Sociodemographic, Industry and Health Factors Associated With Underutilization of Workers' Compensation Insurance

Workers' compensation insurance is an important financial resource for workers, and a key source of occupational injury and illness surveillance and research data. Underutilization of workers compensation is an ongoing concern. Using statewide data for a general working population, we estimated the portion of workers whose work-related injury or illness (WRII) was paid by workers' compensation and assessed workers' compensation utilization by industry, occupation, demographic and health characteristics, and over time.

We combined 5 years of Behavioral Risk Factor Surveillance System telephone survey data (2017-2022, excluding 2020) from Washington State for workers (n = 31,171) and identified respondents with WRII (n = 1463). We estimated the percent of workers who utilized workers' compensation to pay for treatment of their WRII, and calculated adjusted prevalence ratios to estimate underutilization controlling for sociodemographic, work and health factors. Estimates were weighted to be representative of the Washington adult population.

Of the 5.1% of Washington workers who experienced a WRII within the past 12 months, just over half (51.3%, 95% CI: 48.1%, 54.5%) reported that their WRII was paid by workers' compensation insurance. Controlling for other sociodemographic, work and health factors, workers' compensation utilization was lower among workers who were younger, male, graduated from college, reported poorer mental health, and could not afford medical care. Workers' compensation utilization was lower among most service-related industries and occupations. Annual estimates of utilization statewide changed little over time.

Underutilization of workers' compensation insurance is substantial. Workers' compensation data are more likely to miss younger workers, and workers in service-related industries and occupations.