The Frequency and Economic Impact of Musculoskeletal Disorders for California Firefighters

Trends and Outcomes over the Past Decade

by Michael Dworsky, Seth A. Seabury, Nicholas Broten

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Research Questions

  1. What percentage of firefighter injuries are musculoskeletal, and how often do musculoskeletal injuries result from cumulative trauma?
  2. What is the impact of work related MSDs on the employment and earnings of firefighters?
  3. Do reforms introduced by Senate Bill 863 affect the earnings losses or disability benefits of firefighters?
  4. What percentage of MSD claims also involve psychiatric injury?
  5. How often is the cap on physical therapy visits binding for firefighters with MSDs?
  6. Do patterns of injury and post-injury outcomes differ between firefighters and comparable workers in the public and private sectors?

Musculoskeletal disorders (MSDs) are the most common type of occupational injury or illness suffered by firefighters, so there is considerable interest among policymakers and stakeholders about how best to monitor, prevent, and treat firefighter MSDs. In this report, the authors update analyses from a 2010 RAND study on firefighters in California and consider the impacts of the 2013 workers' compensation reforms and the economic shocks of the late 2000s on outcomes for firefighters with MSDs.

The California Department of Industrial Relations requested that the authors address a wide range of specific research questions on various aspects of firefighters' injury risk and outcomes in the workers' compensation system, from case mix and economic consequences to permanent disability rating and medical treatment patterns. The authors analyzed administrative data from the California workers' compensation system linked to data on earnings for workers injured between 2005 and 2015, with additional analyses to tailor the results to the new reforms. They compare firefighters with three groups of workers in broadly comparable occupations — police, other public-sector workers, and private-sector workers with job demands that resemble firefighting — and supplement the analysis using outside data.

The authors found, among other things, that firefighters continue to face elevated risk of work-related MSDs and that earnings losses for firefighters worsened after the Great Recession of 2008–2009. Their findings will be of interest to policymakers in California and other states and to other audiences concerned with the occupational health and safety of firefighters.

Key Findings

Firefighters continue to face elevated risk of work-related MSDs

  • Firefighters are particularly prone to injuries to the lower extremities and trunk.
  • Although the rate of occupational injuries throughout the U.S. labor force has declined steadily, no discernable trend for firefighters or police officers exists.
  • Compared to workers in similar occupations, firefighters have the highest share of injuries that are musculoskeletal in nature.

Earnings losses for firefighters worsened after the Great Recession of 2008–2009, but economic consequences of MSDs for firefighters remain less severe than for workers in similar occupations

  • Postinjury earnings in the second year after injury were sharply lower in comparable occupations.
  • Fire departments appear to do better than other employers — including other public-sector employers — at retaining injured workers.

California Disability Evaluation Unit ratings and statutory permanent disability benefits rose for firefighters after Senate Bill 863 implementation

  • Implementation of Senate Bill 863 was followed by higher final ratings for firefighters with MSDs who received summary ratings.
  • Firefighters have relatively high occupational adjustments, and their slightly older age at injury may also result in more-favorable adjustments under the current disability rating schedule.

There is no evidence that treatment caps on chiropractors, occupational therapy, and physical medicine had a substantial impact on most workers

  • The lack of evidence that workers are substantially constrained by the treatment caps suggests that other, more-harmful consequences of the treatment caps may not be a major concern.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Background on Work-Related Musculoskeletal Disorder Risk for Firefighters Compared to Workers in Other Occupations

  • Chapter Three

    Recent Trends in Injury Rates and Composition Among California Firefighters

  • Chapter Four

    Economic Consequences of Musculoskeletal Injury for Firefighters and Other Workers

  • Chapter Five

    Incidence of Post-Traumatic Stress Disorder and Other Psychiatric Comorbidities for Firefighters with Musculoskeletal Disorders

  • Chapter Six

    Disability Ratings and Benefits for Firefighters with Musculoskeletal Disorders

  • Chapter Seven

    Treatment Caps and Claim Denials

  • Chapter Eight

    Conclusion

  • Appendix A

    Additional Details on Methods

  • Appendix B

    Sensitivity Analyses and Additional Results

Research conducted by

The research described in this report was prepared for the Commission on Health and Safety and Workers' Compensation and conducted by the RAND Institute for Civil Justice (ICJ), part of the Justice Policy Program within RAND Social and Economic Well-Being.

This report is part of the RAND Corporation research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.