بازگشت به کار کارگران صدمه دیده: شواهد از بیمه بیکاری مشابه و اطلاعات جبران خسارت کارگران

This study represents the first analysis of the return to work of an entire population of workers with job-related injuries. Duration estimates indicate that returning to the pre-injury employer is one of the main determinants of the speed of return to work. The worker's pre-injury employment history also plays a large role, while the elasticities of the economic incentives vary across injury lengths and model specifications. The length of time off work is an important determinant of the probability of being employed 1 year after the first return to work. Results do not differ by gender.

In 1996, firms in the United States reported 6.2 million workplace injuries and illnesses, of which 2.8 million involved restricted work activity or at least 1 day lost from work (Bureau of Labor Statistics, 1997). Leigh et al. (1997) estimate the costs of these conditions to have been US$171 billion in 1992. For injured workers and their employers, the duration of time until return to work has important consequences. If return is delayed, workers can lose more than current earnings: skills and work habits depreciate when people are off work a long time, leading to a decline in future productivity and earnings. Long spells off work also can induce employers to find replacements to maintain continuity of production. In addition, they can stigmatize injured workers, making them less successful applicants for future jobs. For employers, early return to work is of value because they typically pay for long spells off work either directly (if self-insured) or with higher insurance premiums. Employers may also pay substantial adjustment costs to maintain activities in which the injured workers were employed. This study differs from previous analyses of the factors leading to the return to work of injured workers in several ways. First, it examines an entire population of injured workers (all workers who suffered a lost-time injury in Wisconsin during 1989 or 1990), while previous research has been limited mainly to groups of workers who suffered specific injuries or received only specific types of workers' compensation benefits.3 Second, it makes use of data on the earnings histories of injured workers, permitting us to develop a better measure of the date of return to work. Third, it represents the first study that explores whether the use of after-tax (instead of pre-tax) earnings may change the magnitude of income replacement as an incentive to return to work. Fourth, it uses an instrumental-variables approach to derive a measure of post-injury wage offers, rather than assuming that pre-injury earnings adequately measure them. Finally, up to now, virtually, no research has been conducted to detect gender differences in the factors shaping return to work. Given the evidence (Kelsh and Sahl, 1996), documenting that women face a substantial risk of work related injury—partially as a consequence of their entrance into traditionally male jobs—this study aims to fill this gap in knowledge by developing an analysis by gender.

This study of return to work after occupational injury has several distinctive features. First, it uses unemployment insurance data to develop an improved measure of the date of return to work. It also uses an instrumental variables approach to incorporate information about the post-injury wage and about the probability of returning to the pre-injury employer. Two types of duration models are estimated: a Weibull model and a semiparametric hazard model with a flexible baseline. In both cases, we control for individual unobserved heterogeneity. The results are largely consistent across the models. However, while the Weibull model with gamma heterogeneity suggests positive duration dependence in the return to work of injured workers, the semiparametric hazard specification with the flexible baseline indicates that the hazard does not increase monotonically, but actually reverses its trend after 6 months. Three of the four estimated elasticities of post-injury wage offers and benefit levels on the duration off work are greater for the flexible hazard model than for the Weibull model Table 4. In both specifications, they are on the low end of the range of estimates of previous studies. Using after-tax rather than pre-tax earnings has virtually no impact on our estimates. We find also that workers who return to work at their pre-injury employers lose much less time from work. The duration off work is also affected by workers' pre-employment history. We also find few clear gender differences in factors affecting durations off work. Different estimates present different pictures of whether men or women are more responsive to economic incentives and whether loss of the pre-injury job has a greater impact on men or women. We do find gender differences related to the part of body injured. Back injuries represent a more serious obstacle for the return to work of men with longer spells off work, while upper extremity injuries appear to lengthen the return of women with shorter-duration injuries relative to men. Women also appear to have lower levels of employment after their initial return to work, even after accounting for observed labor-market characteristics and the time until initial return. Finally, the probability of being employed 1 year after the first return to work increases with the time off work after the job-related accident. Thus, the costs of extended return to work are likely to be much greater than just those costs incurred before the initial return. This suggests that workers experiencing long periods off work after injury still carry with them the burden of their injuries even after they return to employment. We conjecture that this burden is not simply caused by long-term physical disabilities, but is also affected by the impact of long periods off work on workers' skills and on employers' perceptions of workers' commitment to the labor force. This set of results suggests the need to partly refocus the debates about public policy in the area of workers' compensation. Typically, the attention concentrates on the role played by disability benefits in affecting the return to work of injured workers, but our findings indicate that other factors may play an even larger role. For example, returning to the pre-injury employer can have a very large impact on the duration off work after the injury. This is particularly true for workers with at least 6 months tenure at the pre-injury employer. This underscores the importance of incentives for the pre-injury employer to rehire the injured worker. Also, the finding that, even among workers who suffered only a temporary disability, absences longer than 6 months appear to have a larger negative effect on future employability (Table 7), indicates efforts aimed at return to work should start early to avoid future unemployment. So far, in the US, a few states have introduced polices that provide finical incentives to employers who rehire or hire workers who suffered a job related disability. Such incentives may be shaped differently, ranging from tax rebates to subsidies for wages and expenses related to job modification (Galizzi and Boden, 1996), and they should always respect the need for the workers to recover adequately from the injury. We have also found a simple measure that identifies a group of workers at risk of substantially longer times off work: the continuity of their pre-injury employment. This measure may reflect limited marketable skills. To the extent that this is the case, it may indicate a need for early identification of these workers at risk by providers of medical care, vocational rehabilitation and claims services. This could suggest early referral for identification of suitable alternative employment. However, intermittent pre-injury employment may also reflect some workers' low valuation of employment compared to nonwork activities. For these workers, an injury may tip the balance from continuing to work to remaining off work. Then, the factors affecting intermittent employment would be outside the purview of workers' compensation systems and, given any regulations, would present challenges to employers, insurers, trade unions and public officials who wish to improve after injury return to work outcomes.