On another front, he noted statistics showing that workers with limited English and education face a high risk of injury. Latinos, he said, are 60 percent more likely to be killed on the job than other workers.

Communication errors lead to occupational injuries and death, Mr. Hartwig said, adding that with 35.1 million people between the ages of 18 and 64 who don't speak English at home--9.68 percent of the U.S. population--language barriers on the job are a "powder keg for injury."

Mr. Hartwig also spoke, as he has in the past, of the impact of Iraq war veterans returning to the job, noting that 40 percent of the troops serving in that theatre are National Guard or reservists who will be returning to the workplace. The vast majority will reintegrate without problem, but currently 30 percent of all returning troops are exhibiting some form of mental health problems, he said.

In addition, many have undiagnosed injuries including traumatic brain injuries resulting from exposure to the concussion of improvised explosive devices.

Other factors that could lead to comp injury severity or frequency include post-traumatic stress disorder and related depression, sleep deprivation, substance abuse and social maladjustment. He suggested returning vets need monitoring in stressful jobs and those involving heavy equipment and driving.

Zurich North America's Ms. Tomlin said the metal powder beryllium, which is used in dental labs and in products such as televisions, X-rays, mirrors, springs, calculators and computers, could impact 10,000 employer locations and 48,000 employees.

Another injury causation factor she revealed was the stress to hotel housekeepers who must change 500 pounds of linen a day on king-sized beds. Such workers, she said, face a disability injury rate 51 percent higher than for other service sector workers.

Bed bugs, she said, are a hazard that can injure workers in hotels, theatres, dormitories and apartments, and can cause skin swellings, irritation and itching that can lead to infection and "cause anxiety and mental anguish."

Ms. Tomlin also noted the danger of chronic, disabling and sometimes fatal injury from silica dust--a substance that at least 1.7 million workers are exposed to.

In the unknown comp injury category, Ms. Tomlin placed the 25,000 workers currently laboring in the field of nanotechnology, the manufacture of items with matter the size of a billionth of a meter.

At this point, she said, it is undetermined what the effects might be from exposures in that industry.

At a separate session, Mr. Hartwig was one of several experts assessing the comp insurance industry, who said the sector is showing continuing improvement even as worries persist over terrorism and medical costs. He noted that workers' comp had a 7.9 percent rate of return last year and its combined ratio was 90 for the accident year and 102 for the calendar year--a vast improvement for a sector that in 2001 had a calendar-year combined ratio of 122.

The line, he opined, was "very profitable indeed."

The p-c sector overall, he said, had its combined ratio helped by workers' comp. This year, the p-c industry overall should see its combined ratio end at 97 or perhaps even better, he predicted.

While lost-time claims frequency was down 4.5 percent last year, medical costs have continued to climb, he said. Since 1985, the medical share of comp claim payments has grown from 44 percent to 58 percent, and Mr. Hartwig forecast it will hit 75 percent in five or six years.

Susan Doyle, Wausau Insurance executive vice president and general field operations manager, said the medical cost issue "goes well beyond workers' compensation."

"This is an overall health care issue and we will be swept along." Comp insurers, she said, should work to "stimulate movement to improve the overall health care situation."

John Santulli, PMA Insurance Group senior vice president for marketing and field operations, listed tools that comp insurers can use to keep costs down: getting accident reports in on a timely basis, checking the effectiveness of network treatment systems, working to control prescription plan costs, and preventing improperly upcoded provider bills.

Unless the comp system puts more controls on health treatment utilization, there will be more acceleration in medical costs, he added.

Vern Steiner, CNA vice president for workers' compensation claims, said while claimant fraud has not increased there are now more attempts to tie all a worker's ailments "to work-related woes."

Mr. Steiner also voiced a concern that as more states institute utilization controls there could be the kind of reaction that has been seen against health maintenance organizations, restricting treatments.

Medical treatment, he said, "isn't black and white," and if utilization controls are too restrictive there could be "a public backlash and reforms might be undone."

Mr. Hartwig also voiced alarm over how comp insurers will fare if the Terrorism Risk Insurance Act is allowed to expire in 2007.

The way to lobby the issue, he said, is to involve local Chamber of Commerce members. At this point, however, he said local business people are not thinking about this. "Hardly a neuron fires on the TRIA issue," he said.

Art caption: