Tips for Effective Use of an Interpreter in Workers’ Comp

interpreter in workers' compThe need to use an interpreter in workers’ comp has increased with the changing dynamics of the American workforce including those individuals who do not fluently speak English – whether it be as a primary language, limited use or no working knowledge at all.  The use of an effective translator to assist when communicating with non-English speaking people during the claims investigation process is beneficial for improved claim outcomes.



English as a Primary Language – A Changing Dynamic


There is no “official language” in the United States.  Although roughly 30 states have enacted laws making English (American English) the official language for business purposes, our country remains a melting pot filled with numerous languages and dialectics.  Recent estimates indicate about 350 languages are spoken in the US.  This creates many challenges when a work injury occurs. Members of the claims management team and other interested stakeholders need to be aware of these issues and use interpreters to make sure their claims are properly investigated, and the information is received accurately.



Goals of Using an Effective Interpreter in Workers’ Comp


Using an interpreter is a relationship where all parties need to be on equal footing and involvement.  It is important to set the right tone at the beginning of the process.


  • Get to know the interpreter. Understand how they interpret – simultaneous or consecutive.  When using consecutive translation, get a good idea of the length of sentences or phrases one should use.  Patience is key.


  • Set expectations for best practices. Understand a good interpreter in workers’ comp is not an advocate for either party.  They should never be used to add persuasion or in a coercive manner.


  • Set timelines for translation. Translation services are taxing physically and mentally.  A good interpreter will need frequent breaks.  Understand these limitations and respect them.



Signs of a Good Interpreter


Finding a good interpreter in workers’ comp can be a challenge even if it is a language that is common.  Because work comp claims involve legal matters, it is important to use a court certified interpreter in all instances.  This includes translations taking place during recorded statements, witness interviews, depositions, independent medical examinations/independent vocational evaluations and hearings.  Characteristics of a good interpreter will include the following:


  • Interpretation of every word: Accuracy is key. When an interpretation is “word for word,” it ensures the information is being relayed completely and avoids issues for appeal.


  • Not providing one-word answers when there was clearly a longer answer: When this takes place, it is noteworthy that accuracy is not valued.  It may be time to stop what is taking place and locate a new interpreter.  This might mean stopping a deposition and re-setting the proceeding.  Although there are additional expenses, it will avoid problems down the road.


  • No side conversations: It is important that all parties are involved in a conversation and what is being shared by the non-English speaking person is provided to all.  In some instances, an interpreter may need to ask a question to clarify a term being used. If this is the case, it is important for the interpreter to note this and translate the “side conversation” completely.


  • Be aware of regional dialectics: This is something that should be discussed well in advance of using an interpreter.  As is the case in English, words in other languages have different meanings to people in different regions.



Other Barriers and Challenges


It is also important to understand people from other cultures may have misconceptions on the American legal system.  Examples of this may come from people who immigrated from oppressive regimes and governments.  They may have a distrust of the legal system in the United States based on prior experiences.  Other cultures may also view someone with a personal injury differently.  Best practices in claims management must include cultural competence.  Remember to treat all people with respect and dignity.





While there is an added cost, members of the claims management team cannot avoid the demand to use an interpreter in workers’ comp for an injured worker with limited use of the English language – or none at all.  These costs can translate into savings when done correctly.  This includes using a qualified court-certified interpreter, getting to know the person and using one in the right (and necessary) circumstances.





Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center.



Workers’ Comp Roundup Blog:


©2018 Amaxx LLC. All rights reserved under International Copyright Law.


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Catastrophic Claims Handling Part 1: Demonstrate Care and Investigate

catastrophic claims handlingHandling any workers’ compensation claims can be a challenge, but it is especially the case in catastrophic claims handling for workers’ comp’s most serious injuries. These claims can ruin lives and incur many millions of dollars in costs. Everything done to manage a claim becomes that much more critical when a severe injury is involved.


In addition to getting the right treatment to the injured worker as soon as possible and demonstrating care and concern for the employee as well as his family, it is also vital to investigate these claims as thoroughly and as quickly as possible. In addition to the best practices for claims handling, there are additional strategies that can ensure the best outcomes for employees, employers, and payers.


Demonstrate Care & Establish Trust


Any injury that occurs in the life of an employee is disruptive, and even minor injuries can seem like major events.  A serious catastrophic injury, by comparison, causes high stress, fear, and anxiety. Questions such as “will I ever work again,” “how will I support my family,” or “will I be able to walk my daughter down the aisle” are prevalent in the employee’s mind.


Demonstrating care and establish trust with the injured worker and their family is the highest priority item in your catastrophic claims handling plan. You need to establish that you are working together on the same team toward a common goal.


  1. Visit the Hospital. Visiting the hospital is a non-negotiable requirement in a catastrophic claims handling plan. It serves as an opportunity to both give and receive information with the injured employee. You will express care and concern for the employee and ensure they understand and are comfortable with the process; as well as get a feel for the employee’s attitude, the kind of care received from the medical provider, and the prognosis.


  1. Work with the Family. The injured worker’s family are typically the first people the adjuster or employer representative will see. They are likely scared for the injured worker and concerned about what is coming, how they will pay for medical care and other expenses, and how they will be able to juggle being with him and handling their daily routines. Leverage empathy and active listening to understand and meet the needs of the family.


It is critical to put yourself in the shoes of the injured worker and his family, to understand what they are going through and consider how you would want to be treated if it was your spouse or best friend. This leads to positive outcomes and prevents litigation.



The Investigation Elements


Investigating a workplace injury is, or should be routine for organizations. You want to find out what happened, how, when, where and why. Typically that involves things such as:


  • Talking with the injured worker
  • Identifying and taking statements from witnesses
  • Reviewing any available video – from the scene and surrounding areas
  • Assessing the accident scene


These actions may be a bit more complicated when a catastrophic injury is involved. Mistakes in the process can lead to unnecessary expenses and/or improper medical care. Properly investigating a catastrophic injury claim must be undertaken with the utmost care.


Carriers or third-party administrators often have specialized teams of experts available to conduct these and provide information to the claims adjuster.  Each member of the team understands his responsibilities in collecting and saving information. In addition to the basic information needed, these professionals will get additional details, such as


  • When the employee arrived at work
  • When/where he was working when the injury occurred
  • Who was in the area at the time of the injury
  • Who, if anyone else was involved in the accident
  • What equipment was in the vicinity of the accident
  • Whether any machines malfunctioned
  • What actions were taken immediately following the accident/injury
  • How quickly the worker received medical care
  • When and where the worker was ultimately taken


The claims adjuster needs this information as quickly as possible before she questions the employer or the injured worker. The adjuster may either go to the hospital to meet with the worker and/or his family, or send a nurse case manager to the facility and go herself to the worksite first.


Those who have been conducting the initial investigation can meet with the claims adjuster once she arrives at the employer’s offices to discuss their findings. The adjuster can then take pictures and do a more thorough investigation before getting a statement from the injured worker.




Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center .



Workers’ Comp Roundup Blog:


©2018 Amaxx LLC. All rights reserved under International Copyright Law.


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

6 Effective Claim Handling Tips For Undocumented Employees

6 Effective Claim Handling Tips For Undocumented EmployeesInterested stakeholders in workers’ compensation need to pay attention to the changing workforce as immigration continues to change the composition of the American workforce.  This includes being mindful of immigration laws and making good faith efforts to comply with the Immigration Reform and Control Act and the employment of individuals authorized to work within the United States.  Notwithstanding these efforts, people without such proper documentation enter the workforce and become injured.  This creates problems for employers and insurers that can add costs to a claim.



Understanding the Basics


The Immigration Reform and Control Act controls employment practices in the United States.  Under this law, only American citizens or non-citizens with the proper work permits are allowed to perform work legally.  However, employers continue to employ people without proper authorization – in some instances knowingly engaging in this type of employment practice.


A state’s workers’ compensation law defines eligibility for benefits.  In many instances, one’s legal employment status does not serve as a bar to benefits after following a work injury.[1]  The issue of hiring someone not legally allowed to work in the United States is not going away.  The only true way to deal with such issues is to make good faith efforts when verifying someone’s work status.  The reality is even if an employer undertakes these efforts, people not legally allowed to work will continue to seek employment.



Effective Claim Handling with Undocumented Employees


Many employees working inside the United States without proper documentation are hardworking and performing “high risk” jobs.  Handling a claim with someone who is undocumented does not give stakeholders in the workers’ compensation process license to discriminate.  The bottom line is all injured employees should be treated with respect and dignity.


Employers need to take the lead on this issue during the pre-employment screening phase and following a work injury.  Interested stakeholders within these organizations should take note of the following principles:


  • Understand the requirements of the Immigration Reform and Control Act in employment practices;


  • Apply consistent standards to acceptable documents for verifying an applicant’s immigration status. Special document requests cannot be made unless prescribed by applicable law; and


  • Complete and maintain the proper paperwork for all employees. This includes the federal I-9 form.


The workers’ compensation insurer must provide all benefits an injured worker is entitled to under the jurisdiction’s law following a work injury.



Other Tips to Avoid Traps


Members of the workers’ compensation claims management team need to be proactive when it comes to handling claims involving employee’s who are undocumented.


  • Effective Discovery: It is important to understand the facts of the case in order to develop a complete analysis.  Digging too deep into an employee’s immigration status following an injury during the investigation and discovery phase may not be helpful in the end.  If the employer legitimately believes an injured worker is legally able to work inside the United States, but later has knowledge of their true status, they may be precluded from making a valid written job offer.


  • Encourage RTW Efforts for All Employees: Returning all employees to work following an injury reduces the medical and indemnity benefits paid on a claim.  If an employer believes an employee is legally permitted to work inside the United States and does not have knowledge otherwise, it is permissible to make a job offer conditioned on the presentation of valid work documentation.  Consultation with an attorney before choosing this option is prudent.


  • Cooperate and Make Timely Wage Loss Benefits: Unless specifically excluded by statute or case law, all employees regardless of immigration status are entitled to wage loss benefits.  Failing to cooperate or make timely payment of benefits can lead to litigation, sanctions/penalties and create ill will.





All employees need to be treated ethically.  This includes common courtesy and respect regardless of one’s immigration status.  After making sure these prerequisites take place, interested stakeholders need to be proactive and coordinate efforts when dealing with someone who is not legally allowed to work inside the United States following a work injury.  This includes understanding the law and working with an attorney to avoid excessive workers’ compensation program costs.



[1] In Correa v. Waymouth Farms, Inc., 664 NW 2d 324 (Minn. 2003), the Minnesota Supreme Court upheld the award of TTD benefits to an undocumented worker based on basic tenants of statutory construction.  The Court did not discuss the undocumented employee’s edibility to vocational rehabilitation benefits.  Courts in other jurisdictions have reach a similar conclusion in all but a few instances.




Michael Stack - AmaxxAuthor Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center .



Workers’ Comp Roundup Blog:


©2018 Amaxx LLC. All rights reserved under International Copyright Law.


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

If It’s a Safety Issue, Can You Learn What Medications Your Employee Is Taking?

execStaffby Robert Dooley

V.P. Administration & General Counsel @ Medcor


Medcor operates clinics that have over 300,000 patient visits each year. As you can imagine, Medcor has had to deal with its fair share of tricky compliance issues that can occur in a workplace clinic. The following is one of those issues.




I’m Joe’s supervisor. I heard a rumor that Joe, who drives a forklift, is taking anti-seizure medication for a personal health issue. If I ask the Medcor clinic personnel, can they tell me what medications Joe is taking? This is a safety issue and I think I’m entitled to the information.





Generally, the answer is, “no,” for jobs not governed by the DOT, FAA, etc. As a HIPAA covered entity, Medcor is responsible for making sure that all Protected Health Information (PHI), including information about medications acquired by Medcor in the course of treating a patient is properly secured and not released to anyone, unless permitted by law. This means that unless the patient has executed a valid authorization, or unless the release of the information about medications is permitted or required by law, Medcor may not be able to tell the supervisor about the medication.


Employers must be careful when pursuing this information. Acquiring information about an employee’s prescription medications may implicate the ADA and other laws. Employers should obtain legal advice about how to properly implement comprehensive policies for screening for impaired employees. Employers should consider limiting the application of these policies to safety sensitive positions, and not to all employees. The policy should contain a legally vetted definition of “safety-sensitive position,” such as a position where, “even a momentary lapse of concentration or attention could result in injury to the employee or others, or damage to property or the environment.” The policy should have a list of all safety sensitive positions that meet the requirements of the definition. All safety sensitive positions should have job descriptions that include as an essential safety function, “the ability to work in a constant state of alertness and safe manner,” or equivalent language. Policies should require clearance from the employee’s physician after the physician has reviewed the employee’s job description and the definition of safety sensitive position. The policies should limit disclosure to designated individuals in HR and generally not permit disclosure to supervisors.


There are ways prescription information can be obtained by an employer. The best way is for the employee/patient to execute a proper authorization, which would allow the clinic to provide the prescription information to the employer. The authorization must meet all the requirements of HIPAA and any applicable state law. The authorization should be part of any company policy dealing with impaired employees.


Armed with proper comprehensive policies and procedures, employers can protect themselves and others from impaired employees.



Author: Robert E. Dooley joined Medcor in 2005. Bob’s responsibilities include regulatory compliance, contracting, and general administration. He also oversees operations at several on-site clinics.

Remembrance: Tribute to Marsh and AON Colleagues Killed Sept. 11, 2001 — 10 Years Later

It is human nature to forget and move on from tragedy. Most of us do … eventually. But those of you new to Work Comp Roundup may not know our ties to Sept 11, 10 years ago today. We will never move on, only adapt.


Nestled in the World Trade Center Towers were two of the largest insurance brokers in the world, Marsh and AON – giants in workers compensation. As Roundup’s founder, I had been an employee of both companies and had recently retired when the towers fell. Nearly 600 people, so many friends and colleagues, were lost that day between those two companies. Some of these people were key to the field of workers’ compensation cost containment, working beside us and supporting our efforts to build cost containment into formalized practices. They helped bring cost reduction to many companies.


Click to read original post published September 11, 2011.




New Court Decision Marks Increased Importance Of Return to Work

A decision from the New York Appellate Division 3d Dept., “Schirizzo v Citibank NA-BANKING” signals a return to the original method of measuring workers’ compensation payments after a lapse of more than 65 years.


A worker with a permanent disability  (other than arm, leg, fingers and toes not requiring further treatment) receives in New York a ”permanent partial” or “permanent total” disability. According to the NY Workers’ Compensation Law, the amount of payment is measured by the “loss of earning capacity” not the severity of the injury. A clerical worker with a college degree would have far less of a loss of earning for an intermittent painful bad back than an unskilled assembly line worker.



Workers Were Receiving Far Greater or Far Below What Was Warranted


However, starting around 1947 the New York system casually abandoned the wage loss system on measurement in favor of medical disability (minimal, mild, moderate or marked disability) which awarded a percentage of the average weekly wage, regardless of the impact of the injury on future earnings. The medical “severity” yardstick was a lot easier in terms of trials and appeals since it eliminated the need for vocational testimony, but it led to cookie-cutter adjudication which swiftly led to the majority of decisions resulting in a fixed 50% disability. It sounded reasonable but, in fact people with little or no disability received the same payments and settlements as the most disabled, who were receiving far below what their disabilities warranted.


The new decision, published on 5/28/15, involves a person with a 75% medical disability who was awarded 99% wage loss awards; essentially a total disability. The court distinguished between medical damage and loss of earning capacity. The worker, who had a back injury, had little education and had an unskilled job requiring constant standing and lifting.



Decision Signals Return to Original Statutory Plan & Increases Importance of Return to Work


The decision signals a return to the original statutory plan, which will require vocational, in addition to medical, assessments before making extended disability payments. What will be the effect on employers? For some using unskilled workers, probably higher compensation costs. For others, with a clerical/professional workforce, probably a lot lower costs. (A lot will depend on the willingness of parties to become involved, provide objective information and resist the 50% settlements.)


The decision will also reward employers who provide return to work programs, which almost always reduce the amounts of permanent disability awards.  As helpful as vocational testimony might be, an actual return to work resolves all doubts.




Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.


©2015 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.





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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.



Defending Traumatic Brain Injury Cases

Over the last few years, more attention has been given to the seriousness of head injuries.  These types of trauma are often referred to as “traumatic brain injuries,” which can result in serious consequences if not properly investigated.



What is a TBI?


A traumatic brain injury (TBI) involves an event that causes change in the structure or metabolism of the brain.  Previously these types of injuries were referred to as “organic brain syndrome.”


TBI’s occur in a number of different ways.  The most common TBI is the result of a worker striking their head against an object.  It can also result from a slip/fall that results in the head making contact with a surface or via “whip lash.”  They can also occur after being exposed to chemicals or gases, such as carbon monoxide in the work environment.



How Can You Identify a TBI?


Unlike a broken bone, bruising or burns, TBIs are often not evident when looking at a person suffering from this condition.  While every worker who suffers a blow to their head should be immediately treated by a trained medical professional, it is essential to observe them for other symptoms that develop shortly afterward.  These symptoms include:


  • Physical deficits and motor skill operations;
  • Cognitive problems or dysfunction; and
  • Issues with strength and balance.


Exposure to a TBI may also impact a person from a psychological perspective.



Successfully Investigating a TBI Incident


A comprehensive post-injury investigation is essential for any claim involving a TBI or injury to one’s head.  This investigation should include the following components:


  • Specific information concerning the mechanism of injury and areas where impact was made on the person’s head. If the TBI involves a workplace exposure to chemicals, it is important to include this information.


  • Identification of all witnesses. This includes not only people who witnessed the incident or exposure, but those who have knowledge of the employee’s behaviors before and after the incident.


  • Obtain all medical records related to the incident and care provided immediately after the incident. It is also important to obtain a history of any and all psychological treatment and care before and after the occurrence of the TBI.



Management of a TBI Claim


Managing a complex workers’ compensation case that involves a TBI will require additional steps beyond the standard best practices.  In addition to an independent medical examination, the use of other specialists may be important to defend successfully these claims.  It is important to check with the requirements of the applicable workers’ compensation act and an attorney concentrating their practice in this area before scheduling any evaluation.


  • Neurological Evaluation: This type of examination is conducted by a neurologist and will pay particular attention to CT and MRI scans.  The neurologist will help explain the significance of any findings and provide an expert opinion as to causation.


  • Neuropsychological Evaluation: This type of evaluation is performed by a neuropsychiatrist.  It differs from a neurological evaluation in that this specialist will determine the existence of any brain dysfunctions.  In addition to an oral examination, testing will also take place during the course of this examination and analysis will be provided.


A complete psychiatric evaluation and surveillance may also be required when defending these claims.  Some claim management teams have developed specialized units to investigate and handle TBI cases.




TBIs require special claims handling practices from the onset of the claim.  In addition to a complete investigation, it is essential to understand these injuries and employ specialized experts that can be used to successful mitigate future exposures.




Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. He is an expert in employer communication systems and helps employers reduce their workers comp costs by 20% to 50%. He resides in the Boston area and works as a Qualified Loss Management Program provider working with high experience modification factor companies in the Massachusetts State Risk Pool.  He is co-author of the #1 selling book on cost containment, Your Ultimate Guide To Mastering Workers Comp Costs Contact:


©2015 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.





SUBSCRIBE: Workers Comp Resource Center Newsletter


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.




ADA and Return-to-Work Best Practices Webinar / Tues Mar 24 @ 11am EDT

On Tues March 24 @ 11am EDT, prepare for a surprise or two as a group of experts discuss how some common practices in workers’ compensation violate both the spirit and the law of the ADA, as amended in 2009.   The webinar will also clarify what employers who want to abide by the spirit as well as the letter of the ADA should be doing.  Injured workers with significant medical restrictions are likely to meet the expanded definition of people with newly-acquired disabilities — whose jobs should be protected.  This free, one-hour webinar will feature Amaxx Risk Solutions’ Rebecca Shafer, Webility Corp’s Jennifer Christian MD, EEOC’s Aaron Konopasky, Amaxx Risk Solutions’ Michael Stack, and Advisen’s David Bradford as panelists.  They will answer audience questions as time permits during a Q&A period.


This webinar is part of a series that expands on content contained in THE ULTIMATE GUIDE TO LOWERING WORKERS COMP COSTS, a $249 soft-cover book available via



Tues March 24 @ 11am EDT


This is a free, one-hour webinar



  • Rebecca Shafer, JD., President, Amaxx Risk Solutions, Inc., Attorney/Risk Consultant
  • Jennifer Christian, MD, President, Webility Corporation
  • Aaron Konopasky, JD, Senior Attorney Advisor, Equal Employment Opportunity Commission
  • Michael Stack, CPA, Principal, Amaxx Risk Solutions
  • David Bradford, President, Research & Editorial division, Advisen (moderator)



  • When do the employer’s obligations under the ADA kick in for a workers’ comp injury?
  • Can an employer require an employee to return to work after an injury?
  • What’s the difference between light/modified/transitional duty and a reasonable accommodation?
  • Can an employer set a policy about how long a transitional duty position can last?
  • What should the “interactive process” required by the ADA look like — in workers’ comp?
  • How long does an employer have to wait before terminating an employee who can’t come to work?
  • Are indefinite periods of time out of work permissible?
  • Can the injured employee refuse to accept a transitional work assignment?




  • Risk Managers and Safety Directors involved in workers compensation claims management
  • Brokers and Consultants who consult or advise on specific aspects of cost containment
  • Producers looking to impress prospects with the latest strategies to stay on top of workers comp issues



Purchase the book or view sample chapters via or contact Advisen’s Merri Bastone at   Author: Rebecca Shafer, JD.


The book’s topics are organized into the following chapters:

  1. Workers Compensation Insurance Fundamentals
  2. Cost Containment Basics
  3. Training and Building Commitment
  4. Roles & Responsibilities Best Practices
  5. Reporting the Claim
  6. Post Injury Response Procedure
  7. Communication with Employees
  8. Working with Your Insurance Adjuster and TPA
  9. Safety and Loss Control
  10. Wellness Programs
  11. Return to Work and Transitional Duty
  12. Other Indemnity Cost Containment Measures
  13. Directing Medical Care
  14. Medical Cost Containment
  15. Fighting Fraud and Abuse
  16. Rehabilitating the Injured Employee
  17. Managing Prescription Drug Use and Abuse
  18. Claims Resolution and Settlements
  19. Federal Employees Compensation Act (Bonus Chapter)




Join the Workers Compensation Roundtable via

Worksite Healthy Sleep Program: Helping Employees Sleep One Z at a Time

Robin Kobayashi 65x57By Robin E. Kobayashi, J.D., LexisNexis Legal & Professional Operations


The CDC reports that 30 percent of civilian employed U.S. adults, which equates to 40.6 million workers, lack sufficient sleep. These adult workers are sleeping less than 6 hours a day, when the recommended amount of sleep is 7 to 8 hours a day. The CDC survey showed a 34.1 percent rate of short sleep duration among workers in manufacturing compared with all workers combined. About 44 percent of workers who worked the night shift experienced short sleep duration compared to 28.8 percent of day shift workers. Workers with high rates of short sleep duration included 69.7 percent of night shift workers in transportation and warehousing and 52.3% of health-care and social assistance workers.


The lack of sleep may lead to the development of chronic diseases and conditions such as diabetes, cardiovascular disease, obesity, and depression. In addition to soaring health care costs to treat these chronic diseases and conditions among workers, businesses must also contend with safety issues and lost productivity.


A new study published in the Journal of Occupational and Environmental Medicine points out that chronic sleep deficits can cost up to $3,156 per employee. The problem is how to reach workers who could benefit from healthy sleep guidelines and healthcare. The study examined a novel approach to how businesses can deliver an effective healthy sleep program through a workplace wellness facility.



Cognitive-Behavioral Therapy


According to the study, there have been numerous studies on the effectiveness of cognitive-behavioral therapy for insomnia (CBT-1) to help people sleep better both short- and long-term. CBT-1 even carries an evidence-based medicine “stamp of approval” for treatment of chronic primary insomnia and comorbid insomnia symptoms. CBT-1 covers “sleep hygiene, stimulus control, guided imagery, self-talk (cognitive restructuring of dysfunctional thoughts about sleep), meditation, and relaxation techniques”, among other things.


As the study indicates, the question then becomes how to deliver CBT-1 effectively to employees?



How The Study Was Set Up


A voluntary 8-week worksite-based healthy sleep program was set up at the Mayo Clinic Dan Abraham Healthy Living Center to help employees gain knowledge of factors that influence sleep as well as gain skills and behavioral techniques to improve their sleep. The participants completed questionnaires about their sleep behavior, energy level, sleep problems, bed partners, use of sleep medication, daytime performance, stress level, caffeine habits, napping, etc., both before and after the completion of the sleep program.


Eight, one-hour live participatory sessions covering CBT-1 were held, with seven of those sessions delivered by wellness coaches. Participants were given skill-building exercises such as guided imagery, muscle relaxation, sleep hygiene, meditation, and yoga, and their assignments included, among other things, keeping a sleep log, attending classes in meditation and yoga, and identifying self-talk related to sleep.


The study analyzed the outcomes for 53 individuals covering the period 2010 through 2012.



Key Facts About The Participants


  • 2% of the participants were female
  • Median age was 56.4 years
  • 9% were married
  • 2% worked day shifts
  • Average body mass index of 26.6 kg/m
  • 6% of the participants were employees
  • 17% of the participants were spouses or domestic partners
  • 4% of the participants were students, retirees, or volunteers at the medical center



Key Findings Pre- And Post- Healthy Sleep Program


  • Poor quality sleep: Decrease in poor quality of sleep from 5 nights on average per week to 3.5 nights on average per week
  • Impact on job performance: Slight decrease in sleepiness impacting job performance from 2.5 days on average per week to 2 days on average per week
  • Feeling rested: Increase in average rating of 3.9 (10 = always) for feeling rested after a night’s sleep to 5 (out of 10)
  • Knowledge about sleep: Increase of average rating of 4.9 (10 = extremely knowledgeable) for knowledge about sleep to 6.9 (out of 10)
  • Trouble getting asleep: Decrease of average rating of 5.5 (10 = always) for trouble getting asleep to 3.8 (out of 10)
  • Trouble staying asleep: Decrease in average rating of 7.0 (10 = always) for trouble staying asleep to 5.8 (out of 10)
  • Ability to deal with sleep problems: Increase in average rating of 4.4 (10 = extremely confident) in ability to deal with sleep problems to 6.3 (out of 10)



Study Limitations


The study examined a small group of people who voluntarily participated in the healthy sleep program. The authors believe that a larger study with more diverse samples is needed.



OCCUPATIONAL MEDICINE PERSPECTIVE: Leslie J. Hutchison, MD, MPH, FACOEM, of HLM Consultants notes that although the article does not indicate the cost of the program, he believes the savings cited can carry over multiple years without repeated training. “The significant positive effects of the intervention suggest that other interventions are likely to increase the impacts on job performance, further decreasing sleepiness impacting job performance,” explains Hutchison. “Follow-up study of this group might define residual problems that could be addressed in further training or other interventions.”





The study results show the benefits of a healthy sleep program where workplace wellness coaches are used and sleep experts help design and deliver the program in a group setting. The participants reported an improved quality of life, more energy at work and at home, and a significant decrease in stress. The study also underscored the importance of participants having more confidence in their ability to deal with their sleep problems after completing the program, as this could lead to behavior change.


© Copyright 2015 LexisNexis. All rights reserved. Reprinted with permission.




Author Robin E. Kobayashi, J.D., Workers’ Compensation Practice Area Lead at LexisNexis. She is the site coordinator for the LexisNexis Legal Newsroom Workers’ Compensation Law. She has been a Sr. Legal Editor at LexisNexis specializing in workers’ compensation law for over 28 years. She also serves as the Editor-in-Chief of theLexisNexis Workers’ Compensation eNewsletters and the Co-Editor-in-Chief of Workers’ Compensation Emerging Issues Analysis, a 50 state survey of workers’ comp legislation and trends. Contact:

British Quilt Firm Designs Fine

As one British quilt maker discovered, authorities will design a significant fine for you if your safety standards are not up to par.

The Middleton employer was fined recently after a worker suffered severe injuries when his right hand was trapped in a moving machine.

The 60-year-old, from Rochdale, who did not want to be named, was carrying out maintenance work on a pillow filling machine at Comfy Quilts Ltd in Stakehillwhen the incident happened in July of 2013.

The company, which designs and manufactures pillows, quilts and other bed linen, was prosecuted in late May by the Health and Safety Executive (HSE) after an investigation found it had not provided suitable safe systems of work or adequate training for maintenance workers.


Incorrect Procedures Lead to Two Months Missed Work

Trafford Magistrates’ Court heard that the worker was attempting to rectify a problem with the pillow filler. The fixed guards had been removed to allow access, but correct procedures to isolate the power supply had not been followed and his right hand was trapped in the machine as a result.

He lost a significant amount of skin and badly fractured his thumb, which had to be pinned following surgery. He was unable to return to work for two months and could then only undertake light duties.

HSE served an Improvement Notice at the Stakehill site in the aftermath of the incident and also carried out an inspection of the company’s other site in Middleton. This resulted in further Improvement Notices being served, all highlighting the general lack of knowledge about the importance of machinery guarding.

The court was told Comfy Quilts Ltd made several changes to its working practices following the incident, including making and publishing risk assessments for working on each machine at the site, and formally implementing procedures and training for maintenance staff.

Comfy Quilts Ltd, of Stakehill Industrial Estate in Middleton, was fined more than $20,000 and ordered to pay a little more than $1,200 in prosecution costs after pleading guilty to a breach of Section 2(1) of the Health and Safety at Work etc. Act 1974.



Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%.  Contact:


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