Why most workers with occupational repetitive trauma do not file for workers' compensation

Despite the availability of no fault insurance for wage replacement and med ical care costs, the majority of workers diagnosed with an occupational dis ease do not apply for workers' compensation. The objective of the study was to determine the reasons why workers diagnosed with work-related musculosk eletal disease did not apply for workers' compensation benefits. A cross-se ctional study of 1598 individuals diagnosed with neck, upper extremity, and low back work-related musculoskeletal disease from April to June 1996 was performed All individuals were interviewed over the telephone using a stand ardized questionnaire. The questionnaire included questions about the preci pitating event; demographics; health limitations; mood; pain level; and att itudes toward their health care provider, fellow workers, management, work environment, and filing for workers' compensation. Whenever possible, stand ardized questions from previous surveys were used. The interviewed individu als with work-related musculoskeletal disease were reported by health care practitioners as required by the state of Michigan's occupational disease r eporting law. Workers reported during 12 weeks in the spring of 1996 by a M ichigan health care professional as having a neck, back, or upper extremity musculoskeletal disorder were eligible to participate. Among the 2703 repo rts received, 490 individuals could not be reached, 22 did not speak Englis h, 12 had died or were too incapacitated by other medical conditions, and 5 81 refused. We interviewed 59% of all eligible workers and 73% of all worke rs who were reachable and capable of responding in English. Only 25% of wor kers diagnosed with musculoskeletal disease filed a workers' compensation c laim. The factors significantly associated with filing a claim were (1) inc reased length of employment (>21 years: odds ratio [OR] 3.01, 95% confidenc e interval [CI], 1.31 to 6.90); 11 to 20 years: OR, 2.34 95% CI, 1.01 to 5. 47; 6 to 10 years: OR, 1.76, 95% CT, 0.73 to 4.25; 1 to 5 years: OR, 2.36, 95% CI, 1.03 to 5.42; < 1 year: OR, 1.00; (2) lower annual income (<$40,000 : OR, 1.75, 95% CI, 1.06 to 2.88 vs $80,000: OR, 1.00); (3) workers' dissat isfaction with coworkers (OR, 1.76, 95% CI, 1.01 to 3.06); (4) physician re strictions on activity (OR, 2.16, 95% CI, 1.55 to 3.00); (5) type of physic ian providing treatment (specialist, including surgeon or orthopedist: OR, 3.63, 95% CI, 2.37 to 5.55); physical and occupational therapist: OR, 2.15 95% CI, 1.35 to 3.43); family practitioner: OR, 1.33, 95% CI = 0.89 to 2.01 ; company physician: OR = 1.00); (6) off work greater than or equal to 7 da ys (OR, 14.85, 95% CI, 10.57 to 20.85); (7) decreased current health status (OR, 082, 95% CI, 0.70 to 0.96); and (8) increased severity of illness (OR , 1.24, 95% CI, 1.06 to 20.88). This study showed that only 25% of workers with a work-related musculoskeletal condition filed for workers' compensati on and refutes the common perception that an individual with a work-related Problem is likely to file a workers' compensation claim. The strongest pre dictors of who would file were those factors associated with the severity o f the condition. Other factors were increasing length of employment, lower annual income, and worker dissatisfaction with coworkers. Our study populat ion consisted mainly of unionized autoworkers, and our findings may not be generalizable to the total workforce.