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Workers' compensation is a system through which the injured worker is assured by law of a partial income during the period in which he or she is unable to work. Presented in this article is a general discussion of the role of workers' compensation in our industrial society and how it relates to the practice of podiatric medicine.
In 1983 the Washington State Supreme Court ruled unconstitutional a unique exemption that excluded farm workers from workers' compensation if they had not earned $150 in continuous work with the same employer. In order to examine the effect of removing this restriction, workers' compensation data were analyzed to examine the number of farm workers covered, the number of claims submitted, and claim acceptance rates before and after the ruling. Although the 1983 ruling appears to have had a significant impact on the treatment of claims, no increase in utilization of the workers' compensation system was observed. Further intervention is required if the objective of treating farm workers equitably is to be realized.
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State workers' compensation laws have been subjected to criticism since their inception; pressure to change them is now increasing. Most of the current challenge arise from dissatisfaction with the level of benefits available to disabled workers or their survivors, and, to a lesser degree, with the extent of program coverage. In response to this challenge, changes will occur that my range from reform-simply raising benefit levels and extending coverage-to program redesign, implying major structural revisions or abolishment of the system. For several reasons, including public apathy, the role of interest groups, and experience with other social insurance programs, it seems likely that basic structural shifts will not occur in the near future. While the criticism of these state laws is widespread, the problems can be dealt with in the existing framework. One area, however, could conceivably arouse sufficient public and legislative interest to upset this forecast. If it develops that the system is excluding large numbers of individuals disabled or killed by occupational diseases, workers' compensation laws could be placed in jeopardy. While evidence on this is scarce, it is clear that the current system compensates only a small number of serious cases of disability arising from occupational diseases.
In 1990 job-related injuries are estimated to have cost American employers over $60 billion in direct workers' compensation expenses, a figure which has doubled in the past four years and which may do so again by 1995. The medical costs of treating work-related injuries and illnesses are estimated to have consumed 41 percent of workers' compensation payouts for 1990, the remainder by indemnity claims costs. Taken together with a 17.1 percent increase in group health care costs in 1990, there is concern for the maintenance of a reasonable business atmosphere under which businesses may remain competitive and prosperous, and employment will be available.
The workers' compensation system has become an increasingly important part of our medical care system. That this system presents problems to attending physicians is apparent. Most of these problems result from ignorance on the part of physicians, born of the lack of effective training in this area and its dependence upon timely and complete reporting. This paper emphasizes the importance of communication and suggests simple procedures by which the attending physician can accomplish this. It is incumbent upon the medical profession to involve itself in controlling the cost of health care delivery.
Mortality and workers' compensation patterns were studied among 1,064 Ontario asbestos insulation workers. A proportional mortality analysis of 153 asbestos worker deaths found increased mortality from malignant diseases (65 deaths observed; 35.1 expected), cancers of the lungs and pleura (32 deaths observed; 11.5 expected), peritoneal mesothelioma (4 deaths), and respiratory diseases (14 deaths observed; 7.9 expected). Despite the publicity given to asbestos-associated diseases, dependents of many men potentially eligible for workers compensation awards have not received pensions because claims were not filed. These findings suggest that much occupationally related disease is not being recognized in Ontario.
Under most workers' compensation statutes, an injury must "arise out of " and "in the course of" employment in order to qualify as a compensable disability. In U.S. Industries v. Director, the Supreme Court held that the Longshoremen's and Harbor Workers' Compensation Act must be strictly construed to avoid transforming the compensation system into a form of social insurance. In U.S. Industries, the Court denied a disability claim based on an arthritic condition which was manifested while the worker was at home in bed. This Note contends that the Supreme Court neglected to consider pertinent medical realities when analyzing the causation question. Thus, the decision undermines the overall rationale behind workers' compensation legislation. Nonetheless, the Note argues that the case does not relax the requirement of adequately scrutinizing the causative elements underlying any reasonable claim for disability benefits. An analysis adequately accommodating both medical and legal facts, instead of relying upon the vagaries of statutory interpretation, is necessary to improve the efficiency and fairness of workers' compensation disability determinations.
Workers' compensation laws impose a no-fault status on injuries and illness sustained in the workplace. Under the statutes, victims of industrial injuries or their survivors are assured prompt, equitable payment for medical expenses, lost wages and other expenses associated with their injuries. Each state, territory or province has developed its own laws governing workers' compensation. As a result, the type, amount and duration of benefits vary. The cost of workers' compensation benefits is paid by the employer. The National Safety Council estimates that these benefits cost employers almost $35 billion in 1986. Employers pay for these benefits through the purchase of insurance, by becoming self-insured, or by participating in a state-run fund. Each state has an agency, commission or board to oversee compliance with the law.
The first workers' compensation program was introduced 80 years ago. Its purpose was to compensate occupationally injured workers and their families for lost wages and medical expenses from job-related injury, regardless of fault. Today, each of the State and Federal programs that provides coverage to more than 86 percent of the work force uses a combination of private insurance, State or Federal funds, and self-insurance to meet its benefit obligations. The workers' compensation program is of continuing interest to the Social Security Administration (SSA) for several reasons. Since 1965, Social Security Disability Insurance benefits have been subject to reduction if such benefits, when combined with those provided under workers' compensation laws, exceed 80 percent of the worker's earnings. Because the two programs have gaps in protection as well as duplication in coverage, a periodic review of the workers' compensation program is necessary. In addition, SSA administers Part B of the Black Lung program--established to provide income-maintenance protection to coal miners disabled by pneumoconiosis--to about 1 million beneficiaries whose claims were filed before July 1973. This article provides revised benchmark data on the workers' compensation programs and presents a review of program operations during the early 1980's.
Workers' compensation provides medical care and income maintenance protection to workers disabled from work-related injury or illness. This program is of considerable interest to the Social Security Administration (SSA) from several perspectives. For example, since 1965 Social Security Disability Insurance (DI) benefits and workers' compensation payments have been integrated. Information on the experience under workers' compensation provides a framework for examining questions concerning gaps and overlaps in the Nation's social insurance system. In addition, since December 1969 SSA has administered claims filed through 1973 under part B of the Black Lung program--the program providing income maintenance protection to coal miners disabled by pneumoconiosis. The workers' compensation experience reported here consists of information on benefits for work-related injury and disease, including data on the combined benefits paid under the entire Federal Black Lung program administered by the Labor Department and SSA.
Workers' compensation has become a focus of public attention in the 1970's to a degree unprecedented in its 70-year history. Federal legislation, two national study groups, a rush of State reform amendments, and congressional hearings and bills proposing Federal standards have all contributed to the ferment of inquiry about the relevance and adequacy of the present system of State workers' compensation. Among the questions raised are: Does the system cover all the workers that should be protected? Are the benefits provided adequate? And what are the cost implications to employers of the changing program? For many years, the Social Security Administration has published estimates of the number of workers covered, the benefits paid, and the costs of workers' compensation. This article provides benchmark data to bring coverage and benefit estimates up to date and analyzes statutory provisions measuring several aspects of benefit adequacy.
About 93.1 million workers were covered under workers' compensation laws in 1988--an increase of 11 percent from the 1984 total. Benefit amounts totaled $30.7 billion--an increase of about 56 percent since 1984. Of the total payments made under the workers' compensation program, $17.6 billion went to disabled workers, $1.6 billion to their survivors, and $11.5 billion for medical care. The Social Security Administration (SSA) is interested in measuring economic security in the United States, and workers' compensation plays a large role in that measurement. This article represents one part of our overall effort to determine the roles the various income-maintenance programs play in helping citizens of the United States achieve economic security. The figures presented here provide readers with an opportunity to review workers' compensation program operations during much of the 1980's. Workers' compensation is also important to SSA because that program is directly related to the Social Security Disability Insurance program. Since 1965, Social Security disability benefits have been subject to reduction if the beneficiary also receives workers' compensation and the combined benefits exceed 80 percent of previous earnings. In addition, SSA has been directly involved in providing income maintenance for disability from work-related diseases since 1969 when the Federal Black Lung benefits program was established.
The usefulness of workers' compensation claims for the surveillance of occupational injuries was evaluated by analyzing claims for cold injury. Five hundred ten claims filed in 1983 from 23 states participating in the Bureau of Labor Statistics Supplementary Data System and an additional 147 claims filed with the Division of Safety and Hygiene of the Industrial Commission of Ohio from Jan 1, 1984, to June 30, 1985, were examined. As expected, the number of injuries per winter day increased as temperature decreased and wind speed increased. The rate of injury began to increase when temperatures fell below 10 degrees F and wind speeds exceeded 10 mph. These weather conditions were milder than previously published cold hazard charts suggest. Frostbite injuries of the lower extremities occurred at milder temperatures, required more lost workdays, and were more costly than cold injuries to the head and face or to the upper extremities. Industries with the highest rates of injury included agriculture, oil and gas extraction, trucking and warehousing, protective services, and interurban transportation. Injuries during nonwinter months involved the processing, distribution, and preparation of food. Vehicle breakdown or contact with water, gasoline, alcohol, or cold water were noted as contributing factors on many of the compensation claims. This probe suggests that claims for workers' compensation adequately reflect the expected association of environmental factors and the occurrence of cold injury.
Although the workers' compensation program covered more workers and paid more in benefits in 1981 than it did a year earlier, the rise in both of these indicators was slightly smaller than those in 1980 and considerably smaller than the increases that took place in the 1970's. Employers paid $22.9 billion in premiums in 1981, less than 3 percent more than the previous year and the smallest annual increase since 1958. The cost-payroll ratio also showed a 12-point drop in 1981, the first such decline since 1959 and a sharp contrast to the almost 9 percentage point average annual rise in the 1970's. The Black Lung program, which made up more than a fifth of the benefit payments under workers' compensation in 1973, accounted for only about an eighth by 1981.
Psychiatric claims under workers' compensation law have increased substantially in recent years. This chapter explores the history and varying jurisdictional standards of workers' compensation law followed by a discussion of issues pertinent to performing a psychiatric evaluation of a claimant for workers' compensation.
Long term workers' compensation patients can be a source of stress for the treating doctor. They often make little progress in spite of large amounts of time, effort and support. The author explores the reasons for this and suggests ways to minimise doctor burnout in the face of it.
An understanding of workers' compensation and of the physician's role in it can significantly improve communication with patients, insurance companies and employers. Early rehabilitation is essential. Treatment of difficult patients can be enhanced by recognizing and treating the factors that are delaying recovery, encouraging activity and minimizing the use of narcotics. Factors delaying recovery include depression, alcoholism and pending litigation against the employer.