In 2020, amputations made up 0.4% of the workplace injury and illness cases that cost an employee time away from work, according to the Bureau of Labor Statistics (BLS). They were far from routine, though: the median amputation case kept a worker away for 30 days, against 12 days for all cases, and 2,470 of the estimated 5,160 amputation cases lasted 31 days or more.
Those days away are only the first chapter of the claim. Surgery, healing, fitting, training, and years of device care come next, and the same BLS data shows one more fact that shapes all of it: nearly every one of these injuries is to the upper limb.
Where amputations happen
Of the 5,160 cases, 4,880 (94.6%) involved the upper extremity, and 4,790 of those involved the hand. Lower extremity amputations accounted for 270 cases, or 5.2%.
Machinery and equipment account for much of the pattern. In 2,760 cases (53.5%) the worker was caught in an object, equipment, or material, and machinery was the source of injury in 2,660 (51.6%). Production occupations accounted for 1,810 cases (35.1%), more than any other group, followed by service occupations (930) and transportation and material moving (870).
What it means for the claim
Workers’ compensation sees the mirror image of the general amputee population. Among amputees overall, only about 20% have lost an upper limb; among the work-related cases above, the figure is 94.6%. That mismatch can affect care. According to David Anderson, ATP, Specularis Medical’s COO, many certified prosthetists have limited experience fitting upper limb devices. When an injured worker is referred to a provider without the relevant expertise, the device may not fully meet the worker’s needs, and fitting, adjustment, maintenance, or repair may become more difficult.
The job adds another layer, because the hand is the tool and the device has to match the work. Body-powered devices can be durable and waterproof and do not require charging, but they generally require more physical effort and may offer a more limited range of motion. Myoelectric devices may require less effort and offer greater dexterity, but they can be heavier, require recharging, and take time to learn. Hybrid designs combine the two approaches, and task-specific devices are built for a single occupation or activity. Each option involves tradeoffs, so the choice depends on the worker’s needs and daily tasks.
The financial stakes can be substantial. National Safety Council data for 2019 to 2020 puts the average amputation claim at $118,837, about three times the $41,353 average across all claims, with more than two-thirds attributed to medical costs. Ongoing expenses may include annual supplies, socket replacement at intervals that can average about two years, and device replacement at intervals that can average about five years. The product examples cited in the presentation range from about $12,000 for a custom mechanical finger system to about $95,000 for a myoelectric hand.
Not every amputation becomes a prosthetic claim
The BLS counts every amputation, from a fingertip to a full arm, and its table does not specify how many cases involved partial digits or the level of limb loss represented. Some of the 4,790 hand cases may involve finger injuries that do not result in a prosthetic claim. Others may involve a partial hand, wrist, or arm, where device decisions can be more complex and costs may be significant.
Two more limits apply. The figures cover only cases with at least one day away from work, and they are estimates drawn from a survey sample for 2020. Read them as the size of the population at risk for an upper limb prosthetic claim, not as a count of prosthetic claims.
Questions worth asking
Five questions can keep an upper limb claim on track:
- Has the worker been referred to a provider with upper limb experience?
- What does the job require of the hand, and does the proposed device match those tasks?
- Which type of device is proposed (body-powered, myoelectric, hybrid, or task-specific), and why that one over the others?
- What do the lifetime costs look like, including supplies, socket replacement, and device replacement, and not only the first invoice?
- Who will adjust and repair the device, and what do the warranty and follow-up cover?
David Anderson’s CEU presentation also identifies circumstances that may warrant additional clinical review: items over $15,000, an amputation less than a year old, a custom upper limb device, a change in provider or device, legal or settlement implications, non-specific coding, and multiple devices.
A good outcome is achievable
A 2017 study in Occupational Medicine of workers with occupational upper limb amputations, cited in David Anderson’s CEU presentation, found that 82% returned to work after a median of 172 days, most of them to the same or a similar position. Careful alignment among the provider, the device, and the job may help a claims team support a worker’s return to work.
David Anderson speaks on prosthetics at the Arkansas Workers’ Compensation Commission’s Annual Educational Conference in Little Rock on October 22, and presents on upper limb prosthetics at the Texas Circus CEU Day in Austin on October 27. The Austin session is complimentary and approved for 1 hour of TX Adjuster and CCM credit. Reserve a seat in Austin.
Two days later, he presents Prosthetic Technology Today at the Texas Circus CEU Day in Plano on Thursday, October 29, at Maggiano’s Little Italy Willow Bend. The Plano event is a complimentary customer appreciation day with 6 hours of continuing education and lunch; his session runs from 10:00 to 10:50 a.m. and is approved for 1 hour of TX Adjuster and CCM credit. Reserve a seat in Plano.
Sources: Bureau of Labor Statistics, Survey of Occupational Injuries and Illnesses, nonfatal cases involving days away from work by worker and case characteristics and nature of condition, all U.S., all ownerships, 2020 (published October 3, 2022); National Safety Council, workers’ compensation costs by nature, 2019 to 2020; Occupational Medicine, 2017, volume 67, issue 3, return to work after occupational injury and upper limb amputation.