Abstract
Purpose Examine the potential for using information in short-term disability claims to identify workers at high risk of leaving the workforce and entering Social Security Disability Insurance (SSDI). Methods We analyze state-wide California data on claimants of State Disability Insurance (SDI) and Workers’ Compensation (WC) and present statistics on: (1) characteristics (primary diagnosis, sex, age, geography, wage level) by claim duration (0–3, 4–6, 7–12, 12 + months); and (2) the ability of initial claim characteristics to predict duration of at least 12 months. All data are for claims with disability lasting more than 1 week. Results 22.2% of SDI claims last longer than 6 months and 12.5% last 12 months. More WC claims reach these durations: 33.7 and 18.6%, respectively. Long-term SDI and WC claimants are similar to SSDI awardees, nationwide, but differ in age distribution; they are typically younger. Conclusions Characteristics of SDI and WC claims can help predict claims likely to last 12 months, but more information is needed to effectively target early intervention services. Waiting longer to intervene improves targeting but risks missing opportunities where early intervention could be more effective. Collecting additional information at SDI or WC entry or soon thereafter could improve both the efficiency and timing of interventions.
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Notes
Several states have exemptions for employers with a small number of employees or for workers in specific classifications [12].
Certain limited conditions are eligible for up to 5 years (260 weeks) of payments, including hepatitis B and C, amputations, severe burns, certain injuries to the eyes, and certain chronic lung diseases.
The WC claims with missing diagnoses tend to have relatively short durations, consistent with poorer reporting on minor, shorter-term WC claims.
SDI benefits extend for a maximum of 52 weeks while workers’ compensation pays up to 104 weeks (more under exceptional circumstances). To make the data comparable, we treat all workers compensation cases lasting 52 weeks or longer by truncating the duration at 52 weeks for purposes of calculating duration statistics.
The SDI and WC claims in our analysis samples do not represent all of the short-term disability and WC claims for California workers during the sample period. In addition to the 36% of WC cases that we excluded because of data limitations, we estimated that 15% of California workers had short-term disability coverage outside of SDI (mostly federal, state, and local workers) and 1.4% of workers (federal employees) had WC coverage outside of the state system. Our estimates of the percentages of California short-term disability and WC claims captured in our data assumed that short-term disability incidence rates were the same for public and self-insured employees as for others and that the incidence of WC claims for federal employees was the same as for others.
We determined primary diagnosis from ICD-9 codes. We based the wage groups (low, medium, and high) on the wage at the minimum benefit level in WC and the maximum benefit level for SDI. These levels change annually based on the change in the state average weekly wage. The southern region includes the counties of Imperial, Kern, Los Angeles, Orange, Riverside, San Diego, San Luis Obispo, Santa Barbara, and Ventura; the remaining counties are in the northern region.
Prior to the production of descriptive statistics, we trimmed the samples further because of the small size of some cells in the WC data. First, because EDD had to aggregate some small cells to meet the cell size restriction (at least 30), we excluded these cells from both data sets when making comparisons. Second, because some of the remaining cells in the WC data had fewer than 30 cases, we symmetrically excluded these cells from both data sets. Ultimately, there were 555 separate cells with at least 30 claims for each system.
Musculoskeletal conditions include (1) musculoskeletal and connective tissue (not back), (2) intervertebral disc disorders, (3) other back disease, (4) sprains and strains (back), and (5) sprains and strains (not back).
The large other illnesses group represents numerous conditions that each account for less than 4% of all cases.
We do not know which SDI or WC claimants actually entered SSDI, or the number of SSDI entrants from California who were not among those with SDI or WC claims of 12-month duration. Some workers with SDI or WC claims of 12 months may not enter SSDI because they do not apply or because SSA determines that they are not eligible for medical or work history reasons. Some workers who enter SSDI may have never entered SDI or WC (especially public employees) or their SDI or WC claim ended before 12 months—possibly due to death. Deaths are relatively rare in WC (a few hundred per year); they may be higher in SDI, but we do not have a count for this period. According to mortality data from the Centers for Disease Control and Prevention, in 2014 there were about 25,000 deaths among California adults between the ages of 25 and 64, but presumably many of these were not for workers with active SDI claims (see http://www.worldlifeexpectancy.com/california-cause-of-death-by-age-and-gender, accessed November 21, 2016).
We have 555 such groups in our analytical dataset. There are 660 possible groups in the data, because we have 11 primary diagnoses, 2 sexes, 5 age groups, 2 geography indicators, and 3 wage levels. However, our analytical dataset is restricted to 555 groups because certain cells where too small, < 30 in either SDI or WC, leading to exclusion of the cells in both systems to maintain comparability.
Franklin et al. [17], for example, show that the odds of returning to the same job decline rapidly with every month away from work for workers who received state workers’ compensation disability benefits in Washington State. This finding by itself does not necessarily imply that a certain intervention is less effective when its delivery is delayed. However, even if evidence-based services produce identical clinical and work outcomes when delivered late rather than early, earlier delivery of services would result in reduced costs to the worker, employer, and benefit program. Furthermore, industry experts routinely stress the importance of maintaining attachment to an employer and preventing missteps in treatment, adherence, communication, or other actions that can lead to preventable work disability [10].
Washington is one of four states that have a public, monopolistic WC system. The other three are North Dakota, Ohio, and Wyoming.
In additional analysis performed on these data we controlled for differences in the composition of the data to make the two systems comparable. When we weight to a common distribution of demographics and diagnoses the duration of disability and the fraction of cases lasting at least 12 months are more similar between WC and SDI, but WC still demonstrates longer average durations and a greater fraction exceeding 12 months.
Some WC systems require specific medical reports; all systems allow subpoenas and depositions regarding return to work and other medical issues. HIPAA carved out a specific exception to the protection of medical information for WC claimants, allowing communication between employers, insurers, and the treating physicians. For SDI claims, physicians are not required by statute or regulation to make any direct communication with the employer and HIPAA puts them at risk of liability for even disclosing anything about their treatment of a worker to an employer or other party without the worker’s consent.
At a minimum, this is meant to align the doctors’ interests more closely with the employer or insurer as well as to drive treatment to physicians with specific experience with occupational treatment and return to work. SDI claimants in California are likely enrolled in some form of managed care if they have insurance, but expeditious return to work is rarely, if ever, among the metrics of health insurer performance.
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Acknowledgements
The authors thank the California Division of Workers’ Compensation and Employment Development Department for providing the data, the representatives of multiple relevant California organizations for providing further context through in-person interviews, and David Wittenburg for providing helpful comments on an early draft. The research reported herein was performed pursuant to a grant from the Social Security Administration that was funded as part of the Disability Research Consortium (Grant DRC12000001-04-00). The opinions and conclusions expressed are solely those of the authors and do not represent the opinions or policy of SSA nor of any other agency of the federal government. Neither the U.S. government nor any of its agencies or employees makes any warranty, expressed or implied, or assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of the contents of this paper.
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Frank Neuhauser, Yonatan Ben-Shalom, and David Stapleton declare that they have no conflict of interest.
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Neuhauser, F., Ben-Shalom, Y. & Stapleton, D. Early Identification of Potential SSDI Entrants in California: The Predictive Value of State Disability Insurance and Workers’ Compensation Claims. J Occup Rehabil 28, 574–583 (2018). https://doi.org/10.1007/s10926-018-9791-9
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DOI: https://doi.org/10.1007/s10926-018-9791-9