The Workplace Safety Rules Changed and Most Companies Don’t Even Know It.

OSHA ReflectionIn late March, a Houston company selling Christmas trees was hit with fines of $117,000 for OSHA violations.  The case stemmed from a worker injury in December, triggering an inspection that found more than a dozen serious violations.  The most significant thing about the case is that, prior to last year, OSHA would probably never have even inspected the location.  


At the beginning of 2015, the Occupational Safety and Health Administration (OSHA) launched one of the biggest changes in American safety in years and most companies don’t even know about it.  The change came in the form of a new definition for “severe injuries” under OSHA’s regulations and new reporting requirements.  Before, companies were required to report any time a worker was killed or at least three workers were hospitalized within eight hours of the accident.  However, as of January 1, 2015, employers are now required to report fatalities and any injury resulting in a hospitalization, amputation or loss of an eye.

One of the first businesses in the country to learn what a change that meant was a Houston-area construction company.  Less than one month after the change was instituted, a worker fell through a hole in the roof and was seriously injured on one of the company’s projects.  The details of the case caused OSHA to hit the company with a massive fine of $362,500, including $70,000 because it waited three days to report the accident.

Since then, more than 600 other companies have been fined for failing to properly report incidents, according to Bloomberg BNA.  But it is not the fines for failing to report that have made the biggest impact; it is the way the reports give OSHA an up-close, real-time view of how people get hurt on the job in America.

Now a year later, OSHA has released a report that shows just how much they have learned about on-the-job injuries.  For starters, the agency received more than 10,000 reports last year, about 30 a day.  Making matters worse, OSHA estimates that industry is under-reporting by 50 percent.

The reports that are made give OSHA two things: a big-data window into the relative safety of different industries, and a brand-new approach to inspecting and investigating individual businesses.

Big Data

The injuries included 7,636 hospitalizations and 2,644 amputations.  As one OSHA publication puts it, “statistics are people with the tears washed off.”  It is the amputation statistics that jumped out.  OSHA has been preaching to the manufacturing sector about amputation hazards for a long time.  However, amputations in grocery stores and other companies that use food slicers appear to have been an eye-opener for agency officials and they have singled that sector out with a program to raise awareness and also for stepped-up enforcement.

Grocers are one example of the way the new rule has allowed OSHA to target its limited resources.  Before, a store had relatively little chance of ever getting a visit from an OSHA inspector.   Now they are getting attention from regulators.   In March, a national grocery store chain was fined $45,500 after a worker sliced off a fingertip.   And that may be the least of that company’s worries.  As attorney Howard Mavity of Fisher & Phillips has pointed out, a second violation at any of a company’s stores in the next five years could potentially make it a repeat offender under the regulations and open the door to a $70,000 fine for each offense.

What happens when the data identifies a high number of injuries within a certain industry or area?  On March 16, after reviewing reports that indicated that meat processors in Nebraska had an injury rate well above the national average, OSHA launched a local emphasis program. The very next day, OSHA added a regional emphasis program for Kansas, Nebraska, Missouri poultry processors.  OSHA emphasis programs are part carrot, part stick approach – The carrot is a communications outreach to companies and workers. The stick is dramatically increased, targeting inspections.  In the words of the order, “Meat processing facilities will be evaluated to determine whether the employers are in compliance with all relevant OSHA requirements, to help employers come into compliance, and to ensure that employees are protected from the hazards related to animal slaughtering and processing. “

Once an industry is on the list, companies in that industry will see increased inspections, which bring the potential for new violations, the threat of becoming a repeat offender and, over time, more pressure on the agency itself to take any measures within its power to improve safety in that industry.  Suddenly companies that have flown under OSHA’s radar will get to know their regulators very well.

Company Inspections

The rules also triggered a complete change in the way OSHA handles investigations of incidents.   Most companies are still not prepared for this.  To understand the change, you must first understand that OSHA already does a lot with a very limited budget.   Once accident reports started flooding in, local offices did not have the resources to visit every accident site.

So they started a triage system.   About a third of the time, investigators went to the accident scene and performed an inspection.  About five percent of the time, they decided no investigation was required.  What about the remaining 62 percent?  For those cases, OSHA invented a new type of investigation, the Rapid Response Investigation (RRI).  Employers are asked to perform their own investigation, including a root cause analysis.  The company is told to:

  1. Analyze the incident;
  2. Identify the causes;
  3. Present its finding to OSHA, potentially including pictures and blueprints; and
  4. Propose steps it will take to keep the accident from happening again, such as training or changes to procedures.

For companies with staff who understand incident analysis and safety programs, this has not been much of a problem.   Anecdotally, company safety professionals have said OSHA was easy to work with and focused on prevention more than punishment, which should be everyone’s goal.

But smaller companies may lack that expertise and this process can be difficult and potentially expensive.  A lot of companies, especially those in low-risk industries, may go years without an incident, even though they don’t have formal programs or training in recognizing hazards.  However, if someone is hurt, they may find themselves in a kind of double jeopardy.  First they had the accident, and then they run the risk of bringing additional scrutiny by performing a haphazard investigation.  Sure enough, OSHA investigators say privately that they spend a lot of time explaining to small companies what they need to do to perform the investigation.

Finally, there is always the temptation to cheat.  As OSHA says, if there were 10,000 reports last year, there may have been 10,000 more injuries that went unreported.  Of course, lying to OSHA has always been a reckless approach that can result in criminal penalties.

Overall, OSHA is one year into an ambitious program that could dramatically improve workplace safety in America, but there are still some bumps along the way.  Companies need to understand the new paradigm, step up their safety programs and recognize that the way they investigate an accident and the steps they put in place to prevent it in the future are critical in determining how OSHA treats them in the future.

Ken Wells is the founder and president of Lifeline Strategies, consulting firm located in Houston.  Lifeline Strategies’ units work with companies to manage their safety and regulatory programs, maintain healthy workplace through occupational medicine management and establish integrated brands for their customers and the public.

How Long is Too Long to Wait to File Workers Comp?

Thanks to the excellent website for calling attention to a case where an injured employee waited two months after an alleged incident to apply for workers comp.   His argument was that he didn’t think the injury was serious, but it got progressively worse for two months, when he had to see a specialist. He said he informed the company as soon as he realized the seriousness of the injury.  The company argued that “it always stressed to its employees the importance of immediately reporting injuries because of the presence of bacteria and chemicals in the workplace that could cause even minor cuts to become infected.”

It happened in Kentucky where the workers comp laws say workers need to tell the company about an injury “as soon as practicable.”

The courts found against the worker because so much time had passed, but it creates a question, how long is “as soon as practicable?”    Apparently it is not two months, but is it one month?  Is it a week?   Back injuries may take a while to heal or present themselves as a longer-term problem.  How long is too long to report?

For employers that creates a high degree of uncertainty and potential exposure for incidents they didn’t even know occurred.  It is a pretty common problem in the oilpatch where crews may head home after a hitch, only to see their local doctor and start the workers comp process.

That is one reason why companies should look at companies that provide immediate post-incident injury management.  Typically an injured worker will talk to a trained professional by phone and describe the symptoms. In most cases on-site first aid is warranted and the employee is urged to contact them again if the symptoms worsen.  If the injury requires treatment, the service may recommend a clinic or, if it is an emergency, the worker can be taken to an E.R.

What does this accomplish?

  1. It establishes a treatment regime that is aimed at the right treatment for the injury.  Sending an employee home with an injury that could get worse with time doesn’t help the employee or the employee. Proper and early intervention has been shown to dramatically reduce the need for workers comp and shorten the period before an employee is able to return to work.
  2. It answers worker questions quickly and opens a communications channel in case the injury needs further treatment.  This helps encourage workers to report an injury when it happens.
  3. It “freezes the facts” by giving a quickly documenting what happened, the severity of the injury in real time and the recommended course of treatment.
  4. It gives a clear process and documentation that makes it harder for a worker to not report an incident and come back later with a claim.

CORE Health Network‘s TimeZero injury case management gives companies and their employees the peace of mind to know that an RN is just a call away if there is an incident.  CORE’s nurses are experienced in injury management and OSHA regulations, and are certified on workers comp in all 50 states.  If a worker is injured, they will be on the phone immediately to perform triage, find the nearest clinic qualified to treat the specific injury and will follow-up to ensure that the worker is receiving the right care.   For more information contact 



Sex and Drugs: OSHA’s New Walk on The Wildside

OSHA inspectors spend their days sorting through the details of missing machine guards and slippery walkways.  That is a long way from the world of Sex, drugs and, potentially, rock and roll.  But some recent cases have you wondering if OSHA hasn’t decided to take a walk on the wild side.


In California, Cal-OSHA, the state agency enforces safe workplace requirements, has been wrestling with how to regulate the porn industry, particularly how to reduce the risk of sexually transmitted diseases.  This month, Cal-OSHA fined a film company run by a porn star $78,000 for violations, including not requiring actors to use condoms, the porn industry’s versions of Personal Protective Equipment.   However, earlier this year the Cal-OSHA Standards Board considered and failed to get the required number of votes for a blanket rule requiring condom use for all porn films.  One argument against the requirement – it could force the industry back underground.   the other arguement was, if you require condoms, what else would you require:

“If you think about how porn is looking today, and how it’ll look…. we’re talking about gloves, full body cover, and goggles,” said Eric Leue, executive director of the Free Speech Coalition, a porn industry trade group. “It’s going to turn into surgical porn.”  

Surgical porn?   Kinky!


The whole decriminalization of marijuana has also created some strange issues for the government.  Even though states have allowed medical or recreational use, pot use is still against federal law.  And yet, OSHA needs to ensure that the new marijuana industry operates safely.   A tragic event at a New Mexico medical marijuana lab sent two workers to the hospital and resulted in an OSHA fine of $17,500.   You can read about it here.   Clearly this is an industry that still needs to grasp its responsibilities to provide a safe workplace.

Rock and Roll

Oh and, as for Rock and Roll, that came last fall when a TV station did an investigation of the mind-numbingly loud music played in health club spin classes.   They found that noise levels were consistently higher than allowed by OSHA standards.  Watch that video here.  No word on whether OSHA is investigating music noise levels.





News Reports on Occupational Health: Experience Matters!

There are a lot of occupational health and medicine companies around.  A quick google search of the words “occupational” and “clinic” turns up more than 100,000,000 entries. The number of companies involved in Occ Med will continue to grow.  I even  saw an article recently by a chiropractor telling his colleagues how Occ Med Services were a good way for them to new income to their current practice.

However, this is one field where companies that need help testing new employees, handling return to work clearances or helping injured employed after an incident really need to look at the experience and expertise of the service providers.   This is especially true in the area of telemedicine – helping companies by handling their administrative needs, interpreting results or working to manage injuries by phone, email or video.  It presents great opportunity for companies to solve occupational medicine headaches and save money, but it all depends on the quality of the provider.

I recently took on a new client, CORE Health Networks, and they are generating some positive feedback from the media, especially for the experience of their staff and expertise at handling occupational health needs.

Here are a couple of articles that included CORE, one from the Society for Human Resource Management that looks at the ways  telemedicine can help HR departments and another from the employment website that looks at the need for quality medical personnel who can work remotely.

Contact me at if you would like to learn more.

Storm Clouds Ahead For Your Workers Comp Insurance

It has never been more important for you to control your workplace injuries and the reasons aren’t even your fault.

A very good article by Steve Doss of CCIG looks at three signs of trouble for workers comp rates.  They all have to do with national trends.

  1. Obama Care (the Affordable Care Act) – The Affordable Care Act and workers comp are supposed to be two separate programs with two separate purposes.  The problem is that doctors may “leak” cases that should be covered by health insurance into worker’s comp.  Why?  Patients  can avoid high deductibles by going through worker’s comp and doctors can charge more for workers comp treatment than they can under group policies.  So there is an incentive for both to classify things as work-related.
  2. Accident Frequency – As the economy has improved since 2012, accidents have gone up, especially in construction and transportation.  Two distinct problem there – more inexperienced workers entering the workforce and an aging demographic as more people delay retirement.  According to Doss, “non-fatal work-related construction injuries jumped 9.5 percent from 2012 to 2013. Also, as older employees work longer, the number of accidents among those 65 and older rose 18.5 percent from 2012 to 2013.”
  3. Accident  Severity – Fatalities are going up.  For example, the government says that between 2013 to 2015, construction fatalities rose 5.6 percent and manufacturing fatalities rose 9.3 percent from 2013 to 2014.   At the same time, hospital and drug costs are rising faster than inflation and those are the biggest expenses impacting workers comp.

What should you do about it?  Doss says prevention is the best investment you can make; every dollar spent on prevention saves two-to-six dollars in savings.

At CORE Health Network, a leader in integrated occupational health management, the four keys to prevention are:

  1. Documentation – Companies that don’t monitor worker health and on-the-job injuries may have no way to determine whether an injury was really work-related and they have limited options on getting workers back to work quickly.
  2. Make sure the people you hire can perform their job duties safely – That is done through a network of 1300 clinics around the country that can perform drug and alcohol testing, compliance testing and functional assessments during the onboarding process.
  3. Keep track of worker medical conditions as their careers progress – Return-to-work assessments are a critical to preventing re-injury and helping workers return to work.
  4. Post-incident case management – The first minutes after an injury are critical to determining injury severity and the right level of treatment.  They are also important in re-assuring workers that they will receive the proper care and that company wants them to return to work healthy.  CORE’s TimeZero service addresses those concerns.

Let us know if we can help you manage your worker health needs.


Workplace injuries: And the winner is….

Safety programs are naturally focused around hazards.  We identify job site hazards and implement policies to control or eliminate those risks.  But what if we went at it from the other direction – identify the types of injuries that occur and focus on preventing those classifications?

I wondered about this when I saw a listing of types of injuries both as a percentage of total injuries and direct cost.  It comes from the Liberty Mutual Research Institute for Safety, which has long been a leader in safety research.  Every year, the group puts together a list of injuries based on the latest data.   Here’s what the 2016 report looks like:

injuries list

In total, Liberty Mutual found that businesses spend more than $one-billion a week on nonfatal injuries, for a total of almost $62-billion a year.  The 80-20 rule also applies – eighty percent of the injuries come from the top categories of injury types.    By far, the top cause is overexertion involving outside sources, meaning injuries related to lifting, pushing, pulling, holding, carrying or throwing objects.   Those types of injuries make up a quarter of the total.

We should never turn away from hazard identification as a foundation of safety, but can we also focus on injury types.  To some extent that is the health part of  Health, Safety and the Environment.  Some companies are having a great deal of success in reducing musculature injuries by training workers on avoidance skills – stretching, proper lifting techniques and awareness.  For many companies, that involves a cultural shift.

The other piece involves occupational health.  Knowing that certain injuries are more likely to occur, focus on ensuring that new hires are capable of performing their specific job duties.  If an injury does occur, ensure that appropriate treatment is used to reduce the long-term impact, find light duty work that can be performed while the worker heals and use a case management process get workers back to work as soon as is practical.

Are you still taking workers to the ER?

EREmergency rooms are for emergencies. A worker who experiences a life-threatening injury needs to go to the emergency room.  The problem is that too many companies consider the emergency room as their first option.  Research shows companies may not be getting their employees the right level of care and it carries a tremendous cost.

According to a study by the New England Healthcare Institute,  overuse of emergency room visits costs Americans  $38 billion a year.    The study found that more than 50 percent of all emergency room visits area avoidable.

When you look at workplace injuries, the number may be even higher.   According to Dr. Bradley Kenny, who specializes in occupational healthcare, “75 percent of all work-related injuries that go to the emergency room are non-emergencies.”

And there are indications that emergency room visits don’t offer advantages to workers.  A study by the American College of Emergency Physicians (ACEP) found that the median wait for patients was a shocking 4.5 hours.  That is four-and-a-half-hours for a worker to be in pain, frustrated and, ultimately, angry about their care.   So companies are wasting millions or even billions of dollars to almost guarantee that workers have a bad experience.

So what should companies do?   The two biggest solutions appear to be appropriate use of telemedicine to put workers on the phone with trained medical personnel who can do a preliminary assessment of the level of care that is necessary.  That was one of the findings of the New England Healthcare Institute study.   The second is to understand the capabilities of nearby occupational clinics.  It is important to work with staff who can provide the appropriate levels of treatment and also understand the nuances of the OSHA recordkeeping rules.

CORE Health Networks has built its integrated approach to occupational health around those two principals.  CORE has build relationships with more than 1300 clinics around the country to help serve clients anywhere their crews are working.  Through its Time-Zero intervention and case management, CORE puts RNs with experience in injury care, OSHA recordkeeping and workers comp laws into immediate communication with workers and supervisors to make sure they receive the right treatment at the right time.    The emergency room will still be there for emergencies, but there is no reason to use them unnecessarily.

For more information on CORE’s services email me at


Occupational Health – Knee ACL Reconstruction Has High Rate of Re-injury

Credit:  St. Louis Children's Hospital
Credit: St. Louis Children’s Hospital

The goals of a good workplace health management program are to make sure that workers are not assigned to job duties where the risk of injury is high and to make sure they have timely and proper treatment if there is an injury.

New research shows there is good statistical reason to take a close look at new employees who have had Anterior Cruciate Ligament Reconstruction (ACLR) surgery on a knee or at employees returning to work after that injury. A new study of soldiers in the British Army has just been released.    Apparently, prior to 2005,  ACL surgery was a cause for discharge or rejection, but after 2005, the Brits changed their recruitment policies to allow enlistees who had previously undergone ACL surgery.   As a followup, they wanted to find out whether those recruits went on to experience additional knee problems.   The study compared recruits who had ACL surgery with a control group who had not had the surgery (and we assume, had not had knee problems).  It found that “Sixty-one per cent of cases experienced complications linked to their previous surgery.”

Another, earlier study had looked at young athletes who had ACLR surgery.  It found that about 69% of them experienced a re-injury.

What does this mean to employers?  Well, first you need to recognize that military surgery and sports are likely to place special stress on knees.  Most jobs don’t create that kind of physical stress.   But some do.  There are two lessons here:

  1. It is important to understand job duties and make sure new hires or employees returning to work can perform those duties without risking additional injury.
  2. It is important to document pre-existing conditions or surgeries.   Depending on the severity and where the operation takes place, an ACL operation can cost $20,000-50,000.

If you want to learn more about the onboarding process as practiced by CORE Health Networks, contact me at


Worker injuries and mistrust: Why the first few minutes after an incident are so important.

taller de ilustracion digital - 212Near the end of his shift, a warehouse worker lifts a box while talking to a co-worker.  He’s distracted and doesn’t remember to lift with his legs.  He feels a twinge in his back and by 10 o’clock that night, the pain is so bad he can’t sleep.

Want to know one of the top factors that will determine how soon he is back on the job?   Whether he is afraid of losing his job.

The Workers Compensation Research Institute (WCRI) surveyed injured workers in 12 states.  It found that trust, or rather mistrust, of the company and fear of losing their jobs was strongly related to workers staying off the job longer.  In fact, the study found that “concerns about being fired were associated with a four-week increase in the average duration of disability.”  Workers who were afraid of being fired also were much more dissatisfied with the care they received and had more problems with access to care.

There is a very good recap of the study here in CFO Magazine.

Why is this important?  Time off the job is a cost to the company and shows up as OSHA recordables. Workers who don’t trust their employers may also be more likely to sue.  More importantly however, getting workers back to where they can earn a living is a priority.  Good companies understand the value of keeping a productive, engaged workforce.  A high level of distrust and workers feeling like the company doesn’t support them if they are injured can destroy a company culture.

What you can do about it.  The article gives a number of valuable tips.  On the front end, companies should engage workers in identifying hazards and avoiding them as a part of their overall safety program.   They should also plan ahead by identifying transitional jobs that allow workers to return to work without risking their recovery.

One of the biggest recommendations is something that is at the heart of CORE Health Network’s approach – Early intervention by trained professionals who can make sure that worker know they will be taken care of with appropriate, timely treatment.  Here is what the article on the study says:

Providing a 24/7 nurse triage program to speed treatment for injured employees so they get the care they need as soon as possible. The employee can contact the nurse triage line immediately after feeling a twinge of pain or sustaining an injury that doesn’t require emergency treatment. This service not only ensures the employee gets the right care immediately, it also cuts down on unnecessary visits to the physician when the employee can use such self-care treatments as ice, rest, elevation, or (over the counter Ibuprofen).

If you need more information on the early intervention offered by Core Health Network, contact us at

New OSHA Target: Midwest Manufacturers

OSHA has a new focus areaosha_logo_pub for targeted inspections – Manufacturing industries in Iowa, Kansas, Missouri, and Nebraska (OSHA Region 7).   The safety agency has what it calls regional emphasis programs that identify industries with injury and illness rates that are above national averages.

When OSHA adds an industry to its regional emphasis program, companies in that industry are more likely to receive inspections and those inspections tend to be much more detailed.  One of the main criteria OSHA uses in placing an industry on the emphasis program is its Days Away, Restricted or Transferred (DART) rate.  The national DART rate for private industry is 3.3.  The other criteria is what is called serious violation rate per inspection (SVPI).

Five Things Companies Should To to Prepare for OSHA

  1. Aggressive Occupational Health Management – Research has shown that one of the most cost-effective ways to reduce OSHA recordables, like DART, and lower workers comp costs is to help workers stay healthy.  That means strength and functional assessments on the front end to make sure workers aren’t assigned duties that exacerbate pre-existing conditions.  It also means that, if there is an incident, the company helps get workers the right treatment at the right time.  Many incidents are mis-characterized as OSHA recordables because the worker was not given the right level of treatment immediately after the incident occurs.   Lifeline Strategies is working with one of the leaders in integrated occupational health, CORE Health Networks.
  2. Safety Program Management – Start by looking at your overall safety and training, because that is the first thing OSHA will look at.   Many companies that think they have safety programs really just have a bunch of policies gathering dust on the shelf.   Make sure your program is up-to-date and addresses the actual risks that workers face on the job.
  3. Communicate and Train to Your Safety Program – Safety programs are useless if the workers who need to rely on them don’t understand them and follow them every day.  OSHA has realized that and is increasingly looking at management commitment and worker engagement on safety.
  4. Prep For OSHA Inspections – Some companies with great safety records can look very bad in an OSHA inspection if they don’t know what to expect.  Make sure safety professionals and management know what takes place during an OSHA inspection, what inspectors will want to see and management’s responsibilities under the law.  It may be worth holding a surprise inspection drill.
  5. Understand Changing OSHA Requirements – The rules on what needs to be reported, when and how to follow-up have changed and will change again in the next few months.  Companies that didn’t know about the changes or ignored them have been hit with thousands of dollars of fines.

If you need help with any of these recommendations, contact us at

According to its criteria, OSHA will target the following industries in those states:

For DART rates

  • food
  • nonmetallic mineral products
  • fabricated metal products
  • machinery
  • computer and electronic products
  • furniture and related products (337).

For SVPI data

  • beverage and tobacco products
  • wood products
  • printing and related support
  • primary metal
  • miscellaneous