Study finds investing in occupational health "best practices" improves outcomes for injured workers

The study is published in the December 2011 issue of the American Public Health Association journal, Medical Care. Dr. Gary Franklin, medical director for the Department of Labor & Industries (L&I), was one of the researchers involved in the study; Dr Thomas Wickizer, Ohio State University, College of Public Health, was the lead investigator.

“Work-related disability is a major public health problem that’s largely overlooked in the U.S.,” Dr. Franklin said. “This study shows that using occupational health best practices when treating injured workers can have an important effect on their recovery.”

A few years ago, L&I first teamed up with physicians in Washington and throughout the country, health care researchers at the University of Washington, as well as business and labor leaders to find ways of helping workers in the first 12 weeks after a work-related injury.

The result of that work was the creation of L&I’s Centers of Occupational Health and Education (COHE). COHEs are community-based organizations that work with medical providers to encourage the best ways to treat injured workers.

These “best practices” focus on the safe, healthy return of injured workers to full function and full employment. Examples of best practices include promptly filing the workers’ compensation claim, phoning the employer to talk about the worker’s ability to return to work or a light-duty job, and regularly assessing a worker’s ability to do work activities.

L&I gives COHE health care providers financial incentives and organizational support to get injured workers back to work sooner. A key component of the COHEs is using health services coordinators, who report to the health care delivery team and assist with community-wide integration of care.

The overall effort at improved integration of care through the use of best practices and appropriate incentives is an early model of what has been envisioned in the accountable-care organization concept under U.S. health care reform.

For the study, seven researchers from L&I, the College of Public Health at Ohio State University, and the University of Washington’s Department of Environmental and Occupational Health Sciences analyzed 105,607 workers’ compensation claims filed from July 2001 through June 2007, both COHE and non-COHE claims.

The study found that injured workers treated by health-care providers operating under COHE best practices had 19.7 percent fewer disability days than other injured workers receiving treatment, and a reduction in total disability and medical costs of $510 per claim.

Workers suffering from back strain had a reduction in disability days of 29.5 percent.

“We’re especially encouraged that the outcomes for workers with low-back strain were significantly better,” said Dr. Franklin. “Lower-back strain is a costly and common disabling condition in workers’ compensation.”

Currently, four COHE sites serve 2,000 providers and hundreds of employers, treating about one-third of injured workers in Washington. The findings of the study led to new legislation earlier this year that will expand access to COHEs to all injured workers in the state by 2015.

Employer Options after a Citation

As an employer who has been cited, you may take either of the following courses of action:
  • If you agree to the Citation and Notification of Penalty, you must correct the condition by the date set in the citation and pay the penalty, if one is proposed.
  • If you do not agree, you have 15 working days from the date you receive the citation to contest in writing any or all of the following:
    • Citation;
    • Proposed penalty; and/or
    • Abatement date.

Before deciding to contest the citation, you may request an informal conference with the OSHA area director within the 15 working day period to discuss any issues related to the Citation and Notification of Penalty. (See the following section on Informal Conference and Settlement). OSHA will inform the affected employee representatives of the informal conference or contest.

Informal Conference and Settlement

Before deciding whether to file a Notice of Intent to Contest, you may request an informal conference with the OSHA area director to discuss the Citation and Notification of Penalty. You may use this opportunity to do any of the following:
  • Obtain a better explanation of the violations cited;
  • Obtain a more complete understanding of the specific standards that apply;
  • Negotiate and enter into an informal settlement agreement;
  • Discuss ways to correct violations;
  • Discuss issues concerning proposed penalties;
  • Discuss proposed abatement dates;
  • Resolve disputed citations and penalties, (thereby eliminating the need for the more formal procedures associated with litigation before the Occupational Safety and Health Review Commission); and
  • Obtain answers to any other questions you may have.

OSHA encourages you to take advantage of the opportunity to have an informal conference if you foresee any difficulties in complying with any part of the citation. Please note, however, that an informal conference must be held within the 15-working-day Notice of Intent to Contest period and will neither extend the 15-working-day contest period nor take the place of the filing of a written notice if you desire to contest. Employee representative(s) have the right to participate in any informal conference or negotiations between
the regional administrator or area director and the employer.

If you agree that the cited violations exist, but you have a valid reason for wishing to extend the abatement date(s), you may discuss this with the area director in an informal conference. He or she may issue an amended citation that changes the abatement date prior to the expiration of the 15-working-day period without your filing a Notice of Intent to Contest.

If you do not contest within 15 working days, your citation will become a final order not subject to review by any court or agency. After this occurs, the OSHA area director may continue to provide you with information and assistance on how to abate the hazards cited in your citation, but may not amend or change any citation or penalty which has become a final order. The area director may only advise you on abatement methods or extend the time you need to abate the violation. (See Petition for Modification of Abatement).

Whenever the employer, an affected employee, or employee representative requests an informal conference, all the parties shall be afforded the opportunity to participate fully. If either party chooses not to participate in the informal conference, that party forfeits the right to be consulted before decisions are made that affect the citations. If the requesting party objects to the attendance of the other party, OSHA may hold separate informal conferences. During a joint informal conference, separate or private discussions will be permitted if either party requests them. Informal conferences may be held by any means practical.

To avoid any citations, make sure you have an up-to-date safety training program within your company. National Safety Compliance provides many safety training videos, booklets and other resources to help your company be in compliance with OSHA's regulations.

What types of violations can be cited during Federal OSHA Inspection


A willful violation exists under the OSH Act where an employer has demonstrated either an intentional disregard for the requirements of the OSH Act or a plain indifference to employee safety and health. Penalties range from $5,000 to $70,000 per willful violation.


SSection 17(k) of the OSH Act provides that “a serious violation shall be deemed to exist in a place of employment if there is a substantial probability that death or serious physical harm could result from a condition which exists, or from one or more practices, means, methods, operations, or processes which have been adopted or are in use, in such place of employment unless the employer did not, and could not with the exercise of reasonable diligence, know of the presence of the violation.” OSHA may propose a penalty of up to $7,000 for each violation.


This type of violation is cited in situations where the accident/incident or illness that would be most likely to result from a hazardous condition would probably not cause death or serious physical harm, but would have a direct and immediate relationship to the safety and health of employees. OSHA may impose a penalty of up to $7,000 for each violation.

De Minimis:

De minimis conditions are those where an employer has implemented a measure different from one specified in a standard, that has no direct or immediate relationship to safety or health. These conditions do not result in citations or penalties.

Failure to Abate:

A failure to abate violation exists when a previously cited hazardous condition, practice or non-complying equipment has not been brought into compliance since the prior inspection (i.e., the violation remains continuously
uncorrected) and is discovered at a later inspection. If, however, the violation was corrected, but later reoccurs, the subsequent occurrence is a repeated violation. OSHA may impose a penalty of up to $7,000 per day for each violation.


An employer may be cited for a repeated violation if that employer has been cited previously, within the last five years, for the same or a substantially similar condition or hazard and the citation has become a final order of the Occupational Safety and Health Review Commission (OSHRC). A citation may become a final order by operation of law when an employer does not contest the citation, or pursuant to court decision or settlement. Repeated violations can bring a civil penalty of up to $70,000 for each violation.