Occupational differences in workers' compensation indemnity claims among direct care workers in Minnesota nursing homes, 2005-2016

Christina E. Rosebush, Brian Zaidman, Katherine E. Schofield, Darin J. Erickson, Marizen Ramirez, Breca Tschida, Patricia M. McGovern

Research output: Contribution to journalArticlepeer-review


Background: Nursing assistants have one of the highest injury rates in the U.S., but few population-based studies assess differential injury risk by occupation in nursing homes. This statewide study assessed differences in musculoskeletal disorders (MSDs) and patient handling injuries among direct care workers in Minnesota nursing homes. Methods: Indemnity claims from the Minnesota workers' compensation database were matched to time at risk from the Minnesota Nursing Home Report Card to estimate 2005 to 2016 injury and illness claim rates for certified nursing assistants (CNAs), licensed practical nurses (LPNs), and registered nurses (RNs). Associations between occupation and claim characteristics were assessed using multivariable regression modeling. Results: Indemnity claim rates were 3.68, 1.38, and 0.69 per 100 full-time equivalent workers for CNAs, LPNs, and RNs, respectively. Patient handling injuries comprised 62% of claims. Compared to RNs, CNAs had higher odds of an indemnity claim resulting from an MSD (odds ratio [OR] = 1.67; 95% confidence interval [CI], 1.31-2.14) or patient handling injury (OR = 1.89; 95% CI, 1.47-2.45) as opposed to another type of injury or illness. CNAs had lower odds of receiving temporary and permanent partial disability benefits and higher odds of receiving a stipulation settlement. Conclusions: CNAs in Minnesota nursing homes are at heightened risk for lost time MSDs and patient handling injuries. Claims filed by CNAs are more frequently settled outside the regular workers' compensation benefit structure, an indication that the workers' compensation system is not providing adequate and timely benefits to these workers.

Original languageEnglish (US)
Pages (from-to)517-526
Number of pages10
JournalAmerican Journal of Industrial Medicine
Issue number6
StatePublished - Jun 1 2020

Bibliographical note

Funding Information:
This study was supported by a Pilot Projects Research Grant, Midwest Center for Occupational Health and Safety, and Education and Research Center (T42OH008434) funded through: National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control, and Department of Health and Human Services.

Publisher Copyright:
© 2020 Wiley Periodicals, Inc.


  • descriptive epidemiology
  • disability
  • health disparities
  • injury compensation
  • occupational injury

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