Health Care Costs and Financing

Clinical and social factors predict application for Social Security disability benefits by workers with back injuries

The Workers' Compensation (WC) system is intended to provide injured workers with health care access, appropriate medical treatment, and compensation for residual disability so that they can eventually return to work. Another goal is to prevent long-term disability, as reflected by application for Social Security Disability Insurance (SSDI) benefits, which is often a marker for a permanent exit from the labor force. Yet the majority of injured workers are dissatisfied with their employers and the medical care they receive under WC, according to a new study. Moreover, these dissatisfied workers are far more likely to apply for SSDI than those who are satisfied with how they are treated.

Improving satisfaction with medical treatment rendered through the WC system is likely to reduce long-term disability claims, concludes Raymond C. Tait, Ph.D., of the St. Louis University School of Medicine. Dr. Tait and colleagues examined SSDI claims among 1,372 black and white WC claimants who settled low back injury claims in areas of Missouri in 2001 or 2002. The claimants were about 42 months post-injury. Nearly one in five claimants (19.3 percent) were either receiving SSDI or had applied for it. Black race, older age, herniated disc diagnosis, surgery, and longer time since injury (more than 49 months vs. less than 33 months) were associated with increased likelihood of SSDI.

Higher preinjury wage or compensation rate (more than $344 vs. less than $248 per week), more education, and higher satisfaction with medical treatment and/or treatment by employer were associated with decreased odds of SSDI. Finally, those who retained an attorney due to dissatisfaction with medical treatment related to the injury were nearly twice as likely to apply for SSDI. Herniated disc diagnosis and surgery were expected predictors of SSDI, since they tend to be proxies for severity of injury. The study was supported by the Agency for Healthcare Research and Quality (HS13087).

More details are in "Clinical and social predictors of application for social security disability insurance by workers' compensation claimants with low back pain," by John T. Chibnall, Ph.D., Dr. Tait, Elena M. Andresen, Ph.D., and Nortin M. Hadler, M.D., in the July 2006 Journal of Occupational and Environmental Medicine 48(7), pp. 733-740.

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