The Year of Immigrant Workers and their work injury risks

Leaders Speak at WorkCompWire invited me to write two columns on what employers need to know about work injury risks of foreign-born workers. Below are the two columns. Thanks to Stephen Sullivan of WorkCompWire.
Part 1 (8 20 13)
This is the Year of the Immigrant Worker.
As we all know, Congress is deeply engaged in the first serious chance for comprehensive immigration law reform since the 1980s.
Foreign born workers, in part due to their numbers, in part due to their employment skewed toward above average injury risk jobs, sustain a large share of the nation’s annual three million work injuries.
In 2012, there were 25 million foreign-born persons in the U.S. labor force, comprising 16% of the total workforce. Hispanics accounted for 48% of the foreign-born labor force in 2012, and Asians accounted for 24%. (Recently Asians have been entering the U.S. at higher levels than Hispanics.) Undocumented workers account overall for about 5% of the nation’s total workforce and roughly one third of foreign-born workers.
For those engaged in some aspect of work injury risk management —work safety, claims, medical care, the law, corporate risk management, insurance, etc. – a closer look at the immigrant workforce is urgently needed:
• Work safety and claims experts who know this workforce have been warning that, when paired with a native born worker, a foreign born worker poses higher injury risk due to language barriers, cultural miscues and poor health literacy
• The growing presence of immigrant workers is not temporary and reversible. It is part of global economic forces. Some 150 million workers globally are estimated to be working outside their country of origin.
• Private sector employment growth has been and will continue be in fields with relatively high immigrant participation, ranging from software engineers to personal health aides.
These trends come to life when we examine a few key occupations below. But first a note on undocumented workers, which we often, incorrectly, view as an essentially isolated workforce.

Back in 1995, the dominant workplaces of illegal workers were either in agriculture or in large, rural factories for meat processing and carpet making. These workers lived and worked relatively isolated from mainstream America. Their work injury issues relatively hidden from view.
The latter half of the 1990s ushered in the residential housing boom. This, and a natural tendency of workers to seek higher paying jobs in metropolitan areas, triggered a huge expansion of more widely visible employment of illegal workers in construction, healthcare, and hospitality other urban-centered sectors. About half of illegal workers today are in formal employment and are paying social security taxes, which go into a Social Security suspense file when the social security number is unverifiable. The other half are paid under the table in cash.
Unless you allow yourself to engage in the idea that these workers will “self-deport” (and cause a collapse of much of the country’s farms and other disruptions), it is prudent to approach the immigrant workforce as a whole without distinguishing initially between legal and illegal workers.
I examined a list of jobs expected to grow fast between 2010 and 2020. I narrowed down on the ten jobs with the largest employment growth expected between these years. Thee ten jobs are growing by on average close to 40% and will add combined 2.2 million jobs.
They include, with current percentage of their ranks filled by immigrants, personal care aides (24%), software engineers (36%), and HVAC mechanics (13%). Taken as a whole, the share of the new jobs in this list of 10 occupations that will be taken by immigrants looks like 15%, just under the current share of total jobs held by immigrants, or 16%.
However, the work injury picture is strikingly different. When you estimate the number of future work injuries, taking into account the injury rates of the individual jobs and their expected growth of openings, you find that immigrant workers will likely sustain 20% — one of every five – of work injuries. This is due, of course, to the fact that while some immigrants are highly talented and work in largely injury free jobs, such as software programming, there is a larger number of immigrant workers who have limited education, relatively few job market chances, and work in injury-prone jobs.
In the follow up article, I will discuss how a workers’ compensation professional can her mastery of this work injury risk that, after years of emergence, is taking center stage.
Part 2 (8 27 13)
How do we reduce the number of work injuries and ensure timely return to work for a huge and extremely diversified, foreign-born workforce? A workforce within which many do not speak English well, and are baffled by a health system that confuses even many native born workers?
In my prior article I described the evolution of foreign-born workers in the United States. I documented how these workers have on average taken on a higher level of work injury risk than native-born workers.
I follow up now to highlight what American employers and their agents, such as occupational medical providers, loss control consultants, and workers’ compensation claims payers, can do to reduce injury risks of these workers.
First a question: where can you find people with know-how?
That’s a question that led me on a search throughout the country, extending to conversations with several hundred individuals, ranging from medical professionals to claims adjusters, safety experts, lawyers, immigrant labor activists, translators, and others. Expertise is both extremely valuable and extremely scattered.
So, colleagues and I decided to write a guide to bring the expert advice together. We will distribute the guide at that National Workers Compensation and Disability Conference in Las Vegas in late November. This free employers guide to safety and health of a diversified workforce will then made available throughout the country.
The guide, the first of its kind, will include, for example, special safety training techniques, emerging regulation, medical treatment pitfalls. Advice will be as specific as, for instance, how to check if your bi-lingual employee is correctly describing work hazards in, say, Vietnamese.
We’ll also lead a conference session on immigrant workers on November 21 at 2 PM. We will talk about work safety, claims management and medical care of injured immigrant workers. We will be using case studies. We’ll include practical advice about translation.
For now, workers’ comp professionals might focus on a few key steps.
First, carefully inventory your and your organization’s experience with safety and health issues involving foreign-born workers. This requires patience, persistence and tact. More likely than not, a very few people know a very great deal, but have never had an opportunity to articulate and convey what they know.
You may bump into a stumbling block of doubt and fear that to probe deeply into the experience of immigrant workers will uncover something illegal, such as undocumented workers, or something unhealthy such as pervasive under-reporting of injuries.
A claims adjuster told me that some accounts hire “many illegal and legal immigrant workers that speak little to no English. This can delay handling of claims for many reasons. Many are afraid to report claims for fear of being fired; others are not sure how to report claims and this delays reporting of a claim. There are also many claimants that are very familiar with system and file highly questionable claims and seek attorneys immediately to extend claims and disabilities. On acceptable claims I find that medical care can be delayed as workers are not sure where or who to go to and language barrier exists.”
Second, review your written communications to make sure that they are truly accessible to people who are not brought up in the United States. Some one can be pretty competent in English in a workday sense, and yet have a hard time really comprehending a document larded with legal and technical terms.
A doctor told me about a teaching hospital, proud of its patient centered care, which discharged an injured worker with hardly any English, giving him pages upon pages of medical instruction in English and no money to pay bus fare.
Third, develop as complete a mental picture as you can of the whole life of an immigrant worker. Is she working a second job? (It could be that a fifth of your workers do.) Can you really expect the worker, with limited career-savvy, to really “lean in” to the job to learn safety and other rules when prospects of advancement are perceived as very limited?
Fourth, discuss these issues openly in business association and professional gatherings, online groups, and publications. More discussion will lead to good ideas and practices.
As of today (late August) comprehensive immigration reform’s prospects are up in the air. If Washington enacts reform, all immigrant workers will enjoy legal protections and thus meld more into the regular workforce. That will be a boon to employee safety and health. It will also raise expectations for better safety and health. In any event, we can, and will, figure out ways to make our foreign born workers safer.

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