Age and Overwork
Oct 4, 2018

Two frequent topics in these august pages have been the employee age dimension of risk and the need for risk management and HR to work together instead of acting like rival fiefdoms. The current issue of The Journal of Occupational and Environmental Medicine (, subscription required) includes new work from South Korea which underscores both points. The research was in part triggered by the growing interest in karoshi or death from overwork. The term is Japanese and the first serious research on the phenomenon was done in Japan, but concern about this insidious risk has spread well beyond the Land of the Rising Sun.

Wikipedia defines the term thus:


Karōshi, which can be translated literally as "overwork death" in Japanese, is occupational sudden mortality. The major medical causes of karōshi deaths are heart attack and stroke due to stress and a starvation diet. This phenomenon is also widespread in other parts of Asia as well.

The South Korean study asked two related questions about karoshi: (1) what are the clinical precursors and can they be tracked and (2) how does the risk of karoshi vary across employee age?

The study deployed a very sophisticated approach and used high sensitivity C-Reactive Protein (hsCRP) as a primary precursor/indicator of karoshi risk. The authors used overtime as their index to normal or over-work. The very brief answer is that employees under age 60 handled regular and significant overtime with no changes in their hsCRP, but levels spiked for employees 60 and over, called the "old age group" in the report. In other words, the ability of most employees to cope physically with heavy work assignments falls off rapidly about age 60.

Here in the USA, home of the aging workforce and the full employment economy, this is important news and it illuminates that place where risk, safety, HR, and workforce management all cross paths. Classic karoshi is dropping dead at your workplace, but increasing levels of hsCRP indicate a variety of less than sudden death health conditions which can negatively impact employee performance and productivity and constitute serious co-morbid conditions in the event of on the job injury.

Human beings are not precision-engineered, interchangeable parts. This JOEM report underlines one more consideration in managing human factor risk intelligently to avoid unnecessary costs and, yes, heartache. They both count.

Is Everything Up to Date in Kansas City?

From our friends in KC comes this news report: "A nationwide shortage of truckers has some industry officials and national lawmakers supporting a plan to allow 18-year-olds to become long-haul drivers..." Did that idea also give you a little tingle somewhere down your spine? The AP news item goes on to explain that this is just a proposal being floated and, obviously, it's more than a little controversial.

This item is an important straw in the wind, whether or not we actually get 21st Century Ferris Buellers* slipping into the driver’s seats of 18 wheelers. The full employment economy we are currently enjoying creates many new twists in corporate risk that we certainly have not had to think about for several decades now. This report reminds us that hiring in a full employment economy can create three high risk scenarios.


The dumbbell curve: you may find yourself hiring more very young and more older than usual employees in order to fill employment needs. Monitor the age band populations of your higher risk job classifications very carefully.


Hiring at the margins: when fewer applicants are available, hiring managers make compromises along the lines of "well, he or she will do, I hope." Gone are the days when you could hire out of work MIT astrophysicists for entry level IT jobs. Can you quantify a factor for marginal/high risk hires in your HRIS? If you don't know, ask.


Beginner's luck: One lesson we all know well in workers’ comp is that the first six months on a new job are the most dangerous. Multiply this by the two factors noted above and you might want to rethink a few attachment points and risk corridors, not to mention upping your game in your safety and training functions.

Full employment is a good thing, but it requires some creative rethinking to be certain that your evolving exposures are understood and effectively covered.

In this year of 2018 risk management and workforce planning need to be working as one. Remember Ferris and the Ferrari 250 GT?

*Millennials: this is what Google is for. Just type "Ferris and the Ferrari 250 GT" and see what pops up.

Want Co-morbids with That Frappacino?

The August Wall Street Journal (, subscription required) has weighed in on the corporate sugar wars in an article published on September 17. The reporter, Rolfe Winkler, has done a masterful job of outlining the ongoing battles between bosses and donuts (and anything else with a ton of fat and sugar). He looks at several companies where management is trying to get employees to leave the donuts and cupcakes and holiday cookies, etc., etc. at home. Some of this battle of the carbs comes under the term "sugar shaming."

Does this fight involve risk management or can you safely leave the sugar wars to HR? Here's the real question: what are all those excess calories doing to your workers' comp costs? At some point management may well ask you to put a few numbers around this question. This journal has carried many studies about the impact of obesity on the cost of comp claims. Some research has shown that obese employees have twice the disability durations and medical costs, per injury type, as their non-obese peers. Depending on your industry and claim severity mix, that could be material.

Have you had the "fat talk" with your TPA or carrier? Until recently, co-morbids, like obesity, were captured haphazardly in the comp claim process - if they were captured at all. They were usually buried in the adjuster notes and/or physician reports. That's changing and it's important. We see two mega-trends clearly in the US workforce - growing obesity and employee aging. In claims, these factors manifest as co-morbid conditions and claims with co-morbids cost more, often much more, than similar claims without these complications.

How much of your total comp claim cost is being driven by the donut brigade? Should you be weighing in (all puns intended) on the sugar debate? Do you have a dog, maybe a big dog, in this fight? Get your facts and figures. You never know when someone in the C-suite may turn to you and ask, "say, what's the impact of overweight on our comp costs? Does risk management have a position on getting sugary treats out of the workplace?" Don't get caught napping.

Hey, what's in that pink cardboard box in the risk management office?

Do Weekend Warriors Get the Monday Blues?

You know the drill. Old Fred over in your fulfillment center tries to prove he can still play tackle football with the kids one Sunday afternoon. Monday morning he drags himself in to work and then claims that his pulled hammy just happened in the warehouse. As my friends in Joisey say, "yeaah, shuuure."

The National Council on Compensation Insurance (NCCI) decided a while back to check out this scenario - urban legend or statistical fact? Their approach was very clever. If this scenario is statistically significant, the additional access of millions of people to health insurance, courtesy of the ACA, should show up in recent comp claim frequency. If more people have health insurance now and thus less incentive to claim that weekend accidents are work related, we should see at least a small decline in Monday morning claims, right? Well, what happened?

The NCCI report shows the following:


The share of claims with Monday accident dates is slightly higher than the share of claims with accident dates on any other single day of the week, both before and after the ACA took effect.


There is no noticeable impact of the ACA on the share of claims by day of the week.


The lack of impact holds even when we restrict the analysis to the states that had the largest decrease in those without health insurance prior to the ACA becoming effective.

Looks like the fabled Monday morning claim may indeed be more legend than fact. True, the overall frequency of comp claim events is higher on Mondays, but we have long known that heart attacks, for example, are also statistically more frequent on Monday mornings. There is a good deal of medical science behind this fact, although we still don't understand all of the factors that make specific types of CVAs more common on Mondays.

Yes, you want your adjusters to make certain that all claims are work related under the regs of your state, but Mondays are just plain tough. Give ol’ Fred a break.


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