.1 billion and
$29.5 billion, respectively.

Most workers’ compensation insurance car-
riers are private entities except for exclusive
state insurance funds in North Dakota, Ohio,
Washington and Wyoming. Also, twenty states
offer state-sponsored nonprofit competitive
insurance companies or state licensed mutual
insurance plans, some to only selected portions

Workers’ compensation data are
likely to be more complete for acute
injuries and more representative of
population risks than occupational
illness data.

of the market such as those employers that are
unable to obtain insurance coverage in the vol-
untary market. There are typically dozens if not
hundreds of private carriers in each state. Large
employers in the U.S. are often self-insured under
rules established by the states.

Workers’ Compensation Records
Workers’ compensation insurance, in various
forms, covers in excess of 90% of the U.S. wage
and salary workers [Sengupta et al. 2012]. Ideally,
each workplace injury or illness requiring medical
care covered by workers’ compensation would
result in a record being created for the claim.
The primary purpose for the record is to ensure
proper payment to injured or ill workers and to
the medical providers. Yet the record may contain
useful information for public health purposes
on the nature of the injury or disorder, the part-
of-body, the event or exposure, industry sector,
occupation, and the worker’s ability to continue
working or disability status. Descriptive contents

may provide additional
information on materials
related to the event such as
biological, chemical, ergo-
nomic or physical hazards.

Medical records for workers’
compensation cases can
provide further information

about the extent and severity of the injury plus
information about the injured workers such as
gender, age, race/ethnicity, and other chronic
health conditions that may exacerbate an injury.
Workers’ compensation medical records also
identify disabilities that result from the occupa-
tional injuries or illnesses and billing records can
contain information on treatments and costs for
the medical portion of the claims.

Insurance carriers and self-insured entities are
required to provide state government agencies
with claims information that is used for admin-
istrative requirements such as oversight and to
conduct hearings for adjudication of disputes.
The level of detail and quality of information vary
among the data providers. Nonetheless, in each
state, a government agency has longitudinal data
that may be suitable for public health research and

Workers’ Compensation Insurance: A Primer for Public Health 3Workers’ Compensation Insurance: A Primer for Public Health

surveillance purposes. It is noteworthy that the
Health Insurance Portability and Accountability
Act (HIPAA) Privacy Rule exempts workers’
compensation medical information from its
disclosure restrictions.1

If information from multiple sources or jurisdic-
tions could be combined, workers’ compensation
insurance records would permit better analysis
and tracking of occupational injuries and some
diseases. In public health, use of these tracking
systems is called surveillance. (See box for a defi-
nition.) Health scientists,
economists, and others use
large surveillance data sets
for informative analyses
of trends in incidence and
costs, identification of health
hazards associated with new
technologies, evaluation of
injury and illness preven-
tion program effectiveness,
and to provide employers
with information needed to
protect their workforce.

Limitations on Records
Utility
For public health research and surveillance pur-
poses, workers’ compensation data are likely to be
more representative of population risks for acute
injuries than they are for occupational illnesses.
Some investigators have used limited workers’
compensation data to estimate the frequency,
magnitude, severity, and cost of compensated
injuries and to examine trends over time. Several
papers at the 2012 workshop described deficien-
cies in workers’ compensation records for injury
and illness surveillance purposes, even for more
severe injuries such as amputations, fractures and
concussions [NIOSH 2013a].

C ombining workers’ compensation data
from a number of jurisdictions is a major

technical challenge. Each state legislature and
the District of Columbia establish workers’
compensation requirements2 with significant
variations. For example, states vary in the cov-
erage of compensable cumulative injuries such
as carpal tunnel syndrome, levels of payments
for partial and total disability, both temporary
and permanent, and the minimum number
of days away from work to qualify for wage-
replacement compensation. In many states,
employers with small numbers of employees,
temporary employees and other groups, such

as farm employees, are
excluded from coverage
requirements. Certain
groups of workers such as
railroad, longshore, many
maritime and all Federal
employees are covered by
rules established at the
national level. Special
compensation funds have
been established at the
Federal level for atomic
weapons workers and for
those disabled by black
lung disease.

Another factor that makes it difficult to combine
data from multiple sources is the lack of national
data standards. For example, although some
nationally standardized data coding systems
are available, such as Occupational Injury and
Illnesses Classification System (OIICS), and
North American Industry Classification System
(NAICS), they are not universally used across
the states. In fact, workers’ compensation rate-
making bodies like the National Council on
Compensation Insurance (NCCI) and several
state rating bureaus use coding systems that
pre-date OIICS and NAICS systems. These
coding systems are discussed in subsequent
chapters.

The U.S. Centers for Disease Control
and Prevention (CDC) defines
public health surveillance as the
“ongoing systematic collection,
analysis, and interpretation of
health data essential to the planning,
implementation, and evaluation
of public health practices, closely
i n t e g r a t e d w i t h t h e t i m e l y
dissemination of these data to those
who need to know.”

1More on the exclusion of workers’ compensation medical records from the HIPAA Privacy Rule can
be found at http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/workerscomp.html

2This document uses “requirements” as a substitute term for legislation, statutes, rules and regula-
tions since the sources for the legal obligations vary among the states.

http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/workerscomp.html

Workers’ Compensation Insurance: A Primer for Public Health4

Furthermore, access to workers’ compensation
data can be difficult to obtain. Insurance carriers
are usually private businesses that manage very
large data sets in integrated, proprietary systems.
These data are generally not shared with external
groups. Some insurance organizations like NCCI
routinely collect standardized data from insurance
carriers in many states but their contracts protect
the proprietary interests of the contributing
carriers and restrict data uses to issues directly
related to estimating or recommending insur-
ance premium rates for establishments within
industries. Only one private insurance entity, The
Liberty Mutual Research Institute for Safety, has
published extensive peer-review articles related to
injury and illness prevention based on workers’
compensation records [Courtney 2010].

E v e n w h e n c o n d u c t –
ing analyses of workers’
compensation data from
a single state, there are
c h ar a c t e r i s t i c s of t h e
workers’ compensation
data that limit its utility.
Multiple researchers have reported limitations
on the utilization of workers’ compensation for
occupational injury and illness research and
surveillance. Azaroff, et al. [2002] described
a number of filters that limit the reporting and
filing of cases and the subsequent development
of a medical record or workers’ compensation
claim following a workplace injury or illness.
Several investigators have reported much less
than full participation in workers’ compensation
for occupational injuries and illnesses with up to
half or more of the compensable claims going
unreported [Biddle et al. 1998; Rosenman et
al. 2000; Fan et al. 2006; Scherzer et al. 2008;
Lipscomb et al. 2009].

Leigh [2012] estimated that only 21% of the total
economic burden of occupational injuries and
illnesses was paid by workers’ compensation
insurance carriers. Others describe the diffi-
culty in estimating the portion of the burden
that is shifted to other social and health insur-
ance programs [Boden et al. 2001] such as when
workers with occupational injuries and illnesses

Each state has its own set of rules
about which employers are required
to obtain workers’ compensation
insurance.

file disability claims with the Social Security
Administration [O’Leary et al. 2012].

3. Brief History of Workers’
Compensation in the US
Following European examples from the 19th
century, states in the U.S. began to develop

workers’ compensation
laws in the early 1900’s to
address the increasing risks
of occupational injuries and
illnesses associated with the
industrial revolution. Initial
laws in several states were
declared unconstitutional

but, in 1911, Wisconsin became the first state
to establish a workers’ compensation system
that withstood constitutional challenges in the
courts. By 1920, most states and territories3 had
followed suit. Mississippi was the last state to
adopt a workers’ compensation law in 1948.4
These laws provide partial benefits to affected
workers and protect employers from tort suits for
occupational injuries and illnesses in nearly all
cases. This “grand bargain” circumvents lengthy,
expensive trials where the burden of proof was on
the employee and removed a source of financial
uncertainty for the employer.

Since the beginning of workers’ compensation
programs in the U.S., nearly all employers have

3References to state workers’ compensation laws in this document should be read to include the
territories of Guam and the Virgin Islands plus the District of Columbia, all of which have sepa-
rate statutes and regulations.

4For greater details on the history and development of workers’ compensation laws in Europe and
the U.S., readers are directed to http://www.iaiabc.org/files/Resources/2006HistoryofIAIABC.
pdf, http://eh.net/encyclopedia/workers-compensation/, http://www.ncbi.nlm.nih.gov/pmc/
articles/PMC1888620/, or http://www.aascif.org/public/1.1.1_history.htm

http://www.iaiabc.org/files/Resources/2006HistoryofIAIABC

Workers’ Compensation

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1888620/

http://www.aascif.org/public/1.1.1_history.htm

Workers’ Compensation Insurance: A Primer for Public Health 5Workers’ Compensation Insurance: A Primer for Public Health

been required to have insurance to cover pay-
ments for: (1) medical costs resulting from
occupational injuries and some occupational
illnesses suffered by workers; and (2) partial
replacement of injured or ill workers’ lost wages,
also known as indemnity. Death benefits are paid
to survivors for occupational fatalities. These
benefits are paid only for claims where workers
were injured or became ill due to conditions that
“arise out of and in the course of employment,”
with restrictions that vary substantially among
the 50 states due to legislation and case law. In
return for this coverage, employers are granted
immunity from employee law suits (tort litiga-
tion) for nearly all occupational injuries and
illnesses. Thus workers’ compensation insurance
is structured to be the sole employee remedy for
restitution subsequent to occupational injuries
and illnesses. Some exceptions exist for willful
injuries and gross negligence.

Mandatory Coverage
Each state has its own set of requirements about
which employers are compelled to obtain workers’
compensation insurance. Varying factors are
generally the industry sector of the employer,
the minimum number of employees, length of
employment, and, in some cases, the familial
relationship of the employee with the employer.
The minimum number of employees requiring
provision of workers’ compensation coverage
varies between one and five across the states.
Some states exclude agricultural employers
with less than a specified number of employees.
Some states exclude self-employed workers while
other states provide an option for their coverage.
Some states exclude corporate officers in limited
liability corporations without other employees.
Other states have specific workers’ compensation
rules for industry sectors such as mining and
construction. The employment relationships of
employers with employees versus contractors are
clearly defined in many states.5

Since the enactment of Texas workers’ compensa-
tion legislation in 1913, employers in that state
have been allowed to voluntarily participate in
workers’ compensation insurance coverage. Those
employers who choose to opt out of coverage
are not protected from tort suits by the injured
or ill workers, or by surviving family members
in case of fatalities. Any medical expenses are
the responsibility of the injured or ill workers.
No payments are required for the workers’ lost
earnings for the duration of their recovery period
or for permanent disabilities. More recently,
Oklahoma legislation that was enacted in May
2013 allows employers to opt out of workers’
compensation insurance. In this state, employers
who opt out are required to have an internal
compensation program for occupational injuries
and illnesses that is consistent with Employee
Retirement Income Security Act (ERISA)
[Oklahoma Insurance Department 2013].

Basis for Insurance Premiums
Throughout the history of workers’ compensation
in the U.S., premiums for insurance policies have
been determined by a set of factors related to
employer risks, primarily the mix of occupational
classes they employ. Employers are assigned to
work classifications6 according to state-sanctioned
rating bureau guidelines. In general, employers
in classifications with greater injury and illness
risks and loss costs have higher “manual rates.”
For example, a roofing contractor generally has a
higher manual rate than a bank. Recommended
or specified manual rates must be approved by
the state regulators in most cases. Additionally,
those employers which qualify for experience
rating and that have a history of greater injury
and illness claims and costs within the risk classes
are charged even higher premiums through the
application of an experience modification factor.
Those employers with fewer claims and lower loss
costs benefit from lower premiums.

5For greater details on workers’ compensation trends and individual state requirements, readers
are directed to the annual NASI report [Sengupta et al. 2012] and the annual report produced by
the U.S. Chambers of Commerce [U.S. Chamber of Commerce 2012].

6The classifications do not directly correspond to Standard Industry Classification (SIC) or NAICS
codes or occupational classification systems, such as the Standard Occupation Classes (SOC).

Workers’ Compensation Insurance: A Primer for Public Health6

Motivations for Prevention
From the beginning of workers’ compensa-
tion insurance laws in the U.S., the experience
modification factor was intended to encour-
age employers to invest in safety. A history of
elevated claims frequencies and costs results in
higher insurance premiums for the employer.
Adoption of effective safety strategies reduces
occupational injuries and illnesses which should
decrease future premiums. Additionally, many
states have enacted legislation that requires carri-
ers to provide premium discounts for the presence
of employer-based leading indicators such as
safety and health programs
which meet specific criteria.
Moreover, most carriers
provide loss prevention ser-
vices to client employers in
order to limit escalation of
claims costs and insurance
premiums. Some states, for
example Texas, Missouri
and Arkansas, mandate that insurance carriers
provide loss prevention services to clients and
many specify that the services shall be provided
at no additional cost beyond the annual premium.

Recent Changes in the Industry and Market
The workers’ compensation insurance market
is dynamic. Both the nature of work and work-
force are changing. In recent years, the mix of
industries and technologies in the U.S. have
changed and the workforce is aging [Restrepo
and Shuford 2011] and increasingly non-English
speaking [Hakimzadeh and Cohn 2007] and obese
[Ostbye et al. 2007; Trogden
et al. 2007; Schmid et al.
2012]. In the past couple
of decades, there have been
substantial changes in state
laws that affect workers’
comp ens ation p olicies
and procedures. Workers’
compensation insurance
requirements on issues such as managed care
organizations, limited physician choice, voca-
tional rehabilitation, minimum standards of care,
and restrictions on treatment options have been
enacted in many states. Meanwhile, medical costs
for claims have escalated [Shuford et al. 2009]

and litigation of claims is common in many states
[Willborn et al. 2012].

Changes in the relationships between employees
and employers have created needs for newer
workers’ compensation insurance policy types.
For example, contingent work arrangements
through temporary employment agencies and
professional employer organizations (PEO) are
becoming more common [Smith et al. 2010].
These emergent work arrangements can compli-
cate coverage and incentives for injury prevention.
PEOs primarily have provided human resource

and management services to
client employers although
they increasingly employ
workers in other industries.
PEOs result in co-employ-
ment by the host agency and
the client employer. Newer
workers’ compensation
policy arrangements have

been developed for PEOs and similar employment
leasing organizations [Shuford 2013] since a single
host agency may employ workers at different times
in industries with various risk classifications.

In contrast, workers who are employees of a
temporary agency are covered under the workers’
compensation policy for that agency, not that of
the client employer. Independent contractors,
which are defined in the workers’ compensa-
tion statutes in many states, are not covered by
the policy of the contracting employer, e.g. the
general contractor at a construction site. Also,

independent contractors
which are self-employed
persons are qualified for
workers’ compensation
insurance in some, but not
all, states. Each of these
arrangements can blur the
responsibility for provision
of workers’ compensation

coverage and has resulted in a lack of coverage
for some workers.

Insurance Industry Resources
Many organizations produce information
that is used by various parts of the workers’

New types of workers’ compensation
insurance policies have been devel-
oped to cover the recent changes in
the relationships between employees
and employers.

The relationship between claims
frequencies and costs and the
employers’ premium is intended to
encourage investments to reduce the
risk of injuries and illnesses.

Workers’ Compensation Insurance: A Primer for Public Health 7Workers’ Compensation Insurance: A Primer for Public Health

compensation insurance industry. The U.S.
Department of Labor formerly compiled reports
on benefits and costs and annual summaries of
changes in state workers’ compensation require-
ments. They also employed regional experts
on workers’ compensation. The federal efforts
have shifted and some of the products have been
replaced by private or nonprofit entities such as
NASI and a number of others. For example, a
biannual report that compares the average cost
of workers’ compensation insurance per $100
of employer payroll among states is published
by the State of Oregon [Oregon Department of
Consumer and Business Services 2012]. The roles
and contributions of a number of these insurance
organizations appears later in this document.

Effectiveness of State Laws
The comparative impact of the various state
requirements has been a source of debate over
the entire history of workers’ compensation in
the U.S. Federalization
of the programs has been
suggested from time to
time. The Occupational
Safety and Health Act in
1970 created the National
C om m i s s i on on St ate
Workers’ Compensation
Laws which, after public
meetings and comment period, proposed Federal
minimum standards for state programs if the
states did not substantially improve their laws.
Related Congressional actions failed to pass. The
Commission did develop a set of recommenda-
tions for the state programs.7 Changes in state
requirements subsequent to those recommenda-
tions have been periodically reviewed which
indicate partial adoption by each of the states.8

According to national surveillance data, the fre-
quency and rate of occupational injuries have
declined over the past several decades [Sengupta

et al. 2012; U.S. Bureau of Labor Statistics 2012].
In 2010, employer costs for workers’ compensa-
tion benefits as a proportion of payroll were at
the lowest level in 30 years [Sengupta et al. 2012].
There has also been a general trend across the
states to limit compensation for disabled workers
[Spieler and Burton 2012]. Whether the surveil-
lance trends are due to reduced injuries, increases
in underreporting, or other factors is the subject
of ongoing research.

4. Workers’ Compensation
Insurance Benefits

Payments for workers’ compensation claims can
be for employee medical treatment, loss of wages
(indemnity), vocational rehabilitation, perma-
nent disability, and death. The rules for the level
of payment vary tremendously among the states
with a few exceptions. First, all medical expenses

are the responsibility of the
insurance provider without
co-payment by the claim-
ant but may be subject to
legislated time limits and
to medical fee schedules.
These covered costs include
the initial treatment and
subsequent treatments plus

physical therapy or vocational rehabilitations.
Second, indemnity payments to the worker who
misses work for greater than the minimum waiting
period are provided tax-free. Third, most states
provide wage replacement payments for the initial
waiting period after lost work time exceeds a number
of days that is set by the individual states (Table 1).
For example, if the initial waiting period for indem-
nity payments is five calendar days, payments for that
initial period would be made once the lost work time
on that claim exceeds a separate minimum period
such as 21 calendar days. This latter minimum time
period is called the retroactive period.

7http://www.workerscompresources.com/National_Commission_Report/national_commis-
sion_report.htm

8http://www.ncbi.nlm.nih.gov/pubmed/15182746,
http://www.ssa.gov/policy/docs/ssb/v65n4/v65n4p24 http://www.workerscompresources.
com/, National_Commission_Report/National_Commission/1-2004/Jan2004_nat_com.htm

Payments for workers’ compensa-
tion claims cover employee medical
treatment, loss of wages, vocational
rehabilitation, permanent disability
and death.

http://www.workerscompresources.com/National_Commission_Report/national_commission_report.htm

http://www.ssa.gov/policy/docs/ssb/v65n4/v65n4p24 http://www.workerscompresources.com/

Workers’ Compensation Insurance: A Primer for Public Health8

Table 1. Waiting period for claimant to receive wage replacement benefits and the retroactive
period which, if exceeded, results in payment for the waiting period

State Waiting Period (days) 1 Retroactive (days) 2

AL 3 21
AK 3 28
AR 7 14
AZ 7 14
CA 3 14
CO 3 14
CT 3 14
DE 3 7
DC 3 14
FL 7 21
GA 7 21
HI 3
ID 5 14
IL 3 14
IN 7 21
IA 3 14
KS 7 21
KY 7 14
LA 7 42
ME 7 14
MD 3 14
MA 5 21
MI 7 14
MN 3 10
MS 5 14
MO 3 14
MT 4
NE 7 42
NV 5 6
NH 3 14
NJ 7 7
NM 7 28
NY 7 14
NC 7 21

Workers’ Compensation Insurance: A Primer for Public Health 9Workers’ Compensation Insurance: A Primer for Public Health

Table 1. Waiting period for claimant to receive wage replacement benefits and the retroactive
period which, if exceeded, results in payment for the waiting period
State Waiting Period (days) 1 Retroactive (days) 2

Table 1. Waiting period for claimant to receive wage replacement benefits and the retroactive
period which, if exceeded, results in payment for the waiting period (continued)

ND 5 5
OH 7 14
OK 3
OR 3 14
PA 7 14
RI 3
SC 7 14
SD 7 7
TN 7 14
TX 7 14
UT 3 14
VT 3 10
VA 7 21
WA 3 14
WV 3 7
WI 3 7
WY 3 9

1The minimum number of days away from work to qualify for indemnity payments, also known
as the waiting period.

2If away from work for a number of days in excess of the retroactive period, claimant qualifies for
indemnity payment for the waiting period.

Source: 2011 Chambers of Commerce Workers’ Compensation Laws, Chart IX, (see caveats pp.
78 – 79 in reference)

Workers’ Compensation Insurance: A Primer for Public Health10

Temporary Disabilities
Temporary and permanent disability benefits can be
in the form of partial or total benefits. Temporary
partial benefits would be merited when workers are
away from work beyond the specified minimum
period but able to return to work in a limited capacity
that would partially affect their income. Temporary
total disability benefits occur when the worker is
unable to be employed in any capacity for a period
of time that exceeds the specified waiting period.
Many states have set time limits on temporary total
disability indemnity payments such as 104 weeks.
These benefits may convert to temporary partial
benefits if the worker is able to return to work part-
time for limited periods or if able to complete work
in another position at a lower pay rate.

Permanent Disabilities
Permanent partial disability payments are awarded
for workers who may no longer return to work with
sufficient capacity to perform their prior duties or
if they lose part or all of the function of a specific
body part due to a work-related amputation or other
disability. The loss of a body part or function is often
compensated based on a fee schedule such that a
set multiplier of the average wage is paid either as a
lump sum or over a period of time. Many states also
provide permanent partial coverage for disfigurement
of the face or other body parts.

The extent of permanent partial disability is deter-
mined by the degree of impairment at the point of
“maximal medical improvement” in order to settle
the case. Impairment is usually determined according
to medical references such as the American Medical
Association Guides to the
Evaluation of Permanent
Impairment [Cocchiarella
and Anderson 2001].

Permanent total disability
indemnity payments are
made to those workers who can no longer be
employed in any capacity. Depending on the state,
these payments may continue until retirement
age, for the life of the individual, or until disability

payments are received from another source such
as the Social Security Administration.

In some cases, the portions of the disability that are
attributed to work and non-work conditions can
factor in the amount of the disability payment. For
example, in some jurisdictions, a worker who is
disabled as a result of occupational exposures to a
respiratory hazard may have their benefits reduced
if a non-occupational exposure, such as smoking, is
demonstrated to have contributed to the impairment.

Death benefits are paid to survivors of the worker
who was killed on the job. The level of benefits usually
varies with the number of dependents. Although
generally a function of the average weekly wage,
death benefits are often limited by a minimum and
maximum amount but may last for the lifetime of the
surviving spouse or until dependent children attain
18 years of age or older in certain cases.

Settlement of Claims
Lump sum settlements, also known as negotiated
settlements or compromise and release agreements,
in lieu of limited periodic payments, have been
increasing for disabilities covered by workers’ com-
pensation insurance. These agreements are reached
between the disabled employee, the employer and
the insurance provider. In some states, settlements
may cover only indemnity portions of a claim,
with future medical benefits provided, while others
allow payouts for future medical care (including
Medicare set-asides,9 if appropriate). Often times,
the settlements must be approved by a state workers’
compensation authority.

Claim Costs and Reserves
Claims that are not settled
through mutual agree-
ment remain open until all
payments for medical treat-
ments, rehabilitation and

indemnity have been completed and the worker
returns to work, reaches the maximum indemnity
period or retirement age or dies. As a result,
the cost of a claim can continue to grow. Future

9Medicaid set-asides for occupational injuries and illnesses are explained at http://www.medicare.
gov/supplement-other-insurance/how-medicare-works-with-other-insurance/who-pays-first/
workers-comp-payments.html.

Future obligations on a claim are
handled in the form of reserves that
are established for open ended claims.

Workers’ Compensation Insurance: A Primer for Public Health 11Workers’ Compensation Insurance: A Primer for Public Health

obligations on a claim are handled in the form
of reserves that are established for open ended
claims and are dependent on the nature of the
injury and the likelihood of the rehabilitation of
the worker. Reserves typically represent estimates
of the most likely future cost of the claim, which
approximates the mode of the distribution of
claims of that type, rather than the mean.

With the open-ended nature of longer duration
claims, insurance carriers often value (estimate
cost of ) the claims based on the payments made
to date, the payments plus reserves, or the pay-
ments plus reserves as of a certain period of
time, such as 30 months after the date of injury.
Claims can also be valued using “factor-adjusted”
methods that calculate costs by applying actu-
arial loss development factors that attempt
to estimate the ultimate payout amounts for
the claims. For the “factor-adjusted” method,
reserves therefore represent the mean future
cost of claims of the same type. This method
is applied to groups of claims and is used by
insurance underwriters for analyzing aggregated
claims for loss trends. A potential drawback
with “factor-adjusted” methods is that their
values are usually higher than the actual values
of the individual claim (since the mean is always
higher than the mode and median in claim cost
distributions) [Wurzelbacher et al. 2013]. Some
carriers use yet other cost valuation methods.

5. Workers’ Compensation
Insurance Providers

The workers’ compensation insurance industry
is complex with total per annum expenditures
in excess of $70 billion [Sengupta et al. 2012].
The primary types of groups in the industry
include insurance carriers, state regulatory
agencies, third-party administrators and
numerous trade organizations. Insurance
providers may be privately-held corpora-
tions, mutual corporations (owned by the
policy holders), and state or Federal agen-
cies. All states except North Dakota permit
self-insurance for qualified employers [U.S.
Chamber of Commerce 2012].

Insurance Providers and Policies
The insurance providers are regulated by indi-
vidual state requirements. Even nationwide
insurance carriers must follow the require-
ments in each of the states where they offer
coverage. In most states, private insurance
carriers compete in the regulated voluntary
market. Twenty states offer alternatives to
the private insurers in the form of non-profit
state-sponsored insurance programs. In addi-
tion, state funds are the exclusive providers
of workers’ compensation insurance in four
states – North Dakota, Ohio, Washington
and Wyoming.

Insurance providers employ a range of special-
ists such as actuaries, adjusters, underwriters,
claims administrators and loss control con-
sultants (see glossary). Brokers directly
market insurance policies to employers and
they may offer policies from a single insurance
carrier or multiple competing carriers. Many
private insurance providers specialize in spe-
cific industry sectors in which they are most
familiar with risks. Large national carriers
offer insurance across diverse sectors but may
still focus on certain industries. Many private
insurance providers also offer other lines of
coverage beyond workers’ compensation, such
as property and liability.

Insurance providers typically issue annual
policies. An employer may opt to change
insurance carrier on the anniversary of the
policy except in states with exclusive funds.
Annual policies add to the competitiveness
of the market yet they reduce the investment
commitment of a carrier to client employers.
For example, carriers are not likely to invest
in cost reduction strategies such as safety
equipment if the recovery of the investment
would take several years to materialize.

Residual Market
The residual market customarily consists of those
employers that are unable to obtain insurance
coverage in the voluntary market. The residual
market usually serves newer employers without
sufficient years of experience in workers’ com-
pensation, employers with poor claims experience

Workers’ Compensation Insurance: A Primer for Public Health12

or employers in high-risk industries unable to
obtain a policy to underwrite their potential losses.
However, the residual market in some states may
include employers that voluntarily participate when
there are economic or services advantages. All 24
state-sponsored insurance
programs provide coverage
for their residual markets. A
few of the state-sponsored
government insurance pro-
grams provide insurance
coverage only to the residual
market. Some states require
the private insurance compa-
nies in their markets to write
proportionate coverage for the residual market
employers in the form of assigned-risk pools. The
Burton primer on workers’ compensation pro-
vides additional details on the residual market and
assigned-risk pools [Burton 2004].

6. State Workers’ Compensation
Agencies

Each state has an agency that provides administrative
services for workers’ compensation, has adjudicatory
responsibilities in cases of disputes, and/or develops
regulations and rules for the workers’ compensa-
tion system consistent with the intent of legislative
mandates. Portions of the agencies may operate as
commissions, bureaus, or departments. They may
be affiliated with other levels of government in the
states such as labor, industry, insurance or commerce.

Collection of Records
All states require that some
portion of the workers’
c o m p e n s a t i o n c l a i m s
records be reported to
the agency by employers
(Table 2). In some cases
only indemnity claims are
reported yet in others all
claims (including medical
only claims) are reported.
More and more states have
developed automatic Web (internet)-based or
telemetric reporting systems that use standard
forms and require the use of standardized codes

The residual market usually serves
newer employers without sufficient
experience in workers’ compensa-
tion, employers with poor claims
experience, or employers in high-risk
industries unable to obtain a policy
to underwrite their potential losses.

for fields in the forms. For example, the Workers’
Compensation Insurance Organization (WCIO)
part-of-body, nature of injury or illness, and
cause of incident codes are used in nearly all
jurisdictions.

State agencies may be
restricted by requirements in
the portions of the workers’
comp ens at ion re cords
which may be released to
the public. In some states,
those restrictions can extend
to other in-state agencies as
well. It bears repeating that

HIPAA Privacy Rule exempts workers’ compen-
sation medical information from its disclosure
restrictions.

Other Roles of State Agencies
Many state agencies oversee special funds that
provide benefits to injured or ill workers whose
employer failed to obtain the legally required
coverage. Most states also offer second injury
funds which reimburse employers for certain
claims paid to workers with pre-existing injuries.
A few state agencies, e.g. Ohio and Washington,
provide safety grants to offset some portion
of an employer’s expenses for installation of
safety equipment. Grants in other states, e.g.
Massachusetts and Oregon, are made to support
development of injury prevention training pro-
grams (Table 3).

A few states have research
c o m p o n e n t s i n t h e i r
workers’ compensation
agencies. These components
may track expenditures,
evaluate the implications
of proposed legal changes,
or consider other aspects of
policy options. Many states,
e.g. Florida [Florida Division
of Workers’ Compensation
2011], develop annual
reports for their agen-

cies that reveal the number of cases in various
categories such as indemnity, medical-only and
disallowed claims as well as the number of claims

All states workers’ compensation
agencies require that some portion
of the claims records be reported.

HIPPA Privac y Rule exempts
workers’ compensation medical
information from its disclosure
restrictions. (See footnote 1)

Workers’ Compensation Insurance: A Primer for Public Health 13Workers’ Compensation Insurance: A Primer for Public Health

that are contested by the employer or the insurance
provider. The reports may also describe recent
changes to the requirements and the status of
claims that are open and those that are closed.
Other data may be pre-
sented on the average cost
of claims for various injury
and illness types as well as
the distribution of claims
across industry segments.

Web (Internet) Services
Most state agencies provide diverse services and
extensive information via Web sites. Available
services include injury, illness and death claim
forms for employees and employers and the means
to report suspected fraud. Proof of insurance cover-
age by individual employers may be obtained in
some states through their Web sites. The Web site
information may describe the rights and responsi-
bilities of employees, employers, insurance carriers,
medical providers, and the state agency according to
requirements in the state. Many states provide plain-
language guides for employees and employers that
explain claims processing and appeals. Ombudsmen
in some states may be contacted through the Web
sites to assist claimants.

Most state agencies also use Web sites to promote
safe and healthful working
conditions and to provide
information on safety and
health program aids that
can be readily used by
employers. Other infor-
mation on participation in
various programs associated
with premium discounts or
penalties is offered as well.
Lists of insurance providers as well as consultants
and third party administrators are available on
many state sites. Training on the workers’ com-
pensation requirements is often made available
through the Web sites. Links to state statutes
and regulations are common.

7. Third-Party Administrators

Third-party administrators (TPA) are insurance
organizations other than the brokers, providers,

associations and the state agencies. TPAs provide
a wide range of services. They often complete
the actual claims forms and may be the direct
payer of benefits to workers and to medical

providers. They can be the
intermediary that reports
the claim information to
the respective state agency
and they provide analytical
reports to their clients. Self-
insured businesses often
employ TPAs for a diverse

range of claim and insurance services. TPAs may
complete and otherwise process claim forms for
the employer, pool or group including an initial
determination of compensability. Complete risk
management information systems are offered by
some TPAs.

In addition, they can provide services such as
medical case management, medical bill review,
and programs for the injured employee to return-
to-work. Some TPAs provide investigation,
subrogation and legal services to their clients.
Pharmacy benefit management and Medicare set-
aside services are some of the later additions to the
TPA offerings. Yet others may provide loss pre-
vention services and health and safety training for
employees and employers. TPAs may also provide

clients with their required
Occupational Safety and
Health Administration
(OSHA) logs for recordable
injuries and illnesses.

8. Types of
Policies

Workers’ compensation insurance policies vary
in many ways. The most straightforward policies
cover the claims costs due to a worker injury
or illness experienced by a single employer at a
single business establishment, i.e. location. Some
employers have multiple establishments for
a single policy and the risk classification for
the individual establishments may be differ-
ent, e.g. a manufacturer that also has a retail
outlet. Yet other policies may cover workers at
multiple establishments that change over time

Third-party administrators (TPA) are
insurance organizations other than the
brokers, providers, associations and the
state agencies.

Increasing risk retention by the
employer is accommodated by
the following insurance or policy
types: guaranteed cost, dividend,
retrospective rating, deductible, and
self-insurance.

Workers’ Compensation Insurance: A Primer for Public Health14

Table 2. Required employer reporting of injuries, illnesses and deaths to State Workers’
Compensation Bureaus.

State
Medical Treatment beyond

1st Aid Provided1
Indemnity Only (Min. No.

Days)2,3

AL Y(3)
AK Y
AR Y
AZ Y
CA Y(1)
CO Y(3)
CT Y(1)
DE Y
DC Y
FL Y
GA Y(7)
HI Y
ID Y Y(1)4

IL Y(3)
IN Y(1)
IA Y(3)
KS Y(1)
KY Y(1)
LA Y(7)
ME Y(1)
MD Y(3)
MA Y(5)
MI Y(7)
MN Y(3)
MS Y(5)
MO Y
MT Y
NE Y
NV Y
NH Y
NJ Y
NM Y
NY Y(1)
NC Y(1)
ND Y

Workers’ Compensation Insurance: A Primer for Public Health 15Workers’ Compensation Insurance: A Primer for Public Health

Table 2. Required employer reporting of injuries, illnesses and deaths to State Workers’
Compensation Bureaus (continued).

OH Y(7)
OK Y
OR Y(3)
PA Y(1)
RI Y Y(3) 4

SC >$500 Y(1) 4

SD Y Y(7) 4

TN Y
TX Y(1)
UT Y
VT Y Y(1) 4

VA Y
WA Y(1)
WV Y
WI Y(3)
WY Y

1If Y, employers are required to report all claims that result in medical treatment beyond first aid
to the workers’ compensation bureau. (In SC, all claims with >$500 in medical expenses must be
reported.)

2Employers are required to report all claims for occupational injuries and illnesses for workers
missing work for a period of time in excess of these values.

3All deaths due to occupational injuries or illnesses must also be reported in all states.
4Additional reporting required for disabilities in excess of the number of days indicated.

Source: 2011 Chambers of Commerce Workers’ Compensation Laws, Chart IX, (see caveats pp.
78 – 79 in reference)

Workers’ Compensation Insurance: A Primer for Public Health16

Table 3. States with statutes, rules and/or regulations about employer-based occupational
safety and health program elements plus states with approved state OSHA Plans or consultation
programs only, 2011

State OS&H Regulations States

Requirements

Employer Written Safety and
Health Program

CA1, HI2, LA3, MN4, NE, NV5, NH5, NC6,WA

Employer/Employee Safety and
Health Committee

AL7, CA4, CT8, MN9, MT10, NE, NV11, NH10, NC12, OR13, TN14,
WA5

Insurer to Provide Loss Prevention
Services

AR, CA, KS, MS, MO, MT, NM, OR, PA, RI, SD, TX

On-Site Inspection by Loss
Prevention Services

AR15, CA16, DE17, NM18, NY19, RI20, TX21

Incentives

Premium Reduction for Safety
Program Elements

CO, DE22, FL, HI, ME, NH, NM, NY, ND, OH, OK, PA, SD23,
UT24, WI, WY25

Employer Penalty for Violation of
Rule at Time of Injury

CA, IL, MA, MO, NC, WI

Safety Grant MA26, MN, NY, ND, OH, OR26,UT, WA

Registry of S&H Practitioners
HI, LA, MO

State OSHA Plan
AK, AZ, CA, CT27, HI, IL27, IN, IA, KY, MD, MI, MN, NV, NJ27,
NM, NY27, NC, OR, SC, TN, UT, VT, VA, WA, WY

State Consultation Program
Only

AL, AR, CO, DE, FL, GA, ID, KS, LA, ME, MA, MS, MO, MT,
NE, NH, ND, OH, OK, PA, RI, SD, TX, WV, WI

Information in this table was obtained from Web sites of state legislatures and agencies. Due to
the difficulty in locating statutes, rules, regulations and relevant case law, some information may
have been omitted from the table. Further information may be obtained from the primary author.

1Reduced documentation requirements if <10 employees; <20 employees and not on high hazard list and experience modification is <1.1; or < 20 employees and on designated low-hazard list.

2If >24 employees
3If > 15 employees
4For high hazard industries on list
5If >10 employees

Workers’ Compensation Insurance: A Primer for Public Health 17Workers’ Compensation Insurance: A Primer for Public Health

6If experience modification factor is >1.5
7Upon written request of an employee
8If >25 employees or injury and illness rate greater than average for industry
9If > 25 employees or if in top 10% within industry lost-days rate or if top 25% of pure premium
for all classes

10If >5 employees
11If >25 employees
12If >10 employees and experience modification factor >1.5
13Routine safety meetings also allowed
14If experience modification factor is >1.2
15Or other appropriate services if premium > $25,000, or if > $5,000 and loss ratio > 100%, or if
loss ratio > 150%

16For targeted high hazard employers
17Fee is charged and employer required to participate in Workplace Safety Program discount
18If premium > $5,000, self-inspection is allowed
19If payroll > $800,000 and experience modification factor >1.2
20If premium > $25,000 and requested by employer
21If premium > $25,000 and loss ratio >1.0, or if premium > $5,000 and loss ratio > 2.5
22If premium > $3,161
23Unspecified penalty for establishments where deficiency has not been corrected at time of
subsequent safety review

24If experience modification factor >1.0 or if 3-year loss ratio > 100% and if “work place safety
program” not adopted after request from the insurer then 5% premium surcharge is allowed

25Based on reduced loss ratio attainment
26Grants available for training only
27Public sector employees only are covered by the state plan along with consultation program for
most private businesses

Workers’ Compensation Insurance: A Primer for Public Health18

such as one for a company in the residential
construction industry.

If employees of the business routinely travel to other
states, provisions that cover losses in the other states
may be added to policies. If the business has employ-
ees located in multiple states, multiple policies are
typically required. With workers’ compensation
records alone, it may be difficult to associate an
injury or illness with an establishment when the
policy covers multiple establishments.

In many states, employers are allowed to form groups
or pools to obtain insurance in the voluntary markets
or to combine as a self-insured entity. Membership
in a group is usually restricted to similar industries.
Other insurance arrangements include carve-outs,
which are labor/management agreements,10 and
captives, i.e. an insurance company that is wholly-
owned by a single employer or a group of employers
and provides insurance to the owners’ businesses.

Risk Retention
Workers’ compensation insurance policies deter-
mine the amount of risk the employer retains for
workplace injuries and illnesses. Risk retention may
increase employer interest in reducing potential
losses through safety and health prevention since
they could be responsible for payments on some
claims. In order of increasing risk retention by the
employer are the following insurance or policy
types: guaranteed cost, dividend, retrospective
rating, deductible, and self-insurance [Thamann
and Reitz 2000]. For example, with a guaranteed
cost policy, the loss to the employer in a given policy
year can never be more than the policy premium.
On the other hand, with large deductible policies,
the employer is self-insured up to an amount of the
deductible yet obtains an insurance policy for excess
coverage purchased from a provider. The deduct-
ible amounts may be per claim and/or aggregate
and range from a few thousands of dollars to $1
million or more. Nonetheless, the carrier of the

excess coverage is, according to the state regula-
tors, responsible for the entire claim amount. The
carrier then obtains reimbursement from the client
employer through an agreed mechanism.

Self-insurance is a form of insurance that is generally
limited to larger employers which demonstrate to
their state workers’ compensation regulating agency
that they have the financial resources to make the
equivalent of indemnity, medical and death benefit
payments to their employees who suffer occupa-
tional injuries and illnesses. Qualifications for
self-insurance vary among the states. For example,
some require surety bonds. In Ohio, an exclusive
state program, self-insurance is permitted only for
those employers with a minimum of 500 employees.

Other Policies
As mentioned earlier, state-sponsored programs
also provide insurance coverage for workers whose
employer failed to obtain the required insurance
policy. Most states also provide special coverage
for second injuries which reduces the financial
disincentives of employing a worker with an
existing disability.

9. Policy Premiums

Premiums for workers’ compensation insurance
policies are determined by the risk classification of
the insured employer, the size of the payroll, and in
many cases, on the employer’s past claims experience.
“Manual rates” or “base rates” are set for each of the
industry risk classes by actuarial organizations like
NCCI and are expressed as the cost of insurance per
$100 in payroll. The manual rate is then adjusted
using an experience modification factor for those
employers who are sufficiently large to be rated based
on their claims history. The premium setting process
and related terms are more fully explained in other
sources such as A Primer on Workers’ Compensation
by John F. Burton, Jr.11

10“Carve out” has different meanings across the insurance industry. The definition used for
workers’ compensation insurance carve outs in California may be found at http://www.dir.
ca.gov/dwc/carveout.html.

11 Burton’s Workers’ Compensation Resource provides access to a wide range of relevant materials.
http://workerscompresources.com/wp-content/uploads/2012/11/ND04A

http://www.dir.ca.gov/dwc/carveout.html

http://workerscompresources.com/wp-content/uploads/2012/11/ND04A

Workers’ Compensation Insurance: A Primer for Public Health 19Workers’ Compensation Insurance: A Primer for Public Health

Experience Modification Factor
In general, an employer’s history of increasing
numbers of claims and costs leads to higher expe-
rience ratings and higher overall premiums. The
experience modification factor is usually affected
more by the frequency of claims from the policy
holder than by the total cost, although these rules vary
among the states. The loss ratio is one of the factors
used to calculate premiums and it is equal to the
total costs for losses divided
by total premiums paid. The
loss ratio may be calculated
for a single client, a risk class
or for the insurance industry
as a whole.

Other Premium
Adjustments
The premium may be further
altered by discounts that are awarded for multiple
reasons. For example, discounts may encourage
certain activities such as an employer’s participation
in a safety council, having joint labor management
health and safety committees, or having documented
safety and health programs. Some provide premium
discounts for firms with drug and alcohol programs.
Many mutual insurance companies provide divi-
dends that effectively reduce
the premiums.

10. Workers’
Compensation
Records

Workers’ compensation
claims records contain
information that may be used to determine the
frequency of injuries and illnesses plus indicators
of morbidity severity such as medical treatments,
their costs, hospitalizations, days away from work,
types and percentages of disabilities, and reha-
bilitation. As mandated by the individual state
laws, parts of workers’ compensation records and
record systems may be completed by employees,
employers, medical providers, insurance carriers,
third-party administrators, and the state agencies.

Premiums for workers’ compensation
insurance policies are dependent on
the risk classification of the employer,
the size of the payroll, and in many
cases, on the establishment’s past
claims experience.

Not only can workers’ compensation
records be used to determine the
frequency of injuries and illnesses,
but also disability status, medical
treatments, their costs, hospitaliza-
tions, days away from work, and
rehabilitation.

The most common types of records are the
claims forms for injury and illness and these
are required in all states.

Yet other potentially useful records may be
collected and retained by the carrier. These
additional records may describe employer safety
and health programs, work-site inspections
and other loss prevention activities. Records

may also exist on the
current insurance status
of individual employers,
carrier enrollments to
conduct business in the
state, registrations of con-
sultants and third-party
administrators, adjudi-
cations and appeals, and
self-insurance applica-

tions, among others. Access to these records
may be restricted by the applicable laws in each
state. Individual investigators need to verify
all legal restrictions in each state of interest.

Standard Records
The most common claims record is the first
report of injury (FROI) form. The form col-

lects some demographic
i n f o r m at i o n o n t h e
injured or ill employee,
disability status, and
contact information for
the employer, insurance
carrier, and medical pro-
vider. Many states use the
standard FROI developed
through the Electronic

Data Interchange (EDI) by the International
Association of Industrial Accident Boards and
Commissions (IAIABC). An example of the
EDI form and instructions can be accessed at the
Missouri Department of Labor and Industrial
Relations Web site.12 Three versions of this
form are now in use across the participating
states. Forms used by yet other states contain
similar information but the range of forms is
too broad to list each one of them.

12One example of an EDI FROI can be found at http://labor.mo.gov/DWC/Forms/WC-1-EDI-AI .

http://labor.mo.gov/DWC/Forms/WC-1-EDI-AI

Workers’ Compensation Insurance: A Primer for Public Health20

The EDI forms include sections on employee wage,
gender, date of birth and date of hire, occupation,
employment status, and
number of dependents. The
event fields include date,
time of day, date employer
was notified and date dis-
ability began, type of injury
and affected body part, and
descriptive information on
the equipment involved,
worker activities, work
process, sequence of events,
and check boxes for use of personal protective equip-
ment. Dates for return to work or for deaths are also
listed on the form. The medical treatment provider
is also identified and their address is listed along with
a checklist for the level of treatment (from none to
hospitalization), and future lost work time antici-
pated. Many of the fields on the FROI use standard
codes which are described below in section 11.

Subsequent reports of injury (SROI) for each
claim may be completed at the time treatment
is provided by a health care
practitioner, when a benefit
type is changed (e.g. from
temporar y total to per-
manent total disability), or
when the claimant returns to
work or dies. Thus, a series of
reports may be available for
each claim. A computerized
record is generally used to combine the information
from the claims record series.

Billing forms from treatment providers are
another set of records that provide important
information. These forms list the treatment
costs and may include information on diagno-
sis and treatments (such as Current Procedural

The initiator of workers’ compen-
sation claims has a major role in
ensuring that all fields in the FROI
form are accurately completed.
The initiator may be the employer,
injured employee, insurance broker,
TPA, or a treating physician depend-
ing on the state.

Information in the workers’ com-
pensation records that is used for
payment of workers and medical
providers is likely to be more accu-
rate and complete than other fields
in the record systems.

Terminology codes) which may differ from the
FROI and SROI. The differences may result from

additional medical testing
or from aggravation of an
existing condition such as
an infection. Any changes
in diagnosis should be
recorded in the injury claim
record system.

Another record system
widely used in the U.S. is
the Unit Statistical Report

that is provided by insurers to NCCI and other
workers compensation data collection organiza-
tions. These reports are initially valued at 18
months after policy effective dates and include
premium and loss information on a state basis.
Open claims are valued and reported annually
for up to 10 years to track loss development.13, 14

Limitations of Record Information
It is important to mention, once again, that the
primary purpose for the injury and billing records

is the timely payment of the
injured or ill workers and their
medical providers. Therefore,
information in these records
that is used for these purposes
is likely to be more robust
than other fields in the record
systems. For example, diag-
nostic and treatment codes

are more likely to be accurate and complete than
information on occupation and employment status,
particularly for medical only claims. An estimated
80% of all claims are medical only [Sengupta et al.
2012]. The statutory days away from work time
limits for “medical only” versus “lost time” claims
vary significantly from one state to another (Table 2).

13set of slides that explain unit reporting is available at http://www.ncci.com/documents/DRW-
2008-Unit-Data-Reporting

14NCCI’s Statistical Plan for Workers Compensation and Employers Liability is applicable in Alaska,
Alabama, Arizona, Arkansas, Colorado, Connecticut, District of Columbia, Florida, Georgia,
Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Mississippi,
Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, Oklahoma, Oregon, Rhode
Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, Virginia and West Virginia.

http://www.ncci.com/documents/DRW-2008-Unit-Data-Reporting

Workers’ Compensation Insurance: A Primer for Public Health 21Workers’ Compensation Insurance: A Primer for Public Health

The information in many claim records evolves over
time and delays in availability are to be expected.
Statutes of limitation are common for workers filing
claims for an occupational injury or illness and often
extend to 2 years in many states. Employers are
required to report claims information to state agen-
cies within specified periods that vary among states
– usually less than 15 days (Table 2). Employers
and insurers are also required to maintain claims
records for time periods that vary among the states.
Records maintenance is one of the primary services
provided to employers by TPAs.

Many of the terms used in the workers’ compensa-
tion industry have specific meanings. For example,
the term “claim,” itself is subject to confusion as
it is applied to the notification of the supervisor,
notification of the insurer at the time of injury, the
“first report” for the state workers’ compensation
agency, or a request for arbitration on the part of
the worker. Some of these terms are defined in the
glossary (p. 35). For any set of electronic data, it is
important to obtain the applicable data dictionary
that specifically defines each data element and
each code used. An historical dictionary may
be essential for longitudinal data. Additional
limitations on claims information are described
in the Background section of this document.

Disallowed and Zero-Cost Claims
Claims can be disallowed by insurance carriers or
contested by the employer. The basis for denial
is usually related to the degree of disability or the
requirement that the injury or illness “arise out
of and in the course of employment.” Disallowed
claims may be appealed to administrative or
judicial bodies depending on the state and may
result in litigation which follows established
procedures in each jurisdiction.

Zero-cost claims may also occur but these are not
the same as disallowed claims. The claim may
have been initiated yet the injury or illness did
not result in medical treatment or in lost work
time. At least one state, Ohio, allows employers
to pay the initial treatment and/or indemnity
cost up to specified limits. If the claim is paid

by the employer and remains within those limits,
the claims records would indicate zero costs to
the agency.

11. Standardized Codes
and Systems in Workers’
Compensation

Numerous standardized data coding systems are
utilized for workers’ compensation claims infor-
mation. Some of these were specifically developed
and adopted within the workers’ compensation
industry while other coding systems such as
NAICS and International Classification of Disease
(ICD) were developed for other purposes.

Standard Systems
There have been and are many attempts to stan-
dardize data for workers’ compensation records.
For example, WCIO led a collaborative effort to
standardize codes for the part-of-body, nature of
injury, and cause of event that are used across the
workers’ compensation insurance industry including
NCCI, IAIABC and the Association for Cooperative
Operations Research and Development (ACORD)
but not in all jurisdictions. NCCI coding systems for
industry risk classifications and a number of other
factors are used in about 40 jurisdictions. IAIABC
in collaboration with a number of states developed
standardized forms that utilize several different data
coding structures. The standards and codes have
changed over time and different release versions have
been adopted by states.15 U.S. government coding
systems are used extensively such as OIICS from
the Bureau of Labor Statistics (BLS) and Federal
Employer Identification Number (FEIN) from the
Internal Revenue Service (IRS). The Standard
Occupational Classification (SOC) and Standard
Industry Classification (SIC) also continue to be
used in some states.

Several states, e.g. California and New York,
have developed their own codes for certain
classes of workers’ compensation information.
Crosswalks may be available for some of the

15http://www.iaiabc.org/i4a/pages/index.cfm?pageid=3339

Workers’ Compensation Insurance: A Primer for Public Health22

coding systems. Unfortunately, the comparisons
are often uncertain. For example, it is not always
possible to identify unique ICD codes for the
NCCI injury classification codes and the OIICS
nature of injury codes do not correspond one-
to-one with WCIO recommended codes.

Portions of the individual records may be completed
by parties unfamiliar with various coding systems
which may lead to errors. For example, many
employers may not know the codes for the nature
of injury although online guides are available in
many jurisdictions. Multi-source documents may
be more prone to errors and omissions.

12. Loss Prevention

Many insurance carriers have loss prevention
programs to identify and describe the particular
risks that exist at policyholders’ establishments,
make recommendations for their abatement, and
offer loss prevention16 services to help policyhold-
ers manage these risks. They also assess risks that
exist at establishments for which they contem-
plate underwriting new policies. For current
policyholders, the primary purposes for the loss
prevention services are to reduce the frequency
and severity of workers’ compensation claims
and to improve the health
and safety program of the
client. Policyholders with
higher premiums are more
likely to receive routine loss
prevention services from
carriers than those with
smaller premiums [Morin
et al. 2013].

The provided services, which frequently are
viewed as marketing tools to retain existing
clients, may range from delivering relevant safety

In general, loss prevention programs
identify and describe risks at
policyholders’ establishments and
make recommendations for their
abatement.

and health pamphlets and brochures to full risk
characterizations that include recommendations
for remediation with follow up inspections. Most
small employers would not receive site visits
unless their claims experience indicated a need
for intervention.

Mandated Prevention Programs
All states have enacted legislation and developed
related rules and regulations to reduce occupa-
tional injury and illness risks. The strategies
employed by the states vary extensively and may
include employer safety and health program
requirements and incentives, insurance carrier
loss prevention activities, registries of authorized
occupational health and safety practitioners,
and employer or organizational grants for risk
mitigation and worker training (Table 3).17 These
inducements are often limited to those employ-
ers with greater than a minimum number of
employees, minimum qualifying premiums,
elevated experience modification factors, or
that appear on lists of high hazard industries.
Twelve states require workers’ compensation
insurance carriers to provide loss prevention
services to many employers at no additional cost
(Table 3). Requirement for these services is often
limited to those policyholders with greater than
a minimum number of employees, such as 25,

or with premiums above
minimum thresholds such
as $25,000.

C a r r i e r – b a s e d L o s s
Prevention Programs
Most large workers’ com-
pensation insurance carriers

invest portions of their revenues in loss prevention
programs [Dembe 1995; Nave and Veltri 2004;
Ryan 2013] although the amounts or percent-
ages are not readily available. According to one

16Note that “loss control” and “loss prevention” are terms that are often used interchangeably. In con-
trast, the term “loss reduction” is typically used to refer to the management of costs and disability once
an injury or illness has occurred through programs such as case management and return-to-work.

17States that do not appear in Table 3 list of prevention requirements or incentives are Alaska,
Arizona, Georgia, Idaho, Indiana, Iowa, Kentucky, Maryland, Michigan, New Jersey, South
Carolina, Vermont, Virginia and West Virginia

Workers’ Compensation Insurance: A Primer for Public Health 23Workers’ Compensation Insurance: A Primer for Public Health

recent report, 13% of large workers’ compensation
insurance clients, on average, receive loss control
visits in a given year although that value varies
widely by industry group (e.g. Manufacturing
= 32%, Construction = 16%, Agriculture = 4%)
[Ryan 2013]. For the most part, loss prevention
programs collect information on hazards and
other determinants of risks from employers either
prior to the issuance of a policy, i.e. risk selection
for underwriting, or as a means of providing
services to existing clients. Depending on the
size of the premium, loss prevention services may
include conduct of site visits which frequently
include walk-through inspections of facilities,
interviews with employees, supervisors and
managers, as well as reviews of the employer’s
safety and health program elements. The report
for the initial survey is shared with the carrier’s
underwriting staff as well
as a broker that may be
involved in the transaction.
These risk selection reports
are considered privileged
information and often only
selected portions of the
reports are shared with the client [Morin et al.
2013].

For new and existing clients, key elements of loss
prevention reports, such as a description of the
hazards identified and recommendations for their
abatement, may be provided to the employer. The
loss prevention staff may also communicate the
need for improvements (such as specific training
or documentation) to the employer’s health and
safety programs. They may also provide specific
services such as training employees, supervisors
and managers and make training materials and
model program elements available. Industrial
hygiene and ergonomic surveys are included
as needed. Afterwards, the loss prevention
program may track progress through follow-up
communications with the employer. The loss
prevention professional may assist the employer
in the completion of a safety grant application if
they are available.

Loss prevention records are not standardized
except perhaps within insurance providers. The
availability of mobile technology applications

for loss prevention programs is increasing and
may provide additional opportunities for data
standards developments on hazards and employer
health and safety program elements.

13. Workers’ Compensation
Associations and Organizations

The workers’ compensation insurance industry is
supported by a large number of professional and
trade associations and other organizations that
operate at the international, national, state and
even local levels. Some are membership organiza-
tions that provide professional services such as
annual meetings, education and training. Some
are research organizations that complete work

under contracts. Others
are affiliations of state and
provincial agency represen-
tatives. Only a few of the
longest-standing organi-
zations will be mentioned
here.

Two of the oldest workers’ compensation insur-
ance industry associations are NCCI and IAIABC.
These organizations date from the earliest state
workers’ compensation programs in the U.S.

According to their Web site, NCCI “is the largest
provider of workers’ compensation and employee
injury data and statistics in the nation.” NCCI
receives proprietary claims information from
insurance carriers in their member states in the
form of a Unit Statistical Data report which guides
setting of manual rates for their client jurisdic-
tions. To support the reporting system, NCCI in
conjunction with WCIO has developed a number
of standard coding schemes for nature of injury,
event causation, and part-of-body. In addition,
NCCI standard codes for industry, occupation
and other factors are used by the nearly 40 affiliate
jurisdictions. NCCI also conducts research and
other analyses across a range of issues in the
workers’ compensation insurance industry. Many
of their reports may be accessed at https://www.
ncci.com/nccimain/pages/default.aspx.

The workers’ compensation insurance
industry is supported by many
professional and trade associations
that provide a range of services.

https://www.ncci.com/nccimain/pages/default.aspx

Workers’ Compensation Insurance: A Primer for Public Health24

The IAIABC mission statement is “to improve
the efficiency and effectiveness of workers’
compensation systems throughout the world.”
Among its published strategic principles are:
“provide a forum for regulators, stakeholders and
experts to share information and discuss issues
and solutions; assist jurisdictions in identifying
opportunities for reducing costs and improving
the delivery of benefits; and develop, analyze, and
promulgate standards and uniform practices.”
IAIABC has published a number of important
insurance industry documents and it sponsors
and supports the EDI. Much of their information
may be accessed at http://www.iaiabc.org/i4a/
pages/index.cfm?pageid=3277.

Other workers’ compensation organizations
include WCRI whose mission statement is: “to be
a catalyst for significant improvements in workers’
compensation systems, providing the public with
objective, credible, high-quality research on
important public policy issues.” The institute is
an independent and not-for-profit organization
providing peer-reviewed, objective information
about workers’ compensation systems. Most of
their documents are available to members only
but some useful information may be found at
http://www.wcrinet.org/about.html.

According to the NASI Web site, the academy is
a nonprofit, nonpartisan and non-governmental
organization led by the nation’s experts on social
insurance. It evaluates programs and data to develop
solutions to challenges on social insurance and
economic security. NASI supports research and
publishes documents on social insurance topics and
produces an annual report on workers’ compensa-
tion programs in the U.S. that may be obtained free
of charge at http://www.nasi.org/about.

WCIO “is a voluntary association of statutorily
authorized or licensed rating, advisory, or data
service organizations that collect workers com-
pensation insurance information in one or more
states.” Members of the WCIO are managers of
boards and agencies within the jurisdictions. Its
forum supports development of electronic data
transmission standards for insurers and rating/
advisory organizations. Additional information
about WCIO and its range of products can be

found at https://www.wcio.org/Document%20
Library/AboutPage.aspx.

ACORD is an international organization that
facilitates the development of open consensus
data standards and standard forms for many
segments of the insurance industry, and works
with its members and partner organizations to
drive implementation of those standards. Their
information may be found at http://www.acord.
org/Pages/default.aspx.

A couple of other organizations that are widely
recognized in the insurance industry include:
John F. Burton Jr.’s Workers’ Compensation
Resource which provides access to data, research,
and other information pertaining to workers’
compensation in the United States and other
countries when possible. The resource offers
open access to many publications such as the
1972 Report of the National Commission on State
Workmen’s Compensation Laws. The extensive
workers’ compensation information may be found
at http://workerscompresources.com/. Dr. Burton
also hosts an annual meeting for discussion of
current workers’ compensation research.

The Liberty Mutual Research Institute for Safety
(LMRIS) is a research organization funded by a
private insurance company. For over 60 years,
the institute has conducted scientifically rigor-
ous, peer-reviewed research to improve worker
safety and health. They conduct laboratory
and field studies and publish records-based
research using workers’ compensation data col-
lected by Liberty Mutual Insurance. Extensive
information on LMRIS can be found at http://
w w w. l i b e r t y mutu a l g roup. c om / om app s /
ContentServer?pagename=LMGroup/Views/
LMG&ft=2&fid=1138356633468&ln=en

Other organizations that serve the workers’
compensation insurance industry include the
American Association of State Compensation
Insurance Funds (AASCIF), American Insurance
Association (AIA), National Association of
Insurance Commissioners (NAIC), National
Conference of Insurance Legislators (NCOIL),
and Property and Casualty Insurers Association
of America (PCIAA).

http://www.iaiabc.org/i4a/pages/index.cfm?pageid=3277

http://www.wcrinet.org/about.html

About the National Academy of Social Insurance

https://www.wcio.org/Document%20Library/AboutPage.aspx

http://www.acord.org/Pages/default.aspx

http://workerscompresources.com/

http://www.libertymutualgroup.com/omapps/ContentServer?pagename=LMGroup/Views/LMG&ft=2&fid=1138356633468&ln=en

Workers’ Compensation Insurance: A Primer for Public Health 25Workers’ Compensation Insurance: A Primer for Public Health

14. Public Health Research and
Surveillance18

Public health is “the science and art of preventing
disease, prolonging life and promoting health
through the organized efforts and informed
choices of society, organizations, public
and private, communities and individuals”
[Winslow 1920]. Fundamentally, public health
relies on surveillance programs to describe
the distribution of disease and injury, detect
new and emerging diseases and disorders,
target intervention activities to prevent their
incidence, and monitor the effectiveness of
those interventions. Workers’ compensation
records may be used for public health research
and surveillance activities. The terms “research”
and “surveillance” have specific meaning in
Federal public health activities which are briefly
discussed here.

Research
Federal regulations state
that “research means a
systematic investigation,
i n c l u d i n g r e s e a r c h
development, testing and
evaluation, designed to
de velop or cont r ibute
to generalizable knowledge” [45 Code of
Regulations (CFR) 46.102(d)]. Investigators
performing public health research or surveillance
activities have the responsibility to ensure that
the research is conducted in a manner consistent
with legal and ethical requirements. All research
involving human participants that is conducted
or supported by the U.S. Department of Health
and Human Services (DHHS) must comply with
DHHS Policy for Protection of Human Research
Subjects [45 CFR part 46]. Investigators should
consult with their local institutional review board
for assistance with development of research
or surveillance projects to insure that human
subjects are appropriately protected.

Federal regulations state that
“research means a systematic
investigation, including research
development, testing and evaluation,
designed to develop or contribute to
generalizable knowledge” (45 CFR
46.102(d)).

Surveillance
Public health surveillance is the systematic,
ongoing collection, management, analysis,
and interpretation of data followed by the
dissemination of these data to public health
programs to stimulate public health action
[Thacker et al. 2012]. Surveillance systems
can be used to monitor infectious and non-
infectious diseases as well as injuries and deaths.
Surveillance data can be primary in that they
are collected for a specific public health purpose
or they may be secondary in that the data were
collected for other purposes yet they can be useful
for tracking injuries, illnesses and deaths that
occur in a defined population.

Occupational health surveillance is the tracking
of workplace injuries, illnesses, hazards, and
exposures. In the U. S., because there are no
periodic national surveys of worker health,

o c c u p a t i o n a l h e a l t h
s u r v e i l l a n c e r e m a i n s
fragmented with substantial
data gaps. However, the
available surveillance data
are used to guide efforts
to improve worker safety
and health and to monitor
trends and progress over
time [NIOSH 2013b]. Data

and information derived from surveillance can
be used to:

(1) guide immediate action for important cases;
(2) measure the burden of an injury, disease,
or other health-related event or exposure,
including changes in related factors;
(3) identify populations at risk, including new
or emerging health concerns;
(4) guide the planning, implementation, and
evaluation of programs to prevent and control
injuries, disease, or adverse exposures;
(5) evaluate policies and practices;
(6) detect changes in health practices and the
effects of the changes;
(7) prioritize the allocation of health resources;

18For a thorough explanation of public health research and non-research as defined by CDC, please
see http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-
research-nonresearch .

http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch

Workers’ Compensation Insurance: A Primer for Public Health26

Estimations of the populations at risk
that are needed for rate calculations
are likely to require information
from record sets other than workers’
compensation.

(8) describe the clinical course of disease; and
(9) provide a basis for epidemiologic research.

Workers’ compensation records, most commonly
administrative claims data, are used for occupational
surveillance. In some states,
for example California
(California Labor Code) and
Washington (Department
of Labor and Industries),
workers’ compensation claims
information is used to identify
more hazardous industries or
leading events for claims across all industries. Claims
information has been used to establish priorities
for loss prevention and other intervention actions
[Silverstein et al. 2002; Bonauto et al. 2006; Anderson
et al. 2013]. Yet other investigators have determined
that workers’ compensation claims data are currently
inadequate to characterize occupational injuries and
illnesses in particular [Rosenman et al. 2000; Azaroff
et al. 2002; Utterback et al. 2012].

Formerly, workers’ compensation claims information
from a large number of states was collected by BLS
for the Supplementary Data System (SDS), a non-
representative sample of occupational injuries and
illnesses. SDS contained discrepancies due to the
quality of data retrieved from states and the variability
of state laws on which injuries and illnesses were
reported [National Research Council 1987]. The
system was discontinued in the late 1980’s when the
Survey of Occupational Injuries and Illnesses (SOII)
along with the Census of Fatal Occupational Injuries
(CFOI) were being developed.

Estimating Rates
Rates of occupational injuries and illnesses require
estimates of at-risk populations (a “denominator”).
The denominator commonly used in the workers’
compensation industry is dollars of payroll. In
public health, preferred denominators for rates are
numbers of people or, in the case of occupational
studies, full-time equivalent (FTE) workers. Data
sets used to estimate the numbers of workers

within industries and/or occupations may be
obtained from population household surveys such
as the Current Population Survey (CPS) or the
American Community Survey (ACS), or from
employer establishment survey programs such as

Occupational Employment
Statistics (OES), Current
Employment Statistics (CES),
or County Business Patterns
(CBP). All of these data
sources have broad coverage
but exclude some types of
workers. The Quarterly

Census of Employment and Wages (QCEW),
which is nearly comprehensive and collected by
states for unemployment insurance purposes does
report the number of workers by establishments
although it does not distinguish between full-time
and part-time workers. The QCEW data may be
adjusted to estimate FTEs with hours per industry
data from the surveys listed above. In any case, the
scope, exclusions, and restrictions on survey and
state level data should be carefully examined and
understood.

15. Public Health Regulations

Many Federal, state and local government
regulations have been developed to address
public health concerns. It is beyond the scope
of this document to describe the myriad public
health concerns that are regulated. Instead,
we limit this description to those authorities
where workers’ compensation data may be
useful. The Occupational Safety and Health
Administration (OSHA) and the Mine Safety and
Health Administration (MSHA) are two Federal
agencies with regulatory mandates to protect the
health and safety of workers in the U.S. OSHA
and MSHA regulations are available through
their respective Web sites and elsewhere.19, 20
Additionally, the US Environmental Protection
Agency regulates pesticide hazards for agricultural
workers.21 State and local health departments are

19http://www.osha.gov/law-regs.html
20http://www.msha.gov/30CFR/CFRINTRO.HTM
21http://www.epa.gov/agriculture/twor.html

http://www.osha.gov/law-regs.html

http://www.msha.gov/30CFR/CFRINTRO.HTM

http://www.epa.gov/agriculture/twor.html

Workers’ Compensation Insurance: A Primer for Public Health 27Workers’ Compensation Insurance: A Primer for Public Health

Regulations are perceived by many
as essential to the protection of
public health. Individuals may not
have the knowledge or resources
that are required to make deci-
sions about personal exposure to
potentially hazardous materials
including chemical, ergonomic,
physical and biological agents.

charged with protecting
the health of all residents
in their jurisdictions, and
some health departments
are active in workplace
he a lt h and s afe t y and
t r a ck i ng o c c up at i ona l
illnesses and injuries. In
fiscal year 2013, NIOSH
provided funds to help
s u p p o r t o c c u p at i o n a l
health and safety surveillance programs in
twenty-three states.22

Regulations are perceived by many as essential
to the protection of public health. Individuals
may not have the knowledge or resources that
are required to make decisions about personal
exposure to potentially hazardous materials
including chemical, ergonomic, physical and
biological agents. In the occupational arena,
regulations are established by OSHA and MSHA
to limit potential hazards through the use of
interventions such as exposure limits, machine
guarding, fall protection, trenching standards,
medical screening and many more.

Regulations pertaining to workers’ compensation
are established by the individual jurisdictions
including the states, territories, and the District
of Columbia, and the Federal government for its
own employees. The states frequently require
all employers including those self-insured for
workers’ compensation
to provide health and
s a f e t y p r o g r a m s f o r
t h e i r e s t a b l i s h m e n t s .
These requirements vary
substantially across the
jurisdictions and many are
augmented by occupational
s a f e t y a n d h e a l t h
requirements in departmen s of labor or similar
agencies. Carrier-based loss prevention programs

recognition and control of
hazards for which regulations
apply. In addition to the
insurance claims and medical
information, records for these
mandated activities may
be useful for occupational
safety and health research
and surveillance.

16. Breaking through Barriers

Despite its limitations, research organizations,
state-based surveillance programs, and workers’
compensation agencies and associations have
used claims data for research and surveillance
purposes. Collaborations have been mostly
within states due to problems with combining
data from multiple jurisdictions. Additional
collaborations would create further opportunities
to use workers’ compensation records and related
information to prevent occupational injuries,
illnesses and fatalities.

Overcoming some of the limitations would
be possible with more systematic collection
and analysis of workers’ compensation data
across industries and occupations. Further
standardization of data elements and coding
schemes such as universal adoption of ICD
medical codes and ICD-E external cause of injury

codes would be beneficial.
Development of additional
computer-based record
systems would provide
g re at e r o p p or t u n it i e s
for m ore i n for m at i ve
d a t a c o l l e c t i o n a n d
interpretation. Advances
in auto-coding of data by

computer systems, which rely on standard codes,
would reduce the number of errors and missing

often assist employers in the

22The NIOSH funded surveillance programs in 2013 exist in the following states: California, Colorado,
Connecticut, Florida, Georgia, Illinois, Iowa, Kentucky, Louisiana, Maryland, Massachusetts,
Michigan, Minnesota, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North
Carolina, Oregon, Texas, Washington, and Wisconsin.

In some states, for example California
and Washington, the workers’
compensation claims information
is used to identify more hazardous
industries or leading events for
claims across all industries.

Workers’ Compensation Insurance: A Primer for Public Health28

data from the workers’ compensation insurance
records. Effective searching of unstructured text
fields has also improved [Lehto et al. 2009; Patel
et al. 2012; Bertke et al. 2013].

Although systematic data analysis within a carrier’s
operations contributes to risk management goals
and client service, the information is not readily
available to public health organizations. When
made available, practitioners and researchers
have used claims data for epidemiologic studies,
to identify hazards, assess the effectiveness of
controls, assign priorities for limited resources,
and evaluate intervention programs.

Additional infor mation on e valuations
of workplace safety and health programs,
hazard monitoring and hazard exposure
data, and observations of worksites are types
of loss prevention information that could be
standardized and made more useful for research
and surveillance purposes. Over the past century
and more, carrier-based and state agency workers’
compensation programs have used data to identify
and evaluate risks for specific hazards across
industry sectors.

When systematically available, workers’
compensation data has been used extensively
for occupational safety and health research and
surveillance [NIOSH 2010; Utterback et al. 2012;
NIOSH 2013a] and they have supplemented the
surveillance information available from other
occupational resources.23 This primer provides
background information for those interested
in utilizing workers’ compensation data for
prevention purposes.

23Descriptions of many data sources used for occupational surveillance may be accessed at http://
wwwn.cdc.gov/niosh-survapps/Gateway/DataSources.aspx.

Workers’ Compensation Insurance: A Primer for Public Health 29Workers’ Compensation Insurance: A Primer for Public Health

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Workers’ Compensation Insurance: A Primer for Public Health

Workers’ Compensation Insurance: A Primer for Public Health 35Workers’ Compensation Insurance: A Primer for Public Health

Appendix A: Workers’ Compensation Primer Glossary and Other
Industry Terms

actuary – one who calculates insurance premiums, reserves and dividends

adjuster – see claims adjuster

appeal – right of an individual who received an adverse decision to seek review by a higher authority

assigned risk – an insured entity that would normally be rejected by commercial insurance carriers
in the voluntary market but is designated for coverage by state law

audit – examination and verification of employer records on payroll

basic premium – portion of a standard retrospective insurance premium that covers administrative
costs, fees and commissions

broker – business that sells insurance coverage to employers; may represent a number of insurance
carriers

captive – insurance provider for a single business organization that is owned by that organization

carrier – organization acting as an insurer

carve-outs – labor/management agreements for insurance coverage of occupational injuries and
illnesses (has various other meanings in the insurance industry as a whole)

case manager – insurer representative that oversees medical treatments for injury or illness claims

claim – application for insurance benefits due to occupational injury or illness

claim disallowance – insurer rejection of a claim for medical treatment or indemnity costs

claimant – person making a demand for payment of benefits

claims adjuster – insurer representative who investigates claims for authenticity and settlements

claims initiator – person who completes the initial claim form for compensation

deductible – a type of workers’ compensation insurance policy for which the initial loss to some
specified limit is not reimbursed by insurance payment, i.e. the risk is retained by employer

Workers’ Compensation Insurance: A Primer for Public Health36

disability – condition that curtails a person’s ability to carry on normal pursuits

dividend plan – a type of workers’ compensation insurance policy for which the insured may receive
funds back (a dividend) if losses are less than anticipated

doctor’s first report – initial claimant evaluation by physician which is required in some states

Electronic Data Interchange – developed several standard claim data reporting forms and was
fostered by the IAIABC

exclusive funds – state-sponsored workers’ compensation insurance in jurisdictions where private
insurance is not allowed

exclusive remedy – in workers’ compensation, the only recourse for worker injuries and illnesses

experience modification factor – multiplier adjustment to employer’s premium based on prior
claims history in comparison with the average experience of the risk class, may be greater than or
less than unity

first report of injury – initial form completed by claims initiator with detailed information on the
claimant, employer, nature of injury, event description, and anticipated medical treatment needs

groups – similar industry employers that combine to share risks and insurance coverage; also may
be employees that are covered under single insurance policy, e.g. group health insurance

guaranteed cost – a type of workers’ compensation insurance policy where the premium is the only
cost to the employer

impairment – alteration of an individual’s health status; a deviation from normal in a body part or
organ system and its functioning (Cocchiarella and Anderson 2001)

incurred losses – paid plus reserved claim costs, including medical and indemnity; experience
modification ratings are based on incurred costs

indemnity payments – compensation for lost work time claim paid to covered injured or ill workers
to partially replace lost wages

independent medical examiner – registered medical practitioners who provide impartial medical
assessments

loss control – see loss prevention

loss development factor – prediction of future payments on open claims

loss prevention – actions to limit risk through hazard recognition and abatement and safety and
health program evaluation; also known as loss control

Workers’ Compensation Insurance: A Primer for Public Health 37Workers’ Compensation Insurance: A Primer for Public Health

loss ratio – insured losses divided by premiums earned in a given period

loss reduction – activities to limit financial losses and disability after a claim is filed for an injury or
illness; also known as medical or disability management

loss runs – employer-based information on prior claims experience

lost work days – accrual of time away from work due to an occupational injury or illness

managed care – enrolled medical services that focuses on care utilization and costs

manual rate – published rates, established by rating bureaus, for insured groups based on average
costs for the group

medical only claim – workers’ compensation claim for medical treatment expenses and does not
include lost work days meeting the minimum lost time requirement for indemnity payments

medical review board – state sanctioned group of medical practitioners that provides independent
medical expertise on appropriate treatments, disability determination, and other science-based criteria

Medicare set-aside – allocation in a claim settlement to pay future medical expenses that would
have been paid by Medicare

monopolistic funds – see exclusive funds

mutual insurance company – organization that issues insurance policies and is owned by its
policyholders

net premium – total insurance premium after adjustments for experience modification and discounts

pools – multiple meanings but usually a collection of groups that share insurance coverage

professional employer organization (PEO) – firm that hires a client company’s employees, becoming
the policy holder of record for workers’ compensation; this arrangement results in co-employment

pure premium – portion of manual rate that covers anticipated losses and loss adjustment expenses

rating bureau – state sanctioned private group that establishes permitted manual rates for insurance
premiums

reciprocal group – association of employer entities that mutually share risks of economic losses

re-insurance – insurance purchased by an insurance carrier to limit risks

Workers’ Compensation Insurance: A Primer for Public Health38

reserve funds – accounting liability for the current value of future expected costs on a claim

residual market – portion of employers unable to obtain insurance coverage in the voluntary market

retrospective rating – a type of workers’ compensation insurance policy where the premium is based
on the actual insured losses during the policy term

return-to-work – program to assist injured workers regain employment after a claim has been filed

risk group – see groups

risk retention – portion of possible future liability that is not covered by an insurance policy

scheduled benefit – pre-determined amount of payment for specified loss such as an amputation

Second Injury Fund – insurance provided for previously disabled workers

self-insured – a type of workers’ compensation insurance policy where the employer is responsible
for its own losses associated with required risk coverage

single payer – for health insurance, a single entity, generally a government agency, is responsible
for all insured costs

state funds – state government offered mandatory insurance; may be exclusive (monopolistic) in a
few states or competitive in yet other states

subrogation – recovery of claim expenses from another responsible party

Supplemental Data System – survey of workers’ compensation claims information by Bureau of
Labor Statistics in the 1970’s and 1980’s prior to the Survey of Occupational Injuries and Illnesses
and the Census of Fatal Occupational Injuries

surety bond – financially backed guarantee to reimburse third party losses

surveillance – ongoing systematic collection, analysis, and interpretation of health data essential to
the planning, implementation, and evaluation of public health practices, closely integrated with the
timely dissemination of these data to those who need to know

third-party administrator – insurance businesses that provide services to employers, brokers, insurers,
and groups related to workers’ compensation claims

underwriter – one who selects risks to be solicited or rates the acceptability of risks

underwriting – to be responsible for financial losses in accordance with an insurance policy

Workers’ Compensation Insurance: A Primer for Public Health 39Workers’ Compensation Insurance: A Primer for Public Health

uninsured employer fund – state funds to cover losses when employer has failed to obtain required
insurance

Unit Statistical Report – information on workers’ compensation loss experiences reported to a rating
agency

value – estimates of current or future liability costs on a claim

voluntary market – competitive market for workers’ compensation insurance that exists in all but
the 4 exclusive fund states

Workers’ Compensation Insurance: A Primer for Public Health

Workers’ Compensation Insurance: A Primer for Public Health 41Workers’ Compensation Insurance: A Primer for Public Health

Appendix B: Preparing for Engagement

In preparation for contacting the workers’ compensation data custodian, one should consider
several issues and evaluate some available resources. For example, one should visit the Web site
for the workers’ compensation program in the state to evaluate the available information such as
annual reports and reporting forms. In addition, the Web sites have links to applicable statutes and
regulations with explanatory guides for injured workers and their employers. Researchers and public
health practitioners may also want to think about the issues below prior to approaching potential
collaborating organizations who are workers’ compensation data custodians. If the state workers’
compensation Web sites does not provide specific information on their requirements, these issues
may be addressed in direct communications with a knowledgeable agency official.

Study Background Questions

What are the proposed project concept and time commitments? Might provide examples from
other jurisdictions

● Surveillance – ongoing analysis of longitudinal data
● Etiologic research – may be time limited relationship but usually longitudinal data

What data sources may be needed for the project?
● Public agencies – do they have a research unit or other organization with shared interest/

mission?
● Private – if restricted, can they share de-identified data, are they comprehensive?

Are there specific legal restrictions on data availability from state agencies?

Can data be examined or explored prior to collaboration commitment?

What are the possible mutual benefits for the collaborating organizations?
● Examine their existing products
● Review examples from other jurisdictions (e.g. Florida Annual Report)
● Reinforce experience with confidential handling of personal and other sensitive information
● Think about realistic needs for future information, assistance and review

How are data stored and what formats are used?
● Electronic: on line or downloaded (CD, DVD, hard drives, encryption?)
● Hard copy
● Incomplete data and historical gaps in data
● Denominator (population) data available for rate estimation (unemployment insurance agencies)?

Which, if any, standardized data coding systems and which versions are used (e.g. WCIO, OIICS,
NCCI, NAICS, ICD E-codes)?

Is a data dictionary available?

Are narrative fields part of the records that may require data mining?

What are the proposed agreements for clearance of articles, reports and other products?

Workers’ Compensation Insurance: A Primer for Public Health42

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Construction Safety

QUESTION 6

What might be some reasons that the construction industry has a higher fatality rate than other industries? Your response should be at least 75 words in length.

QUESTION 7

Imagine you are the supervisor of a construction crew in which half of the workers speak only limited English. What steps should you take to ensure everyone is equally protected? Your response should be at least 75 words in length.

QUESTION 8

Explain the rationale for workers’ compensation. What are the objectives of workers’ compensation? Who is covered by this program, and how does it help prevent future accidents? Your essay should be at least 200 words in length and include an introduction, a body, and a conclusion.

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What might be some reasons that the construction industry has a higher fatality rate than other industries?
Your response should be at least 75 words in length.

Imagine you are the supervisor of a construction crew in which half of the workers speak only limited English. What steps should you take to ensure everyone is equally protected?
Your response should be at least 75 words in length.

Explain the rationale for workers’ compensation. What are the objectives of workers’ compensation? Who is covered by this program, and how does it help prevent future accidents?
Your essay should be at least 200 words in length and include an introduction, a body, and a conclusion.