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Health risk factors as predictors of workers' compensation claim occurrence and cost
  1. Natalie V Schwatka1,
  2. Adam Atherly2,
  3. Miranda J Dally1,
  4. Hai Fang3,
  5. Claire vS Brockbank4,
  6. Liliana Tenney1,
  7. Ron Z Goetzel5,
  8. Kimberly Jinnett6,
  9. Roxana Witter1,
  10. Stephen Reynolds7,
  11. James McMillen8,
  12. Lee S Newman1,9,10
  1. 1Department of Environmental and Occupational Health, Center for Health, Work, and Environment and Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado, USA
  2. 2Department of Health Systems, Management & Policy, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
  3. 3China Center for Health Development Studies, Peking University, Beijing, China
  4. 4Segue Consulting, Denver, Colorado, USA
  5. 5Johns Hopkins University Bloomberg School of Public Health, Institute for Health and Productivity Studies, and Truven Health Analytics, Bethesda, Maryland, USA
  6. 6Integrated Benefits Institute, San Francisco, California, USA
  7. 7Department of Environmental and Radiological Health Sciences, School of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
  8. 8Pinnacol Assurance, Denver, Colorado, USA
  9. 9Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
  10. 10Department of Medicine, School of Medicine, University of Colorado, Aurora, Colorado, USA
  1. Correspondence to Dr Natalie V Schwatka, Center for Health, Work and Environment, Colorado School of Public Health, 13001 E. 17th Place, 3rd Floor, Mail Stop B-119, Aurora, CO 80045, USA; natalie.schwatka{at}


Objective The objective of this study was to examine the predictive relationships between employee health risk factors (HRFs) and workers' compensation (WC) claim occurrence and costs.

Methods Logistic regression and generalised linear models were used to estimate the predictive association between HRFs and claim occurrence and cost among a cohort of 16 926 employees from 314 large, medium and small businesses across multiple industries. First, unadjusted (HRFs only) models were estimated, and second, adjusted (HRFs plus demographic and work organisation variables) were estimated.

Results Unadjusted models demonstrated that several HRFs were predictive of WC claim occurrence and cost. After adjusting for demographic and work organisation differences between employees, many of the relationships previously established did not achieve statistical significance. Stress was the only HRF to display a consistent relationship with claim occurrence, though the type of stress mattered. Stress at work was marginally predictive of a higher odds of incurring a WC claim (p<0.10). Stress at home and stress over finances were predictive of higher and lower costs of claims, respectively (p<0.05).

Conclusions The unadjusted model results indicate that HRFs are predictive of future WC claims. However, the disparate findings between unadjusted and adjusted models indicate that future research is needed to examine the multilevel relationship between employee demographics, organisational factors, HRFs and WC claims.

  • Occupational injury
  • Health risk assessment
  • Small business
  • Worksite wellness
  • Total Worker Health

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Twitter Follow Natalie Schwatka at @nvschwatka

  • Contributors Each author has made substantial contributions to this study, provided help revising this paper for important intellectual content, gave final approval for this version of the paper and agree to be accountable for all aspects of this work.

  • Funding This study was funded by Pinnacol Assurance.

  • Competing interests All coauthors have filled out the ICMJE form. The competing interests include support from Pinnacol Assurance to conduct this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.