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Taming the #1 Cause of Disability Claims at Navistar, Inc.

By Brian Schilling

The workplace has never been kind to the back or neck, which together account for about 18 percent of all workplace-related disability insurance claims.1 The extremities—fingers, toes, hands—also suffer the workplace poorly, accounting for another 9 percent of such claims.2 Humans may better adapt to the workplace in another few millennia, but in the meantime, employers may do well to follow the example of truck manufacturer Navistar, Inc., which saw a 45 percent reduction in per-claim cost at its Ohio manufacturing facility between 2004 and 2006. Their secret: talking to area doctors.

In 2001, Navistar determined that nearly two-thirds (65%) of companywide disability claims were musculoskeletal-related claims from employees at its Springfield, Ohio manufacturing plant. The company determined that employees with such injuries were not always adequately diagnosed or treated. The lapses in care were all too typical: some employees were not referred to specialists when they should have been, others were when they didn't need to be, and still others got unnecessary prescriptions for painkillers that delayed their safe return to work.

Company medical director Dr. Thomas Ehni believed that reaching out to area physicians might go a long way toward improving care for Navistar employees. He and a team of researchers from Pfizer developed a three-year, three-stage plan to try to reduce musculoskeletal disability claims. Briefly, the program involved the following:

Stage 1: Identify area physicians typically involved in treating musculoskeletal disorders. Invite those and other physicians to attend a diagnostic training seminar, based on guidelines from the American Academy of Orthopedic Surgeons (AAOS), developed by Springfield-area specialists. The seminar featured education on appropriate care for various injuries and conditions. Share employee job descriptions with physicians to help them better determine when employees could safely return to work.

Stage 2: Distribute AAOS-developed clinical practice guidelines specific to injured employees to treating physicians. Conduct additional diagnostic seminars. Encourage area physicians to direct employees to use on-site physical therapy facilities.

Stage 3: Communicate with area physicians to encourage them to prescribe safe, over-the-counter pain relievers rather than more dangerous opioids whenever appropriate.

The program worked. Specifically, over the three-year period of the study, work-related injuries dropped 75 percent, days lost per injury dropped by 21 percent, average medical costs per injury decreased by $2,169 (or 45%) and use of the company's physical therapy facilities increased by half. The absence of any concurrent program to make jobs safer or to help educate employees about avoiding injuries makes the study results all the more impressive.

"The drop in [musculoskeletal] disability claims costs can really only be attributed to our staged program," said Ehni. "And that drop reflects our employees getting better care."

Ehni was quick to offer would-be copycats a word of advice. "Do everything at once," he recommended. "There's really no need to unroll the program in three one-year stages. The point is to get to the end game of reducing disability claims as quickly as possible."

There's more good news: in the three years since the study was originally published, the results have held up. According to Dr. Ehni, accidents, claim volume, and per-claim costs at the Ohio plant are all still well below 2004 levels.

Related Link:
Read the full study at the American Journal of Managed Care.

1 HIAA Source Book of Health Insurance Data 1999–2000.
2 Ibid.

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