Top 10 Preventable Absences

Podcast: Line on LeaveBeing proactive about the health and safety of your employees is one of the most important ways to keep your workforce productive. By leveraging our advanced analytics, we’ve discovered the top ten most common medical conditions that lead to preventable absences. Tune in to hear Dr. Mark Williams, medical director at The Hartford, and Will Gray, data scientist on The Hartford’s Health Services team, share the top 10 list of preventable absences and tips for keeping workers healthy and safe.
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Laura Marzi: Hi everyone. I'm Laura Marzi and thank you for tuning into our latest Line on Leave Podcast from The Hartford. Today's topic is one I know employers think about all the time, the health and the safety of their workforce. Our guest today will discuss the latest study from The Hartford that identifies the top 10 preventable absences. And by sharing this list, we hope that employers come away with a better understanding of proactive steps they can take to keep their workers safe.
So I'm excited about my guests today from The Hartford. Joining me, our Medical Director, Dr. Mark Williams, as well as Will Gray, who is the data scientist on The Hartford's Health Services team. So thank you both for joining us. And I was wondering if we could start off by having you briefly tell our listeners what your role is here at The Hartford. And Dr. Williams, I thought we'd start with you.
Dr. Mark Williams: Yes, of course. Muchas gracias. Happy to be here. I am a chiropractic physician, board certified in occupational health and ergonomics. And as a Medical Director here at The Hartford, I provide consultative services to our clinical and claims staff to evaluate injuries and illnesses that are preventing return to work and exploring how best we can get a person back to their highest level of function possible. I also get to work on projects like this one where I can partner with our really extensive resources and drive innovation and efficiency and help us be a valuable resource to our customers.
Laura Marzi: And Will, could you tell us a little bit about your role at The Hartford and what the Health Services team does?
Will Gray: In the insurance world you – have this concept of risk mitigation, which is a fancy way of saying reducing or eliminating the likelihood of a loss. Think antilock brakes for your car. The Health Services team is just risk mitigation for people. Our mission is to help employers and employees reduce or eliminate unplanned absences.
My role is to leverage deep data in occupational or workers' comp and non-occupation disability absences to design services that help employers maximize the health of their workforce. It's a lot of fun and it's rewarding when you get to see that full cycle of data leading to insight, insights leading to action, and those actions ultimately leading to better outcomes.
Laura Marzi: Okay. That makes a lot of sense. And Will, could you kick us off by sharing how and why we developed the study of the top 10 preventable absences?
Will Gray: More and more employers are realizing the true cost of not having someone at work, and realizing it doesn't matter if they're out of work due to an injury at home or an injury at work. In fact, regardless of whatever kind of insurance you buy, nearly 90% of the cost of an absence1 actually falls to employers. And that's important. It's important because once you have a claim, it's too late for prevention. And developing a robust culture and practice around a return to work, that takes time.
So employers have to think about what they can do today to prevent or reduce the duration of an absence. In this study we leveraged advanced analytics to sift through the thousands and thousands of workers' comp and disability claims we see each year, and we let the data tell us which claims are likely to be preventable. And then once we had that list, we took it to our team of doctors, nurses, vocational rehab specialists to said, "Does this make sense to you? And more importantly, what should employers do about it?"
Laura Marzi: Perfect. So, I think that transitions us to Dr. Williams. I was wondering if you could give us a brief overview of the top preventable absences that you discovered? Maybe we kind of do a top 10 countdown just to acquaint the listeners.
Dr. Mark Williams: Absolutely. Yes. Well, number 10 actually came in with generalized anxiety disorder. And this is a severe anxiety that interferes with daily activities. That's when it becomes a disorder.
Shoulder sprains, this is occurring when ligaments in the shoulder are stretched or torn, and this allows bones to become potentially unstable.
Lumbar sprain, pretty much the same way. This is a tearing of the supportive ligaments in the area and can result in spasm and pain.
And at number seven is hernia. This is a weakness primarily in the abdominal wall where it allows some protrusion of organs or tissue through that weakness. And sometimes we can prevent this particular injury by getting a good history with a preemployment or post offer, a physical examination. Sometimes this can be brought out in learning that maybe there's a family history of hernias that would predispose the worker to having one themselves. So having those examinations beforehand can minimize that risk.
And number six was carpal tunnel syndrome. And this is the compression of a nerve root within the wrist. And it can lead to pain, numbness, tingling, even some atrophy in the hand in severe cases. And it used to be felt that repetitive motions was primarily the cause of this, but more recent data suggests that forceful gripping and power grasping, that type of thing, is at least as important or perhaps more.
And then at number five, radiculopathy. This is a pinching of a nerve root within the spinal column. And symptoms would be a radiating pain, weakness, numbness and tingling. And it can be difficult to treat once someone has it.
Laura Marzi: I was wondering if I could stop these for a minute. Why is radiculopathy so difficult to treat?
Dr. Mark Williams: Well, generally it's best to manage this condition conservatively, at least initially. But if that's not successful and it can lead patients down a pretty complex path of many interventions that can eventually lead to surgery. We see a large variation in the rates of surgery by geographic location for example, as well as long-term outcomes vary widely as well. So it just can become a very complex condition to manage.
Number four is rotator cuff syndrome. And this, our shoulder is the most mobile joint in the body, but we sacrifice stability for that mobility. And there are four muscles grouped together called a rotator cuff. And these muscles attached to the arm and are responsible for a lot of that rotational motion that we see in the arm. And when this structure is damaged, it can lead to pain and dysfunction. And improper reaching and a lot of overhead work in particular is problematic for this condition.
Now number three and number two, low back pain and joint pain. We see these very commonly, but they're really more symptoms than actual diagnoses. And the reason for that is we see claims early on after an injury and they may not have elucidated the actual diagnosis yet, so was sort of a placeholder and, but we know there's an orthopedic condition there.
And number one is meniscus tear, and this was the most commonly seen diagnosis. And the meniscus is a sort of specialized piece of cartilage within the knee, in between the two large bones of the knee. And it's particularly damaged by things like deep squatting, as well as particularly torquing or twisting of the knee. And it's most commonly seen in men as well.
Laura Marzi: Well, that is fascinating. When you were reviewing the data, Will, did anything jump out at you?
Will Gray: We knew from the data that there was a ton of overlap between workers' comp and disability. But you have to keep in mind that workers' comp covers workplace injuries while disability covers pretty much everything else from knee injuries to shoulder replacement to cancer. And so with that backdrop, I was surprised to see just how much overlap there was, and it was so large.
Think about it this way, out the thousands of conditions you can get each year, just 10 conditions, the 10, make up a little over 13% of disability claims and one out of every five workers' comp claims. That's a ton of overlap. And what that means to an employer is that you don't just have to think about prevention as a workplace or outside of workplace thing.
Laura Marzi: Sure. That makes total sense. Dr. Williams, what do you consider a preventable absence? And when you looked at this list, were there any surprises from the analysis?
Dr. Mark Williams: Yes. Well, I think employers are often surprised to learn how much they can do to mitigate employee absences and durations of whether they're done on the job or off. I think it's also particularly important to remember that not all medical conditions are preventable and not all claims are avoidable. Sometimes, despite our best efforts, an injury or an illness happens. And fortunately The Hartford's claim team is ready to help employees all along the way in getting them back to work as soon as possible.
The Hartford's preventable preventative service programs like fit for duty testing, physical demand analysis to clearly define a job's physical requirements, and post offer physical testing for new hires. These are excellent resources to prevent injuries. But I was surprised to learn that 35% of meniscus tears and 41% of low back pain occurred within the first year of employment. I think this suggests the value of proper training for employees, as well as providing time and space for things like stretching and warmup. For an organization to normalize this warming up period prior to physical demands is very important. Workers with high physical demands are really no different than athletes. In fact, the term industrial athletes now, right? So, they perform better and with less injury when they can prepare properly for the demands of their work. Likewise, I think employees need to take the physical demands of their occupation seriously and strive to remain fit, be rested and ready to accomplish the tasks of the day.
Also, having ergonomics and modification of work activities is important. Proper ergonomics, things like adjusting desks and chairs can reduce shoulder problems. Like we see as well as carpal tunnel syndrome, back pain and joint pain. Consider modification of work activities that may require squatting and pivoting so that we can minimize the potential for the number one condition that we see, and that's meniscus tears.
Also, assisted devices and wearable technology becoming much more available and accepted in the workplace. And so if we can encourage these types of devices to minimize things like overhead activities, to help mitigate rotator cuff tears, shoulder sprains, as well as lifting belts and assisted devices for pushing and pulling and lifting so that we can minimize those hernias and lumbar sprains.
Laura Marzi: I was going back and looking at the list and I see generalized anxiety disorder is there. And Dr. Williams, since this isn't a physical injury, I was wondering how employers should think about approaching it.
Dr. Mark Williams: That's a great question. Yes. It came in at number 10. And untreated without early intervention, this can lead to short term disability or even prolonged absences. The Hartford, their Estudio sobre el futuro de los beneficios, we found that 70% of employers now recognize employee mental health as a significant workplace issue. 72% unfortunately noted a stigma associated with mental illness prevents a lot of workers from seeking help.
More recently, just published from the Integrated Benefits Institute, IBI, their analysis of the impact of work disruptions of the pandemic. They found that two in five employed adults reported symptoms of anxiety or depression disorder. That's a fourfold increase from pre-pandemic levels. So I think what employers need to think about is how to break down that stigma associated with mental health disorders and foster this open and inclusive work environment. Also, I think it's important to train supervisors, to be able to recognize some of the early signs of stress and encourage employees to connect with the employee assistance programs and other mental health services.
Laura Marzi: Thank you. That's really good perspective. And for our listeners, we're going to be doing a deeper dive into mental health and stigma with our partner, The National Alliance on Mental Illness also known as NAMI in an upcoming podcast. Now, if I could pivot for a second, I'd love to talk about remote work and how employers address safety in a virtual workplace. Will, I was wondering if you could speak to that.
Will Gray: No surprise to anyone, but the pandemic has dramatically accelerated the transition to remote work from what might have taken 10 years to just a few months or even a few weeks in some cases. And while there are some good and bad things with that, the one thing it has done is pushed more and more services virtual.
The Hartford now offers a suite of prevention services from ergonomics to preemployment screening, to fit for duty, all virtual. And that has opened the door to smaller employers and employers with many locations, AKA people working from home to provide some of the same services traditionally only provided by large employers with centralized locations.
As this develops It's going to be exciting to see the impact on absences as more and more folks adopt these kinds of virtual prevention services.
Laura Marzi: And since the pandemic started, we've seen more employer interest in injury prevention services, correct Dr. Williams?
Dr. Mark Williams: Yeah, actually employer's interest in protecting their worker's health, safety, and preventing injuries and absences really has been rising before the pandemic. Pre-pandemic there were more than 80% of US jobs were predominantly sedentary and 600,000 workers miss work every year because of ergonomic injuries. And we've been serving these customers with our preventive services that Will mention.
But to your point, we have seen more and more employers being concerned with protecting their worker's health and safety. And the number of customers seeking The Hartford's injury prevention services actually jumped 200% in the last 18 months. So this was terrific. And The Hartford is really well positioned to help. We're a leading workers, excuse me, workers' compensation and disability insurer and we help more than 1 million US workers each year return to active productive lives. And also, during the labor shortage, it's important, I think, more important than ever for employers to keep them healthy and as safe as possible.
Laura Marzi: Will, is this top 10 list something that The Hartford will be compiling on a regular basis and would you anticipate if you did that, that there would be changes or trends to the data?
Will Gray: This is the first time we released the study and honestly, as the team developed it, we had just more ideas than we had time to look at them. So we're going to make this an annual publication. Each year we'll reevaluate the top 10 and share with everyone emerging trends and what has changed.
Laura Marzi: Well, thank you. This has been a great discussion. Appreciate your time. And I know, I agree with our listeners that your insights were invaluable. If you'd love more information on this topic and the Future of Benefits Study, I encourage you to visit The Hartford's Top 10 Preventable Absences List, which is available at
And always, if you like what you hear, please subscribe to our podcast and share it with your colleagues. You can visit us at for more information and resources to help you keep your employees safe and healthy on the job. Until next time, please be well and stay safe everyone. Gracias.
941976 10/21
1 IBI Industry Report Average Duration. Hartford claim data. Indirect costs come from Society for Human Resource Management, Bureau of Labor Statistics, and other studies including The Hartford’s internal research.
This informational material is subject to change as The Hartford continues to receive guidance from states and municipalities. It shall not be considered legal advice. The Hartford assumes no responsibility for legal compliance with respect to an employer’s business practices, and the views and recommendations contained herein shall not constitute The Hartford’s undertaking on a company’s behalf, or for the benefit of others, to determine or warrant that an employer’s business operations are in compliance with any law, rule, or regulation. Employers seeking resolution of specific legal or business issues, questions, or concerns regarding this topic should consult their own attorney or business advisors; and employees should continue to consult their employers’ Human Resources or other employment benefits department for guidance on the application of any law, rule, or regulation.
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