Disparities in work-related injuries associated with worker compensation coverage status

Background: This exploratory study addresses patterns of injury in an emerging population of contingent workers who are not covered by either worker's compensation (WC) or health insurance. The primary purpose is to improve the information base regarding the entire population of uninsured, injured workers. Because Latino workers are over-represented in the uninsured group, we include additional characterization of their patterns of injury. Recent studies have found that worker compensation claims and reports address a shrinking proportion of occupational injury and exposure, and about two-thirds of occupational injuries are not captured in the U.S. national surveillance system. Methods: Following the NEISS methodology, a work-relatedness indicator was retrieved for emergency department (ED) visits to an academic health center in fiscal year 2005. Results: Twenty percent of self-declared work-related injuries were not associated with self-reported WC coverage. Parametric and non-parametric statistical analysis found several significant disparities in workers without WC. These disparities included a higher proportion of Latinos, workers under age 25, and construction workers. In the uninsured group, Latino workers had a higher proportion of moderate and severe injuries. Nearly all (92 percent) workers without WC also lacked health insurance. Injured low-income workers who lack access to both WC and employer-sponsored health insurance comprise an increasing percentage of the occupationally injured. Our exploratory study found this to be particularly true in high-risk populations. Conclusions: Work-relatedness indicators collected routinely in ED and outpatient settings should be incorporated into standard reporting systems to facilitate more accurate and comprehensive surveillance and better-targeted interventions.